Christina Zarcadoolas, Ph.D., is associate clinical professor in the Department of Community and Preventive Medicine, Mount Sinai School of Medicine, in New York City. She is a sociolinguist who has spent thirty years studying language and literacy of vulnerable populations. Andrew F. Pleasant, Ph.D., is an assistant professor in the Department of Human Ecology and the Extension Department of Family and Community Health Sciences at Rutgers, the State University of New Jersey in New Brunswick, New Jersey. He previously served as a temporary advisor to the World Health Organization in Geneva, Switzerland, and actively conducts research both in the United States and internationally.David S. Greer, M.D., is dean of medicine emeritus, and professor of community health emeritus at the Division of Biology and Medicine, School of Medicine, Brown University. Greer has been a family doctor, researcher, medical school leader, community leader, and mentor to countless health professionals for many decades. He was a founding director of International Physicians for the Prevention of Nuclear War, which won the Nobel Peace Prize in 1985.

"…an important book because it teaches us lessons from the history of health communications and moves us forward." (PsycCritiques, 08/08/2007) "This is one of the most understandable, useful, and practical texts available to assist with developing, implementing, and evaluating community health programs." (Choice, February 2007)"We recommend that public health directors make this book required reading for everyone in their communications department." (New England Journal of Medicine, February 15, 2007)

• List of Tables, Figures, and Exhibits xiPreface xvThe Authors xxiii1. Health Literacy: Why Is It a Public Health Issue? 1Definitions of Key Terms 4Medical Information 6The Relationship Between Health and Literacy 10Characteristics of People as Language Users 16Wrapping Up 18Exercises 182. Advancing Health Literacy: Getting Here from There 21Historical Considerations 21A Brief History: How Did We Get to Health Literacy? 23Early Public Health Promotion and Education 27Social Movements and Advocacy in the 1960s and 1970s 34Informed Consumer Decision Making and Community Collaboration in the 1980s and 1990s 35The 21st Century 38Wrapping Up 43Exercises 433. Defining Health Literacy 45Literacy: Defining Terms 45Reality Bytes 46The Evolving Field of Health Literacy 49A Multidimensional Model of Health Literacy 55Wrapping Up 67Exercises 674. Literacy at Work 69How Language Works 69Reading 75Spoken Language 82Implications for Spoken and Written Health Messages 90Wrapping Up 91Exercises 915. The Traditional Mass Media 93Introduction to Mass Media 94Media Content: Challenges and Opportunities to Advance Health Literacy 103Wrapping Up 115Exercises 1156. Health Literacy and the Internet 117Internet Use in Health Care 118Potential Disadvantages and Barriers to the Internet for Conveying Health-Related Information 127Wrapping Up 136Exercises 1367. Baby Basics: A Prenatal Program Focusing on Developing Health Literacy 141Healthy Beginnings: Infant and Maternal Health 142The Baby Basics Book and Program 146The Baby Basics Program Model 159Wrapping Up 162Exercises 1638. Anthrax: A Missed Opportunity to Advance Health Literacy 165The American Public Reacts 170The U.S. Postal Service Postcard: A Mixed Success 172Seeking Anthrax Answers on the Internet 175Scientific Uncertainty: A Consistent Challenge 177Wrapping Up 180Exercises 1829. Genomics and Health Literacy 183Why Genomics? 183Understanding and Misunderstanding Genomics: A Review 186Wrapping Up 203Exercises 20310. Highlighting the Role of Civic Literacy: The Massachusetts Tobacco Control Program 205Smoking and Health: The Threat 205Smoking and Health Literacy 207Massachusetts Tobacco Control Program 207Wrapping Up 220Exercises 22011. Highlighting the Role of Cultural Literacy, Part 1: The Changing Face of HIV/AIDS 223HIV/AIDS in the United States 225The Public Dialogue 227The Conflict in Communicating About HIV/AIDS 228Community Planning: The San Francisco AIDS Foundation 236Wrapping Up 240Exercises 24112. Highlighting the Role of Cultural Literacy, Part 2: Diabetes and Native Americans 243How to Be Culturally Relevant 244Diabetes and Native Americans: An Epidemic of Culture 245The Role of Culture in Diabetes Prevention and Care 248The Sioux San Hospital Diabetes Program 250Listening to the Community 257Wrapping Up 260Exercises 26113. Program Evaluation: World Education’s Breast and Cervical Cancer Project 263Adult Basic Education and Health Literacy 264Targeting Breast and Cervical Cancer 266What Is Evaluation? 271HEAL:BCC Implementation and Evaluation 273Lessons Learned from the Evaluation 283Wrapping Up 284Exercises 28514. Guidelines for Advancing Health Literacy 287Guideline 1: General 288Guideline 2: Vocabulary 291Guideline 3: Sentences 293Guideline 4: Text Structure 299Guideline 5: Giving Instructions 302Guideline 6: Field Testing 303Guideline 7: Spoken Language 305Guideline 8: Language Translation 306Guideline 9: Web Design 309Guideline 10: Graphics and Layout of Print Materials 310Guideline 11: Media 311References 315Name Index 341Subject Index 349

