Maternal and Child Health Journal

, Volume 18, Issue 5, pp 1176–1189

The Influence of Maternal Health Literacy and Child’s Age on Participation in Social Welfare Programs

  • Susmita Pati
  • Elizabeth Siewert
  • Angie T. Wong
  • Suraj K. Bhatt
  • Rose E. Calixte
  • Avital Cnaan

DOI: 10.1007/s10995-013-1348-0

Cite this article as:
Pati, S., Siewert, E., Wong, A.T. et al. Matern Child Health J (2014) 18: 1176. doi:10.1007/s10995-013-1348-0


The objective of this study is to determine the influence of maternal health literacy and child’s age on participation in social welfare programs benefiting children. In a longitudinal prospective cohort study of 560 Medicaid-eligible mother-infant dyads recruited in Philadelphia, maternal health literacy was assessed using the test of functional health literacy in adults (short version). Participation in social welfare programs [Temporary Assistance to Needy Families (TANF), Supplemental Nutrition Assistance Program (SNAP), Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), child care subsidy, and public housing] was self-reported at child’s birth, and at the 6, 12, 18, 24 month follow-up interviews. Generalized estimating equations quantified the strength of maternal health literacy as an estimator of program participation. The mothers were primarily African-Americans (83 %), single (87 %), with multiple children (62 %). Nearly 24 % of the mothers had inadequate or marginal health literacy. Children whose mothers had inadequate health literacy were less likely to receive child care subsidy (adjusted OR = 0.54, 95 % CI 0.34–0.85) than children whose mothers had adequate health literacy. Health literacy was not a significant predictor for TANF, SNAP, WIC or housing assistance. The predicted probability for participation in all programs decreased from birth to 24 months. Most notably, predicted WIC participation declined rapidly after age one. During the first 24 months, mothers with inadequate health literacy could benefit from simplified or facilitated child care subsidy application processes. Targeted outreach and enrollment efforts conducted by social welfare programs need to take into account the changing needs of families as children age.


Health literacy Enrollment Social welfare programs 



Temporary assistance to needy families


Special supplemental nutrition program for women, infant, children program


Supplemental security income


Short form test of functional health literacy in adults


Quasi-likelihood information criterion


Generalized estimating equations


Health insurance improvement project


Supplemental nutrition assistance program

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Susmita Pati
    • 1
  • Elizabeth Siewert
    • 2
  • Angie T. Wong
    • 1
  • Suraj K. Bhatt
    • 3
  • Rose E. Calixte
    • 1
  • Avital Cnaan
    • 4
  1. 1.Division of Primary Care Pediatrics, Department of Pediatrics, Stony Brook Long Island Children’s Hospital, Health Sciences Center T11-020Stony Brook UniversityStony BrookUSA
  2. 2.Statistically Speaking ConsultingWylieUSA
  3. 3.School of Medicine and Health SciencesGeorge Washington UniversityWashingtonUSA
  4. 4.Departments of Pediatrics, Epidemiology and Biostatistics, School of Medicine and Health SciencesGeorge Washington UniversityWashingtonUSA

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