Faculty Bibliography

This study examined 3 questions: (1) What are sources from which low socioeconomic status (SES) mothers of newborns receive parenting information? (2) To what extent are sociodemographic characteristics associated with sources? (3) To what extent are sources associated with intentions regarding activities with infants? In this cross-sectional analysis, mothers were interviewed during the postpartum period about potential sources of information about parenting and asked if and when they planned to initiate shared reading and television exposure during infancy. Maternal high school graduation, US birth, non-Latina ethnicity, language English, higher SES, and firstborn child were each associated with one or more categories representing important sources of parenting information. In adjusted analyses, print, physicians and other health care professionals, and family/friends as important sources of information were each significantly associated with increased frequency of intention to begin shared reading in infancy; television as an important source was associated with intention to begin television in infancy

OBJECTIVES: To assess parents' liquid medication administration errors by dosing instrument type and to examine the degree to which parents' health literacy influences dosing accuracy. DESIGN: Experimental study. SETTING: Interviews conducted in a public hospital pediatric clinic in New York, New York, between October 28, 2008, and December 24, 2008. PARTICIPANTS: Three hundred two parents of children presenting for care were enrolled. MAIN OUTCOME MEASURES: Parents were observed for dosing accuracy (5-mL dose) using a set of standardized instruments (2 dosing cups [one with printed calibration markings, the other with etched markings], dropper, dosing spoon, and 2 oral syringes [one with and the other without a bottle adapter]). RESULTS: The percentages of parents dosing accurately (within 20% of the recommended dose) were 30.5% using the cup with printed markings and 50.2% using the cup with etched markings, while more than 85% dosed accurately with the remaining instruments. Large dosing errors (>40% deviation) were made by 25.8% of parents using the cup with printed markings and 23.3% of parents using the cup with etched markings. In adjusted analyses, cups were associated with increased odds of making a dosing error (>20% deviation) compared with the oral syringe (cup with printed markings: adjusted odds ratio [AOR] = 26.7; 95% confidence interval [CI], 16.8-42.4; cup with etched markings: AOR = 11.0; 95% CI, 7.2-16.8). Compared with the oral syringe, cups were also associated with increased odds of making large dosing errors (cup with printed markings: AOR = 7.3; 95% CI, 4.1-13.2; cup with etched markings: AOR = 6.3; 95% CI, 3.5-11.2). Limited health literacy was associated with making a dosing error (AOR = 1.7; 95% CI, 1.1-2.8). CONCLUSIONS: Dosing errors by parents were highly prevalent with cups compared with droppers, spoons, or syringes. Strategies to reduce errors should address both accurate use of dosing instruments and health literacy

OBJECTIVE: Controlling feeding styles in which parents regulate feeding without responding to child cues have been associated with poor self-regulation of feeding and increased weight, but have not been well studied in infancy. We sought to assess maternal perception of infant feeding cues and pressuring feeding styles in an urban Latina Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) population. METHODS: Secondary analysis of a larger study of Latina mothers participating in New York City WIC programs. We examined maternal perception of infant feeding cues and pressuring feeding style. Using logistic regression, we assessed: 1) characteristics associated with perceptions of cues and pressuring to feed, including sociodemographics, breastfeeding, and maternal body mass index; and 2) whether perceptions of cues were associated with pressuring feeding style. RESULTS: We surveyed 368 mothers (84% response rate). Most mothers perceived that babies sense their own satiety. However, 72% believed that infant crying must indicate hunger. Fifty-three percent believed that mothers should always make babies finish the bottle ("pressure to feed"). Pressuring feeding style was associated with foreign maternal country of birth (adjusted odds ratio [AOR] 3.05; 95% confidence interval [CI], 1.66-5.60) and less than a high school education (AOR 1.81; 95% CI, 1.12-2.91). Two perceptions of feeding cues were related to pressuring feeding style: belief that infant crying must indicate hunger (AOR 2.59; 95% CI, 1.52-4.42) and infant hand sucking implies hunger (AOR 1.83; 95% CI, 1.10-3.03). CONCLUSIONS: Maternal characteristics influence perception of infant hunger and satiety. Interpretation of feeding cues is associated with pressuring feeding style. Improving responsiveness to infant cues should be a component of early childhood obesity prevention.

OBJECTIVE: To assess the health literacy of US parents and explore the role of health literacy in mediating child health disparities. METHODS: A cross-sectional study was performed for a nationally representative sample of US parents from the 2003 National Assessment of Adult Literacy. Parent performance on 13 child health-related tasks was assessed by simple weighted analyses. Logistic regression analyses were performed to describe factors associated with low parent health literacy and to explore the relationship between health literacy and self-reported child health insurance status, difficulty understanding over-the-counter medication labeling, and use of food labels. RESULTS: More than 6100 parents made up the sample (representing 72600098 US parents); 28.7% of the parents had below-basic/basic health literacy, 68.4% were unable to enter names and birth dates correctly on a health insurance form, 65.9% were unable to calculate the annual cost of a health insurance policy on the basis of family size, and 46.4% were unable to perform at least 1 of 2 medication-related tasks. Parents with below-basic health literacy were more likely to have a child without health insurance in their household (adjusted odds ratio: 2.4 [95% confidence interval: 1.1-4.9]) compared with parents with proficient health literacy. Parents with below-basic health literacy had 3.4 times the odds (95% confidence interval: 1.6-7.4) of reporting difficulty understanding over-the-counter medication labels. Parent health literacy was associated with nutrition label use in unadjusted analyses but did not retain significance in multivariate analyses. Health literacy accounted for some of the effect of education, racial/ethnic, immigrant-status, linguistic, and income-related disparities. CONCLUSIONS: A large proportion of US parents have limited health-literacy skills. Decreasing literacy demands on parents, including simplification of health insurance and other medical forms, as well as medication and food labels, is needed to decrease health care access barriers for children and allow for informed parent decision-making. Addressing low parent health literacy may ameliorate existing child health disparities

