Skip to main content

Advertisement

SpringerLink
Log in

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

  • Published:
Maternal and Child Health Journal Aims and scope Submit manuscript

Abstract

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

Abbreviations

TANF:

Temporary assistance to needy families

WIC:

Special supplemental nutrition program for women, infant, children program

SSI:

Supplemental security income

S-TOFHLA:

Short form test of functional health literacy in adults

QIC:

Quasi-likelihood information criterion

GEE:

Generalized estimating equations

HIP:

Health insurance improvement project

SNAP:

Supplemental nutrition assistance program

References

  1. Devaney, B. L., Ellwood, M. R., & Love, J. M. (1997). Programs that mitigate the effects of poverty on children. Future of Children, 7(2), 88–112.

    Article  CAS  PubMed  Google Scholar 

  2. McKernan, S., & Ratcliffe, C. (2006). The effect of specific welfare policies on poverty. Washington: The Urban Institute.

    Google Scholar 

  3. McCartney, K., Dearing, E., Taylor, B. A., et al. (2007). Quality child care supports the achievement of low-income children: Direct and indirect pathways through caregiving and the home environment. Journal of Applied Developmental Psychology, 28(5–6), 411–426. doi:10.1016/j.appdev.2007.06.010.

    Article  PubMed Central  PubMed  Google Scholar 

  4. Lee, B. J., & Mackey-Bilaver, L. (2007). Effects of WIC and Food Stamp Program participation on child outcomes. Children and Youth Services Review, 29(4), 501–517.

    Article  Google Scholar 

  5. Haley, J. M., & Kenney, G. M. (2001). Why aren’t more uninsured children enrolled in medicaid or SCHIP?. Washington: Urban Institute. Contract No.: B-35.

    Google Scholar 

  6. Wolkwitz, K. (2008). Trends in Food Stamp Program Participation Rates: 2000–2006. Washington: Mathematica Policy Research, Inc.

    Google Scholar 

  7. Office of the Assistant Secretary for Planning and Evaluation. Indicators of Welfare Dependence, Annual Report to Congress, 2009–2013. Washington, DC: US Department of Health and Human Services.

  8. Sommers, B. D. (2005). The impact of program structure on children’s disenrollment from Medicaid and SCHIP. Health affairs (Millwood), 24(6), 1611–1618. doi:10.1377/hlthaff.24.6.1611.

    Article  Google Scholar 

  9. Lake Research Partners, Perry M. Reducing Enrollee Churning in Medicaid, Child Health Plus, and Family Health Plus. Findings from Eight Focus Groups with Recently Disenrolled Individuals New York, NY: NYS Health Foundation; February 2009.

  10. Pati, S., Kavanagh, J. E., Bhatt, S. K., et al. (2012). Reading level of medicaid renewal applications. Academic Pediatrics, 12(4), 297–301. doi:10.1016/j.acap.2012.04.008.

    Article  PubMed  Google Scholar 

  11. Pati, S., Romero, D., & Chavkin, W. (2002). Changes in use of health insurance and food assistance programs in medically underserved communities in the era of welfare reform: an urban study. American Journal of PublicHealth, 92(9), 1441–1445.

    Google Scholar 

  12. Dion, M. R., & Pavetti, L. (2000). Access to and Participation in Medicaid and the Food Stamp Program: A review of the recent literature. Washington: Mathematica Policy Research, Inc.

    Google Scholar 

  13. US Department of Health and Human Services. (2010). Healthy People Washington: Office of Disease Prevention and Health Promotion.

  14. Yin, H. S., Johnson, M., Mendelsohn, A., et al. (2009). The Health literacy of parents in the United States: A Nationally Representative Study. Pediatrics, 124, S289–S298.

    Article  PubMed  Google Scholar 

  15. Pati, S., Mohamad, Z., Cnaan, A., et al. (2010). Influence of maternal health literacy on child participation in social welfare programs: the Philadelphia experience. American Journal of Public Health, 100(9), 1662–1665. doi:10.2105/AJPH.2009.172742.

    Article  PubMed Central  PubMed  Google Scholar 

  16. Pati, S., Feemster, K. A., Mohamad, Z., et al. (2011). Maternal health literacy and late initiation of immunizations among an inner-city birth cohort. Maternal and Child Health Journal, 15(3), 386–394. doi:10.1007/s10995-010-0580-0.

    Article  PubMed  Google Scholar 

  17. Centers for Disease Control and Prevention. National Health Interview Survey. Atlanta, GA. Accessed December 4, 2012 from http://www.cdc.gov/nchs/nhis.htm.

  18. Nurss, J. R., Parker, R., Willams, M., et al. (2001). TOFHLA: Test of functional health literacy in adults (2nd ed.). Snow Camp: Peppercorn Books and Press.

    Google Scholar 

  19. Parker, R. M., Baker, D. W., Williams, M. V., et al. (1995). The test of functional health literacy in adults: a new instrument for measuring patients’ literacy skills. Journal of General Internal Medicine, 10(10), 537–541.

    Article  CAS  PubMed  Google Scholar 

  20. Office of Child Care. FY 2010 Child Care and Development Fund Data Tables. Washington, D.C.2013.

  21. Office of Family Assistance. Characteristics and Financial Circumstances of TANF Recipients FY 2010. Washington, D.C.

