Background:
Health literacy is defined as a collection of reading and comprehension skills that facilitate functioning in a health care environment. Low health literacy (L-hl) is associated with adverse health outcomes.

Objective:
Describe health literacy levels among New York City (NYC) STD clinic attendees.

Method:
Surveys were conducted in three clinics during 2004 among persons 18-65 years old, who received a physician exam, had corrected eyesight measured at better than 20/200 (to differentiate poor vision from reading disability), and were comfortable answering an English-language survey. Questions assessed demographics, health literacy, STD knowledge/attitudes, and sexual behavior. Health literacy was measured using the Rapid Estimate of Adult Literacy in Medicine (REALM). Bivariate and multivariate analyses examined predictors of L-hl (<8th grade reading level), and its associations with STD-related knowledge and sexual behavior.

Result:
A total of 645 persons participated (55% male, median age 27 years); 58% scored at >9th grade level, 32% at 7th-8th grade, and 10% at < 6th grade. After adjusting for race/ethnicity, age, schooling, and other demographics, less schooling and non-white race were significantly associated with L-hl. STD knowledge scores were high for all persons and there was little association between health literacy and sexual risk behaviors. Persons with L-hl were more likely than persons with high health literacy to report that a health provider was their main source of health information (p=0.006).

Conclusion:
Almost half of participants read below a 9th grade level, however, STD-related knowledge was high in this population. Providers may be the only source of health information for persons with L-hl.

Implications:
Health messages should be developed at a 7th grade level to be comprehensible to 90% of clinic attendees. Provider and client communications during the clinic visit must be viewed as the single most important means of imparting health information.