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      Health Literacy Mediates the Association Between Socioeconomic Status and Productive Aging Among Elderly Chinese Adults in a Newly Urbanized Community

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          Abstract

          Productive aging, or older adults engaging in paid or unpaid activities that produce socially valued goods or services, has been suggested to have the beneficial impact on older adults' health and well-being. We performed a cross-sectional study to examine the influence of health literacy on the relationship between socioeconomic status (SES) and productive aging among older Chinese adults in a newly urbanized community. Data was collected from 995 older adults from a newly urbanized community between June and August 2013 in Chengdu, China. We used structural equation modeling (SEM) to test the hypothesized relationship among SES, health literacy and productive aging. Results showed that education attainment and income had a direct positive effect on health literacy (β = 0.47and β = 0.15, respectively). Education had a partial indirect effect on productive aging through health literacy (β = 0.27). And health literacy was an important factor in improving the productive aging of the elderly. Interventions targeting health education and health promotion should be taken to improve health literacy of older adults under the background of urbanization, especially for those with lower SES.

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          Most cited references55

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          Health literacy as a public health goal: a challenge for contemporary health education and communication strategies into the 21st century

          D Nutbeam (2000)
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            The Relationship Between Health, Education, and Health Literacy: Results From the Dutch Adult Literacy and Life Skills Survey

            Health literacy has been put forward as a potential mechanism explaining the well-documented relationship between education and health. However, little empirical research has been undertaken to explore this hypothesis. The present study aims to study whether health literacy could be a pathway by which level of education affects health status. Health literacy was measured by the Health Activities and Literacy Scale, using data from a subsample of 5,136 adults between the ages of 25 and 65 years, gathered within the context of the 2007 Dutch Adult Literacy and Life Skills Survey. Linear regression analyses were used in separate models to estimate the extent to which health literacy mediates educational disparities in self-reported general health, physical health status, and mental health status as measured by the Short Form-12. Health literacy was found to partially mediate the association between low education and low self-reported health status. As such, improving health literacy may be a useful strategy for reducing disparities in health related to education, as health literacy appears to play a role in explaining the underlying mechanism driving the relationship between low level of education and poor health.
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              The prevalence of limited health literacy.

              To systematically review U.S. studies examining the prevalence of limited health literacy and to synthesize these findings by evaluating demographic associations in pooled analyses. We searched the literature for the period 1963 through January 2004 and identified 2,132 references related to a set of specified search terms. Of the 134 articles and published abstracts retrieved, 85 met inclusion criteria, which were 1) conducted in the United States with > or =25 adults, 2) addressed a hypothesis related to health care, 3) identified a measurement instrument, and 4) presented primary data. The authors extracted data to compare studies by population, methods, and results. The 85 studies reviewed include data on 31,129 subjects, and report a prevalence of low health literacy between 0% and 68%. Pooled analyses of these data reveal that the weighted prevalence of low health literacy was 26% (95% confidence interval [CI], 22% to 29%) and of marginal health literacy was 20% (95% CI, 16% to 23%). Most studies used either the Rapid Estimate of Adult Literacy in Medicine (REALM) or versions of the Test of Functional Health Literacy in Adults (TOFHLA). The prevalence of low health literacy was not associated with gender (P=.38) or measurement instrument (P=.23) but was associated with level of education (P=.02), ethnicity (P=.0003), and age (P=.004). A pooled analysis of published reports on health literacy cannot provide a nationally representative prevalence estimate. This systematic review exhibits that limited health literacy, as depicted in the medical literature, is prevalent and is consistently associated with education, ethnicity, and age. It is essential to simplify health services and improve health education. Such changes have the potential to improve the health of Americans and address the health disparities that exist today.
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                Author and article information

                Contributors
                Journal
                Front Public Health
                Front Public Health
                Front. Public Health
                Frontiers in Public Health
                Frontiers Media S.A.
                2296-2565
                09 April 2021
                2021
                : 9
                : 647230
                Affiliations
                [1] 1Laboratory for Aging and Cancer Research, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University , Chengdu, China
                [2] 2Department of Health Related Social and Behavioral Science, West China School of Public Health and West China Fourth Hospital, Sichuan University , Chengdu, China
                [3] 3School of Aging Studies, College of Behavioral & Community Sciences, University of South Florida , Tampa, FL, United States
                [4] 4Department of Public Health Sciences, University of Rochester Medical Center , Rochester, NY, United States
                [5] 5Zhong He Community Health Service Center in Chengdu Hi-Techzone , Chengdu, China
                [6] 6West China School of Public Health and West China Fourth Hospital, Sichuan University , Chengdu, China
                Author notes

                Edited by: Giuseppe Liotta, University of Rome Tor Vergata, Italy

                Reviewed by: Paola Scarcella, University of Rome Tor Vergata, Italy; Alessandra Coin, Azienda Ospedaliera Universitaria di Padova, Italy

                *Correspondence: Danping Liu liudanping03@ 123456163.com

                This article was submitted to Aging and Public Health, a section of the journal Frontiers in Public Health

                Article
                10.3389/fpubh.2021.647230
                8062760
                33898380
                0409a4cd-87b0-4fbb-9496-633e270000b8
                Copyright © 2021 Ma, Meng, Ye, Jia, Sun and Liu.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

                History
                : 29 December 2020
                : 08 March 2021
                Page count
                Figures: 2, Tables: 6, Equations: 0, References: 56, Pages: 8, Words: 6389
                Categories
                Public Health
                Original Research

                health literacy,socioeconomic status,productive aging,mediation,newly urbanized community

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