Development of a tobacco health literacy instrument for American Indians

Low health literacy, an established risk factor of poor health outcomes, may be applied to better understand individual health related decisions and actions. Health literacy can help explain why and how people make prevention and treatment choices and is particularly salient in developing interventions among populations experiencing health disparities. American Indians experience the highest smoking and tobacco use rates of any racial/ethnic group in the United States, yet health literacy has never been examined for association with tobacco use. In this project, we developed and tested an instrument to assess tobacco health literacy among American Indians using a long (THL-L) or short (THL-S) form. The instrument was developed to measure prose, numeracy, and document literacy across five domains (health risks, addiction, cessation, environmental tobacco smoke, and cost). We tested both a long (25 question) and a short form (12 question) by administrating them to American Indians aged 18+ years attending community events at both urban and reservation communities in Kansas, Missouri, and South Dakota (THL-L: N=205; THL-S: N=114). Descriptive statistics were computed for all scored THL-L questions and demographic characteristics. The average score on the long form instrument was 17.76 (SD = 3.53); for the short form, it was 8.18 (SD = 2.17). THL-S scores show no statistically significant difference (p=0.16, Wilcoxon rank sum test). Both long- and short-form instruments appropriately assessed tobacco health literacy among American Indians. Neither measure includes traditional tobacco as a domain or item, suggesting this index may, with further testing, be appropriate for other populations.