Rapid Estimate Of Adult Literacy In Medicine-Short Form Research Articles

Assessment of literacy and numeracy skills related to medication labels in patients on chronic in-center hemodialysis

ObjectivesPatients on hemodialysis have complicated medication regimens requiring the ability to accurately interpret medication information. Literacy and numeracy skills have been shown to differ by the types of materials provided to patients. The aims of this study were to determine prescription and over-the-counter medication label understanding and to assess the prevalence of low health literacy regarding medication labeling among in-center hemodialysis patients. Design, setting and participantsThe Medication Literacy and Numeracy in Dialysis (MedLitD) tool is an assessment of a person’s ability to read and understand medication labels. A comparison with the Rapid Estimate of Adult Literacy in Medicine Short Form (REALM-SF), an established literacy tool, was conducted to determine if there were differences in the literacy results from the 2 tools that could be leveraged to target education initiatives for this specialized population. ResultsA total of 110 patients receiving hemodialysis from 3 dialysis facilities in the Capital Region of upstate New York were enrolled in the study. Most patients (77%) achieved a maximum REALM-SF score, indicating a high level of literacy proficiency; however, their MedLitD scores varied. Patients who were 65 years and older had lower scores on the MedLitD tool compared with younger patients. Gender, education, and the number of medications did not influence the MedLitD scores. Only 16% of all participants correctly answered the question asking for an indication of the phosphate binder (PB), although the most patients were currently taking PBs. ConclusionA continuum of medication literacy levels exists among patients on hemodialysis. Appropriate evaluation of medication literacy should be done to better inform individualized education and counseling.

Health Literacy Assessment of Detained Individuals and Correctional Officers Within a Large Urban Jail: Optimizing Health Education.

Little research has been done to address the health literacy level of detained individuals and correctional officers. The aim of this pilot project was to describe the health literacy of individuals detained or working within a large urban jail to inform their health education. Health literacy assessments were conducted using the Rapid Estimate of Adult Literacy in Medicine-Short Form (REALM-SF) and the Newest Vital Sign (NVS) tools. Of the 48 participants, 17% (n = 8) exhibited low health literacy on the REALM-SF, whereas 38% (n = 18) demonstrated the need for improved health literacy when assessed with the NVS. Detained individuals from the women's tiers were more likely to have lower health literacy than the detained veterans or correctional officers. Results indicate that tailored health education programming, using evidence-based health literacy improvement techniques, should be offered to the individuals detained or working within a correctional facility.

Relationship of functional health literacy to patients’ knowledge of their own chronic diseases- an Indian perspective

Introduction: Functional Health Literacy is an emerging topic of healthcare system which analyses a person’s ability in two aspects- reading and numeracy and is believed to affect patient’s health through a number of parameters. Objective: The objective of the study is to establish the relation between functional health literacy of patients and the knowledge of their chronic diseases. Materials and Methods: Total 50 patients were included in the study suffering from diabetes or hypertension or both for more than six months which reported to the General Medicine department of the two tertiary care hospitals. The patients were assessed for their functional health literacy level and knowledge about their disease by using an instrument Rapid Estimate of Adult Literacy in Medicine-Short Form (REALM-SF) and providing separate questionnaires for diabetes and hypertension respectively. The data collected from the above study was maintained in the MS Excel sheet and analysed using the test of proportion and significance. Result: Out of total 50 patients, 27 patients were suffering from diabetes and 16 of hypertension whereas 7 of both diabetes and hypertension. 14/50(28%), 17/50(34%) and 19/50(38%) patients were found to be with inadequate, marginal and adequate health literacy respectively The literacy scores were correlated with the knowledge in patients of hypertension and diabetes using Pearson’s Chi Square test of significance which was found to be highly significant with chi square value of 19.06 and 18.69 for hypertension and diabetic patients respectively with p value of Keywords: REALM-SF, Adult health literacy, Diabetes, Hypertension.

Implementation of a Health Literacy Universal Toolkit to Improve Postdischarge Care at an Urban Trauma Center.

