Article

Maternal and Child Health Journal

, Volume 15, Issue 3, pp 386-394

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

  • Susmita PatiAffiliated withPediatric Generalist Research Group & the Division of General Pediatrics, The Children’s Hospital of PhiladelphiaLeonard Davis Institute of Health Economics, University of PennsylvaniaCenter for Clinical Epidemiology and Biostatistics, University of Pennsylvania Email author 
  • , Kristen A. FeemsterAffiliated withLeonard Davis Institute of Health Economics, University of PennsylvaniaRobert Wood Johnson Clinical Scholars Program, University of PennsylvaniaIntern at Division of Disease Control, Immunization Program, The Philadelphia Department of Public HealthDivision of Infections Diseases, The Children’s Hospital of Philadelphia
  • , Zeinab MohamadAffiliated withPediatric Generalist Research Group & the Division of General Pediatrics, The Children’s Hospital of PhiladelphiaIntern at Division of Disease Control, Immunization Program, The Philadelphia Department of Public Health
  • , Alex FiksAffiliated withPediatric Generalist Research Group & the Division of General Pediatrics, The Children’s Hospital of PhiladelphiaLeonard Davis Institute of Health Economics, University of PennsylvaniaCenter for Clinical Epidemiology and Biostatistics, University of PennsylvaniaCenter for Biomedical Informatics, The Children’s Hospital of Philadelphia
  • , Robert GrundmeierAffiliated withPediatric Generalist Research Group & the Division of General Pediatrics, The Children’s Hospital of PhiladelphiaCenter for Biomedical Informatics, The Children’s Hospital of Philadelphia
  • , Avital CnaanAffiliated withCenter for Clinical and Community Research, Children’s National Medical Center

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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.

Keywords

Health literacy Immunizations Pediatric care