1. 1 Racial/Ethnic Disparities in Adults Reading to Two Year Old Children: A Population-based Study Olivia Sappenfield Emory University School of Public Health Office of Family Health, Oregon Public Health Division Ken Rosenberg, MD, MPH Office of Family Health, Oregon Public Health Division Oregon Public Health Association annual meeting October 10, 2011

2. 2 Introduction Education is associated with a persons health – People with low literacy have 1.5 to 3 times higher risk of poor health outcomes than people whose literacy is not low 1 Reading aloud to children is associated with education – Children who are read to at age 2 are more likely to read well in third grade 2 – Third graders who dont read at grade level are more at risk for poor educational performance 3-6

3. 3 Risk factors associated with adults reading to children every day Education Income Have more books at home Birth order – First > Second > Third Books at home (including library books) History of family literary practices Support from pediatric provider Maternal depression References 7-12

4. 4 Racial/Ethnic Disparities Previous research has found: Black and Hispanic Parents are less likely to read to their children than white parents 7-13 Spanish speaking families have fewer childrens books at home 7 Spanish speaking families are more likely to never read to their children than non-Spanish speaking families 13

5. 5 Methods Research Question: Is there an association between maternal race/ethnicity and reading to a two year old every day? Dataset: 3 linked datasets: 2004-2005 Oregon Birth Certificate 2004-2005 PRAMS and 2006-2008 PRAMS-2 – 1911 Participants 37 did not answer read to child question 6 did not answer race/ethnicity question – Final Sample: 1868 Mothers

6. 6 Methods Outcome: Whether the mother or someone else in her household read to her two year old every day Covariates: Maternal race/ethnicity, maternal nativity, birth order, maternal age, household income, maternal education, maternal depression, childcare, marital status, whether mother lives with another adult, time child spent watching TV Weighted bivariate analysis determined covariates for model Multivariate logistic regression used for final model

7. 7 Results 62.4% of respondents reported reading to their child every day Hispanic and Black mothers were the least likely to report reading to their child every day

8. Table 1. Racial/ethnic disparities in reading to two year old children every day, Oregon PRAMS- 2, 2004-2005 birth cohorts (n=1868) Characteristicn** Read to child everyday (weighted)*** Multivariate OR (95% CI) Total186862.40%- Maternal race/ethnicity (birth certificate): White*81971.60%Referent Hispanic35834.10%0.30 (0.20, 0.44) Black*18638.80%0.32 (0.21, 0.48) AI/AN*21853.90%0.58 (0.39, 0.87) Asian/ Pacific Islander*28758.40%0.39 (0.27, 0.57) *non-Hispanic **weighted number ***weighted percent 8 Controlling for poverty status, maternal age, birth order and maternal education

9. 9 Discussion Significant racial/ethnic disparities among mothers reading to two year old children – Hispanic and Black mothers are less likely to report reading to their children every day compared to White mothers – Hispanic and Black mothers were more likely to report low income, low education and low maternal age Among minority groups, American Indian mothers were the most likely to report reading to their two year old every day.

10. 10 Reading to Hispanic Children Some parents may have limited access to bilingual or Spanish resources Some have discomfort reading in English Some believe they should wait until child is 5 years old Some do not consider reading a leisure activity Some parents believe the school is responsible for teaching their child to read

11. 11 Reading to Black Children More likely to be a single parent household Black mothers may be more stressed than other mothers Residing in a disadvantaged neighborhood impedes academically relevant verbal skills Racial discrimination – Disciplined more harshly – Feel less capable – Diversion of resources/fewer resources in largely black schools – Difficulty in job and housing market

12. 12 Reading to American Indian/Alaska Native Children Oral tradition – Story telling as an effective tool to change behavior – Instills cultural values and allows reclamation of native language Governmental support for programs that improve literacy among the AI/AN population – Early Head Start Value of children – Investing in children secures the tribes future

13. 13 Interventions Reach Out and Read – Trains pediatric providers to provide instruction and advice on reading to children – Give books at every pediatric visit from 6 months to 5 years – Volunteers in waiting rooms to model reading to children – Families participating in ROR score higher on language development exams Early Head Start – Serves low income families from birth to three years – Provide parent-child activities, home-visits, development plans and adult education – EHS children score higher on language and cognitive tests – Improves parental support for literacy development and daily reading

14. 14 Conclusion Results help us understand other factors that influence educational outcomes Reading to children is an effective tool to improve academic performance Other cultural factors affect parents reading to their children Programs developed for early childhood education need to be culturally sensitive Future efforts should focus on testing interventions on a large scale

15. 15 References 1.DeWalt D.A., Berkman N.D., Sheridan S., Lohr K.N., Pignone M.P. Literacy and Health Outcomes. Journal of General Internal Medicine 2004;19(12):1228-1239. 2.Sénéchal M, LeFevre J. Parental involvement in the development of childrens reading skill: a five-year longitudinal study. Child Development 2002;73(2):445- 460. 3.Lloyd D.N. Prediction of school failure from third-grade data. Educational and Psychological Measurement 1978;38(4):1193-1200. 4.Neisser U., ed. Poor readers: teach, dont label. The School Achievement of Minority Children: New Perspectives. Hillsdale, NJ: Erlbaum Associates; 1986.105- 143. 5.Berlin G. & Sum A. Toward a more perfect union: Basic skills, poor families, and our economic future. New York, N.Y: Ford Foundation; 1988. 6.Jimerson S., Egeland B, Sroufe L, Carlson B. A Prospective longitudinal study of high school dropouts: examining multiple predictors across development. (1999). Journal of School Psychology 2000;38(6):525-549. 7.Raikes H., Luze G., Brooks-Gunn J., et al. Mother-child bookreading in low- income families: Correlates and outcomes during the first three years of life. Child Development 2006;77(4):924-953. 8.Cameron C.A., Pinto G. A day in the life: Secure interludes with joint book reading. Journal of Research in Childhood Education 2009;23(4):437-449.

16. 16 References Cond 9.Duursma E., Pan B.A., Raikes H. Predictors and outcomes of low-income fathers reading with their toddlers. Early Childhood Research Quarterly 2008;23:351-365. 10.Kuo A.A., Franke T.M., Regalado M, Halfon N. Parent report of reading to young children. Pediatrics 2004;113(6):1944-1951. 11.Bigatti S.M., Cronan T.A., Anaya A. The effects of maternal depression on the efficacy of a literacy intervention program. Child Psychiatry and Human Development 2001;32(2):147-162. 12.Luomo I., Tamminen T., Kaukonen P., et al. Longitudinal study of maternal depressive symptoms and child well-being. Journal of the American Academy of Child and Adolescent Psychiatry 2001;40(12):1367-1374. 13.Flores G., Tomany-Korman S.C., Olson L. Does disadvantage start at home? Racial and ethnic disparities in health-related early childhood home routines and safety practices. Archives of Pediatric and Adolescent Medicine 2005;159:158-165.