Low health literacy impacts the financial burden of hospitals up to $238 billion annually. A trauma center located on the East Coast implemented a Transitional Care Management (TCM) model targeting individuals at risk for readmission, but not every patient receives this service. A gap analysis of the facility's discharge process identified a deficit in the formal evaluation of health literacy upon discharge. The purpose of this project was to implement a Health Literacy Universal Toolkit to assess and improve medication education for low literacy patients. Included in the toolkit were the Rapid Estimate of Adult Literacy in Medicine Short Form (REALM-SF), an evidence-based health literacy screening tool, and 2 interventions, additional education on their inpatient or discharge medication list, and a Brown Bag Medicine Review of medications at a postdischarge clinic appointment. Seventy-one patients were screened using the REALM-SF. Sixty-two percent (n = 44) of patients scored at a high school reading level, 30% (n = 21) scored at a seventh- to eighth-grade reading level, and 8% (n = 6) scored at or below a sixth-grade reading level. Eight percent of patients scored as having low health literacy, 30% scored as having marginal health literacy, and 62% scored as having adequate health literacy. Twenty patients received additional medication education with My Medicines Form or a Brown Bag Medicine Review. Regardless of literacy level, patients appreciated the additional medication education interventions. Health care providers should observe universal health literacy precautions regardless of literacy level.

HIGHER LITERACY ASSOCIATES WITH BETTER BRAIN STRUCTURE AND COGNITION IN MIDDLE-AGED INDIVIDUALS

Education, occupational complexity, and cognitively stimulating leisure activities, were shown to be positively associated with brain structure and better cognitive function, suggesting that these may mitigate the deleterious effects of neurodegenerative processes. Association of literacy, which may reflect quality of education, with brain structure and cognition has not been thoroughly investigated. Participants were 616 adults (mean age of 55.1 ±3.6 years), 53% female and 40% black from the Coronary Artery Risk Development in Young Adults (CARDIA) study who had completed brain MRI, cognitive testing, and the Rapid Estimate of Adult Literacy in Medicine Short-form (REALM-SF), a literacy measurement. Total-brain and regional gray matter volumes were obtained from structural MRI, and total-brain and regional fractional anisotropy (FA) values, which are indirect measures of white matter integrity, were obtained from diffusion tensor imaging. Participants were grouped into high-literate (n=499, REALM-SF score=7), and low-literate groups (n=117, REALM-SF score<7), and MRI and cognitive test scores were standardized as z-scores. Logistic regression models were used to examine the associations between literacy and MRI and cognitive outcomes. All models were adjusted for age, sex, race, depression, exercise and hypertension. The high-literate group had higher total-brain FA (b=0.28, SE=0.13, p=0.03) and higher frontal (b=0.26, SE=0.13, p=0.04) and temporal (b=0.25, SE=0.12, p=0.04) FA compared to the low-literate group. The high-literate group had also better performance on all cognitive tests: Montreal Cognitive Assessment (b=0.36, SE=0.03, p<001), Digit Symbol Substitution Test (b=0.50, SE=0.09, p<001), Rey Auditory Verbal Learning Test (b=0.49, SE=0.09, p<001), Stroop Test (b=−0.54, SE=0.09, p<001), letter fluency (b=0.76, SE=0.10, p<001) and categorical fluency (b=0.49, SE=0.10, p<001). Higher literacy is associated with higher white matter integrity in frontal and temporal regions as well as with better cognitive performance. Future studies will determine whether having higher white matter integrity and better cognitive performance can mitigate the deleterious effects of neurodegenerative diseases.

Does Lower Level of Education and Health Literacy Affect Successful Outcomes in Bariatric Surgery?

Background: Our previous study demonstrated that lower level of education was associated with increased rates of postoperative hospital visits following bariatric surgery, potentially secondary to decreased understanding of postoperative expectations. Our follow-up study seeks to evaluate whether patients with lower level of education and health literacy have decreased weight loss success and resolution of comorbidities after bariatric surgery. Methods: Bariatric surgery patients presenting between October 2015 and December 2016 were administered a preoperative questionnaire, which reported education level and contained the Rapid Estimate of Adult Literacy in Medicine-Short Form (REALM-SF) health literacy test. The percentage of excess weight loss (EWL) and improvement of hypertension and diabetes mellitus at 6 months were compared across education level (≤12th grade versus >12th grade) and health literacy score (≤8th grade versus high school level) using Fisher's exact and Wilcoxon tests. Results: Seventy-eight patients were followed until their 6-month postoperative appointment (median 7 months, range 4-12 months); 6 scored ≤8th grade for health literacy on the REALM-SF (8%); and 21 had a ≤12th grade level education (27%). Patients with ≤8th grade on REALM-SF health literacy test lost 35% EWL versus 44% EWL by those with high school level health literacy score (P = .03). There was no significant difference in EWL compared across education level (44% versus 43%, P = .63). There were no significant differences in comorbidity improvement. Conclusions: The few patients in our cohort with a low health literacy level had a significantly lower EWL following bariatric surgery, and no differences were seen across education level. Increased vigilance in patients with low health literacy may be warranted to ensure excellent outcomes.

