1. Racial/Ethnic Disparities in Adults Reading to Two Year Old Children: A Population-based Study Olivia Sappenfield Emory University School of Public Health Oregon Public Health Division Kenneth D. Rosenberg, MD, MPH Oregon Public Health Division Table 1: Protective factors for reading to two year old children every day, Oregon PRAMS-2, 2004-2005 birth cohorts (n=1868) Characteristicnana Read to child everyday (weighted) b Bivariate OR (95% CI) Multivariate OR (95% CI) Total186862.4%-- Maternal race/ethnicity (birth certificate): White, non-Hispanic81971.6%Referent Hispanic35834.1%0.21 (0.15, 0.28)0.30 (0.20, 0.44) Black, non-Hispanic18638.8%0.25 (0.17, 0.37)0.32 (0.21, 0.48) AI/AN, non-Hispanic21853.9%0.46 (0.33, 0.66)0.58 (0.39, 0.87) Asian/ Pacific Islander, non-Hispanic28758.4%0.56 (0.40, 0.77)0.39 (0.27, 0.57) Poverty Status (PR2): Less than 100% FPL37937.0%Referent 100-199% FPL38552.0%1.84 (1.18, 2.88)1.26 (0.76, 2.09) 200% FPL or higher99077.2%5.77 (3.91, 8.52)2.54 (1.56, 4.13) Maternal age at birth of index child (PR): Less than 25 years51549.9%Referent 25 - 29 years51861.5%1.60 (1.10, 2.32)1.40 (0.86 2.26) 30 years or older83572.6%2.66 (1.88, 3.76)2.03 (1.27, 3.25) Birth order (birth certificate): Third child or greater45048.2%Referent Second child57965.5%2.04 (1.41, 2.97)1.84 (1.17, 2.91) First child83868.1%2.30 (1.61, 3.28)2.43 (1.56, 3.79) Maternal education (PR2): 12th grade or lower67945.6%Referent Higher than 12th grade118173.4%3.28 (2.42, 4.45)1.55 (1.01, 2.38) Introduction Methods Results Discussion Public Health Implications Risk factors associated with reading to children every day Racial/ethnic disparities Reading to racial/ethnic minorities Reading Interventions Strengths and Weaknesses Over a wide range of adverse health outcomes, people with low literacy have 1.5 to 3 times higher risk of poor health outcomes than people whose literacy is not low. If a parent begins reading to a child by the age of two, the child is more likely to read well in third grade. Third graders who do not read at grade level are more at risk for poor educational performance High parental education High family income Lower birth order First > Second > Third More books at home (including library books) Studies have indicated racial/ethnic disparities exist in reading to children. Previous research found Black and Hispanic parents were less likely than white parents to read to their children; Spanish speaking families had fewer children’s books at home; and Spanish speaking families were more likely to never read to their children than non-Spanish speaking families. This study proposed to assess the association between maternal race/ethnicity and reading to two year olds. 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 2006-2008 PRAMS-2 1911 Participants, Final Sample: 1868 Mothers 37 did not answer question about reading to child 6 did not answer race/ethnicity question Outcome: Whether the mother or someone else in her household read to her two year old every day Exposure: Maternal race/ethnicity Other covariates: 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 the model. Multivariate logistic regression was used for the final model 62.4% of respondents reported reading to their child every day. Hispanic and non-Hispanic Black mothers were the least likely to report reading to their child every day. Hispanic and non-Hispanic Black mothers were most likely to report low poverty status, low education and low maternal age. Hispanic mothers are 70% less likely to report reading to their 2 year old everyday than NH White mothers (ORa 0.30; 95% CI: 0.20, 0.44). NH Black mothers are 68% less likely to report reading to their 2 year old every day than NH White mothers. (ORa 0.32; 95% CI: 0.21, 0.48). NH American Indian/Alaska Native mothers are 42% less likely to report reading to their 2 year old every day than NH White mothers (ORa 0.58; 95% CI: 0.39, 0.87). NH Asian/Pacific Islander mothers are 61% less likely to report reading to their 2 year old every day than NH White mothers. (ORa 0.39; 95% CI: 0.27, 0.57). Table 1 This study found significant racial/ethnic disparities among mothers reading to two year old children. Compared with non-Hispanic (NH) White mothers, Hispanic and NH Black mothers were significantly less likely to report that they or someone else in the household read to the child every day. Hispanic and NH Black mothers were also more likely to report low income, low education and low maternal age. Given that there are still racial/ethnic disparities after adjusting for age, education, household income and birth order, cultural factors specific to race/ethnicity could explain the remaining disparities. Some Hispanic parents may have limited access to bilingual resources, feel they should wait until their child is 5 to read to them, be uncomfortable reading to their child or feel it is the school’s responsibility to teach their child to read. NH Black children are more likely to come from a single-parent household, are discriminated against or reside in disadvantaged neighborhoods which impede academically relevant verbal skills. Also NH Black mothers may be more stressed than other mothers. NH American Indian/Alaska Native children may participate in programs promoting early literacy such as Early Head Start. NH American Indians/Alaska Natives have a history of oral traditions and values such as children’s worth contribute to reading aloud. Two programs have been shown to be effective in increasing adults reading to young children. Reach Out and Read (ROR) is a program which utilizes pediatric providers to encourage parents to read to their children. The providers provide instruction and advice on reading to children, give books at every pediatric visit from 6 months to 5 years and volunteers in waiting rooms model how to read to children. Families participating in ROR score higher on language development exams. The second program is the federally funded community-based Early Head Start (EHS) which serves low-income families from birth to three years. Services provided by EHS include, but are not limited to, parent-child activities, home-visits, development plans and adult education. Children participating in EHS score higher on language cognitive tests. The program also improves parental support for literacy development and daily reading to their children. The strengths of this study include being population-based and large sample size. Some of the study’s limitations include data were self-reported; child care providers were not asked whether they read to the children; race/ethnic categorizations may not accurately describe the differences among Hispanic groups, Asian/PI groups or multiracial groups; the weighted response rate was only 56.6% which is excellent for a population-based survey but limits generalizability; the data cannot be generalized beyond Oregon; and the study was cross- sectional so causality cannot be established. The results of this study can help us understand other factors that influence educational outcomes. The disparities among racial/ethnic groups indicate there may be other cultural factors which affect reading to children and programs developed for early childhood education need to be culturally sensitive. Expansion of existing interventions could lead to improved early learning which could lead to improved academic performance and health outcomes. Future efforts should focus on testing interventions on a larger scale. Family history of reading habits Support from pediatric provider Mother not depressed