title: Maternal health literacy and late initiation of immunizations among an inner-city birth cohort.
abstract: To determine if maternal health literacy influences early infant immunization status. Longitudinal prospective cohort study of 506 Medicaid-eligible mother-infant dyads. Immunization status at age 3 and 7 months was assessed in relation to maternal health literacy measured at birth using the Test of Functional Health Literacy in Adults (short version). Multivariable logistic regression quantified the effect of maternal health literacy on immunization status adjusting for the relevant covariates. The cohort consists of primarily African-American (87%), single (87%) mothers (mean age 23.4 years). Health literacy was inadequate or marginal among 24% of mothers. Immunizations were up-to-date among 73% of infants at age 3 months and 43% at 7 months. Maternal health literacy was not significantly associated with immunization status at either 3 or 7 months. In multivariable analysis, compared to infants who had delayed immunizations at 3 months, infants with up-to-date immunizations at 3 months were 11.3 times (95%CI 6.0-21.3) more likely to be up-to-date at 7 months. The only strong predictors of up-to-date immunization status at 3 months were maternal education (high school graduate or beyond) and attending a hospital-affiliated clinic. Though maternal health literacy is not associated with immunization status in this cohort, later immunization status is most strongly predicted by immunization status at 3 months. These results further support the importance of intervening from an early age to ensure that infants are fully protected against vaccine preventable diseases.
authors.affiliation: Pediatric Generalist Research Group & the Division of General Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA. pati@email.chop.edu
authors.forename: Susmita
authors.initials: S
authors.lastname: Pati
authors.forename: Kristen A
authors.initials: KA
authors.lastname: Feemster
authors.forename: Zeinab
authors.initials: Z
authors.lastname: Mohamad
authors.forename: Alex
authors.initials: A
authors.lastname: Fiks
authors.forename: Robert
authors.initials: R
authors.lastname: Grundmeier
authors.forename: Avital
authors.initials: A
authors.lastname: Cnaan
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D057220:Health Literacy; D006801:Humans; D007114:Immunization / Q000706:statistics & numerical data*; D007223:Infant; D016015:Logistic Models; D008297:Male; D008423:Maternal Age; D008429:Maternal Welfare; D008484:Medicaid; D009035:Mothers / Q000193:education* / Q000706:statistics & numerical data; D010414:Pennsylvania; D011446:Prospective Studies; D012111:Residence Characteristics; D014481:United States; D014505:Urban Population; D055815:Young Adult