The increasing importance of genomic information in clinical care heightens our need to examine how individuals understand, value, and communicate about this information. Based on a conceptual framework of genomics-related health literacy, we examined whether health literacy was related to knowledge, self-efficacy, and perceived importance of genetics and FHH and communication about FHH in a medically underserved population. The analytic sample was comprised of 624 patients at a primary care clinic at a large urban hospital. About half of participants (47%) had limited health literacy; 55% had no education beyond high school and 58% were Black. In multivariable models, limited health literacy was associated with lower genetic knowledge (β=−0.55; SE=0.10, p<.0001), lower awareness of FHH (OR=0.50; 95% CI=0.28,0.90, p=.020), greater perceived importance of genetic information (OR=1.95; 95% CI=1.27,3.00, p=.0022) but lower perceived importance of FHH information (OR=0.47; 95% CI=0.26,0.86, p=.013), and more frequent communication with a doctor about FHH (OR=2.02; 95% CI=1.27,3.23, p=.0032). The findings highlight the importance of considering domains of genomics-related health literacy (e.g., knowledge, oral literacy) in developing educational strategies for genomic information. Health literacy research is essential to avoid increasing disparities in information and health outcomes as genomic information reaches more patients.

Introduction Participation in the decision-making process and health literacy may both affect health outcomes; data on how these factors are related among diverse groups are limited. This study examined the relationship between health literacy and decision-making preferences in a medically underserved population. Methods We analyzed a sample of 576 primary care patients. Multivariable logistic regression was used to examine the independent association of health literacy (measured by the Rapid Estimate of Adult Literacy in Medicine-Revised) and patients’ decision-making preferences (physician-directed or patient-involved), controlling for age, race/ethnicity, and gender. We tested whether having a regular doctor modified this association. Results Adequate health literacy (OR=1.7; p=0.009) was significantly associated with preferring patient-involved decision-making, controlling for age, race/ethnicity, and gender. Having a regular doctor did not modify this relationship. Males were significantly less likely to prefer patient-involved decision-making (OR=0.65; p=0.024). Discussion Findings suggest health literacy affects decision-making preferences in medically underserved patients. More research is needed on how factors, such as patient knowledge or confidence, may influence decision-making preferences, particularly for those with limited health literacy.

Prior research has demonstrated that shortly after the 1991 Gulf War (Gulf War I), chronic multisymptom illness (CMI) was more common among deployed veterans than among nondeployed veterans. The aims of the current study were to determine the prevalence of CMI among deployed and nondeployed veterans 10 years after Gulf War I, compare the distribution of comorbid conditions, and identify prewar factors associated with CMI. Cross-sectional data collected from 1,061 deployed veterans and 1,128 nondeployed veterans examined between 1999 and 2001 were analyzed. CMI prevalence was 28.9% among deployed veterans and 15.8% among nondeployed veterans (odds ratio = 2.16, 95% confidence interval: 1.61, 2.90). Deployed and nondeployed veterans with CMI had similarly poorer quality-of-life measures and higher prevalences of symptom-based medical conditions, metabolic syndrome, and psychiatric disorders. Diagnoses of prewar anxiety disorders (not related to post-traumatic stress disorder) and depression were associated with CMI among both deployed and nondeployed veterans. Nicotine dependence and veteran-reported physician-diagnosed infectious mononucleosis were associated with CMI among deployed veterans, and migraine headaches and gastritis were associated with CMI among nondeployed veterans. CMI continues to be substantially more prevalent among deployed veterans than among nondeployed veterans 10 years after Gulf War I, but it manifests similarly in both groups. It is likely to be a common, persistent problem among veterans returning from the current Gulf War.