Maternal and Child Health Journal

, Volume 15, Issue 3, pp 386–394 | Cite as

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

  • Susmita Pati
  • Kristen A. Feemster
  • Zeinab Mohamad
  • Alex Fiks
  • Robert Grundmeier
  • Avital Cnaan


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.


Health literacy Immunizations Pediatric care 


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Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  • Susmita Pati
    • 1
    • 2
    • 3
  • Kristen A. Feemster
    • 2
    • 4
    • 6
    • 8
  • Zeinab Mohamad
    • 1
    • 6
  • Alex Fiks
    • 1
    • 2
    • 3
    • 5
  • Robert Grundmeier
    • 1
    • 5
  • Avital Cnaan
    • 7
  1. 1.Pediatric Generalist Research Group & the Division of General PediatricsThe Children’s Hospital of PhiladelphiaPhiladelphiaUSA
  2. 2.Leonard Davis Institute of Health EconomicsUniversity of PennsylvaniaPhiladelphiaUSA
  3. 3.Center for Clinical Epidemiology and BiostatisticsUniversity of PennsylvaniaPhiladelphiaUSA
  4. 4.Robert Wood Johnson Clinical Scholars ProgramUniversity of PennsylvaniaPhiladelphiaUSA
  5. 5.Center for Biomedical InformaticsThe Children’s Hospital of PhiladelphiaPhiladelphiaUSA
  6. 6.Intern at Division of Disease Control, Immunization ProgramThe Philadelphia Department of Public HealthPhiladelphiaUSA
  7. 7.Center for Clinical and Community ResearchChildren’s National Medical CenterWashingtonUSA
  8. 8.Division of Infections DiseasesThe Children’s Hospital of PhiladelphiaPhiladelphiaUSA

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