Discrepancy Between Patient Health Literacy Levels and Readability of Patient Education Materials from an Electronic Health Record.

Limited health literacy is associated with worse health outcomes. It is standard practice in many primary care clinics to provide patients with written patient education materials (PEM), which often come directly from an electronic health record (EHR). We compared the health literacy of patients in a primary care residency clinic with EHR PEM readability by grade level. We assessed health literacy using the Rapid Estimate of Adult Literacy in Medicine-Short Form (REALM-SF), and determined grade level readability for the PEM distributed for the five most common clinical diagnoses using the Simple Measure of Gobbledygook (SMOG) and Flesch-Kincaid metrics. Among 175 participants, health literacy was ≥9th grade for 76 patients (43.4%), 7th to 8th grade for 66 patients (37.7%), and ≤6th grade for 30 patients (17.1%). Average standard PEM readability by SMOG was grade 9.2 and easy-to-read PEM readability was grade 6.8. These findings suggest a discrepancy between the health literacy of most patients who were surveyed and standard PEM readability. Despite national guidelines encouraging clinicians to provide PEM at an appropriate reading level, our results indicate that PEM from EHR may not be readable for many patients. [Health Literacy Research and Practice. 2017;1(4):e203–e207.]

A Comparative analysis of health literacy tools in a primary healthcare setting.

The purpose was to collect assessment data with three separate health literacy tools and compare the efficiency of identifying individuals that are at risk for low health literacy levels.Health Literacy is defined as the capacity to obtain, communicate, process, and understand basic health information and services to make appropriate health decisions. Adults with basic or below basic health literacy skills (35% in the U.S.) have problems reading a chart and understanding simple medical instructions. Literature supports the association between low health literacy levels and poor health outcomes.Approval for the project was obtained from the Human Subjects Committee. A partnership was formed with a local physician office to assess a total of 50 patients. Students worked in pairs and collected the following data: highest level of education, a single question assessment, the Newest Vital Sign (NVS) assessment, and the Rapid Estimate of Adult Literacy in Medicine- Short Form (REALM-SF) assessment.Using linear correlation, the three tools are not well related. Of all participants, 96% reported that they never or rarely ask for help, yet on the NVS, 43% scored a limited or possibly limited health literacy result. Correlating education level: of those participants with a high school, technical, and associate degree, the average scores put them at a limited or possibly limited health literacy level. However, with those participants with a bachelor degree or higher, the average score was at a level of adequate health literacy.

A Randomized Trial Examining Three Strategies for Supporting Health Insurance Decisions among the Uninsured.

The Affordable Care Act allows uninsured individuals to select health insurance from numerous private plans, a challenging decision-making process. This study examined the effectiveness of strategies to support health insurance decisions among the uninsured. Participants (N = 343) from urban, suburban, and rural areas were randomized to 1 of 3 conditions: 1) a plain language table; 2) a visual condition where participants chose what information to view and in what order; and 3) a narrative condition. We administered measures assessing knowledge (true/false responses about key features of health insurance), confidence in choices (uncertainty subscale of the Decisional Conflict Scale), satisfaction (items from the Health Information National Trends Survey), preferences for insurance features (measured on a Likert scale from not at all important to very important), and plan choice. Although we did not find significant differences in knowledge, confidence in choice, or satisfaction across condition, participants across conditions made value-consistent choices, selecting plans that aligned with their preferences for key insurance features. In addition, those with adequate health literacy skills as measured by the Rapid Estimate of Adult Literacy in Medicine-Short Form (REALM-SF) had higher knowledge overall ([Formula: see text] = 6.1 v. 4.8, P < 0.001) and preferred the plain language table to the visual (P = 0.04) and visual to narrative (P = 0.0002) conditions, while those with inadequate health literacy skills showed no preference for study condition. A similar pattern was seen for those with higher subjective numeracy skills and higher versus lower education with regard to health insurance knowledge. Individuals with higher income felt less confident in their choices ([Formula: see text] = 28.7 v. 10.0, where higher numbers indicate less confidence/more uncertainty; P = 0.004). Those developing materials about the health insurance marketplace to support health insurance decisions might consider starting with plain language tables, presenting health insurance terminology in context, and organizing information according to ways the uninsured might use and value insurance features. Individuals with limited health literacy and numeracy skills and those with lower education face unique challenges selecting health insurance and weighing tradeoffs between cost and coverage.

