The Use of the Newest Vital Sign in Children.

To the Editor:

As the individual who led the team that developed the Newest Vital Sign (NVS) health literacy assessment instrument, I feel compelled to comment on the study by Howe, Van Scoyoc, Alexander, and Stevenson (2018) that was recently published in this journal.

Their finding of poor performance in children is not a surprise. Why would we expect children, particularly elementary school children (some of whom, such as the 7-year-olds, are still learning to read) to be able to interpret the complexities of a nutrition label, something that even many adults cannot do.

The study by Howe et al. (2018) is not the first to evaluate performance of the NVS in children. There have been many of them, several of which are cited in their article. Every time I see such a study I wonder why the study was undertaken.

The standard definition of health literacy revolves around the ability to obtain, understand, and use health information to make decisions about one's health and medical care, and to navigate the health system. For the vast majority of children, their parents do that for them. Measuring the parents' health literacy would likely give us a better understanding of things than measuring the health literacy of the children.

It is true that children with certain chronic health problems, such as diabetes or asthma, need to know certain things about their condition to help manage it appropriately; however, that is disease-specific knowledge, not general health literacy.

There are many well-validated tools available for assessing health literacy. We do not need to keep studying them, nor do we need to keep developing more of them; we certainly don't need to be studying them in children. I urge health literacy researchers to focus on how we can improve the health literacy of our patients, and how we can improve the way clinicians and the health care system communicate with them. Doing those things will get us a lot further than spending our resources on measuring health literacy in children.