WASHINGTON -- The nation's estimated 90 million adults with lower-than-average reading skills are less likely than other Americans to get potentially life-saving screening tests such as mammograms and Pap smears, to get flu and pneumonia vaccines, and to take their children for well-child care visits, according to a new evidence report released recently by Carolyn M. Clancy, M.D., director of the Agency for Healthcare Research and Quality. People with a low level of literacy have difficulty reading newspapers and other simple information such as directions for taking medications or hospital discharge instructions. They are also more likely to be hospitalized, which may be because physicians are concerned about the patients' abilities to follow basic instructions and care for themselves at home when they are sick."Health literacy is the currency of success for everything that we do in primary and preventive medicine," said Surgeon General Richard H. Carmona, M.D. "Health literacy can save lives, save money, and improve the health and well-being of millions of Americans. All of us -- government, academia, health care professionals, corporations, communities, and consumers -- working together can bridge the gap between what health professionals know and what patients understand, and thereby improve the health of all Americans."Low literacy plays an important role in health disparities and may contribute to lower quality care and even medical errors, Clancy noted. "This research review confirms the negative impact of low literacy on health outcomes, but even more importantly, it provides a roadmap for the research that needs to be done to answer key questions, including which are the most effective ways to improve health literacy."Last year, AHRQ, the American Medical Association, and the American Hospital Association launched a campaign to help educate clinicians and patients about the importance of effective communication. As part of the 5 Steps to Safer Health Care campaign, posters with five simple tips to encourage dialogue between patients and providers were distributed to doctors' offices and hospitals nationwide."For the 90 million Americans with limited literacy skills, it's tough to read the front page of a newspaper or a bus schedule, much less the complicated documents that go along with being a patient in our country today," said John C. Nelson, M.D., AMA president-elect. "Since 1998, the AMA has been tackling the problem of health literacy because we believe that quality health care depends on patients who are active participants in their own care, and low health literacy robs them of that opportunity."The AHRQ-supported evidence review also found that people with lower literacy skills are more likely to have difficulty understanding informed consent forms and in comprehending their children's diagnoses and medication instructions. They are also less likely to be knowledgeable about the health effects of smoking, diabetes, asthma, AIDS, and post-operative care. In addition, the review found evidence suggesting that well- conceived interventions such as easy-to-read guides and other comprehension aids can at least improve the outcome of knowledge for both lower- and higher-literacy patients.The report calls for more health literacy research to examine whether poor reading ability is really the cause of adverse health outcomes or whether it is a marker for other problems, such as low socioeconomic status, impaired access to care, and low trust in medical providers. It recommends that a patient-centered research design would help identify the challenges associated with navigating the health care system.AHRQ commissioned the evidence review at the request of the American Medical Association.Visit the Agency for Healthcare Research and Quality: www.ahrq.gov"