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

OBJECTIVE: To evaluate the efficacy of a pictogram-based health literacy intervention to decrease liquid medication administration errors by caregivers of young children. DESIGN: Randomized controlled trial. SETTING: Urban public hospital pediatric emergency department. PARTICIPANTS: Parents and caregivers (N = 245) of children aged 30 days to 8 years who were prescribed liquid medications (daily dose or 'as needed'). INTERVENTION: Medication counseling using plain language, pictogram-based medication instruction sheets. Control subjects received standard medication counseling. OUTCOME MEASURES: Medication knowledge and practice, dosing accuracy, and adherence. RESULTS: Of 245 randomized caregivers, 227 underwent follow-up assessments (intervention group, 113; control group, 114). Of these, 99 were prescribed a daily dose medication, and 158 were prescribed medication taken as needed. Intervention caregivers had fewer errors in observed dosing accuracy (>20% deviation from prescribed dose) compared with caregivers who received routine counseling (daily dose: 5.4% vs 47.8%; absolute risk reduction [ARR], 42.4% [95% confidence interval, 24.0%-57.0%]; number needed to treat [NNT], 2 [2-4]; as needed: 15.6% vs 40.0%; ARR, 24.4% (8.7%-38.8%); NNT, 4 [3-12]). Of intervention caregivers, 9.3% were nonadherent (ie, did not give within 20% of the total prescribed doses) compared with 38.0% of controls (ARR, 28.7% [11.4%-43.7%]; NNT, 3 [2-9]). Improvements were also seen for knowledge of appropriate preparation for both medication types, as well as knowledge of frequency for those prescribed daily dose medications. CONCLUSION: A plain language, pictogram-based intervention used as part of medication counseling resulted in decreased medication dosing errors and improved adherence among multiethnic, low socioeconomic status caregivers whose children were treated at an urban pediatric emergency department. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00537433

OBJECTIVE: To assess verbal interactions related to television and other electronic media exposure among mothers and 6 month-old-infants. DESIGN: Cross-sectional analysis of 154 mother-infant dyads participating in a long-term study related to early child development. SETTING: Urban public hospital. PARTICIPANTS: Low socioeconomic status mothers of 6-month-old infants. Main Exposure Media exposure and content. MAIN OUTCOME MEASURES: Mother-infant verbal interaction associated with media exposure and maternal coviewing. RESULTS: Of 154 low socioeconomic status mothers, 149 (96.8%) reported daily media exposure in their infants, with median exposure of 120 (interquartile range, 60-210) minutes in a 24-hour period. Among 426 program exposures, mother-infant interactions were reported during 101 (23.7%). Interactions were reported most frequently with educational young child-oriented media (42.8% of programs), compared with 21.3% of noneducational young child-oriented programs (adjusted odds ratio, 0.4; 95% confidence interval, 0.1-0.98) and 14.7% of school-age/teenage/adult-oriented programs (adjusted odds ratio, 0.2; 95% confidence interval, 0.1-0.3). Among coviewed programs with educational content, mothers reported interactions during 62.7% of exposures. Coviewing was not reported more frequently for educational young child-oriented programs. CONCLUSIONS: We found limited verbal interactions during television exposure in infancy, with interactions reported for less than one-quarter of exposures. Although interactions were most commonly reported among programs with educational content that had been coviewed, programs with educational content were not more likely to be coviewed than were other programs. Our findings do not support development of infant-directed educational programming in the absence of strategies to increase coviewing and interactions

OBJECTIVE: To determine whether mothers with plans related to shared reading and baby books in the home at the time of delivery of their newborns would be more likely to engage in shared reading behaviors at age 6 months. METHODS: This was a cohort study with enrollment after birth and follow-up at 6 months in an urban public hospital. Predictors included mothers' attitudes and resources related to shared reading during the postpartum period. Outcomes included mothers' shared reading activities and resources at 6 months, as assessed by the StimQ-READ measure. RESULTS: A total of 173 mother-infant dyads were assessed. In multiple regression analyses adjusting for sociodemographics and maternal depression and literacy, StimQ-READ score at 6 months was increased in association with all 3 postpartum predictors: plans for reading as a strategy for school success (adjusted mean 1.7-point increase in 6-month score; 95% confidence interval [95% CI], 0.3-3.0), plans to read in infancy (3.1-point increase; 95% CI, 1.6-4.6), and having baby books in the home (2.3-point increase; 95% CI, 0.9-3.6). In multiple logistic regression analysis, mothers with 2 or more attitudes and resources had an adjusted odds ratio of 6.2 (95% CI, 2.0-18.9) for having initiated reading at 6 months. CONCLUSIONS: Maternal attitudes and resources in early infancy related to shared reading are important predictors of reading behaviors by 6 months. Cumulative postnatal attitudes and resources are the strongest predictors of later behaviors. Additional research is needed regarding whether guidance about shared reading in early infancy or pregnancy would enhance programs such as Reach Out and Read