Wolf, Ph.D., M.P.H. Of the Feinberg School of Medicine, Northwestern University, Chicago, and colleagues utilized data from a study of 2,923 Medicare enrollees in Cleveland, Houston, Tampa, and Fort Lauderdale-Miami, Fla. In a one-hour in-person interview, individuals’ physical and mental health status were assessed. Queries included medical history, alcohol and tobacco use and height and fat. Standardized physical and mental health test scores were established. The average age of individuals was 71 years. Around one third of those surveyed had marginal or inadequate health literacy. People with lower wellness literacy were more likely to have never smoked and to avoid alcohol than individuals with adequate wellness literacy, the researchers survey.The original protocol, amendments, and statistical analysis plan can be found with the full text of this article at NEJM.org. The study was designed by the sponsor with involvement of the academic investigators and trial statistician. The data were collected by an independent contract research corporation and were handled and analyzed by an unbiased data management organization . The subsequent and initial drafts of the manuscript were made by the first author, with editorial support that was funded by the sponsor, and all the authors made a decision to post the manuscript for publication. The first writer vouches for the precision of the data and the analyses and for the fidelity of the analysis to the protocol.