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BackgroundIn the United States, disparities in health literacy parallel disparities in health outcomes. Our research contributes to how diverse indicators of social inequalities (i.e., objective social class, relational social class, and social resources) contribute to understanding disparities in health literacy.MethodsWe analyze data on respondents 18 years of age and older (N = 14,592) from the 2003 National Assessment of Adult Literacy (NAAL) restricted access data set. A series of weighted Ordinary Least Squares (OLS) regression models estimate the association between respondent’s demographic characteristics, socioeconomic status (SES), relational social class, social resources and an Item Response Theory (IRT) based health literacy measure.ResultsOur findings are consistent with previous research on the social and SES determinants of health literacy. However, our findings reveal the importance of relational social status for understanding health literacy disparities in the United States. Objective indicators of social status are persistent and robust indicators of health literacy. Measures of relational social status such as civic engagement (i.e., voting, volunteering, and library use) are associated with higher health literacy levels net of objective resources. Social resources including speaking English and marital status are associated with higher health literacy levels.ConclusionsRelational indicators of social class are related to health literacy independent of objective social class indicators. Civic literacy (e.g., voting and volunteering) are predictors of health literacy and offer opportunities for health intervention. Our findings support the notion that health literacy is a social construct and suggest the need to develop a theoretically driven conceptual definition of health literacy that includes a civic literacy component.

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The effect of a fibrolytic enzyme formulation on N and P intake, partitioning, and excretion was evaluated in dairy cows in early and late lactation. Twelve lactating Holstein cows (6 early lactation, 6 late lactation) were fed diets with or without the enzyme formulation in a switchback design with three, 4-wk periods. Diets for the early lactation group contained 45% forage, and late lactation diets contained 61% forage. Cows fed diets containing the enzyme formulation gained more weight than those on the control diet; this weight gain with enzyme addition was greater in early lactation cows than in late lactation cows. The main effect of enzyme treatment did not significantly affect apparent digestibility or excretion of N and P, or retention of these nutrients in body tissue. Interactions observed between the effects of group (stage of lactation) and treatment indicated differences in the nature of the milk yield and manure excretion responses to enzyme treatment between early and late lactation cows. These interactions were due to numerical increases in milk yield, feces excretion, and N excretion in early lactation cows fed diets containing the enzyme formulation compared to control, and slight decreases in these measures in late lactation cows with enzyme addition. Cows fed diets containing a direct-fed fibrolytic enzyme formulation had increased body weight gain, but the effect of addition of the enzyme formulation on milk yield and manure nutrient excretion differed for early and late lactation cows.

The effect of starch source and phytic acid (PA) supplementation on phosphorus (P) partitioning and ruminal phytase activity was evaluated in eight midlactation cows (four ruminally cannulated). Cows were randomly assigned to treatments in replicated 4 x 4 Latin squares with four 18-d periods. Diets included dry ground corn (DG) or steam-flaked corn (SF), with no supplemental P (L; 0.33% P) or supplemental purified PA (0.44% P) to provide additional P from a nonmineral source. Total collection of milk, urine, and feces was conducted on d 16 to 18 of each period. Ruminal fluid was sampled and ruminal pH measured every 8 h on d 17 and 18. Milk yield was unaffected by starch source, despite lower DMI by cows fed SF. Cows fed SF had increased DM digestibility compared with those fed DG, and tended to have higher efficiency of milk yield (1.40 vs. 1.35 kg of milk/kg of DMI). Intake and fecal excretion of P was lower in cows fed SF than in cows fed DG. In cows fed SF, milk P as a percentage of P intake increased compared with cows fed DG. Ruminal pH was unaffected by diet, but milk fat content was lower for cows fed SF. Milk yield, DMI, and feed to milk ratio were not affected by supplementation with PA. Although cows fed PA had increased P intake compared with cows fed low P diet, increased P excretion resulted in no differences in apparent P digestibility. Phosphorus balance tended to be higher in cows fed PA, but milk P as a percentage of intake was reduced. The interaction of starch source and PA affected ruminal phytase activity. Altering starch source to improve efficiency of milk yield in lactating dairy cows may help reduce P losses from dairy farms.