Early Literacy Research Library (ELRL) - Article

Factors Associated With Increased Reading Frequency in Children Exposed to Reach Out and Read

Rikin, S., Glatt, K., Simpson, P., Cao, Y., Anene-Maidoh, O., Willis, E. (2015) Factors Associated with Increased Reading Frequency in Children Exposed to Reach Out and Read. Academic Pediatrics, 15(6), 651-657.,

Access: Institutional Access

Publication year


study description

Cross-sectional study.

core topic(s)

Reach Out and Read (ROR)

Population Characteristics


Exposures, Outcomes, Other

Home Language/Literacy/Learning Environment , Home Routines , Parent Behaviors and Skills , Reading Frequency


We hypothesized that exposure to ROR and other variables such as reading as part of a bedtime routine positively correlate with caregiver-child reading frequency.


Reach Out and Read (ROR).

outcomes evaluated

Caregiver-child reading frequency and home literacy environment.


8 ROR-Milwaukee sites, which serve predominantly low-income populations.


This is a cross-sectional study based on a convenience sample of caregivers at 8 ROR-Milwaukee sites, which serve predominantly low-income populations in Milwaukee. On the basis of results of previously validated questionnaires, odds ratios were calculated to determine which variables are significantly associated with caregivers' reading to children 0 to 2 (rarely), 3 to 6 (often), and 7 (daily) days per week. Random forest analysis was performed to examine relative importance of variables in predicting caregivers' reading frequency.

sample size

n=8 (sites); n=256 (caregivers)


Measure of Home Literacy Environment: 25-item questionnaire adapted from the Before-and-After-Books and Reading survey that assesses:

    • Demographic Characteristics
    • Exposure to ROR-M intervention: as number of children’s books received from pediatricians and age of child when a book was first received from a pediatrician.
    • Caregivers’ literacy-related attitudes and behaviors: such as caregivers’ interest in reading, how caregivers-prepared the child for bed, and the reported number of children’s books in the household.
    • Frequency of reading: as days per week.


A total of 256 caregivers were eligible for analysis; those who reported receiving ≥4 books from pediatricians read to children more days per week compared to those receiving fewer books (5.07 vs 3.61, P < .001) and were more likely to read daily (odds ratio 3.07, 95% confidence interval 1.80-5.23). Caregivers' interest in reading, number of children's books in the home, reading as part of a bedtime routine, and number of books received from pediatricians were among the most important variables in distinguishing rarely, often, and daily reading caregivers.


Exposure to ROR-Milwaukee's intervention is associated with increased reading frequency. Identified variables such as reading as a bedtime routine and number of children's books in the home should be targets for future literacy-promoting interventions.


There are several limitations in this study, and one of them is the lack of a true control group, limiting the ability to interpret the relationships between attitudes/behaviors and intervention. The use of convenience samples may lend to selection bias on the part of the interviewers. Another limitation of this study was that the outcome measure and all variables were based on caregivers' reports, which are prone to social desirability bias. Although our conceptual model of early childhood literacy development is extensive, many additional variables, mediators, and confounders also exist. These include a child's enrollment in day care or preschool, number of children in the household, number of caregivers, and exposures to other forms of language.16, 21 Future studies that randomize the different components of the ROR intervention (eg, book delivery, anticipatory guidance, modeling reading) and include more variables from a child's home environment may enhance the existing data.