1. Engaging Youth to Support Health Literacy Nancy Vandenberg, Youth Engagement Specialist Envision New Mexico, University of New Mexico

2. What is youth engagement? The definition being utilized by the School-based Health Center Improvement Project is: the intentional, meaningful and sustained involvement of young people in the programs, practices and policies that seek to impact them. In partnership with adults, engaged youth develop the capacity and confidence to participate as productive partners in the decisions affecting them individually and collectively. What is health literacy? The American Medical Association defines health literacy as: the ability to obtain, process, and understand basic health information and services needed to make appropriate health decisions and follow instructions for treatment.

3. Why is a focus on health literacy important? 93 million adults have basic or below basic literacy (2003 National Assessment of Adult Literacy) Most health materials are written at a level that exceeds reading skills of the average high school graduate (Harvard School of Public Health report on Literacy and Health) There is an increased demand from complex health care systems and increased responsibility for individuals interacting with health care systems (Adult Literacy and Lifeskills Survey of 2003) The number of medications prescribed, reliance on forms & written directions, and home self-management have all increased (Harvard School of Public Health report on Literacy and Health) It is estimated that the cost of limited health literacy in the U.S. is between $106 and $236 billion dollars annually (National Action Plan to Improve Health Literacy, U.S. Department of Health and Human Services).

4. What are the elements and levels of literacy and health literacy? 5 Core Literacy Elements: Reading Writing Numeracy Speaking Listening Three Levels of Health Literacy: Basic, or functional, health literacy includes basic understanding of health risks and health services. Interactive health literacy includes the capacity to act independently on health advice and actively participate in health care with providers. Critical health literacy includes the ability to understand the determinants of health and act on the information. Source: Health Promotion International: Health literacy as a public health goal: a challenge for contemporary health education and communication strategies into the 21 st century Nutbeam, Don

5. Media Literacy is Part of Health Literacy The internet is a major source of information for teens: 93% of teens use the internet 50% of teens use the internet every day 17% of teens use the internet to find information about health topics it may be hard to talk to parents about (e.g. sex, depression, drug use) Source: Pew Internet and American Life Project survey of 2009 Up to 75% of teens who access the internet use it to look for health- related information Source: How Young People Use the Internet for Health Information, 2001 Kaiser Family Foundation Survey

6. Media Literacy The internet is a major source of information for teens because it is: Immediate Private Interactive However, there are challenges to utilization for teens: Information may be inaccurate Information may not be age- appropriate Information sources may be biased (e.g. drug company sponsored)

7. What Health Literacy Skills Should We Teach? Navigating Health Care Understanding Health Care Self-Advocacy in Health Care

8. Navigating Health Care How to make appointments What the types of healthcare providers are Who I go to for what (PCP vs. school nurse, etc.) When to go to what kind of facility (PCP, urgent care, ER AND school nurse, SBHC, school counselor) Paying for care (what, if any, kind of insurance do I have, and where that leads me) Where I will get health care once I leave school

9. Understanding Health Care Knowing where to find accurate health information Understanding basic health- related terminology Knowing my rights, especially around confidentiality Knowing that health providers can support wellness plans as well as management of illness Understanding basic instructions for taking medication

10. Self-Advocacy in Health Care Being able to ask clarifying questions of my provider Making plans in collaboration with my provider Being able to discuss relevant refusal skills with my provider Bringing questions and concerns to the attention of my provider Choosing appropriate treatment plans in concert with my provider Determine what behaviors to choose to achieve health goals

11. Role of Health Professionals: COMMUNICATION: Set goals collaboratively Use interactive style Request patient demonstration of recall of treatment plan/instructions (e.g. I want to make sure I didnt forget to go over anything; tell me how youll take this medication.) Change language to address: language barriers, literacy, technical jargon, quantitative jargon, speedy speech TEACHING: Navigation of the healthcare system Patients ability to understand health and medical issues and directions is related to the clarity of the communication. Health professionals must take responsibility for clarity. Communicating Health: Priorities and Strategies for Progress, Health and Humans Services 2003 report

12. Role of Schools WHY? Teaching health literacy emphasizes higher order thinking: communication skills, problem-solving, and decision-making Healthy students do better in school! HOW? Collaborate to integrate health literacy efforts across school sectors: science, health, school nurse, SBHC, athletics, career education, English Use the national and state health education standards

13. National Health Education Standards Standard 1: Students will comprehend concepts related to health promotion and disease prevention to enhance health. Standard 2: Students will analyze the influence of family, peers, culture, media, technology, and other factors on health behaviors Standard 3: Students will demonstrate the ability to access valid information, products, and services to enhance health. Standard 4: Students will demonstrate the ability to use interpersonal communication skills to enhance health and avoid or reduce health risks. Standard 5: Students will demonstrate the ability to use decision-making skills to enhance health. Standard 6: Students will demonstrate the ability to use goal-setting skills to enhance health. Standard 7: Students will demonstrate the ability to practice health-enhancing behaviors and avoid or reduce health risks. Standard 8: Students will demonstrate the ability to advocate for personal, family, and community health.

