Faculty Bibliography

'When I gave a discussion to a group of parents at my daughter's day care,' said my friend Dr. Mitchell H. Katz, the San Francisco public health director, 'I counseled parents who were worried about the risks of vaccination to give their children -- if healthy -- the nasal vaccine, because what don't our children put up their noses? 'Given the variety of viruses that our children are exposed to through their noses, it's very hard to imagine how the vaccination could be that different. There had been some tragic and terrifying deaths; I read the news articles about a kindergartner -- healthy boy, no asthma, no heart disease -- who died at Vanderbilt in early September, and the subsequent meetings held at his school with crowds of worried parents, about the sanitizing of the school and the wiping down of the district's 600 school buses

OBJECTIVE: To describe pediatricians' self-reported experiences with health literacy, use of basic and enhanced communication techniques, and perceived barriers to effective communication during office visits. DESIGN/METHODS: A national, random sample of 1605 nonretired, posttraining American Academy of Pediatrics members were surveyed in 2007 about health literacy and patient communication as part of the Periodic Survey of Fellows. The response rate was 56% (N = 900). RESULTS: Eight-one percent of the pediatricians were aware of a situation in the previous 12 months in which a parent had not sufficiently understood health information that had been delivered to him or her. In addition, 44% of all pediatricians were aware of a communication-related error in patient care within the previous 12 months. Using simple language (99%), repeating key information (92%), and presenting only 2 or 3 concepts at a time (76%) were the most commonly used communication strategies. Enhanced communication techniques recommended by health literacy experts such as teach-back and indicating key points on written educational materials were used less often (23% and 28%, respectively). The most common reported barriers to effective communication were limited time to discuss information (73%), volume of information (65%), and complexity of information (64%). The majority of physicians rated themselves highly in their ability to identify caregiver understanding (64%), but only 21% rated themselves as very good or excellent in identifying a parent with a literacy problem. Fifty-seven percent of the respondents were interested in training to improve communication skills, and 58% reported that they would be very likely to use easy-to-read written materials, if available from the American Academy of Pediatrics. CONCLUSIONS: Pediatricians are aware of health literacy-related problems and the need for good communication with families but struggle with time demands to implement these skills. Despite awareness of communication-related errors in patient care, pediatricians report underutilizing enhanced techniques known to improve communication

[...] while I will not in any way claim to have found the best or the most effective method for discussing sex with one's children, I will claim to be in that category of parent who has more trouble shutting up about it than she does getting started. By the time my then-thirteen-year-old son and I came to the salient point during the last presidential election -- the revelations about a vice-presidential candidate's family -- I didn't even have to highlight the moral.

Certain subjects make self-righteous parents of us all: our children thinking they are doing homework when in reality the text messages are flying, the Internet browsers are open, the video is streaming, the loud rock music is blaring on the turntable -- oh, wait, sorry, that last one was our parents complaining about us. [...] I decided to test my digital immigrant biases -- which tell me that no one can study effectively while watching, listening, surfing, messaging -- against my professional experience, which tells me that medical students who don't study effectively can't learn the huge and complex body of material they have to master, and will therefore not pass their frequent tests

'Too many parents are haunted by experiences, both good and bad, that they identify with their birth order,' said Dr. Peter A. Gorski, a professor of pediatrics, public health and psychiatry at the University of South Florida. Birth Order, Family Dynamics and Creative Lives (Pantheon, 1996), points out that second-born children tend to be exposed to less language than eldest children.

'Birth order doesn't cause anything,' Dr. [Frank J. Sulloway] said. 'It's simply a proxy for the actual mechanisms that go on in family dynamics that shape character and personality.' We can all cite examples and counterexamples, from our own families, our friends, history and literature. There are plenty of families where the younger child is brighter or more academic, and plenty of literary and historical examples (Jane and Elizabeth Bennet from 'Pride and Prejudice,' Meg and Jo March from 'Little Women,' Dmitri and Ivan Karamazov from 'The Brothers Karamazov.' You can think about those authors and their older siblings as well, and draw any comparisons you like). And then there are plenty of examples of brilliant eldest siblings. I.Q., though it does grab headlines, might shape family life less than personality and temperament. 'It's a part of a bigger picture that really involves family dynamics,' Dr. Sulloway said. 'Child and family dynamics is like a chessboard; birth order is like a knight.'

'Too many parents are haunted by experiences both good and bad that they identify with their birth order,' said Dr. Peter A. Gorski, a professor of pediatrics, public health and psychiatry at the University of South Florida. [...] that might lead them to classify their own children according to birth order, he went on, which in turn can lead to a sense of identification or even rejection and to 'self-fulfilling prophecies.'

OBJECTIVE: To determine whether maternal literacy level accounts for associations between educational level and the cognitive home environment in low-income families. DESIGN: Analysis of 369 mother-infant dyads participating in a long-term study related to early child development. SETTING: Urban public hospital. PARTICIPANTS: Low-income mothers of 6-month-old infants. MAIN EXPOSURE: Maternal literacy level was assessed using the Woodcock-Johnson III/Bateria III Woodcock-Munoz Tests of Achievement, Letter-Word Identification Test. Maternal educational level was assessed by determining the last grade that had been completed by the mother. MAIN OUTCOME MEASURE: The cognitive home environment (provision of learning materials, verbal responsivity, teaching, and shared reading) was assessed using StimQ, an office-based interview measure. RESULTS: In unadjusted analyses, a maternal literacy level of ninth grade or higher was associated with increases in scores for the overall StimQ and each of 4 subscales, whereas a maternal educational level of ninth grade or higher was associated with increases in scores for the overall StimQ and 3 of 4 subscales. In simultaneous multiple linear regression models including both literacy and educational levels, literacy continued to be associated with scores for the overall StimQ (adjusted mean difference, 3.7; 95% confidence interval, 1.7-5.7) and all subscales except teaching, whereas maternal educational level was no longer significantly associated with scores for the StimQ (1.8; 0.5-4.0) or any of its subscales. CONCLUSIONS: Literacy level may be a more specific indicator of risk than educational level in low-income families. Studies of low-income families should include direct measures of literacy. Pediatricians should develop strategies to identify mothers with low literacy levels and promote parenting behaviors to foster cognitive development in these at-risk families