Adult Literacy Research Articles

Financial literacy among autistic adults

AbstractFinancial literacy is highly correlated to long‐term positive economic outcomes. Research examining the financial literacy of autistic adults is virtually nonexistent which is concerning given the implications of financial decision‐making for quality of life. This study assessed conceptual understanding and financial behaviors of autistic adults compared with a matched group of nonautistic adults. An online questionnaire assessed income, use of financial tools, feelings toward finances, use of financial literacy programs, financial knowledge, and preference for receiving financial education. The findings indicated that autistic adults showed lower financial literacy and greater uncertainty around many financial issues. They were less confident in their financial knowledge and ability to deal with daily financial matters. The autistic group showed less liking for some specific learning tools for receiving financial education. Our findings inform efforts to design specific curricula to improve the financial knowledge and understanding of autistic and other neurodiverse populations.

Validity-reliability of the e-Healthy Diet Literacy Scale in Turkish adults

Introduction: This study aims to establish the validity-reliability of the Turkish version of adult e-Healthy Diet Literacy Scale and to determine its relationship with the Health Literacy Instrument Scale (short-form), the Digital Healthy Diet Literacy Scale, and participants’ characteristics. Ma-terial and Methods: Drawing on a methodological and descriptive design, this research was per-formed in two steps. It was conducted with 240 participants in the first step and 879 participants in the second step. The participants filled out the eHealthy Diet Literacy Scale, Health Literacy In-strument Scale (short-form), and Digital Healthy Diet Literacy Scale. The questionnaire form was sent to the participants online. Results: Cronbach’s alpha coefficient for the 11-item e-Healthy Diet Literacy scale was found to be 0.555. There was a significant relationship between the Health Literacy Instrument Scale (short-Form) and age groups, educational level, occupations, marital status, BMI, weekly physical activity and chronic disease status. Conclusions: This study evaluated the Turkish validity and reliability of the e-HDL, which was originally designed in Taiwan as a valid and reliable tool to evaluate the individuals’ ability to access, understand, appraise, and apply healthy diet information.

Evaluation of the Relationship between Sustainable and Healthy Eating Behaviors with e-Healthy Diet Literacy and Nutrition Knowledge Level in Adults

Giriş ve Amaç: Gelecek nesillere yaşanabilir bir dünya bırakmak için bireylerin sürdürülebilir ve sağlıklı beslenme davranışlarının arttırılması gerekmektedir. Bu çalışma, yetişkin bireylerin sürdürülebilir ve sağlıklı beslenme davranışları ile e-sağlıklı beslenme okuryazarlığı ve beslenme bilgi düzeyleri arasındaki ilişkinin değerlendirilmesi amacıyla yürütülmüştür. 
 Gereç ve Yöntemler: Araştırmanın örneklemini, yaşları 18-65 yıl arasında değişen 110 erkek ve 102 kadın olmak üzere toplam 222 birey oluşturmaktadır. Çalışma verileri anket aracılığıyla toplanmıştır. Bireylerin sürdürülebilir ve sağlıklı beslenme davranışlarını belirlemek amacıyla “Sürdürülebilir ve Sağlıklı Beslenme Davranışları Ölçeği”, elektronik sağlıklı beslenme okuryazarlık düzeyini değerlendirmek amacıyla “e-Sağlıklı Beslenme Okuryazarlık Ölçeği (e-SBO)” ve beslenme bilgi düzeyini belirlemek amacıyla “Yetişkinler için Beslenme Bilgi Düzeyi Ölçeği (YETBİD)” kullanılmıştır. 
 Bulgular: Kadınlarda sürdürülebilir ve sağlıklı beslenme davranışları ölçeği toplam puanı 4,0±1,05 ve erkeklerde 3,9±0,87’dir (p>0,05). Kadınların e-SBO düzeyleri (41,4±7,26) erkeklerden (38,6±7,20) daha yüksektir (p

Mediating effect of depressive symptoms on the relationship between digital literacy and cognitive function in older adults.

