***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVE Few studies have examined how individuals respond to genomic risk information for common , chronic diseases . This r and omized study examined differences in responses by type of genomic information ( genetic test/family history ) and disease condition ( diabetes/heart disease ) , and by race/ethnicity in a medically underserved population . METHODS 1,057 English-speaking adults completed a survey containing 1 of 4 vignettes ( 2-by-2 r and omized design ) . Differences in dependent variables ( i.e. , interest in receiving genomic assessment , discussing with doctor or family , changing health habits ) by experimental condition and race/ethnicity were examined using chi-squared tests and multivariable regression analysis . RESULTS No significant differences were found in dependent variables by type of genomic information or disease condition . In multivariable models , Hispanics were more interested in receiving a genomic assessment than Whites ( OR = 1.93 ; p < .0001 ) ; respondents with marginal ( OR = 1.54 ; p = .005 ) or limited ( OR = 1.85 ; p = .009 ) health literacy had greater interest than those with adequate health literacy . Blacks ( OR = 1.78 ; p = .001 ) and Hispanics ( OR = 1.85 ; p = .001 ) had greater interest in discussing information with family than Whites . Non-Hispanic Blacks ( OR = 1.45 ; p = .04 ) had greater interest in discussing genomic information with a doctor than Whites . Blacks ( β = -0.41 ; p < .001 ) and Hispanics ( β = -0.25 ; p = .033 ) intended to change fewer health habits than Whites ; health literacy was negatively associated with number of health habits participants intended to change . CONCLUSIONS Findings suggest that race/ethnicity may affect responses to genomic risk information . Additional research could examine how cognitive representations of this information differ across racial/ethnic groups . Health literacy is also critical to consider in developing approaches to communicating genomic information OBJECTIVES This study analyzed whether inadequate functional health literacy is an independent risk factor for hospital admission . METHODS We studied a prospect i ve cohort of 3260 Medicare managed care enrollees . RESULTS Of the participants , 29.5 % were hospitalized . The crude relative risk ( RR ) of hospitalization was higher for individuals with inadequate literacy ( n = 800 ; RR = 1.43 ; 95 % confidence interval [ CI ] = 1.24 , 1.65 ) and marginal literacy ( n = 366 ; RR = 1.33 ; 95 % CI = 1.09 , 1.61 ) than for those with adequate literacy ( n = 2094 ) . In multivariate analysis , the adjusted relative risk of hospital admission was 1.29 ( 95 % CI = 1.07 , 1.55 ) for individuals with inadequate literacy and 1.21 ( 95 % CI = 0.97 , 1.50 ) for those with marginal literacy . CONCLUSIONS Inadequate literacy was an independent risk factor for hospital admission among elderly managed care enrollees Abstract Objective : To determine the effect of inequalities in income within a state on self rated health status while controlling for individual characteristics such as socioeconomic status . Design : Cross sectional multilevel study . Data were collected on income distribution in each of the 50 states in the United States . The Gini coefficient was used to measure statewide inequalities in income . R and om probability sample s of individuals in each state were collected by the 1993 and 1994  behavioural risk factor surveillance system , a r and om digit telephone survey . The survey collects information on an individual 's income , education , self rated health and other health risk factors . Setting : All 50 states . Subjects : Civilian , non-institutionalised ( that is , non-incarcerated and non-hospitalised ) US residents aged 18 years or older . Main outcome measure : Self rated health status . Results : When personal characteristics and household income were controlled for , individuals living in states with the greatest inequalities in income were 30 % more likely to report their health as fair or poor than individuals living in states with the smallest inequalities in income . Conclusions : Ine quality in the distribution of income was associated with an adverse impact on health independent of the effect of household income This study examined the unique effects of numeracy on self-efficacy in managing health and on information-seeking experience , and explored the mediating role of information-seeking experience . The proposed model was tested using a national r and om-digit-dial sample ( n = 4,092 ) of adults participating in the 2007 Health Information National Trends Survey . Findings from multiple regression analyses revealed that higher numeracy was associated with higher self-efficacy in managing health and better ( i.e. , more positive ) health information-seeking experience , and that better information-seeking experience partially mediated the association between higher numeracy and higher self-efficacy . Findings indicated that communication factors ( e.g. , information seeking ) partially mediated the relationship between cognitive abilities ( e.g. , numeracy ) and self-efficacy . Theoretical implication s are discussed , along with practical implication s for individuals , health care providers , and public health professionals Objectives : To measure the prevalence of limited functional health literacy in the UK , and