study descriptionQuasi-experimental sequential cohort study.
core topic(s)Early Literacy , Shared Reading
Population CharacteristicsInfant/Newborn , Urban
Exposures, Outcomes, OtherClinic-Based Programs and Interventions , Early Books , Home Language/Literacy/Learning Environment , Home Routines , Parent Behaviors and Skills
objectivesTo describe infant home reading trajectories and environments in the first year and to assess whether receiving books starting in the newborn period, compared with starting at 6 months, alters these trajectories.
exposureShared reading counsel and book distribution.
outcomes evaluatedShared reading behaviors and home literacy environment.
settingStandard group families were enrolled between May 2016 and October 2016 from a single urban pediatric center serving a largely white non-Hispanic and largely college-educated population.
methodsTwo study groups were enrolled in a quasi-experimental sequential cohort study; both groups received shared reading counseling starting in the newborn period and completed surveys throughout the first year. The Standard group received books starting at 6 months, whereas the Early Books group received books starting at 2 weeks. Reading trajectories were assessed both overall and between the study groups.
sample sizen=561 (well visits); n=110 (families enrolled Standard); n=113 (families enrolled Early Books)
Measure of Family Reading Behaviors: items adapted from the Before and After Books and Reading survey and the Stony Brook Family Reading Survey assessed: frequency of shared reading at each interval, whether reading was one of the parents’ top 3 “favorite activities” with their infant, whether reading was listed as a bedtime activity, number of children’s books in the home.
Measure of Home Literacy Environment: whether the parent enjoys reading, whether the parent was read to as a child, and whether the parent had yet received any information about shared reading.
Measures of Sociodemographics: household primary language, parent race/ethnicity, parental educational attainment, number of children in the home, duration of US residency, and use of early childhood community agencies (SNAP, WIC, Head Start, EI/ECSE).
Electronic Medical Record Review: additional demographic information (e.g. infant’s gestational age, birth weight, and sex) and insurance status.
resultsAt the 2-week visit, less than half of families in each group had started shared reading with their infant, which rose to >97% by 12 months. Approximately two-thirds of families owned >10 children's books at 2 weeks, which increased to >80% at 12 months. Incorporating shared reading into bedtime routines also increased during the first year. Early versus standard book distribution did not alter these trajectories.
conclusionsOver the first year of life, families almost universally initiated shared reading and increased the number of books in the home. Reading habits established during this time were maintained in both groups. Literacy promotion beginning at the earliest well-child visits may help establish routines that will persist throughout childhood.
limitationsResearch was limited to a single urban pediatric center and families who could complete a survey in English or Spanish... As the clinic had a largely white non-Hispanic and largely college-educated population, results may not be generalizable to more diverse practice settings. We had some attrition, although comparable in both groups, which could have selected toward families who engage in more shared reading. We included insurance status and parental education as a proxy for household SES. Although oral administration of the survey was made available, no families chose this option. As a result, the survey may have excluded lower-literacy parents, which might lead to overestimation of literacy outcomes. Larger, more diverse cohorts are needed for further study...In addition, because we only surveyed families at 6 and 12 months, we may have missed capturing important differences that would have been present had we assessed earlier, such as at 3 months. Survey data were based on parent report and may not reflect actual behavior. We were also unable to assess the quality of shared reading at home. Although our providers received training on counseling shared reading from birth, there may have been some families who received incomplete counseling because we did not directly observe providers, and our self-reported provider survey indicated that providers do not always provide counseling and some providers were not comfortable with early shared reading counseling despite the training...Our population also had relatively high baseline level of shared reading, likely because of a longstanding ROR program and possibly because of education level. It is possible that the addition of 3 books and targeted counseling <6 months was not a sufficient intervention in the setting of an already well-established shared reading program. Studying early book distribution compared to families with no previous shared reading could produce significant results...Although we quantitatively assessed parental reading frequency and their favorite activities, we did not investigate why parents reported or did not report reading as a favorite activity. "