BACKGROUND: The impact of health literacy on longitudinal asthma outcomes is not known. OBJECTIVES: To measure the association between health literacy and asthma outcomes and to assess how health literacy affects outcomes through covariates. DESIGN: Longitudinal cohort. PATIENTS: One hundred and seventy‐five adult asthma patients. MEASUREMENTS: Independent variables measured at enrollment included demographic and asthma characteristics, depressive symptoms, self‐efficacy, and asthma knowledge. Health literacy was measured with the Test of Functional Health Literacy in Adults. Outcomes were Asthma Quality of Life Questionnaire and SF‐36 scores and emergency department utilization for asthma measured every 3 to 6 months for 2 years. The effects of health literacy on outcomes and interactions between health literacy and covariates were measured with multivariable models. RESULTS: The mean age of study participants was 42 years, and 83% were women. Less health literacy was associated with worse quality of life, worse physical function, and more emergency department utilization for asthma over 2 years (P≤.05 for all comparisons). In multivariable analysis, health literacy did not remain statistically significant with any of the outcomes. Although the magnitude of its effect on emergency department utilization remained relatively intact, its effects on quality of life and functional status became attenuated with the sequential addition of covariates, particularly asthma knowledge. CONCLUSIONS: Less health literacy was associated with poor longitudinal asthma outcomes. This relationship was both direct and indirect through effects on other independent variables, particularly patients' knowledge of asthma and self‐management. Efforts to improve asthma outcomes should focus on improving literacy skills that are required to learn, understand, and implement effective self‐management.

Less asthma self-efficacy, more depressive symptoms, and unrealistic expectations predict worse asthma outcomes. These relatively unexplored patient-centered variables in asthma are potentially modifiable and may offer new ways to intervene to improve asthma outcomes.

The objectives of this cross-sectional study were to measure health literacy and its associations with asthma patients' assessments of care and their desire to participate in making decisions about their treatment. A total of 175 patients completed the Test of Functional Health Literacy in Adults and questions about satisfaction with asthma status, access to care, quality of care, and the desire to participate in treatment decisions. Patients' mean age was 42 years and 83% were women. Lower literacy was associated with less satisfaction with asthma status and worse assessment of quality of care received for asthma and other medical conditions (p < or = .005). Patients with lower literacy also were more likely not to want to participate in decisions about their care (OR .29, 95% CI .13, .65). These relationships persisted after controlling for demographic and asthma characteristics. These results provide additional incentives for physicians to find better ways to explain asthma treatments to low literacy patients.

Objective. Low energy expenditure is a risk for cardiovascular morbidity. The goals of this study were to compare energy expenditure between patients with rheumatoid arthritis (RA) and healthy controls. Methods. A total of 121 RA patients and 120 healthy controls in New York City completed the Paffenbarger Physical Activity and Exercise Index at time of enrollment (1999 -2000) and 1 year later to measure energy expenditure from walking, climbing stairs, and exercise/sports. Analyses were adjusted for age, sex, education, pain, social support, and depressive symptoms and were compared with recommended thresholds of energy expenditure. Results. Participants' mean age was 49 years, and 87% were women. Patients with RA expended fewer kilocalories per week than controls (mean ؎ SD 1,474 ؎ 1,198 versus 1,958 ؎ 1,940, P ‫؍‬ 0.003), with most of this difference from less walking as opposed to high-intensity activities. Although similar percents of RA patients and controls met national recommendations for total weekly energy expenditure (56% versus 64% for the lower [>1,000 kilocalories per week] threshold; P ‫؍‬ 0.14, and 41% versus 48% for the higher [>1,400 kilocalories per week] threshold; P ‫؍‬ 0.17), fewer RA patients met the recommendations (>700 kilocalories per week) for walking (32% versus 48%; P ‫؍‬ 0.01). The strongest predictor of more energy expenditure at 1 year for both groups was more energy expenditure at enrollment. Conclusion. Most of the difference in energy expenditure between RA patients and healthy controls was due to less walking. Given that walking is an effective and relatively safe lifestyle activity, increasing walking should be a priority to improve cardiovascular risk in RA.

Objective. Most studies of employment in patients with rheumatoid arthritis (RA) have focused on job loss. Less is known about workplace events in patients who continued to work. The goal of this longitudinal study was to compare the incidence of negative workplace events between employed patients with RA and healthy controls. Methods. Participants completed the work domains of the Psychiatric Epidemiology Research Interview Life EventsScale and the Inventory of Small Life Events Scale measuring major and minor workplace events. Events were compared between groups according to psychosocial, clinical, and job characteristics. Results. A total of 122 patients with RA and 122 healthy controls were enrolled with similar demographic and occupational characteristics. There were no differences in percentages of patients and controls who had at least 1 major (35% versus 31%) or 1 minor (48% versus 55%) negative event. For patients with RA, negative events were associated with having more pain, more fatigue, more social stress, and less job autonomy (P < 0.05). For controls, in addition to social stress, negative events were associated with job characteristics, functional status, and social support (P < 0.05). Conclusion. A comparable number of patients with RA and controls had negative workplace events. In addition to the well-known contributions of job autonomy and pain, social stress and fatigue also were found to be important variables related to negative events in patients with RA. These potentially modifiable variables have not been fully evaluated with respect to long-term employment in these patients.