Faculty Bibliography

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

OBJECTIVE: Caregivers of young children frequently measure doses of liquid medications incorrectly. Use of nonstandardized dosing instruments and lack of knowledge that dosing is weight-based contribute to dosing errors. We sought to assess whether low caregiver health literacy was associated with these outcomes. METHODS: This was a cross-sectional analysis of caregivers presenting to an urban pediatric emergency room. Dependent variables were caregiver reported use of nonstandardized dosing tools and knowledge of weight-based dosing. The independent variable was caregiver health literacy (Test of Functional Health Literacy in Adults [TOFHLA]). RESULTS: Two hundred ninety-two caregivers were assessed: 23.3% reported use of nonstandardized liquid dosing instruments, and 67.8% were unaware of weight-based dosing. Caregivers who were unaware of weight-based dosing were more likely to use nonstandardized dosing tools (28.3% vs 12.8%; P = .003). In unadjusted analyses, overall health literacy, reading comprehension, and numeracy were all associated with both dependent variables. In analyses adjusting for child age, health care experiences, and caregiver acculturation and education, inadequate/marginal overall health literacy was associated with lack of knowledge of weight-based dosing (adjusted odds ratio [AOR] 2.3; P = .03), whereas lower reading comprehension was associated with both lack of knowledge (AOR 2.0; P = .03) and reported use of nonstandardized instrument (AOR 2.4; P = .007). CONCLUSIONS: Low health literacy, in particular reading comprehension, was associated with reported use of nonstandardized dosing instruments and lack of knowledge regarding weight-based dosing. Both caregiver health literacy and sociodemographic factors should be considered in the design of interventions to prevent medication administration errors

OBJECTIVE: We performed a randomized, controlled trial to assess the impact of the Video Interaction Project (VIP), a program based in pediatric primary care in which videotaped interactions are used by child development specialists to promote early child development. METHOD: Ninety-nine Latino children (52 VIP, 47 controls) at risk of developmental delay based on poverty and low maternal education were assessed at age 33 months. VIP was associated with improved parenting practices including increased teaching behaviors. RESULTS: VIP was associated with lower levels of parenting stress. VIP children were more likely to have normal cognitive development and less likely to have developmental delays. CONCLUSION: This study provides evidence that a pediatric primary care-based intervention program can have an impact on the developmental trajectories of at-risk young preschool children

OBJECTIVE: There has been limited study of the association between media exposure and behavior in children younger than age 3 years. We sought to study this association in toddlers and determine whether the association varied depending on media content. METHODS: We carried out a secondary analysis of a cohort of Latino mother-infant dyads followed from birth to 33 months. We assessed media exposure at 21 and 33 months with a 24-hour recall diary that included information about the duration and content of each program watched. Behavior was assessed at 33 months by the Child Behavior Checklist. RESULTS: This analysis included 99 dyads. Results from multiple logistic regression analyses indicated associations of child behavior outcomes with 21-month total media exposure and both 21-month and 33-month exposure to noneducational young child media such as cartoons, after adjusting for maternal education, country of origin, and depressive symptoms, participation in a parenting program, and difficult child temperament. Media exposure has most consistent associations with aggressive behavior and externalizing problems. CONCLUSIONS: Media exposure was associated with externalizing behavior in Latino toddlers, with the strongest association for media oriented toward young children but without educational content. This finding has importance for both parents of young children and pediatricians as they provide anticipatory guidance

OBJECTIVE: To determine whether electronic media exposure is associated with decreased parental reading and teaching activities in the homes of preschool children. METHODS: A convenience sample presenting for well-child care to an urban hospital pediatric clinic was enrolled. Inclusion criteria were: child's age 3 to 5 years and not yet in kindergarten. Electronic media exposure (TV, movies/video, computer/video games) was assessed with a 24-hour recall diary and characterized on the basis of industry ratings. Reading aloud and teaching activities were assessed with the StimQ-Preschool READ and PIDA (Parental Involvement in Developmental Advance) subscales, respectively. RESULTS: A total of 77 families were assessed. Children were exposed to a mean (SD) of 200.8 (128.9) minutes per day of media, including 78.2 (63.7) minutes of educational young child-oriented, 62.0 (65.6) minutes of noneducational young child-oriented, 14.8 (41.4) minutes of school age/teen-oriented, and 29.2 (56.6) minutes of adult-oriented media, as well as to 16.6 (47.5) minutes of media of unknown type. A total of 79.2% watched 2 or more hours per day. Noneducational young child-oriented exposure was associated with fewer reading (semipartial correlation coefficient [SR] = -0.24, P = .02) and teaching (SR = -0.27, P = .01) activities; similar relationships were not found for other media categories. Children exposed to 2 or more hours of total electronic media per day had 1.6 (95% confidence interval, 0.4-2.9) fewer days per week of reading than children exposed to less than 2 hours (SR = -0.27, P = .01). CONCLUSIONS: This study found an association between increased exposure to noneducational young child-oriented media and decreased teaching and reading activities in the home. This association represents a mechanism by which media exposure could adversely affect development

OBJECTIVE: Attitudes about shared reading among at-risk mothers of newborn babies have not been the focus of previous study. Better understanding of factors associated with these attitudes would facilitate pediatricians' provision of anticipatory guidance. We sought to assess sociodemographic correlates of attitudes regarding and resources available for shared reading among multiethnic, low socioeconomic status (SES) mothers of newborns. METHODS: This was a cross-sectional analysis of consecutive mother-infant dyads enrolled during the postpartum period onto an urban public hospital. Dependent variables were attitudes and resources related to shared reading with infants. Independent variables were family sociodemographics, reading difficulties, and social risks. RESULTS: A total of 211 mother-newborn dyads were assessed; 23.7% reported not planning to look at books together until 12 months or later, 42.2% reported no baby books in the home, and 19.9% reported concerns about shared reading. In multiple logistic regression analyses, independent significant associations with not planning to share books together in infancy were lower maternal education, not speaking English, and firstborn. Independent significant associations of not having baby books were not speaking English, firstborn, and perceived difficulty reading in their native language. CONCLUSIONS: Many at-risk mothers of newborn babies do not report plans to read in infancy and do not have appropriate books in the home. Consideration should be given to universal provision of early anticipatory guidance addressing shared reading, either during the postpartum period or during initial well-child care visits

OBJECTIVE: To assess a two-question screening tool, the Patient Health Questionnaire-2 (PHQ-2), for identifying depressive symptomatology in economically disadvantaged mothers of children in pediatric settings and to explore risk factors associated with a positive depression screen. METHODS: A convenience sample of mothers was enrolled at an inner city well-child clinic with children age 3 days to 5 years. The PHQ-2 and Edinburgh Postnatal Depression Scale (EPDS) (as reference scale) were completed. RESULTS: Ninety-four mothers participated. Agreement of the PHQ-2 and EPDS was moderate. The sensitivity of the PHQ-2 for identifying a positive screen on the EPDS was 43.5%; the specificity was 97.2%. The sensitivity of the PHQ-2 was higher for mothers with education beyond high school compared to those with less education. Perceived lack of support with child care and having two or more children were associated with a positive screen. The rate of positive screen was similar for mothers with infants and with older children. CONCLUSION: Given the low sensitivity of the PHQ-2 in lower educated mothers, additional research in populations with varying sociodemographic characteristics is indicated. Similar rates of symptoms for mothers within and beyond the postpartum period and mothers previously screened support the need for periodic screening