Feasibility of Picture-Based Asthma Medication Plans in Urban Pediatric Outpatient Clinics.

Picture-based Asthma Action Plans show promise for overcoming parental literacy barriers and improving child asthma outcomes, but it is uncertain how parents respond to pictures of specific medications, which may be particularly important for improving disease self-management. Thus, we assessed parent attitudes toward an asthma-related picture-based medication plan (PBMP) in an urban academic pediatric clinic and examined attitudes by literacy level. Surveys were administered to a convenience sample of parents of children presenting to an urban pediatric pulmonary clinic for asthma consultation between March and August 2011. The Rapid Estimate of Adult Literacy in Medicine-Short Form (REALM-SF) was administered to parents. Parents indicated their level of agreement with 9 statements on the potential usefulness of the PBMP: (1) before being shown a PBMP; and (2) after seeing the doctor. McNemar's tests showed that the proportion of high-literate parents (≥9th grade reading level) who endorsed the potential benefits of the PBMP after the clinical encounter was significantly higher than before the clinical encounter. A high proportion of low-literate parents (<9th grade reading level) consistently endorsed the PBMP before and after the clinical encounter. Among a diverse sample seen in an urban asthma clinic, parents of all literacy levels endorse PBMPs as useful, especially after using them in clinical encounters.

Health Literacy and Associated Outcomes in the Postpartum Period at Grady Memorial Hospital [2H

INTRODUCTION: Many studies correlate lower health literacy with poorer health outcomes and inferior provider-patient communication. Little is known about how impaired health literacy among women receiving perinatal care at inner city public hospitals may impact health behaviors and outcomes. METHODS: This study used the Rapid Estimate of Adult Literacy in Medicine-short form (REALM-SF) to characterize health literacy among postpartum women in a public tertiary care center and evaluate the association between health literacy and breastfeeding, prenatal care, and contraception use. RESULTS: These results reflect our interim analysis from 258 participants. The majority were black and completed high school. 94% had a 7th grade or greater reading level with 46% at high school level. 85% reported the most recent pregnancy was unplanned. There was no difference in the proportion breastfeeding at postpartum discharge by literacy level, however there was a significant increase in proportion exclusively breastfeeding at postpartum discharge among women with a higher health literacy (45% high school, 29% 7–8th grade, 8% 6th grade or less, P=.019). Women with higher health literacy were also significantly more likely to continue breastfeeding at the postpartum visit. 97% of women were using contraception at discharge, with 39% using LARC or tubal ligation. There was no difference in contraception use at discharge by health literacy. CONCLUSION: We demonstrate a correlation between health literacy and positive reproductive health outcomes including breastfeeding. Strong postpartum contraception promotion can overcome differences in health literacy. The strikingly high proportion of unplanned pregnancies among our sample deserves further evaluation.

Patient willingness to allow hands-on training for post-graduate learning of new surgical techniques

Background: This study assessed patient willingness to allow hands-on training from the surgeon of record to supplement the current ‘observership’ model when learning new techniques. Methods: A survey was administered to patients in two separate outpatient settings, comprising three components: Rapid Estimate of Adult Literacy in Medicine- Short Form (REALM-SF), State Trait Anxiety Inventory form X2 (STAI-X2), and a specifically designed Observer Questionnaire (OQ) with free space for comments. The OQ included two questions of interest. Exclusion criteria were: sub-sixth grade reading level, non-English speakers, and pregnancy. Demographic data collected were: age, gender, and ethnicity. Results: Ninety-nine patients (Location I) and 100 patients (Location II) met inclusion criteria with 91.9% of patients at Location I and 82% at Location II consenting to hands-on training. For current methods of training, responses were: 61% cadaver lab (A), 63% training video/reading material (B), 62% observation without direct contact (C), and 73% observation with direct trainee contact (D). Neither age (p=0.41), ethnicity (p=0.95), or gender (p=0.42) significantly affected responses, nor did an occupational background in health care (p=0.55, surveyed in Location II only). REALM-SF and STAI-X2 scores did not significantly affect responses at either location. The majority of explanations cited for declining hands-on contact were unease due to history of past surgical complications. Conclusions: Supplementing the current ‘observership’ model utilizing on the job training can be acceptable to the majority of patients given strict boundaries including informed patient consent, the surgeon of record remaining fully in charge, and the trainee surgeon having tested credentials.

Associations and implications of low health literacy in Parkinson's Disease.

