1. What we learned about Adolescent Health Literacy Santa Cruz County Adolescent Wellness Network

2. Three Partners to conduct focus group with local teen groups: MCHC’s Summer Youth Institute SEAHEC’s Health Career Club GEAR UP Team Anonymous Focus Group

3. Step One: • Consent form sent home to minors from groups in both English and Spanish

4. Step Two: Sign in with only specific demographics AGE ZIP CODE PLACE OF RESIDENCY

5. Step Three: The Questions? • Where do you generally get your health information? • Has anyone other than a health care provider (Dr., nurse) given you medical advice. Can you tell me who that was. • Looking at this prescription label, what can you tell me about taking this medication.

6. More Questions??? • On a package of food, where do you find a nutrition label? Looking at the nutrition label, what can you tell me about it. How many calories, servings, etc. • Have any of you been seen by a medical provider (Dr., Nurse)? Were you comfortable asking questions? • Is there anything else you would like to add?

7. Focus Groups Three focus groups were conducted: • One with MCHC’s SYI group and SEAHEC’s HCC • One with GEAR UP • One with Team Anonymous Results only for SYI and Health Career Club Teens; 9 students (including one exchange student from Germany)

8. SYI Mom Grandmother Internet TV Clinic Doctor News Pharmacist in Mexico Pediatrician in Mexico Tucson Doctor House Doctor SYI Peer The Results Question 1

9. Grandmother/Nana Put 2 potato slices on your temples for headaches Cut granny smith apple and smell it for headaches If you get stung by jelly fish, pee on it or put baking soda, toothpaste or vinegar on it Put mustard on a burn Mix onions and honey for a sore throat A lot of homeopathic info Teens go across the border for morning after pill no questions asked The Results Question 2

10. There are no refills Doesn’t have complete instructions What is OTIC How long do you have to take it Tells you when to take it and how many What it is and what it is for How many doses and how often Tells you the quantity Shows caution sign The Results Question 3

11. The Results Question 4 • On the back, bottom or side • Number of calories • How many calories per fat it contains • % of daily vitamins and values • What it offers you • How much energy it has • The fiber and protein contents • How much fiber it contains

12. The Results Question 5 • Majority said yes • Yes they asked questions • All felt more comfortable seeing the doctor with a parent present • 3 of them rephrased the doctors instructions to be sure of what the doctor said • Sometimes doctors use really big words and you have to ask them what they mean

13. The Results Question 5 Cont. • The student from Germany stated that she once had a doctor who didn’t really know what she was doing. The doctor keep having to read and refer to books to get a diagnosis • If you don ‘t ask, you won’t know what they are really trying to tell you

14. Most participants admitted to having self diagnosed and later going to find out truth One participants stated he had been misdiagnosed by a doctor and ended up in the hospital later Most get ailing remedies from nana 5 of the participants said they go to doctors in Mexico because they believe the medicines work better, are more natural and cheaper, plus you can get the medicines without a prescription The Results Question 6

15. Health Literacy Survey

16. Survey Stats • Fall 2009 • 211 students in Middle School • Calabasas Middle School, Coatimundi Middle School, Patagonia Middle School, Desert Shadows Middle School and Wade Carpenter Middle School • 11 Questions

17. The Students • The majority of the students who completed the survey were in the 8th grade (81.5%) followed by 7th grade (10%) and 6th grade (8.5%).

18. Question 1: Have you ever been taught to read a nutrition label • Most of the students replied “yes” (61.2%) when asked if they had ever been taught to read a nutrition label. Health teachers and mothers were the most common responses when asked “How did you learn to read a nutrition label?”

19. Food Label Questions • If you eat an entire container of ice cream, how many calories will you eat? • If you are allowed to eat 60 grams of carbohydrates as a snack, how much ice cream could you eat? • If you measured two servings, how much ice cream would that be if you measrued it in a bowl? • Your doctor advises you to reduce the amount of saturated fat in your diet. You usually have 42 grams of saturated fat each day, which includes one serving of ice cream. If you stop eating ice cream, how many grams of saturated fat would you be consuming each day? • If you usually eat 2500 calories in a day, what percentage of your daily value of calories will you be eating if you eat one serving?

20. Table 1. Responses to Food Label Questions “Yes” = percentage of students who answered question correctly “No” = percentage of students who answered question incorrectly

21. Questions pertaining to medical use practice • The students were asked if anyone other than a healthcare provider had provided medical advice. • 64.5% answered “Yes” • 35.5% answered “No” • “Mothers” were listed most frequently as the person dispensing medical advice, followed by “parents”, “family members”, “grandparents” and “teachers”. • Eighty-seven percent (87.6%) of students reported being seen by a healthcare provider. Of these individuals, seventy-five percent (75%) said that he/she felt comfortable with what the provider told him/her, and sixty-six percent (66%) stated that they felt comfortable asked the healthcare provider questions.

22. Home Remedies • Forty percent (40%) of students stated that they had been told of or ever used a home remedy. The most common home remedies included: • Putting tooth paste on burns • Using aloevera plants for cuts and burns, and • Consuming tea with lime or honey to soothe sore throats.

23. Conclusion • While the majority of youth who completed the survey and participated in the focus groups sought medical treatment from western physicians and nurses, many of the students receive medical advice from their grandmothers and other family members. Many of the students mentioned obtaining medical care and medicine from across the border in Mexico. • And finally, while many of the students demonstrated some proficiency at reading food labels, many additional students could benefit from some further instruction. Findings from this study may be useful when developing a culturally competent health literacy education intervention.