Although several studies have examined the individual relationships among digital literacy, cognitive function, and depressive symptoms, few have integrated all three factors into a single model. This study aimed to address this gap by investigating the mediating effect of depressive symptoms on the relationship between digital literacy and cognition. In doing so, we hoped to contribute to a more comprehensive understanding of the complex interplay among these variables and their implications for mental health and well-being. Participants were 7,988 older adults (65 years or older) who participated in the Living Profiles of Older People Survey 2020. The main type of exposure was digital literacy (communication, information, media, and online transaction literacy). The main outcomes were depressive symptoms measured using the Short Geriatric Depression Scale of Korean version and cognitive function measured using the Mini-Mental State Examination score. Multiple linear regression and mediation analyses were also performed. After adjusting for covariates, our analysis found a significant association between digital literacy and both depressive symptoms and cognitive function (β of four types of digital literacy and depressive symptoms = -0.123, -0.172, -0.702, and - 0.639, respectively; β of four types of digital literacy and cognitive function = 2.102, 2.217, 1.711, and 1.436, respectively). Moreover, our study showed that depressive symptoms play a mediating role in the relationship between media and online transaction literacy and cognitive function (95% CI of indirect effects = 0.0647-0.1212 and 0.0639-0.1277, respectively), implying an indirect pathway (digital literacy, depressive symptoms, and cognitive function). This study sheds light on the relationship between digital literacy, depressive symptoms, and cognitive function in older adults. We found that depressive symptoms mediated the association between specific aspects of digital literacy (online transaction and media literacy) and cognitive function. Our results indicate that community-based digital literacy programs could be effective in reducing depression and preserving or improving cognitive function in older adults.

Validation of the health literacy scale in patients with hypertension in Mexico.

Health literacy integrates skills around health care. The measurement of health literacy is relevant for proposing improvement interventions. The European HLS-EU-Q16 scale allows to comprehensively evaluate health literacy, but its psychometric properties have not been assessed in Mexico. To validate the HLS-EU-Q16 scale in patients with hypertension in Mexico. A validation study of a measuring instrument was carried out. The construct was evaluated by means of factor analysis; internal consistency, using Cronbach's alpha; and test-retest reliability, using intraclass correlation coefficient (ICC). The information was collected by interviewing 349 patients with hypertension in a family medicine unit of the Mexican Institute of Social Security, from April to June 2022. In 23.8% of the patients, health literacy was inadequate; in 44.4%, problematic; and in 31.8%, sufficient. The scale was found to retain 12 items and two factors (HLS-EU-Q12M). Cronbach's alpha was 0.83, and ICC was 0.94. The HLS-EU-Q12M scale in Mexican Spanish is a valid instrument for assessing health literacy in adults with hypertension.

PERSONAL DEVELOPMENT OF RURAL WOMEN THROUGH ADULT LITERACY PROGRAM IN TEHSIL D.G. KHAN

This study assessed the role of adult literacy program in personal development of rural women. A sample of 330 female learners was drawn though multistage sampling. The findings showed that learners have gained awareness about various social and ethical issues. Their confidence, interpersonal skills and problem solving skills have improved. They were able to voice their opinion in domestic affairs and in affairs of relatives. They were able to take decisions about selection of health facilities, education of children, household decisions, purchasing of household items and marriage of children. Their social status within family and community has improved. Further, they were able to maintain their social relationships properly and also form new relationships or contacts. There was improvement in their confidence to voice opinion in their personal and family matters. Their ability to solve the household affairs also enhanced.

How Does the Health Literacy of Adults Residing in Social Housing Compare with That of Those Living in Other Housing Tenures in Australia? A Secondary Analysis of the Australian National Health Survey 2017-2018 Dataset.

Social housing tenants have poorer health outcomes than homeowners or those renting privately. Health literacy is associated with access to care and health outcomes. This study aimed to examine the health literacy of Australian adults residing in social housing compared with that of people living in other housing types. A secondary analysis of the Australian National Health Survey 2017-2018 dataset was undertaken. A total of 5275 respondents were included in the sample and completed the Health Literacy Questionnaire (HLQ). Respondents were categorised according to their housing tenure: 163 (3.1%) respondents were living in social housing, 873 (17%) were living in private rentals, 2085 (40%) were homeowners, and 2154 (41%) were homeowners/mortgages. Mean scores were calculated for each of the nine health literacy domains in the HLQ and compared across housing tenure using linear regression models. Social housing tenants had lower mean domain scores than either homeowners, owner mortgagees, or private renters on six of the nine health literacy domains. This included 'having sufficient information to manage my health', 'social support for health', 'ability to engage with healthcare providers', 'navigating the healthcare system' 'ability to find good health information', and being able to 'understand health information enough to know what to do'. However, the differences in mean scores were small. Increasing health literacy may be an important part of multicomponent interventions seeking to improve the health and wellbeing of social housing tenants.