Low health literacy (HL) indicates a limited ability to understand and use basic information to make appropriate healthcare decisions. While low HL is associated with higher morbidity, mortality, and healthcare costs in multiple chronic conditions, little is known about HL and its associations in Parkinson's disease (PD). Cross-sectional study of non-demented adults with PD participating in the National Parkinson Foundation Parkinson's Outcomes Project at the University of Pennsylvania. Subjects were administered two brief HL assessments-the Rapid Estimate of Adult Literacy in Medicine-Short Form (REALM-SF), a word-recognition test, and the Newest Vital Sign (NVS), a test of literacy, numeracy and understanding of health information-as well as demographic and clinical questionnaires. Adverse outcomes included falls in the 3 months preceding the study visit, and hospital admissions, emergency room visits, infections, or injuries in the preceding year. Caregiver burden was measured using the Multidimensional Caregiver Strain Index. 168 subjects completed both HL screens (mean 65.8 years, 65.5% male, 65.2% Hoehn & Yahr Stage 2). Using the REALM-SF, 97.6% of subjects had adequate HL. Using the NVS, however, 29.8% had low HL, which was associated with older age, lower education, male gender, greater disease severity, and poorer cognition. Low HL was associated with hospital admission and increased caregiver burden. Low HL is common and associated with greater caregiver burden and a higher likelihood of hospitalization in patients with PD. Since HL is associated with both disease severity and adverse outcomes, it may be an important, modifiable contributor to morbidity.

Development and Evaluation of Patient Education Materials for Elderly Lung Cancer Patients.

Patients treated for lung cancer are often elderly presenting a unique challenge for developing patient education materials. This study developed and evaluated a patient education pamphlet on lung stereotactic body radiotherapy (SBRT) designed specifically for an elderly population. The SBRT pamphlet was developed using a participatory design involving a convenience sample of patients. This prospective study assessed patient's opinions of pamphlet effectiveness through self-report questionnaires. The pamphlet was deemed "effective" if patients rated 16/18 evaluation statements as "strongly agree" or "agree." Demographic data and health literacy (Rapid Estimate of Adult Literacy in Medicine short-form (REALM-SF)) were also assessed. Patient opinion of pamphlet "effectiveness" was compared between patients with REALM-SF scores of 7 versus <7 using Fisher's exact test. The overall EQ-5D-5L score was compared for patients who did and did not find the pamphlet effective using the Wilcoxon-Mann-Whitney test. Thirty-seven patients participated. The median age was 76 years (range 56-93) and 22 patients (59 %) had ≤high school education. Most patients preferred to have verbal (65 %) or written (78 %) educational materials as opposed to online information or educational classes. Thirty-two patients (86 %) rated the pamphlet as effective. The proportion of patients who found the pamphlet effective was 85.7 versus 86.7 % (p = 1.00) in those with REALM 7 versus <7. The mean EQ-5D score was 67.5 (SD 19.1) versus 71.8 (SD 8.7) (p = 0.84) in those who found the pamphlet effective versus not. Participatory design is an effective method for developing education materials for challenging patient groups such as elderly patients. Despite advanced age and comorbidity, this patient group had adequate health literacy.

조선족과 다른 출신국 여성결혼이민자의 건강문해력과 영향 요인 비교

Purpose: The purpose of this study was to compare health literacy levels of Asian immigrant women and factors associated with health literacy focusing on Korean-Chinese and other Asian immigrants in Korea. Methods: Data were drawn from 258 immigrant women, comprising 56 Korean-Chinese and 202 other immigrants from the Philippines, Vietnam, Japan, Cambodia, Thailand, Uzbekistan, Taiwan, and Han-Chinese. The Rapid Estimate of Adult Literacy in Medicine - Short Form (REALM-SF) was used to assess health literacy, which consisted of seven medical words in Korean (behavior, exercise, menopause, rectal, antibiotics, anemia, and jaundice). Data analysis was performed using descriptive statistics, t-test, ANOVA with <TEX>$Sch{\acute{e}}ffe$</TEX> post hoc test, and hierarchical regression. Results: Korean-Chinese women showed significantly higher levels of health literacy (<TEX>$M=6.41{\pm}1.07$</TEX>), compared to their other immigrant counterparts (<TEX>$M=4.55{\pm}2.15$</TEX>). While Korean-Chinese women with longer time since immigration (p=.048) reported higher health literacy, for other immigrants, those living with children (p<.001), longer time since immigration (p=.011), and greater Korean language proficiency (p=.004) showed an association with higher health literacy. Conclusion: When providing health care services and health education, health care professionals should consider differences in levels of health literacy and factors associated with health literacy among Korean Chinese and other immigrants.

