Poor literacy is associated with poor health status, but whether illiteracy is also linked to higher medical care costs is unclear. We characterized the literacy skills of 402 randomly selected adult Medicaid enrollees to determine if there was an association between literacy skills and health care costs. Each subject's literacy skills were measured with a bilingual (English/ Spanish) reading-assessment instrument. We also reviewed each subject's health care costs over the same one-year period. The mean reading level of this Medicaid population was at grade 5.6. Mean annual health care costs were $4,574 per person. There was no significant relationship between literacy and health care costs. While there are compelling reasons to improve poor reading skills among Medicaid enrollees, illiteracy in this population does not appear to contribute to the high cost of providing government-sponsored care.

The authors investigated the influence of language proficiency on the cross-language transfer (CLT) of phonemic awareness in Spanish-speaking kindergarten students and assessed Spanish and English receptive vocabulary and phonemic awareness abilities. Correlation results indicated positive correlations between phonemic awareness across languages; CLT occurred. To investigate the role of proficiency in native language (L1) in CLT, the authors disaggregated the sample into two groups by L1 receptive vocabulary. No evidence for CLT of phonemic awareness emerged among children with below-average L1 skills. Regression results indicated that L1 receptive vocabulary predicted phonemic awareness performance of children's language of instruction. The authors suggest that prereading skills may transfer from L1 to L2 following a different pattern in children lacking L1 proficiency. Further investigation of CLT among children with below-average L1 skills is needed.

Research examined the influence of native vocabulary development on cross-language transfer of phonemic awareness. Participants were Spanish-speaking kindergartners learning English in immersion classrooms. Results indicated that limited Spanish vocabulary development negatively influenced cross-language transfer of phonemic awareness to English. The results have clear and profound implications for Spanish-speaking children. Without foundational Spanish vocabulary skills needed to facilitate cross-language transfer of phonemic awareness to English, literacy acquisition difficulties will likely arise.

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