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Individual traits, peers/parents and systems all combineto influence one’s health literacy, which is includedin the center of the framework. People often use education as a proxy measure for literacy inresearch. However, studies have shown that literacycan act as its own predictor of health issues evenwhen accounting for other variables such as race,education, culture and income [5, 60]. A recentlypublished study by Davis et al. [20] tested theRapid Estimate of Adolescent Literacy in Medicine(REALM-Teen), based on the Rapid Estimate ofAdult Literacy in Medicine (REALM). However,there is currently no adequate tool to assess healthliteracy according to the recent report by the IOM[35]. The Test of Functional Health Literacy inAdults [61] and the REALM [62] have been widelyused to measure literacy in health care settings, butthe IOM report points out that these instrumentsmainly assess literacy as it relates to written comprehensionand do not test other aspects of healthliteracy such as the ability to communicate orally orcritical thinking skills [35].Don Nutbeam provides a useful model of healthliteracy, describing functional, interactive and criticalliteracy, which together create a progression ofdevelopment of skills [63]. The first, functional literacy,refers to the basic ability to read and write.Interactive literacy concerns one’s ability to coordinatefunctional literacy and social skills to fullyparticipate in daily activities and communication,while critical literacy addresses a person’s potentialto evaluate information. Media literacy, the abilityto critically evaluate media messages, has beenwidely studied among youth and has been includedas a separate construct [64]. Studies of adolescenthealth literacy may focus on one or more of theseliteracy types.
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