Impact of Educational Levels and Health Literacy on Community Acetaminophen Knowledge

Patient understanding of acetaminophen is important for its safe and appropriate self-use. A cross-sectional survey was conducted in the San Francisco Bay Area to determine the impact of educational level, patient health literacy score, and other demographic characteristics on acetaminophen knowledge. A 17-item, in-person, paper-and-pen questionnaire containing questions about demographics and acetaminophen knowledge was administered to 311 adults outside 5 local grocery stores in varying socioeconomic communities. Knowledge assessed was whether Tylenol–McNeil contains acetaminophen, maximum daily dose, and primary organ affected by toxicity. Participant health literacy was evaluated using the Rapid Estimate of Adult Literacy in Medicine-Short Form (REALM-SF) test. Of the 300 who successfully completed the study, only 3.8% of all subjects were able to answer all 3 acetaminophen knowledge questions correctly regardless of educational level or health literacy score. This reaffirms that a lack of appropriate acetaminophen knowledge remains present in the general population, and further efforts to educate patients will be needed to prevent adverse events.

The relationship between health literacy, knowledge of health status, and beliefs about HIV/AIDS transmission among Ryan White clients in Miami

Objective: The aim of this study was to examine the relationships between health literacy, knowledge of health status, and human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) transmission beliefs among recipients of Ryan White care. Design: Quota and convenience sampled, quantitative analysis captured with closed and open-ended interviews. Setting: Miami-Dade County health organizations in which Ryan White-funded medical case management services were offered. Method: A total of 694 clients were interviewed about their satisfaction with services they were receiving at the case management sites, and whether they received or read any educational materials about the HIV/AIDS virus and their health. Interviews also asked clients to complete the Rapid Estimate of Adult Literacy in Medicine, Short Form (REALM-SF), to give their viral load and cluster difference (CD) 4 counts, and about their beliefs regarding how HIV/AIDS is transmitted. Results: Most clients reported receiving and/or reading educational materials about HIV/AIDS; however, 42% of clients had a health literacy level below high school. More than one-third of clients were unable to give their CD4 count or viral load figure, and one-third also held incorrect beliefs about how the virus is transmitted. Additionally, health literacy was the only predictor of whether or not clients held incorrect transmission beliefs. Conclusion: These results highlight the need for case managers and other health service providers to screen clients for health literacy and communicate with their clients accordingly. Providers should be proactive with clients and utilize multiple approaches when presenting client health indicators and educational information to ensure the client not only can repeat the information, but that they also comprehend it.

Weight matters: knowledge of the relationship between obesity and reproductive health outcomes amongst infertility patients

Nearly 65% of women in the USA are overweight/obese. Little is known about public awareness of weight-related reproductive health risks. This study sought to explore women's knowledge of obesity as a risk factor for reproductive outcomes. Cross-sectional survey study. Non-pregnant women, 18-45 years old, were recruited in the infertility clinic at a midwest academic medical center. Participants completed the Rapid Estimate of Adult Literacy in Medicine Short Form (REALM-SF) and a questionnaire on the health risks of obesity, then height and weight were measured. Of the 75 subjects, 52% were white, 23.9% black, 4.0% Hispanic, 12.0 % Asian, and 2.7% biracial. Average age was 34.4 ± 0.6 years (mean ± SEM). Average BMI was 25.9 ± 0.8 kg/m2, and varied significantly by race. 85.3% of participants had at least 4 years college. 57.3% of participants had a household income of ≥ $100,000. 97.2% of subjects had heard of the term BMI, but only 18.7% knew their own and 52.1% could correctly identify the ideal BMI range. 93.2%, 92%, 95.9%, and 93% of subjects knew that being overweight/obese increased one's risk of diabetes, heart disease, hypertension, and cholesterol respectively. While most of the subjects knew that increased weight is associated with increased risk of infertility (85.1%), miscarriage (63.1%) and irregular periods (73.0%) only 51.4%, 35.1%, 23%, 27%, of subjects knew that risk of c-section, birth defects, endometrial cancer, and stillbirth, were increased. 36.5% and 40.5% of subjects thought that obesity increased risk of osteoporosis and early menopause respectively. Most women did not know their own BMI or the normal BMI range. Most subjects had knowledge of nonreproductive health effects of obesity. The same subjects were unaware of many of the effects of obesity on reproductive outcomes. Fertility treatment provides a unique opportunity for obesity intervention as women are motivated to achieve reproductive success.