The purpose of this article is to discuss the use of the Newest Vital Sign (NVS) health literacy instrument in adolescents with sickle cell disease. The NVS evaluates both literacy and numeracy (the ability to understand and work with numbers) as well as the ability to locate and apply information. It is important to validate the NVS for use in adolescents, as the only currently validated instrument, the Rapid Estimate of Adolescent Literacy in Medicine-Teen (REALM-Teen), does not measure numeracy or the ability to locate or apply information. This cross-sectional, descriptive, exploratory correlational study included appraisal of data from completion of the REALM-Teen and NVS instruments by a convenience sample of 75 adolescents with sickle cell disease. The mean age of this study sample was 14.7 years ( SD = 2.2). The mean grade level of participants was 8.7 ( SD = 2.2). Internal consistency for the NVS in this population was acceptable (α = .63). Criterion validity was based on correlations between raw scores on the NVS and raw scores on the REALM-Teen. There was a significant moderate, positive correlation between NVS and REALM-Teen scores ( r = .38, p < .01), demonstrating good criterion validity. Preliminary evidence for reliability and validity of the NVS in this population was established.

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Purpose After patients with sickle cell disease (SCD) transfer from pediatric care to adult care, significant morbidity and mortality occurs. There are many possible contributors to the success or failure of this transition. One hypothesis is that health literacy influences this transition from pediatric to adult health care. The purpose of this study was twofold: (a) to examine the relationship between caregiver and adolescent health literacy levels in adolescents with SCD; and (b) to further describe individual traits contributing to health literacy levels in adolescents with SCD as described by pilot data. Design and Methods This cross‐sectional, descriptive correlational study included the administration of the newest vital sign (NVS) health literacy instrument to 59 dyads of adolescent patients with SCD and their caregivers in a large, tertiary care center in Dallas, Texas. Convenience sampling was utilized for recruitment. Caregiver health literacy levels, age, current grade level, annual household income, caregiver education level, number of annual healthcare encounters, and adolescent health literacy levels were correlated to determine relationships amongst variables. Results There was no significant relationship between caregiver and adolescent health literacy levels in this population. Adolescent health literacy NVS scores were positively correlated with adolescent age, r(58) = .468, p < .001, caregiver income, r(46) = .293, p = .023, and caregiver highest education level, r(56) = .318, p = .008. Only adolescent age was a significant predictor of adolescent health literacy NVS scores, β = .485 (standard error [SE] = .109), p = .001. None of the other predictors in the model were significant, including the relationship between caregiver and adolescent health literacy NVS scores, β = .065 (SE = .131), p = .633. In addition, although caregiver income and highest education level were positively correlated with adolescent health literacy NVS scores in the bivariate analysis, these relationships were nonsignificant while controlling for each other, adolescent age, and the other variables in the model. Practice Implications This study gives insight on potential practice and research initiatives to evaluate the health literacy of adolescents, with and without SCD, both now and in the future.

Objective Healthcare spending in the US is $3.2 trillion. $1.1 trillion is attributed to hospital care, including emergency department (ED) visits and hospitalizations. There is a relationship between ED utilization, hospitalizations, and health literacy in the general population. Health literacy may play a role in frequent ED visits and hospitalizations in patients with sickle cell disease (SCD). The purpose of this paper is to describe the relationship among health literacy levels, annual hospital encounters, annual clinic visits, annual ED visits, and annual hospitalizations in 134 Black, non‐Hispanic adolescents aged 10–19 years with SCD. Design This is a cross‐sectional, descriptive correlational study evaluating facilitators and barriers to health literacy and clinical outcomes in adolescents with SCD. Sample Data were collected from 134 Black, non‐Hispanic adolescents with SCD at a large, tertiary care center in Texas. Measurements The Newest Vital Sign and REALM‐Teen health literacy instruments were used to evaluate health literacy. Results Contrasting previous studies evaluating the influence of health literacy on ED visits and hospitalizations in the general population, there were no significant relationships within this sample. Conclusions This study gives insight into future research to evaluate other potential influences on ED utilization and hospitalizations in pediatric patients with SCD.

