A reliance on the conceptualization of health literacy as functional skill has limited our views of the adult English-as-a-Second-Language (ESL) context as a site for health literacy interventions. To explore the contributions of alternative views of literacy as social practice to health literacy research, we examined teacher survey data and learner outcomes data collected as part of a multi-year collaboration involving The California Diabetes Program (CDP), university researchers, and adult ESL teachers. The survey results (n=144 teachers) indicated that ESL teachers frequently model effective pedagogical practices that mediate social interaction around health content, the basis for acquiring new literacy skills and practices. In the classroom pilot, (n=116 learners), the majority of learners reported they had learned about diabetes risk factors and prevention strategies, which affirmed existing healthy behaviors or prompted revision of unhealthy ones. About two-thirds of the learners reported sharing preventive health content with members of out-of-school social networks. This study represents a first-step in research efforts to account more fully for the mechanisms by which social interaction and social support facilitate health literacy outcomes in ESL contexts, which should complement what we already know about the development of health literacy as functional skill.

California has a recently documented problem of trans-national environmental lead exposures in imported foods from Mexico but there is limited health information available in immigrant communities about this problem. This report highlights collaborative work with English as a Second Language (ESL) learners to critically review research data on lead exposures and reframe prevention messages about lead contamination of imported foods. These messages are now integrated into ESL curricula for dissemination to Spanish-speaking populations that are disproportionately affected by lead poisoning. This 'learners as interpreters' approach is a participatory method that can be applied across a wide range of public health activities. ESL learners emerged as ideal partners in developing curriculum for lead poisoning prevention for several reasons: the parents expressed strong interest in lead poisoning prevention, several have children under age 6 when lead screenings are recommended, and many have emigrated from regions in Mexico where lead hazards were identified.

Immigrant adolescents are the fastest-growing sector among U.S. youth, but they receive little attention in health literacy research. Immigrant adolescents are a diverse population tasked with mastering new literacies while also navigating new social systems. Many immigrant adolescents serve as important linguistic and cultural resources in their families and local communities, and yet their contributions (and struggles) as new navigators of our health care system remain invisible. In this commentary article, we argue that health literacy researchers need to devote more attention to immigrant adolescents and the pathways by which they learn new language and literacy skills while also developing their own health habits and behaviors. We contend that the study of immigrant adolescents provides a critical window into health literacy as a socially and historically situated practice, specifically how immigrant adolescents’ transnational experiences shape their learning of new health literacy practices. With a coordinated interdisciplinary research agenda on immigrant adolescents, the health literacy field will expand its empirical base for what becoming “health literate” looks like in today’s globalizing world.

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The concept of transnationalism in many disciplines has deepened appreciation for stories of immigrant adaptation in today's globalizing world-stories that reveal shifting conceptualizations of ''home,'' the everyday practices (e.g., cooking) that help families establish meaningful connections to home, as well as the struggles to maintain those connections. Adult English as a second language (ESL) learners' story, however, has been overlooked in transnational research, despite the great potential that the ESL classroom holds for documenting the relationship between identity, changing traditions, and learners' perceptions about home. This article highlights an interdisciplinary partnership between adult ESL and public health that explored the power of learners' stories of home and the implications for ESL teaching and improved immigrant health. Using a classroom-based ethnographic approach, we found that learners' interpretations of health-related texts can promote language learning and critical engagement around texts. Moreover, the learners' talk about stories of home provides evidence that ESL classrooms are valuable sites for the expression of transnational identity and critical dialogue on the challenges of staying healthy in the United States.