Health Literacy Within a Diverse Community-Based Cohort: The Multi-Ethnic Study of Atherosclerosis

Madison D. Anderson, Sharon Stein Merkin, Susan Everson Rose, Rachel Widome, Teresa Seeman, Jared W. Magnani, Carlos J. Rodriguez, Pamela L. Lutsey

Research output: Contribution to journalArticlepeer-review


Background: Health literacy has yet to be described in a non-clinical, racially diverse, community-based cohort. Methods: Four questions assessing health literacy were asked during annual phone encounters with Multi-Ethnic Study of Atherosclerosis (MESA) participants between 2016 and 2018 (n = 3629). We used prevalence ratios (PRs) with 95% confidence intervals (CIs) to characterize how demographic and acculturation factors related to limited health literacy. Models adjusted for age, sex, and race/ethnicity, and race/ethnicity-stratified models were also examined. Results: Limited health literacy was prevalent in 15.4% of the sample. Participants who were older, female, lower-income, or less acculturated were at greater risk for having limited health literacy. Chinese, Hispanic, and Black participants were more likely than White participants to have limited health literacy. Patterns were similar when stratified by race/ethnicity. Discussion: Within MESA limited health literacy was common, particularly among Chinese and Hispanic participants, with some of the variance explained by differences in acculturation.

Original languageEnglish (US)
JournalJournal of Immigrant and Minority Health
Early online dateNov 18 2020
StateE-pub ahead of print - Nov 18 2020

Bibliographical note

Funding Information:
Research reported in this publication was supported by the National Heart, Lung, and Blood Institute of the National Institutes of Health under Award Number T32 HL07779 (Ms. Anderson). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. MESA is a National Institutes of Health (NIH) contract. The NIH was involved in the overall MESA study design and data collection. However the NIH was not involved with the analysis, and interpretation of data; writing the report; and the decision to submit the report for publication. The authors gratefully acknowledge support from the Minnesota Population Center (P2C HD041023) funded through a grant from the Eunice Kennedy Shriver National Institute for Child Health and Human Development (NICHD). This research was supported by contracts HHSN268201500003I, N01-HC-95159, N01-HC-95160, N01-HC-95161, N01-HC-95162, N01-HC-95163, N01-HC-95164, N01-HC-95165, N01-HC-95166, N01-HC-95167, N01-HC-95168 and N01-HC-95169 from the National Heart, Lung, and Blood Institute, and by grants UL1-TR-000040, UL1-TR-001079, and UL1-TR-001420 from the National Center for Advancing Translational Sciences (NCATS). The authors thank the other investigators, the staff, and the participants of the MESA study for their valuable contributions.


  • Acculturation
  • Health literacy
  • Risk factors

PubMed: MeSH publication types

  • Journal Article

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