Christina Zarcadoolas, Ph.D., is associate clinical professor in the Department of Community and Preventive Medicine, Mount Sinai School of Medicine, in New York City. She is a sociolinguist who has spent thirty years studying language and literacy of vulnerable populations. Andrew F. Pleasant, Ph.D., is an assistant professor in the Department of Human Ecology and the Extension Department of Family and Community Health Sciences at Rutgers, the State University of New Jersey in New Brunswick, New Jersey. He previously served as a temporary advisor to the World Health Organization in Geneva, Switzerland, and actively conducts research both in the United States and internationally.David S. Greer, M.D., is dean of medicine emeritus, and professor of community health emeritus at the Division of Biology and Medicine, School of Medicine, Brown University. Greer has been a family doctor, researcher, medical school leader, community leader, and mentor to countless health professionals for many decades. He was a founding director of International Physicians for the Prevention of Nuclear War, which won the Nobel Peace Prize in 1985.

"…an important book because it teaches us lessons from the history of health communications and moves us forward." (PsycCritiques, 08/08/2007) "This is one of the most understandable, useful, and practical texts available to assist with developing, implementing, and evaluating community health programs." (Choice, February 2007)"We recommend that public health directors make this book required reading for everyone in their communications department." (New England Journal of Medicine, February 15, 2007)

• List of Tables, Figures, and Exhibits xiPreface xvThe Authors xxiii1. Health Literacy: Why Is It a Public Health Issue? 1Definitions of Key Terms 4Medical Information 6The Relationship Between Health and Literacy 10Characteristics of People as Language Users 16Wrapping Up 18Exercises 182. Advancing Health Literacy: Getting Here from There 21Historical Considerations 21A Brief History: How Did We Get to Health Literacy? 23Early Public Health Promotion and Education 27Social Movements and Advocacy in the 1960s and 1970s 34Informed Consumer Decision Making and Community Collaboration in the 1980s and 1990s 35The 21st Century 38Wrapping Up 43Exercises 433. Defining Health Literacy 45Literacy: Defining Terms 45Reality Bytes 46The Evolving Field of Health Literacy 49A Multidimensional Model of Health Literacy 55Wrapping Up 67Exercises 674. Literacy at Work 69How Language Works 69Reading 75Spoken Language 82Implications for Spoken and Written Health Messages 90Wrapping Up 91Exercises 915. The Traditional Mass Media 93Introduction to Mass Media 94Media Content: Challenges and Opportunities to Advance Health Literacy 103Wrapping Up 115Exercises 1156. Health Literacy and the Internet 117Internet Use in Health Care 118Potential Disadvantages and Barriers to the Internet for Conveying Health-Related Information 127Wrapping Up 136Exercises 1367. Baby Basics: A Prenatal Program Focusing on Developing Health Literacy 141Healthy Beginnings: Infant and Maternal Health 142The Baby Basics Book and Program 146The Baby Basics Program Model 159Wrapping Up 162Exercises 1638. Anthrax: A Missed Opportunity to Advance Health Literacy 165The American Public Reacts 170The U.S. Postal Service Postcard: A Mixed Success 172Seeking Anthrax Answers on the Internet 175Scientific Uncertainty: A Consistent Challenge 177Wrapping Up 180Exercises 1829. Genomics and Health Literacy 183Why Genomics? 183Understanding and Misunderstanding Genomics: A Review 186Wrapping Up 203Exercises 20310. Highlighting the Role of Civic Literacy: The Massachusetts Tobacco Control Program 205Smoking and Health: The Threat 205Smoking and Health Literacy 207Massachusetts Tobacco Control Program 207Wrapping Up 220Exercises 22011. Highlighting the Role of Cultural Literacy, Part 1: The Changing Face of HIV/AIDS 223HIV/AIDS in the United States 225The Public Dialogue 227The Conflict in Communicating About HIV/AIDS 228Community Planning: The San Francisco AIDS Foundation 236Wrapping Up 240Exercises 24112. Highlighting the Role of Cultural Literacy, Part 2: Diabetes and Native Americans 243How to Be Culturally Relevant 244Diabetes and Native Americans: An Epidemic of Culture 245The Role of Culture in Diabetes Prevention and Care 248The Sioux San Hospital Diabetes Program 250Listening to the Community 257Wrapping Up 260Exercises 26113. Program Evaluation: World Education’s Breast and Cervical Cancer Project 263Adult Basic Education and Health Literacy 264Targeting Breast and Cervical Cancer 266What Is Evaluation? 271HEAL:BCC Implementation and Evaluation 273Lessons Learned from the Evaluation 283Wrapping Up 284Exercises 28514. Guidelines for Advancing Health Literacy 287Guideline 1: General 288Guideline 2: Vocabulary 291Guideline 3: Sentences 293Guideline 4: Text Structure 299Guideline 5: Giving Instructions 302Guideline 6: Field Testing 303Guideline 7: Spoken Language 305Guideline 8: Language Translation 306Guideline 9: Web Design 309Guideline 10: Graphics and Layout of Print Materials 310Guideline 11: Media 311References 315Name Index 341Subject Index 349