How “basic” is basic digital literacy for older adults? Insights from digital skills instructors

IntroductionWith the continuing advancement of digitalization of everyday life, digital literacy becomes more and more a necessity. As a consequence, those who are digitally illiterate experience digital exclusion, which increasingly equals social exclusion. Older adults are typically less digitally active and also less skilled in digital technologies than younger cohorts. Digital inclusion frameworks by governmental and supra-national organizations, on the one hand, and academic definitions of “digital literacy” or “digital skills”, on the other hand, tend to include a broad set of competencies next to technical understanding, such as cognitive and social-emotional skills. However, we argue the problem that expectations of what digital literacy commonly entails are too high level for older adults with no pre-existing digital experience with computers, internet, smartphones, or tablets. Even what is considered as entry-level, basic digital skills, or foundational skills, can be very demanding for older adults with limited or no prior knowledge of and practice with digital technologies.MethodsTo make our point, we draw on own data from interviews with 26 digital skills instructors who give training to older adults in Belgium (collected between December 2020 and February 2021).ResultsWe provide empirical evidence for the circumstances that even seemingly basic digital skills, such as getting a device started or downloading apps, can be very demanding and anything but trivial for older adults without prior experience. We demonstrate evidence along three interrelated domains: (1) ICT-jargon and terminology; (2) Hardware; (3) Software and Internet. Each of these domains entail hurdles of knowledge and understanding that need to be overcome for these older adults before we can start addressing the higher goals of digital literacy frameworks.DiscussionThe main implication from this article is that even the most basic tenets of digital technology are neither trivial nor simple to grasp for older adults with no or limited prior experience — a point not sufficiently addressed by current frameworks of digital skills/literacy/competence.

Who chooses alternative sources of information about childhood vaccinations? A cross-sectional study.

Vaccine hesitancy can lead to problematic outcomes in terms of public health. A factor playing a fundamental role in this dynamic is the source of information considered by parents in the decision-making progress that leads to the acceptance or refusal of childhood vaccinations. This study aims to investigate the sources of information considered by the parents of children attending primary and secondary schools in two large Italian cities and to identify predictors that led to choosing alternative sources of information. An online questionnaire was administered to the parents of students attending elementary, middle, and high schools in Rome and Turin. Two validated tools were used: the Parent Attitudes about Childhood Vaccines Survey and the Vaccine Health Literacy of adults in Italian. Sources of information about vaccinations, trust toward the healthcare system, hesitancy and attitudes about COVID-19 vaccinations, were also investigated. A multivariable logistic regression model was built to identify predictors of the preferred sources of information on the topic. Totally, 2,301 answers to the survey were collected from June to October 2021. Of these, 1,127 came from parents in Rome (49%) and 1,174 from parents based in Turin (51%) with a mean age of 47.7 years (±6.4). The majority of the respondents were mothers (81%), married (73%), with two or more children (70.5%). The multivariable logistic regression model results showed that fathers were more inclined than mothers to use alternative sources of information (OR 1.48, 95% CI 1.29-2.00). Moreover, a higher level of vaccine hesitancy was a strong predictor for choosing alternative sources of information (OR 2.45, 95% CI 1.73-3.46). The HLVa-it scores show that parents with a lower Vaccine Literacy (VL) were more inclined to use alternative sources of information. Addressing health literacy issues and changing the official forms of communication could help improving vaccine acceptance. This study shows the importance of rebuilding a trusting relationship between patients and health care providers, which is fundamental in the fight against vaccine hesitancy.

Nutrition Literacy Status of the Elderly in Kutahya and Their Attitudes towards Healthy Nutrition