14. NM Health Education Standards CONTENT STANDARDS WITH BENCHMARKS AND PERFORMANCE STANDARDS FOR HEALTH EDUCATION, Grades 9-12: Standard 1: Students will comprehend concepts related to health promotion and disease prevention. Standard 2: Students will demonstrate the ability to access valid health information and health-promoting products and services. Standard 3: Students will demonstrate the ability to practice health-enhancing behaviors and reduce health risks. Standard 4: Students will analyze the influence of culture, media, technology and other factors on health. Standard 5: Students will demonstrate the ability to use interpersonal communication skills to enhance health. Standard 6: Students will demonstrate the ability to use goal-setting and decision- making skills to enhance health. Standard 7: Students will demonstrate the ability to advocate for personal, family, peer and community health.

15. Youth Engagement the intentional, meaningful and sustained involvement of young people in the programs, practices and policies that seek to impact them. In partnership with adults, engaged youth develop the capacity and confidence to participate as productive partners in the decisions affecting them individually and collectively.

16. Individual Engagement: Engaging with youth on an individual basis can help ensure they learn, practice and master the health literacy skills they need. This is a primary way in which providers can support patients, teachers can support students, etc. Examples: Collaborate with a student to make treatment decisions – like when to take medicine based on their schedule Collaborate with a student to make a wellness decision – like what kind of exercise theyd most enjoy to increase physical well-being Brainstorm a scenario with a student in which they use refusal skills to avoid risk behaviors Provide a student with information about how they can access care when they go to college Check for understanding of medical terminology – do a teach back

17. Collective Engagement Engaging with youth on a collective basis can increase their health literacy skills while also promoting the learning of their peers. Examples: Engage youth to design, publish and disseminate educational health materials Engage youth to design and implement health promotion activities in your school Engage youth to research and make recommendations regarding school health and wellness policies Engage youth to plan and implement health education activities in the community

18. Use career interests to activate engagement and to grow and diversify the provider pool in our state. Start a health careers club Partner with local health care agencies to sponsor field trips Have volunteer positions in school nurse and SBHC offices for students with health career interests Plan an annual health fair with students interested in health careers Let students know about health career programs at UNM – HSC (http://hsc.edu/programs/di versity) Students as Future Providers

19. Activate student engagement through sports Collaborate with coaches to do health promotion activities for teams (e.g. around nutrition) Integrate health literacy education with sports physicals Encourage a particular team to do a health promotion activity (e.g. football team can use NFL Play60 initiative to encourage physical activity)for the entire campus Work with team captains to create an inter-team health council Student Athletes as Allies

20. Other Youth Engagement Ideas? 1. 2. 3. 4. 5.

21. Related Web Resources: FOR YOUTH: www.kidshealth.org http://us.reachout.com www.girlshealth.gov www.teenhealthfx.com www.youngwomenshealth.org/ www.pamf.org/teen www.medlineplus.gov www.teenhealthexplosion.com http://health.nih.gov www.besmartbewell.com www.healthfinder.gov http://familydoctor.org http://netwellness.org http://unm.kramesonline.com www.thinkfirst.org/teens http://depts.washington.edu/thme dia http://depts.washington.edu/thme dia http://medialiteracyproject.org/ http://www.hon.ch/pat.html FOR THOSE SERVING YOUTH www.cdc.gov/healthliteracy http://www.hon.ch/med.html http://cahealthliteracy.org/ http://www.nlm.nih.gov/medlineplus/ www.healthychildren.org http://www.aap.org/en-us/professional- resources/Research/research- resources/Pages/Health-Literacy-and- Pediatrics.aspx http://www.aap.org/en-us/professional- resources/Research/research- resources/Pages/Health-Literacy-and- Pediatrics.aspx http://scassheap.org/ http://medialiteracyproject.org/ http://tv.nytimes.com/learning/issues_in_depth /teenhealth.html http://tv.nytimes.com/learning/issues_in_depth /teenhealth.html http://depts.washington.edu/thmedia www.diversityrx.org www.hsph.harvard.edu/healthliteracy http://www.npsf.org/for-healthcare- professionals/programs/ask-me-3/ http://www.npsf.org/for-healthcare- professionals/programs/ask-me-3/ http://www.ahrq.gov/qual/literacy/healthliter acytoolkit.pdf http://www.ahrq.gov/qual/literacy/healthliter acytoolkit.pdf http://www.plainlanguage.gov/populartopics /health_literacy/index.cfm http://www.plainlanguage.gov/populartopics /health_literacy/index.cfm http://www.cdc.gov/healthyyouth/sher/stand ards/index.htm http://www.cdc.gov/healthyyouth/sher/stand ards/index.htm http://www.ama-assn.org/ama/pub/about- ama/ama-foundation/our-programs/public- health/health-literacy-program.page http://www.ama-assn.org/ama/pub/about- ama/ama-foundation/our-programs/public- health/health-literacy-program.page

22. Thank You! Please feel free to contact me with questions and ideas: Nancy Vandenberg Youth Engagement Specialist Envision New Mexico University of New Mexico nvandenberg@salud.unm.edu