EVALUATION OF A CLINIC-BASED PROGRAM TO PROMOTE BOOK SHARING AND BEDTIME ROUTINES AMONG LOW-INCOME URBAN FAMILIES WITH YOUNG-CHILDREN

Objective: To evaluate a program of anticipatory guidance in which ped iatric residents and nurse practitioners in a continuity practice gave parents books for their young children along with developmentally app ropriate educational materials describing why and how to share the boo ks and promoting reading as part of a bedtime routine. Study Design: C omparison of 2 cross-sectional groups using consecutive, structured, f ace-to-face or telephone interviews of parents. One group was a histor ical control or a comparison group (group 1). The other was the interv ention group (group 2),which included families who had received 2 book s and educational materials for the children as part of the program to promote book sharing and bedtime routines. Subjects: Before the insti tution of the program to promote book sharing and bedtime routines, th e parents in 51 families with healthy children 12 to 38 months of age who regularly attended continuity clinics conducted by the house-staff were interviewed; these families constituted group 1. Group 1 include d a low-income population of Hispanic, African American, and non-Hispa nic white families. Group 2 included 100 families with similar sociode mographic characteristics with healthy 12- to 38-month-old children wh o had received 2 books and educational materials at all 6- to 36-month well-child visits as part of the program. Results: The intervention w as found to be effective in promoting child-centered literacy activiti es. When asked open-ended questions, 4 (8%) of the parents in group 1 and 21 (21%) of the parents in group 2 said 1 of their child's 3 favor ite activities included books (P=.04); 11 (22%) of theparents in group 1 and 42 (42%) of the parents in group 2 said 1 of their 3 favorite a ctivities with their child was book sharing (P=.01); and 10 (20%) of t he parents in group 1 and 35 (35%) of the parents in group 2 said that they share books 6 or 7 times a week at bedtime (P=.05). By mentionin g 1 of these 3 important child-centered book-sharing activities, 17 (3 3%) of the parents in group 1 and 69 (69%) of the parents in group 2 ( P <.001) demonstrated positive child-centered literacy orientation. A multiple logistic regression analysis controlling for parental educati on, ethnicity, and reading habits, as well as for the sex and age of t he children, found child-centered literacy orientation more likely to be present in group 2 than in group 1 families, with an odds ratio (OR ) of 4.7 (95% confidence interval [CI], 2.1-10.5; P<.001). Book sharin g as part of a bedtime routine was more frequent in group 2 (mean+/-SD , 3.9+/-2.6 nights per week) than in group 1 (mean+/-SD, 2.5+/-2.7 nig hts per week; P=.002); however, no significant differences in prolonge d bedtime struggles, parent-child cosleeping, frequent night waking, o r how children fell asleep were found between the groups. Instead, in multivariate analysis, bedtime struggles occurred more often with youn ger parents (P=.03) and fewer children at home (P=.02), while parent-c hild cosleeping (P<.001) and frequent night waking (P=.04) were less l ikely to occur when children usually fell asleep alone in their own be ds. Conclusions: This simple and inexpensive intervention by pediatric house staff, consisting of the provision of children's books and educ ational materials at well-child visits, resulted in increased enjoymen t of and participation in child-centered book-related activities in lo w-income families. Primary care providers tie, physicians and nurse pr actitioners) serving underserved pediatric populations may have a uniq ue opportunity to promote child-centered literacy in at-risk groups.