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Maternal Health Literacy and Late Initiation of Immunizations Among an Inner-City Birth Cohort

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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.

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Acknowledgments

We would like to thank Drs. Vic Spain and Barbara Watson at the Philadelphia Department of Public Health for supervising confirmation of immunizations from the Philadelphia electronic immunization registry and their support of this project. We thank the network of primary care physicians, their patients and families for their contribution to clinical research through the Pediatric Research Consortium (PeRC) at The Children’s Hospital of Philadelphia. Dr. Pati and Ms. Mohamad were supported by a K23 HD047655 from the National Institute of Child Health and Human Development and The Children’s Hospital of Philadelphia Foerderer-Murray Award. Dr. Feemster was supported by the Robert Wood Johnson Clinical Scholars program at the University of Pennsylvania. Dr. Fiks was supported by institutional development funds from The Children’s Hospital of Philadelphia. The findings and conclusions in this manuscript are those of the authors and do not necessarily represent the views of the Philadelphia Department of Public Health.

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Author notes

  1. Kristen A. Feemster

    Present address: Division of Infections Diseases, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA

Authors and Affiliations

  1. Pediatric Generalist Research Group & the Division of General Pediatrics, The Children’s Hospital of Philadelphia, CHOP North, Room 1534, Philadelphia, PA, 19104, USA

    Susmita Pati, Zeinab Mohamad, Alex Fiks & Robert Grundmeier

  2. Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA

    Susmita Pati, Kristen A. Feemster & Alex Fiks

  3. Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA, USA

    Susmita Pati & Alex Fiks

  4. Robert Wood Johnson Clinical Scholars Program, University of Pennsylvania, Philadelphia, PA, USA

    Kristen A. Feemster

  5. Center for Biomedical Informatics, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA

    Alex Fiks & Robert Grundmeier

  6. Intern at Division of Disease Control, Immunization Program, The Philadelphia Department of Public Health, Philadelphia, PA, USA

    Kristen A. Feemster & Zeinab Mohamad

  7. Center for Clinical and Community Research, Children’s National Medical Center, Washington, DC, USA

    Avital Cnaan

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  1. Susmita Pati
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Correspondence to Susmita Pati.

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Pati, S., Feemster, K.A., Mohamad, Z. et al. Maternal Health Literacy and Late Initiation of Immunizations Among an Inner-City Birth Cohort. Matern Child Health J 15, 386–394 (2011). https://doi.org/10.1007/s10995-010-0580-0

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  • DOI: https://doi.org/10.1007/s10995-010-0580-0

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