1. Low Literacy in Arkansas What’s Food Got to Do With It? Arkansas Hunger Coalition Conference May 26, 2004 Dr. Peggy Sissel-Phelan for

2. What is Literacy? Meaning of Literacy Differs Over time By place Within cultural groups When new conceptual frameworks are developed

3. What is Literacy? Meaning is affected by Politics Resources Biases

4. Who Is Literate? Until recently, no one expected everyone to be literate Emerging views in 60’s and 70’s International development Space race Now, literacy as Crisis Greater expectations for educational attainment Information society

5. National Assessment of Adult Literacy 16,000 adults ages 16+ Tested literacy tasks, not just decoding 5 reading skill levels Level 1 – approx. first grade Level 2 – approx. fourth grade National Results State by State extrapolations

6. Level 1 Literacy Among Adults Age 16 + by County Number of Counties n = 17 n = 27 n = 14 n = 9 n = 4 n = 3 13-19% 20-24% 25-29% 30-34% 35-39% 40-45% Level 1 Level 1 Level 1 Level 1 Level 1 Level 1 Note: Level 1 equates to about 1 st grade reading skills Missing Data

7. Level 2 Literacy or Below Among Adults Age 16 + by County Number of Counties n = 3 n = 8 n = 19 n = 29 n = 12 n = 3 Note: Calhoun County data not available 43-45% 46-51% 52-59% 60-69% 70-79% 80-89% at Level 2 at Level 2 at Level 2 Note: Level 2 equates to about 4th grade reading skills Missing Data

8. Generational Illiteracy Parents/Adult % 8 th Graders % City Low Literacy 7890Forrest City 7192Pine Bluff 6283Texarkana 6470Blytheville 6369El Dorado 5477North Little Rock 5868Paragould Note: Parents data derived from National Adult Literacy Survey, 1992 Students data derived from National Assessment of Educational Progress, 2002

9. Generational Illiteracy Parents/Adults % 8 th Graders % City Low Literacy 5958Magnolia 4670Little Rock 4961Arkadelphia 5058Benton 4655Searcy 4257Rogers Note: Parents data derived from National Adult Literacy Survey, 1992 Students data derived from National Assessment of Educational Progress, 2002

10. Generational Illiteracy Parents/Adult% 8 th Graders % City Low Literacy 4450Jonesboro 4246Conway 4840Springdale 4437Bentonville 3234Fayetteville Note: Parents data derived from National Adult Literacy Survey, 1992 Students data derived from National Assessment of Educational Progress, 2002

11. Generational Illiteracy 8 th Graders Parents/Adults %

12. Child-Well Being Infant mortality rates – 37 th in U.S. Low birth weight - 41 st Child death rates - 46 th Overall child well-being - 47 th

13. Youth Well-Being Teen birth rate - 42nd in U.S. School dropout rate - 41 st in U.S. CDC study on youth behavior in Arkansas: 23% Rarely/never use safety belts 31% Rode with drinking driver in past month 22% Carried a weapon in the past month 30% Report episodic heavy drinking during the past month

14. Community Well-Being Low-literate adults - 56% Less than h.s.diploma -22.8% Bachelor’s degrees or more -18% Person’s Below Poverty – 15.8% Families making less than $25,000 - 28.1%

15. Illiteracy — A Health Problem? Medication Errors DNKA’s (did not keep appt.) Misunderstanding Diagnosis Compliance issues Access to Medical Care Unable to read Patient Education Materials Perceptions of Health

16. Health Literacy “The ability to read, understand, and act on health care information”

17. Findings of American Medical Association Affects 90 million Americans Critical health issue 2x more likely to be hospitalized 2x more likely to report poor health Less likely to access health care system Costs estimated $73 billion annually to health care system

18. Where are the Roots of Illiteracy?

19. Reading and Children’s Brain Development n The architecture of the brain is shaped by early experiences n Under-used nerve connections are “pruned” n Cognitive skills associated with book sharing - memory, comprehension, creativity, and language - ensure that associated brain connections persist