examine associations with health behaviours and self-rated health . Design : Psychometric testing using a British version of the Test of Functional Health Literacy in Adults ( TOFHLA ) in a population sample of adults . Setting : UK-wide interview survey ( excluding Northern Irel and and the Scottish Isles ) . Participants : 759 adults ( 439 women , 320 men ) aged 18–90 years ( mean age _ 47.6 years ) selected using r and om location sampling . Main outcome measures : Functional health literacy , self-rated health , fruit and vegetable consumption , physical exercise and smoking . Results : We found that 11.4 % of participants had either marginal or inadequate health literacy . Multivariable logistic regression analysis indicated that the risk of having limitations in health literacy increased with age ( adjusted odds ratio 1.04 ; 95 % confidence interval 1.02 to 1.06 ) , being male ( odds ratio _ 2.04 ; 95 % confidence interval 1.16 to 3.55 ) , low educational attainment ( odds ratio _ 7.46 ; 95 % confidence interval 3.35 to 16.58 ) and low income ( odds ratio _ 5.94 ; 95 % confidence interval 1.87 to 18.89 ) . In a second multivariable logistic regression analysis , every point higher on the health literacy scale increased the likelihood of eating at least five portions of fruit and vegetables a day ( odds ratio _ 1.02 ; 95 % confidence interval 1.003 to 1.03 ) , being a non-smoker ( odds ratio _ 1.02 ; 95 % confidence interval 1.0003 to 1.03 ) and having good self-rated health ( odds ratio _ 1.02 ; 95 % confidence interval 1.01 to 1.04 ) , independently of age , education , gender , ethnicity and income . Conclusions : The results encourage efforts to monitor health literacy in the British population and examine associations with engagement with preventative health behaviours Objectives Previous studies have shown that a single question may identify individuals with inadequate health literacy . We evaluated and compared the performance of 3 health literacy screening questions for detecting patients with inadequate or marginal health literacy in a large VA population . Methods We conducted in-person interviews among a r and om sample of patients from 4 VA medical centers that included 3 health literacy screening questions and 2 vali date d health literacy measures . Patients were classified as having inadequate , marginal , or adequate health literacy based on the Short Test of Functional Health Literacy in Adults ( S-TOFHLA ) and the Rapid Estimate of Adult Literacy in Medicine ( REALM ) . We evaluated the ability of each of 3 questions to detect : 1 ) inadequate and the combination of “ inadequate or marginal ” health literacy based on the S-TOFHLA and 2 ) inadequate and the combination of “ inadequate or marginal ” health literacy based on the REALM . Measurements and Main Results Of 4,384 patients , 1,796 ( 41 % ) completed interviews . The prevalences of inadequate health literacy were 6.8 % and 4.2 % , based on the S-TOHFLA and REALM , respectively . Comparable prevalences for marginal health literacy were 7.4 % and 17 % , respectively . For detecting inadequate health literacy , “ How confident are you filling out medical forms by yourself ? ” had the largest area under the Receiver Operating Characteristic Curve ( AUROC ) of 0.74 ( 95 % CI : 0.69–0.79 ) and 0.84 ( 95 % CI : 0.79–0.89 ) based on the S-TOFHLA and REALM , respectively . AUROCs were lower for detecting “ inadequate or marginal ” health literacy than for detecting inadequate health literacy for each of the 3 questions . Conclusion A single question may be useful for detecting patients with inadequate health literacy in a VA population OBJECTIVE Our purpose was to describe the relationship between health literacy , ethnicity , and cervical cancer screening practice s and to evaluate physician recognition of low literacy . STUDY DESIGN We studied a prospect i ve cohort of English-speaking patients > or = 18 years ( n = 529 ) in ambulatory women 's clinics . Univariate and multivariate analyses were used to evaluate demographics , health practice s and beliefs , and knowledge regarding cervical cancer screening and prevention . Physicians ' assessment s of patient reading skills were obtained . RESULTS Low health literacy ( < 9th grade ) was found among 40 % of participants . Minority women were half as likely to know the purpose of the Papanicolaou test ( 9 % vs 21 % ; P < .03 ) and were significantly more likely to have low literacy levels compared with white women ( 46 % vs 15 % ; P < .05 ) . Literacy was the only factor independently associated with knowledge related to cervical cancer screening ( adjusted odds ratio , 2.25 ; 95 % CI , 1.05 - 4.80 ) . Physicians detected only 20 % of the lowest readers . CONCLUSION Poor health literacy was a better predictor of cervical cancer screening knowledge than ethnicity or education , yet physicians infrequently recognized low literacy . Improved physician awareness and development of low literacy interventions may improve cervical cancer screening , particularly for the most vulnerable women 
    Output:
    
Some evidence was found on the mediating function of health literacy on self-rated health status across racial/ethnic and educational disparities , as well as on the potential effect of health literacy and numeracy on reducing racial/ethnic disparities in medication adherence and underst and ing of medication intake .