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Cori M. Green, MD, MS; Samantha B. Berkule, PhD; Benard P. Dreyer, MD; Arthur H. Fierman, MD; Harris S. Huberman, MD; Perri E. Klass, MD; Suzy Tomopoulos, MD; Hsiang Shonna Yin, MD, MS; Lesley M. Morrow, PhD; Alan L. Mendelsohn, MD

Arch Pediatr Adolesc Med. 2009;163(9):832-837.

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.

Author Affiliations: Department of Pediatrics, New York University School of Medicine and Bellevue Hospital Center, New York, New York (Drs Green, Berkule, Dreyer, Fierman, Huberman, Klass, Tomopoulos, Yin, and Mendelsohn); and Department of Learning and Teaching, Rutgers Graduate School of Education, New Brunswick, NJ (Dr Morrow).

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