Health Numeracy Confidence among Racial/ Ethnica Minorities in HINTS 2007: Sociodemographic, Attitudinal, and Knowledge Correlates

Hong Huang, Yiu Ming Chan, Dong Feng


Health numeracy skills help people interpret health risks, and make effective medical decisions. Lower health numeracy confidence was observed for blacks and Hispanic groups than whites. Little is known about the important factors that explain racial differences in health numeracy confidence. For this study, we used a nationally representative, cross-sectional data sample of 4,610 U.S. adults from the National Cancer Institute’s 2007 Health Information National Trends Survey. Bivariate (Chi-squares) and multiple logistic regression analyses were conducted to identify the contribution factors that predict health numeracy confidence. Non-linear Fairlie decompositions were used to quantify the factor contributions to racial differences in health numeracy confidence. The priority rankings of the important factors to explain the health numeracy confidence racial and ethnic disparities are different depending on the particular racial and ethnic group. Diverse, culturally appropriate approaches are needed to improve numeracy confidence for specific racial and ethnic groups.

Full Text



Baker, David, Parker, Ruth, Williams, Mark, Clark, Scott, and Nurss, Joanne (1997) The Relationship of Patient Reading Ability to Self-reported Health and Use of Health Services, American Journal Public Health, vol 87, pp 1027–1030.

Berkman, Nancy, DeWalt, Darren, and Pignone, Michael (2004) Literacy and Health Outcomes. Summary, Evidence Report/Technology Assessment No. 87. Rockville: AHRQ; (Prepared by RTI International, University of North Carolina Evidence-based Practice Center under Contract No. 290-02-0016) AHRQ Publication No. 04-E007-1: Agency for Healthcare Research and Quality.

DeWalt, Darren, Berkman, Nancy, Sheridan, Stacey, Lohr, Kathleen, and Pignone, Michael (2004) Literacy and Health Outcomes: A systematic review of the literature, Journal of General Internal Medicine, vol 19, pp 1228–1239.

Fagerlin, Angela, Zikmund-Fisher, Brian, Ubel, Peter, Jankovic, Aleksandra, Derry, Holly, and Smith, Dylan M (2007) Measuring Numeracy without a Math Test: Development of the subjective numeracy scale, Medical Decision Making, vol 27, no 5, pp 672–680.

Fairlie, Robert (1999) The Absence of the African-American Owned Business: An analysis of the dynamics of self-employment, Journal of Labor Economics, vol 17, pp 80–108.

Fairlie, Robert (2005) An Extension of the Blinder-Oaxaca Decomposition Technique to Logit and Probit Models, Journal of Economic and Social Measurement, vol 30, pp 305–316.

Golbeck, Amanda, Ahlers-Schmidt, Carolyn, Paschal, Angelia, Dismuke, Edwards (2005) A Definition and Operational Framework for Health Numeracy, American Journal of Preventive Medicine, vol 29, pp 375-376.

Jensen, Jakob, King, Andy, Davis, LaShara, and Guntzviller, Lisa (2010) Utilization of Internet Technology by Low-income Adults: The role of health literacy, health numeracy, and computer assistance, Journal of Aging and Health, vol 22, no 6, pp 804-826.

Nelson, Wendy, Reyna, Valerie, Fagerlin, Angela, Lipkus, Isaac, and Peters, Ellen (2008) Clinical Implications of Numeracy: Theory and practice Annals of Behavioral Medicine, vol 35, no 3, pp 261–274.

Noar, Seth, Benac, Christina, and Harris, Melissa (2007) Does Tailoring Matter? Meta-analytic review of tailored print health behavior change interventions, Psychological Bulletin, vol 133, pp 673–693.

Nutbeam, Don (2008) The Evolving Concept of Health Literacy, Social Science and Medicine, vol 67, pp 2072-2078.

Osborn, Chandra, Cavanaugh, Kerri, Wallston, Kenneth, White, Richard, and Rothman, Russell (2009) Diabetes Numeracy: An overlooked factor in understanding racial disparities in glycemic control, Diabetes Care, vol 32, no 9, pp 1614-1619.

Osborn, Chandra, Cavanaugh, Kerri, Wallston, Kenneth, and Rothman, Russell (2010) Self-efficacy Links Health Literacy and Numeracy to Glycemic Control, Journal of Health Communication, vol 15, no S2, pp 146-158.

Osborn, Chandra, Paasche-Orlow, Michael, Davis, Terry, and Wolf, Michael (2007) Health literacy: An overlooked factor in understanding HIV health disparities, American Journal of Preventive Medicine, vol 33, no 5, pp 374–378.

Pagán, José, Su, Dejen, Li, Lifeng, Armstrong, Katrina, and Asch, David (2009) Racial and ethnic disparities in awareness of genetic testing for cancer risk, American Journal of Preventive Medicine, vol 37, no 6, pp 524-530.

Peters, Ellen, Dieckmann, Nathan, Västfjäll, Daniel, Mertz, C.K., Slovic, Paul, and Hibbard, Judith H (2009) Bringing meaning to numbers: The impact of evaluative categories on decisions, Journal of Experimental Psychology, vol 15, no 3, pp 213-227.

Portnoy, David, Roter, Debra and Erby, Lori (2010) The role of numeracy on client knowledge in BRCA genetic counseling, Patient Education Counseling vol 81, pp 131-6.

Reyna, Valerie, Nelson, Wendy, Han, Paul, and Dieckmann, Nathan (2008). How numeracy influences risk comprehension and medical decision making, Psychological Bulletin, vol 135, no 6, pp 943-973.

Schapira, Marilyn, Fletcher, Kathlyn, Gilligan, Mary Ann, King, Toni, Laud, Purushottam, Matthews, Alexendra, Neuner, Joan, and Hayes, Elisabeth (2008) A framework for health numeracy: how patients use quantitative skills in health care, Journal of health Communication, vol 13, pp 501–517.

Smith, Samuel, Wolf, Michael, and von Wagner, Christian (2010) Socioeconomic status, statistical confidence, and patient-provider communication: an analysis of the Health Information National Trends Survey (HINTS 2007), Journal of health Communication vol 15, pp 169-185.

Wallston, Kenneth, Rothman, Russell, and Cherrington, Andrea (2007) Psychometric properties of the Perceived Diabetes Self-Management Scale (PDSMS). Journal of Behavioral Medicine, vol 30, no 5, pp 395-401.

Williams, Mark, Baker, David, Parker, Ruth, and Nurss, Joanne (1998) Relationship of functional health literacy to patients' knowledge of their chronic disease, Archives of Internal Medicine, vol 158, pp 166–172.

Zarcadoolas, Christina, Pleasant, Andrew, and Greer, David (2006) Advancing health literacy: A framework for understanding and action, Jossey-Bass, San Francisco, CA.