Introduction: Nutritional literacy is defined as the capacity of individuals to access, process and understand basic nutritional information. Although food and nutrition literacy plays an important role in the development of healthy eating behaviours, there are various factors that facilitate and complicate this situation. Objective: The aim of this study was to evaluate the nutritional literacy levels of individuals aged 60-64 years and their attitudes towards healthy nutrition. Materials and Method: The study is a descriptive and cross-sectional study. It was conducted in March-June 2022 in family health centres in the central district of Kütahya. The sample of the study consisted of 400 individuals aged 60-64 years living in the city centre of Kütahya. The descriptive Socio-demographic Characteristics Data Form consisting of 17 items, the Nutrition Literacy Assessment Tool for Adults (NLSA), and the Attitudes Towards Healthy Eating Scale (ATHS) were used to collect the data. The data were collected by the researcher using face-to-face interview technique. SPSS 25.0, a statistical package programme, was used for research analyses. Results: The mean score of the elderly on the scale of nutrition literacy in adults was 20.99±5.325. The mean scores of the sub-dimensions; general nutrition knowledge 6,37±1,887, reading comprehension 3,89±1,118, food groups 7,70±1,538, portion sizes 2,15±0,752, numerical literacy and food label reading 0,87±1,185. The mean score of the attitude scale of the elderly towards healthy nutrition was 71,86±12,85. The mean scores of the sub-dimensions are; knowledge about nutrition 16,61±4,616, emotion towards nutrition 16,79±4,606, positive nutrition 19,39±4,282, bad nutrition 19,08±4,53. It was determined that the scores of participants with normal weight from the scale of nutritional literacy in adults were higher than those of overweight participants. It was observed that there was a positive relationship between Nutrition Literacy in Adults and Attitude towards Healthy Nutrition at a normal level (r=0.528, p<.01). Conclusion: According to the Attitudes Towards Healthy Nutrition Scale, 61% of the elderly were found to have a high level of attitude towards nutrition. It was observed that 29% of the elderly included in the study had adequate nutritional literacy level and 70.3% of the individuals had limited nutritional literacy,

Literacy at Work: Korean Adult Immigrants’ Lived Experiences

Despite the increasing emphasis on the language and literacy practices of immigrant communities, our understanding of Asian immigrants’ everyday experiences in their workplaces remains limited. This study examines the language and literacy practices of two Korean adult immigrants within their professional environment—a family-owned dry cleaning business. Drawing on the concept of Literacy as Social Practice, this study explores their lived experiences. Research was conducted using an ethnographic approach, incorporating participant observations, interviews, and field notes. The collected data was analyzed using an inductive method, facilitating a deeper understanding of the family's evolving social practices and the crucial role their workplace plays in the context of immigrant families. Findings suggest that the family refined their professional skills and essential English proficiency through self-initiated learning, utilizing available resources. The workplace emerged as a significant platform for the family's immigrant experience, markedly shaping their language and literacy practices. This research provides insight into the underrepresented population's literacy practices and spaces, contributing valuable understanding to the field of adult literacy.

‘Social-contextual’ approaches to family literacy programmes: policy and practice lessons from Nigeria, Mexico and Nepal

ABSTRACTFamily literacy programmes have been framed as effective strategies to improve the learning and literacy of children and adults, particularly among disadvantaged families. However, a number of these programmes have been critiqued as being framed within a deficit discourse, placing the ‘problem of illiteracy’ within ‘non-mainstream’ families. Drawing from a comparative analysis of family literacy programmes from Nigeria, Mexico and Nepal, this paper aims to increase understanding of the dynamics of an alternative, social-contextual approach to family literacy. It identifies the importance of starting with families’ skills, knowledge and everyday realities to shape family literacy programming (instead of the other way round); shifting the aim from community participation to community ownership; and offering programmes that are flexible to accommodate other demands of family life. These could be useful first steps for policymakers and practitioners who are committed to developing a more situated approach to designing and implementing family literacy programmes.

Breaking the Chains of Tuberculosis: Quantifying the Effects of Literacy, Population Density, and Access to Improve Sanitation to Support Defense Health and Security in Indonesia

Background: Tuberculosis (TB) is a global health problem. It poses a significant burden worldwide, requiring urgent control measures and research for effective reduction especially in Indonesia.Objective: Investigating the effects of literacy, population density, and access to improved sanitation on TB incidence can provide insights into the relationship between these factors.Methods: This study was conducted in Jakarta, Indonesia from June to July 2023, using secondary data from 2005 to 2021. It employed a quantitative cross-sectional design to examine the relationship between variables. Data were collected from the ASEAN database and analyzed using descriptive and path analysis techniques to determine variable effects and significance. The study found that the incidence of tuberculosis in Indonesia initially decreased from 2005 to 2020 but significantly increased in 2021.Results: Population density, adult literacy rate, and access to improved sanitation all showed positive trends. Significant direct effects were observed among most variables, and indirect effects of population density on tuberculosis incidence were also identified through literacy and sanitation. The final model showed that higher population density correlated with increased access to sanitation and literacy rate, while access to improved sanitation was associated with reduced tuberculosis incidence. Overall, the model had a very good fit based on the indicators.Conclusion: Priority investments in sanitation infrastructure, especially in densely populated areas, along with improved access to sanitation facilities, combined with targeted health education campaigns and collaboration across defense, health, and education sectors, are recommended to enhance tuberculosis prevention and control