Purpose: There are over 100,000 individuals with sickle cell disease (SCD) in the United States, most of whom are Black, poor, and publically insured. In combination with a chronic illness, these demographics lead to significant barriers to healthcare for patients with SCD, leaving them exceptionally vulnerable within the healthcare system. This unique vulnerability is especially notable when transitioning adolescents with SCD from pediatric to adult care, as this is a significant time of morbidity and mortality for these patients. It is postulated that health literacy influences transition from pediatric to adult care in adolescents with SCD. To better understand this relationship, more adolescent health literacy research must be conducted with both adolescents with and without SCD.Therefore, the purpose of this study is to systematically compare health literacy in adolescents with and without SCD.Design and Methods: This is a cross-sectional, descriptive, exploratory study. One hundred and thirty-four adolescents with SCD and 105 adolescents without SCD were recruited for this study. The Newest Vital Sign (NVS) health literacy instrument was used to evaluate health literacy. Pearson correlations were conducted to evaluate relationships among health literacy and the influencing factors of age, grade level, income, and parental education level. Differences in NVS scores between groups were assessed using independent samples t tests.Results: There was a significant relationship between health literacy, age (r = .286, p < .01) and grade level (r = .317, p = .00) in adolescents with SCD. In adolescents without SCD, there was a significant relationship between health literacy, income (r = .235; p < .05) and parental education (r = .263; p < .01). The mean NVS score was 2.66 for adolescents with SCD and 3.77 for adolescents without SCD. A statistically significant difference in NVS scores was found between groups (t = 4.772; p < .001). Adolescents with SCD demonstrated significantly lower NVS scores than adolescents without SCD.Practice Implications: There are significant differences in health literacy scores and influencing factors in adolescents with and without SCD. Thus, this article provides unique insight for nurses as they design, implement and evaluate health promotion, patient education, and future research initiatives for adolescents and families, both with and without SCD. Further research is needed to gain more insight into this phenomenon.

Background: Health literacy may influence the transition from pediatric care to adult care in adolescents with sickle cell disease (SCD). It is postulated that one influencing factor of health literacy in adolescents with SCD is health-seeking behavior. The purpose of this study was twofold: (1) to explore health-seeking behaviors of adolescents with SCD and (2) to determine if there are significant differences in health literacy levels of adolescents with SCD based upon health-seeking behaviors. Methods: This was a cross-sectional, descriptive study evaluating health-seeking behaviors and health literacy in 110 Black and non-Hispanic adolescents with SCD. Convenience sampling was utilized for recruitment. The inclusion criteria were a diagnosis of one of the four primary genotypes of SCD and age of 10-19 years. Health literacy was evaluated using the Newest Vital Sign (NVS). Frequencies and percentages were calculated for all variables. Independent Samples t-tests were conducted to evaluate differences in health literacy scores based upon differing health-seeking behaviors. Results: The mean age of participants was 14.8 years ( SD = 2.2). The mean NVS score was 2.7 ( SD = 1.6). The two most common responses to “where do you go FIRST for health information?” were the Internet (29.6%; n = 40) and health care providers (27.4%; n = 37). There was no statistical difference in NVS scores between adolescents using the Internet versus health care providers as their first source of health information ( t[75] = − .12; p = .22). Discussion: Knowledge of health-seeking behaviors and health literacy in adolescents with SCD gives insight into the design and evaluation of future interventions to improve health and health literacy in this population.

Phocaeicola vulgatus is one of the most abundant and ubiquitous bacterial species of the human gut microbiota, yet a comprehensive analysis of antibacterial toxin production by members of this species has not been reported. Here, we identify and characterize a previously undescribed antibacterial protein. This toxin, designated BcpT, is encoded on a small mobile plasmid that is largely confined to strains of the closely related species Phocaeicola vulgatus and Phocaeicola dorei. BcpT is unusual in that it requires cleavage at two distinct sites for activation, and we identify bacterial proteases that perform this activation. We further identify BcpT’s receptor as the Lipid A-core glycan, allowing BcpT to target species of other Bacteroidales families. Exposure of cells to BcpT induces a response involving an unusual sigma/anti-sigma factor pair that is likely triggered by cell envelope stress, resulting in the expression of genes that partially protect cells from multiple antimicrobial toxins.

Background: Personal and psychological factors, such as depression, have a considerable influence on nonadherence to medications and self-care in those with heart failure. More evidence is needed about positive personal factors that motivate adherence to medications and self-care in those with heart failure. Objective: The purpose of this study was to investigate whether there was a relationship between the personal resources of resilience, hope, health literacy, social support, and self-care activation and adherence to HF self-care and medications and whether race impacts adherence. Methods: This study used a cross-sectional, correlational design. Stepwise regression was used to test whether resilience, hope, health literacy, self-care activation, and race significantly predicted medication adherence and self-care. A diverse sample was recruited for this study. Results: Of the 174 participants, 51% were female, 51.7% were White, and the mean age was 62 years. After adjustment for differences in age and depressive symptoms, a predictive relationship remained between resilience, health literacy, and medication adherence. Hope, activation, and race were not selected in the final regression model. A high level of perceived social support was the only predictor of better HF self-care. Conclusion: Persons with heart failure may have better medication adherence and overall self-care if sufficiently resilient, health literate, and supported regardless of their degree of hope or activation. Race and age may be important factors to consider. More research is needed to understand the connection between resilience and medication adherence.