20. Emergent Literacy Literacy Develops Literacy acquisition begins before formal instruction Critical cognitive work from birth to age six Literacy develops in real life settings for real life activities

21. Parental Language and Children’s Language n Children’s language evolves primarily through parent-child interactions n By two years of age, children’s language correlates with later cognitive performance

22. Hoff-Ginsberg, 1991 Children 18-29 months old videotaped with mother Measured shared language during routine activities and reading aloud Number and frequency of utterances, number of words, and syntactic complexity were 2 times higher during reading aloud Reading Aloud Promotes Maternal-Child Language

23. Reading with Children Dialogic Reading Ask “What” and “Where” questions Label Give feedback Age appropriate expectations Child directed Part of daily routines Fun

24. Children from Low-Income Families n Low-income status significantly predicts children’s exposure to language (Bloom, 1998) n Children from low-income families are far less likely to be read to on a daily basis (National Research Council, 1999)

25. Consequences of Poverty n In general, children living in poverty: –Are 1.3 times more likely to exhibit developmental delays –Are 1.4 times more likely to be diagnosed with a learning disability –Are 2 times more likely to repeat a grade Brooks-Gunn & Duncan, 1997

26. Reach Out and Read! Clinic-based pediatric literacy intervention by health care providers Adds a literacy component to every well child visit Health care provider gives away free books Educates parents about reading to their child Identifies low literacy parents

27. Reach Out and Read Founded in 1989 at Boston City Hospital Over 1400 sites at present Over 14,000 pediatric providers trained Over 1.5 million children from low- income families reached annually Over 3 million books distributed per year Hopes to double sites to 3000 in five years

28. The ROR Model Culturally and developmentally books given by the pediatric provider at well child visits 6 months to 5 years of age (~10 visits) Volunteers in the waiting room demonstrating reading techniques Anticipatory Guidance for parents at each visit - repeated and reinforced!!

29. ROR Research Parents who received books more likely to remember the anticipatory guidance given by their physician 4 times more likely to report reading to their children at follow up (Needlman et. al., 1991) More positive attitudes toward reading (High et. al., 2000) Children in the ROR program had higher receptive and expressive language scores (Mendelsohn et al., 2001)

30. “Anticipatory guidance for parents about sharing books with young children may be the only concrete activity of a pediatric provider that has been proven to promote child development.” -Barry Zuckerman, MD Founding Director, Reach Out and Read

31. Our Vision – A Healthier and More Literate Arkansas Awareness, Education, & Outreach, Book Distribution Collaboration

32. What You Can Do (1) Spread the news about the concept of early intervention literacy programs (2) Advocate for emergent literacy programming in their communities (3) Invite us to speak: civic, nonprofit, corporate, governmental, professional groups, organizations, and agencies

33. Questions

34. Relationship Between Literacy and Health Status 1/3 could not understand basic health related materials 42% misunderstood medication directions 26% couldn’t understand appointment slip 60% did not understand consent forms 49% couldn’t figure out if they were eligible for hospital financial aid from forms

35. More Implications Lower income Poor nutrition Substandard Housing Violent Neighborhoods Low Ratings/Perceptions of Health Lack of preventative care

36. Nationally, 35% of first graders are labeled as “slow” and placed in remedial reading programs. Nationally, 35% of first graders are labeled as “slow” and placed in remedial reading programs. Dyslexia—prevalence 4-10% Dyslexia—prevalence 4-10% Most of these children, who are not dyslexic, remain in these programs throughout school. Most of these children, who are not dyslexic, remain in these programs throughout school. Creates a vicious cycle for school failure and failure in life. Creates a vicious cycle for school failure and failure in life. Childhood Roots of Illiteracy

37. Contact Us! Peggy Sissel-Phelan, Ed.D. or Chad Rodgers, MD, FAAP Email: arwellchild@aristotle.netarwellchild@aristotle.net Phone: 228-0908 P.O. Box 21712, LR, AR 72221-1712 Order copies of “Volumes to Go Before We Rest”-- $10 each