Exploring the link between Adult Literacy and Textese: A multi-method Approach

The research study aims to find the relationship between textese (using text messaging as a way of communication) and adult literacy. The study was mixed method in nature and was conducted on 60 participants from three different countries – the UK, Uganda, and Bangladesh. Participants of this study were selected conveniently from private and public HE institutions, whereas the countries were selected purposively. Past research on literacy and textese was based on English- speaking countries and school-aged children. This study thus focused on comparing adult participants from both English and non-English-speaking countries to test the hypotheses of the relationship between textese and adult literacy. The data was collected primarily through the survey (a questionnaire) in a quantitative phase, which was followed by a qualitative phase (semi-structured interviews) with 18 participants (6 participants from each country) from the 60 participants. The findings showed that a high rate of textese improves English speaking. However, over 63% of the non-English speaking participants’ scores on the two spelling tests (taken one week apart) declined due to exposure to textese. Textese has been shown to impact spelling, leading to poor writing skills for both English and non-English participants. However, the rise of textese with the utilisation of informative content has been accompanied by a comparative increment in related slang, images, and shorthand text during communication. Consequently, this consideration explores the relationship between textese, content informing, and grown-up education through the present media’s rumour. Keywords: Textese, Spelling, Adult literacy, formal writing, multimethod.

Exploring the relationships between health literacy, social support, self-efficacy and self-management in adults with multiple chronic diseases

BackgroundSelf-management in chronic diseases is essential to slowing disease progression and preventing complications. However, empirical research on the associations of critical factors, such as health literacy, social support, and self-efficacy with self-management in the context of multiple chronic diseases is scarce. This study aimed to investigate these associations and provides insights for healthcare providers to develop effective educational strategies for people with multiple chronic diseases.MethodsUsing a cross-sectional survey design, adults (n = 600) diagnosed with at least two chronic diseases were conveniently recruited. To measure health literacy, social support, self-efficacy, and chronic disease self-management behaviours, the Health Literacy Questionnaire (HLQ), Medical Outcome Study - Social Support Survey, Self-efficacy in Managing Chronic Disease, and Self-management in Chronic Diseases instruments were utilized respectively. Comorbidity status was assessed using Age-adjusted Charlson Comorbidity Index (ACCI). A generalised linear regression model was used with a backward technique to identify variables associated with self-management.ResultsParticipants’ mean age was 61 years (SD = 15.3), 46% were female, and most had up to 12 years of education (82.3%). Mean scores for HLQ domains 1–5 varied from 2.61 to 3.24 (possible score 1–4); domains 6–9 from 3.29 to 3.65 (possible score 1–5). The mean scores were 52.7 (SD = 10.4, possible score 0–95), 5.46 (SD = 1.9, possible score 0–10) and 82.1 (SD = 12.4, possible score 30–120) for social support, self-efficacy, and self-management, respectively. Mean ACCI was 6.7 (SD = 2.1). Eight factors (age > 65 years, being female, 4 health literacy domains, greater social support, and higher self-efficacy levels) were significantly associated with greater self-management behaviours while comorbidity status was not. The factors that showed the strongest associations with self-management were critical health literacy domains: appraisal of health information, social support for health, and healthcare provider support.ConclusionsDeveloping critical health literacy abilities is a more effective way to enhance self-management behaviours than relying solely on self-confidence or social support, especially for people with multiple chronic diseases. By facilitating communication and patient education, healthcare providers can help patients improve their critical health literacy, which in turn can enhance their self-management behaviours.