Christina Zarcadoolas, Ph.D., is associate clinical professor in the Department of Community and Preventive Medicine, Mount Sinai School of Medicine, in New York City. She is a sociolinguist who has spent thirty years studying language and literacy of vulnerable populations. Andrew F. Pleasant, Ph.D., is an assistant professor in the Department of Human Ecology and the Extension Department of Family and Community Health Sciences at Rutgers, the State University of New Jersey in New Brunswick, New Jersey. He previously served as a temporary advisor to the World Health Organization in Geneva, Switzerland, and actively conducts research both in the United States and internationally.David S. Greer, M.D., is dean of medicine emeritus, and professor of community health emeritus at the Division of Biology and Medicine, School of Medicine, Brown University. Greer has been a family doctor, researcher, medical school leader, community leader, and mentor to countless health professionals for many decades. He was a founding director of International Physicians for the Prevention of Nuclear War, which won the Nobel Peace Prize in 1985.

"…an important book because it teaches us lessons from the history of health communications and moves us forward." (PsycCritiques, 08/08/2007) "This is one of the most understandable, useful, and practical texts available to assist with developing, implementing, and evaluating community health programs." (Choice, February 2007)"We recommend that public health directors make this book required reading for everyone in their communications department." (New England Journal of Medicine, February 15, 2007)

• List of Tables, Figures, and Exhibits xiPreface xvThe Authors xxiii1. Health Literacy: Why Is It a Public Health Issue? 1Definitions of Key Terms 4Medical Information 6The Relationship Between Health and Literacy 10Characteristics of People as Language Users 16Wrapping Up 18Exercises 182. Advancing Health Literacy: Getting Here from There 21Historical Considerations 21A Brief History: How Did We Get to Health Literacy? 23Early Public Health Promotion and Education 27Social Movements and Advocacy in the 1960s and 1970s 34Informed Consumer Decision Making and Community Collaboration in the 1980s and 1990s 35The 21st Century 38Wrapping Up 43Exercises 433. Defining Health Literacy 45Literacy: Defining Terms 45Reality Bytes 46The Evolving Field of Health Literacy 49A Multidimensional Model of Health Literacy 55Wrapping Up 67Exercises 674. Literacy at Work 69How Language Works 69Reading 75Spoken Language 82Implications for Spoken and Written Health Messages 90Wrapping Up 91Exercises 915. The Traditional Mass Media 93Introduction to Mass Media 94Media Content: Challenges and Opportunities to Advance Health Literacy 103Wrapping Up 115Exercises 1156. Health Literacy and the Internet 117Internet Use in Health Care 118Potential Disadvantages and Barriers to the Internet for Conveying Health-Related Information 127Wrapping Up 136Exercises 1367. Baby Basics: A Prenatal Program Focusing on Developing Health Literacy 141Healthy Beginnings: Infant and Maternal Health 142The Baby Basics Book and Program 146The Baby Basics Program Model 159Wrapping Up 162Exercises 1638. Anthrax: A Missed Opportunity to Advance Health Literacy 165The American Public Reacts 170The U.S. Postal Service Postcard: A Mixed Success 172Seeking Anthrax Answers on the Internet 175Scientific Uncertainty: A Consistent Challenge 177Wrapping Up 180Exercises 1829. Genomics and Health Literacy 183Why Genomics? 183Understanding and Misunderstanding Genomics: A Review 186Wrapping Up 203Exercises 20310. Highlighting the Role of Civic Literacy: The Massachusetts Tobacco Control Program 205Smoking and Health: The Threat 205Smoking and Health Literacy 207Massachusetts Tobacco Control Program 207Wrapping Up 220Exercises 22011. Highlighting the Role of Cultural Literacy, Part 1: The Changing Face of HIV/AIDS 223HIV/AIDS in the United States 225The Public Dialogue 227The Conflict in Communicating About HIV/AIDS 228Community Planning: The San Francisco AIDS Foundation 236Wrapping Up 240Exercises 24112. Highlighting the Role of Cultural Literacy, Part 2: Diabetes and Native Americans 243How to Be Culturally Relevant 244Diabetes and Native Americans: An Epidemic of Culture 245The Role of Culture in Diabetes Prevention and Care 248The Sioux San Hospital Diabetes Program 250Listening to the Community 257Wrapping Up 260Exercises 26113. Program Evaluation: World Education’s Breast and Cervical Cancer Project 263Adult Basic Education and Health Literacy 264Targeting Breast and Cervical Cancer 266What Is Evaluation? 271HEAL:BCC Implementation and Evaluation 273Lessons Learned from the Evaluation 283Wrapping Up 284Exercises 28514. Guidelines for Advancing Health Literacy 287Guideline 1: General 288Guideline 2: Vocabulary 291Guideline 3: Sentences 293Guideline 4: Text Structure 299Guideline 5: Giving Instructions 302Guideline 6: Field Testing 303Guideline 7: Spoken Language 305Guideline 8: Language Translation 306Guideline 9: Web Design 309Guideline 10: Graphics and Layout of Print Materials 310Guideline 11: Media 311References 315Name Index 341Subject Index 349