Early Literacy Research Library (ELRL) - Article

Prescribing Books for Immigrant Children: A Pilot Study to Promote Emergent Literacy Among the Children of Hispanic Immigrants

Sanders, L.M., Gershon, T.D., Huffman, L.C., Mendoza, F.S. (2000) Prescribing Books for Immigrant Children: A Pilot Study to Promote Emergent Literacy Among the Children of Hispanic Immigrants. Archives of Pediatrics & Adolescent Medicine, 154(8), 771-777.,

Access: FREE/Open Access

Publication year


study description

Pilot, cross-sectional.

core topic(s)

Reach Out and Read (ROR)

Population Characteristics

Immigrant , Lingually Diverse , Race, Ethnicity, and Culture

Exposures, Outcomes, Other

Language and Literacy Development , Parent Behaviors and Skills , Provider Behaviors and Skills


To assess book-sharing activities within first-generation Hispanic immigrant families, and to assess the effect of pediatricians giving books to their patients.


Reach Out and Read (ROR).

outcomes evaluated

Book sharing environment and activities, and book provision by pediatrician.


House staff continuity clinic at a Stanford University children's hospital.


Frequent Book Sharing (FBS) was defined as a parent's reporting more than 3 days per week of sharing books with the child. Main independent variables included the following: (1) exposure to the Reach Out and Read program, defined as having received a children's book from the pediatrician; (2) socioeconomics, as measured by parents' years of education and Medicaid enrollment; (3) acculturation, as defined by 4 questions relating to parents' proficiency with the English language; (4) parent's country of origin; (5) parent literacy, as measured by a parent's reporting more than 3 days per week of reading alone; (6) parent's age; (7) marital status; (8) household size; (9) child's age; (10) child's sex.

sample size

n=122 (families)


Measure of Book Sharing Environment:

    • Frequent Book Sharing (FBS) defined as a parent’s reporting more than 3 days per week of sharing books with the child.
    • Reading as Favorite Activity (RFA): defined by reading as child’s top 3 favorite activities, or parent’s top 3 to do with child.
    • Children’s Books at Home (CBH).

Other Outcome Measures:

    • Exposure to ROR: having received a children’s book from a pediatrician.
    • Socioeconomics: years of education and Medicaid enrollment status.
    • Acculturation: 4 questions related to parental proficiency with English language.
    • Parent Literacy: parent’s reporting more than 3 days per week reading alone.
    • Other: age, marital status, country of origin, household size, child age and sex.


Ninety percent of the parents were born outside of the United States (71% in Mexico), 85% spoke Spanish in the home, and 63% had completed less than a high-school education. Seventy-five percent of children's medical insurance was provided by Medi-Cal (Medicaid), and 9% of children were uninsured. Sixty-seven percent spoke exclusively Spanish at home, and 84% of parents want their children to learn to read in both English and Spanish. High FBS was reported among parents whose children had received books from the physician when compared with parents whose children had received no books. The odds ratio (OR) was 3.62 (95% confidence interval [CI], 1.40-9.37; P<.05). Also associated with FBS were parents reading frequently to themselves (OR = 9.52; 95% CI, 2.09-43.27; P<.05) and national origin outside Mexico (OR = 5.54; 95% CI, 1.59-19.27; P<.05). These findings were independent of parent's educational level, parent's employment, parent's age, acculturation, and family size.


Pediatricians can promote literacy development among Hispanic immigrant children through the provision of free books at well-child visits. Our findings also suggest the independent effects of adult literacy and child age. Further research is needed to understand the effect of pediatric literacy programs on Hispanic immigrant children, their bilingual environments, and their readiness for school entry.


As a cross-sectional study, it does not track the influence of the intervention on families over time. All outcomes were assessed by parent report, and none of the outcome measures has been subject to strict validity and reliability testing in this age group. Responses were likely to have been confounded by parents' proclivity to provide socially desirable answers to the interviewers. As a result, our outcome measures were more likely representative of parental perceptions than of parental behavior. Because of the nonrandomized design, significant differences between child age and sex resulted in the exposure (books) and nonexposure (no books) groups. Nonetheless, the study's main findings remained significant in a logistic regression that controlled for these variables. Because of the noncontrolled design, the intervention itself was limited and varied greatly by physician styles. Physicians provided different verbal messages to the parent, and physicians, not parents, chose whether to give the child an English- or Spanish-language book. Exposure to the intervention was assessed by parent report, although interviewers asked this question near the end of the interview: "Has your child received books during any of your visits?" Most children received only 1 book as the intervention. This limitation, however, would likely bias our conclusions away from the null.