Childhood environmental harshness and unpredictability negatively predict eHealth literacy through fast life-history strategy.

eHealth literacy-the ability to obtain, understand, evaluate, and use health information from the Internet-is important to maintaining and improving personal health. Prior research found that people differ notably in the levels of eHealth literacy, and this study tests a theoretical account of some of those individual differences. Drawing on life history theory, we propose that low eHealth literacy is partly the outcome of people adopting a resource-allocation strategy emphasizing early and fast reproduction, namely, a fast life-history strategy. We conducted a cross-sectional survey study (N = 1,036) that measured Chinese adult respondents' eHealth literacy, childhood environmental harshness and unpredictability, and fast life-history strategy. Covariates included health-information seeking online, self-rated health, sex, age, education level, and monthly income. Supporting a life-history explanation of eHealth literacy, childhood environmental harshness and unpredictability negatively predicted eHealth literacy through fast life-history strategy and mainly the insight-planning-control dimension of it. Harshness, not unpredictability, also directly and negatively predicted eHealth literacy after fast life-history strategy was controlled for. Our findings suggest that the psychological mechanisms associated with human life-history strategies produce at least some of the individual differences in levels of eHealth literacy, including those related to neuroticism, socioeconomic status, self-rated health and social capital. Thus, a possible way to increase future generation's eHealth literacy and thereby their health is to reduce the harshness and unpredictability of the environment in which they grow up, thereby making them more likely to adopt a relatively slow life-history in their adulthood.

Oral health literacy and its association with oral health-related quality of life amongst pregnant women: a cross-sectional study.

This study aimed to evaluate the association of oral health literacy (OHL) and oral health-related quality of life (OHRQoL) of pregnant women. This cross-sectional study evaluated a representative sample of pregnant women assisted in public healthservices in southern Brazil. Demographic, socioeconomic, psychosocial and behavioural data were collected through structured questionnaires. The Oral Health Impact Profile (OHIP-14) questionnaire was used to evaluate the OHRQoL. The Brazilian Rapid Estimate of Adult Literacy in Dentistry (BREALD-30) was used to measure OHL. Dental caries and gingival bleeding were evaluated by clinical examinations. Adjusted multilevel Poisson regression models with a hierarchical approach were used to assess the associations. The results are presented as rate ratio (RR) and 95% confidence interval (95% CI). A total of 520 pregnant women were evaluated. Pregnant women with lower levels of OHL presented overall OHIP-14 scores 14% higher (RR 1.14; 95% CI 1.07-1.22) than their counterparts. High household income and high education level were related to low overall OHIP-14 scores. Furthermore, less dental attendance, low social support, untreated dental caries and gingival bleeding were also associated with high overall OHIP-14 scores. Our findings reinforce that health literacy levels influence patient-reported outcomes. Pregnant women with lower OHL were more likely to present poorer OHRQoL.

Learning technologies for adult literacy: a scoping review and analysis of the current state of evidence

Learning technologies for adult literacy: a scoping review and analysis of the current state of evidence

Socioeconomic status and health literacy as the important predictors of general health in Iran: a structural equation modeling approach


 Background: We aimed to determine the level of health literacy (HL), and its association with general health. In addition, we investigated the direct and indirect association of socioeconomic status (SES) and general health among the adult population in Iran.
 Methods: This cross-sectional study involved 750 literate adults' people. The SES was assessed based on the owning of assets. HL was evaluated using a validated questionnaire in Iran. General health was assessed using the WHO general health questionnaire. The simple and adjusted linear regression models, and structural equation modeling (SEM) were used for data analysis.
 Results: In adjusted model, female gender, higher level of education, use of books, pamphlets, or brochures as a source of health information, the higher level of SES were positively associated with higher HL. In addition, the HL was significantly associated with higher scores of general health. Results of SEM showed that the direct effect of SES on general health was not significant, but the indirect effect via HL was significant (path coefficient: 0.24; p<0.001).
 Conclusion: Results of our study indicated HL is strongly associated with general health among the adult population. SES had a significant indirect association with general health via the effect on health literacy.

The impact of primary schooling expansion on adult educational attainment, literacy, and health: Evidence from India’s Sarva Shiksha Abhiyan

In 2001–2002, India launched a schooling infrastructure program called the Sarva Shiksha Abhiyan (SSA). We examined the long-term associations of SSA with adult education and health. We used data from a national survey and employed fixed-effects regression models to compare outcomes of adults who were originally eligible for primary school during four years before (control) and after 2001 (intervention). Intervention group adults had 0.2 higher grade attainment, 0.04 points higher literacy test score (0–2 scale), and 0.12 higher weight-for-height z-score as compared with the control group. SSA was associated with improved education and health outcomes across socioeconomic subgroups but did not appear to reduce gender gaps substantially.