Early Literacy Research Library (ELRL) - Article

The Impact of a Clinic-Based Literacy Intervention on Language Development in Inner-City Preschool Children

Mendelsohn, A.L., et al. (2001) The Impact of a Clinic-Based Literacy Intervention on Language Development in Inner-City Preschool Children. Pediatrics, 107(1), 130–134.,

Access: FREE/Open Access

Publication year


study description

Intervention comparison.

core topic(s)

Reach Out and Read (ROR)

Population Characteristics

Poverty/Low-Income , Race, Ethnicity, and Culture , Toddler/Preschool , Urban

Exposures, Outcomes, Other

Child Behaviors and Skills


To determine the effect of a clinic-based literacy intervention on the language development of preschool children.


Reach Out and Read (ROR).

outcomes evaluated

Parent-child reading activities and child language development.


Two urban pediatric clinics providing care to populations that are poor, under-educated, and with a preponderance of Latino immigrants.


A convenience sample of families presenting to 2 urban pediatric clinics for well-child care met the following criteria: the family was Latino or black and English- or Spanish-speaking; the child was 2 to 5.9 years old, with no neurodevelopmental disability, at a gestational age of 34 weeks or more , and not attending kindergarten. Participants at the first clinic (intervention group) were exposed to a literacy support program, based on Reach Out and Read (ROR), during the previous 3 years. At the second clinic (comparison group), a similar program started 3 months before the study. Parent-child reading activities were measured using the READ Subscale of the StimQ. Language development was measured using the One-Word Expressive and Receptive Picture Vocabulary Tests, and was performed in the child’s primary language.

sample size

n=49 (intervention); n=73 (comparison); n=122 (total)


Measure of Reading Activities: READ subscale of the StimQ.


Measure of Language Development: One-Word Expressive and Receptive Picture Vocabulary Tests.


A total of 122 study participants (49 interventions and 73 comparisons) met inclusion criteria and completed all measures. Intervention and comparison families were similar for most sociodemographic variables. Intervention families reported reading together with their children approximately 1 more day per week. Intensity of exposure to ROR (measured by total number of contacts with the program) was associated with increased parent-child reading activities, as measured by the StimQ-Read Subscale (r 5 0.20). Intervention children had higher receptive language (mean: 94.5 vs 84.8) and expressive language (mean: 84.3 vs 81.6). After adjusting for potential confounders in a multiple regression analysis, intervention status was associated with an 8.6-point increase (95% confidence interval [CI]: 3.3, 14.0) in receptive language (semi partial correlation [SR]coefficient 5 0.27), and a 4.3-point increase (95% CI: 0.04, 8.6) in expressive language (SR 5 0.17). In a similar multiple regression, each contact with ROR was associated with an adjusted mean 0.4-point increase (95% CI: 0.1, 0.6) in receptive score, and an adjusted mean 0.21-point increase (95% CI: 0.02, 0.4) in expressive score.


ROR is an important intervention, promoting parental literacy support and enhancing language development in impoverished preschool children. Integration of literacy promoting interventions such as these into routine pediatric health care for underserved populations can be recommended.


A possible limitation exists in that unmeasured differences between the 2 clinic populations could have accounted for some of the differences in language development that we attributed to ROR...If anything, the intervention clinic participants might have been at higher risk based on a somewhat lower high school graduation rate and a higher percentage of recent immigrants. Therefore, any differences between the 2 groups would have served to decrease the measured effect size...Another limitation of this study was the reliance on parental report for reading activities in the home as well as degree of exposure to the intervention, leading to potential for recall bias...A third limitation was the lack of blinding of research assistants to either the study hypotheses or the site in which assessments were performed.