  22. Martinez-Schiferl M, Zedlewski S, Giannarelli L. National and State-Level Estimates of Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) Eligibles and Program Reach, 2010. Alexandria, VA: United States Department of Agriculture Food and Nutrition Service, Office of Research and Analysis,2013.

  23. Mabli J, Tordella S, Castner L, et al. Dynamics of Supplemental Nutrition Assistance Program Participation in the Mid-2000 s. Alexandria, VA: US Department of Agriculture Food and Nutrition Service, Office of Research and Analysis,2011.

  24. Bethell, C. D., Kogan, M. D., Strickland, B. B., et al. (2011). A national and state profile of leading health problems and health care quality for US children: key insurance disparities and across-state variations. Academic Pediatrics, 11(3 Suppl), S22–S33. doi:10.1016/j.acap.2010.08.011.

    Article  PubMed  Google Scholar 

  25. Kogan, M. D., Newacheck, P. W., Blumberg, S. J., et al. (2010). Underinsurance among children in the United States. The New England Journal of Medicine, 363(9), 841–851. doi:10.1056/NEJMsa0909994.

    Article  CAS  PubMed  Google Scholar 

  26. Flores, G., & Tomany-Korman, S. C. (2008). Racial and ethnic disparities in medical and dental health, access to care, and use of services in US children. Pediatrics, 121(2), e286–e298. doi:10.1542/peds.2007-1243.

    Article  PubMed  Google Scholar 

  27. Durfee, A., & Meyers, M. K. (2006). Who gets what from government? Distributional consequences of child-care assistance policies. Journal of Marriage and Family, 68(3), 733–748.

    Article  Google Scholar 

  28. Flores, G., Bauchner, H., Feinstein, A. R., et al. (1999). The impact of ethnicity, family income, and parental education on children’s health and use of health services. American Journal of Public Health, 89(7), 1066–1071.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  29. Diggle, P. J., Heagerty, P. J., Liang, K., et al. (2002). Analysis of longitudinal data. USA: Oxford University Press.

    Google Scholar 

  30. Maarascuilo, L. A. (1966). Large-sample multiple comparisons. Psychology Bulletin, 65, 280–290.

    Article  Google Scholar 

  31. U.S. Government Accountability Office. Child Care: Multiple Factors could have contributed to the Recent Decline in the Number of Children Whose Families Receive Subsidies. Washington, D.C.2010. p. 60.

  32. Meyers, M. K., Heintze, T., & Wolf, D. A. (2002). Child care subsidies and the employment of welfare recipients. Demography, 39(1), 165–179.

    Article  PubMed  Google Scholar 

  33. Danziger, S. K., Ananat, E. O., & Browning, K. G. (2004). Childcare subsidies and the transition from welfare to work. Family Relations, 53(2), 219–228.

    Google Scholar 

  34. Baum, C. L, I. I. (2002). A dynamic analysis of the effect of child care costs on the work decisions of low-income mothers with infants. Demography, 39(1), 139–164.

    Article  PubMed  Google Scholar 

  35. Shlay, A. B., Weinraub, M., Harmon, M., et al. (2004). Barriers to subsidies: Why low-income families do not use child care subsidies. Social Science Research, 33(1), 134–157.

    Article  Google Scholar 

  36. Office of Income Maintenance. Cash Assistance Application. Accessed November 1, 2012 from http://services.dpw.state.pa.us/oimpolicymanuals/manuals/bop/ca/104/Table%20of%20Contents.htm#P-1_0.

  37. Acs, G., & Loprest, P. J. (2001). Final Synthesis Report of Findings from ASPE’S ‘Leavers’ Grants. Washington: Urban Institute.

    Google Scholar 

  38. Jordan, J. E., Osborne, R. H., & Buchbinder, R. (2011). Critical appraisal of health literacy indices revealed variable underlying constructs, narrow content and psychometric weaknesses. Journal of Clinical Epidemiology, 64(4), 366–379. doi:10.1016/j.jclinepi.2010.04.005.

    Article  PubMed  Google Scholar 

  39. Baker, D. W. (2006). The meaning and the measure of health literacy. Journal of General Internal Medicine, 21(8), 878–883. doi:10.1111/j.1525-1497.2006.00540.x.

    Article  PubMed Central  PubMed  Google Scholar 

  40. Stuber, J., & Kronebusch, K. (2004). Stigma and other determinants of participation in TANF and Medicaid. Journal of Policy Analysis and Management, 23(3), 509–530. doi:10.1002/pam.20024.

    Article  PubMed  Google Scholar 

  41. Bartlett S, Bobronnikov E, Mendelson M. WIC Participation and Program Characteristics 2006. Alexandria, VA: US Department of Agriculture, Food and Nutrition Service, Office of Analysis Nutrition and Evaluation,2007.

  42. Bollinger, C. R., & David, M. H. (1993). Modeling Food Stamp Participation in the Presence of Reporting Errors. Madison: University of Wisconsin.

    Google Scholar 

Download references

Acknowledgments

We thank Kathy Fisher, Director, Family Economics Security, Public Citizens for Children and Youth for sharing her perspective about public program enrollment and renewal policies. This work was partially funded by R03HD056363 and K23HD047655 from the Eunice Kennedy Shriver National Institute of Child Health and Human Development to Dr. Pati.

Conflict of interest

None.

Author information

Authors and Affiliations

  1. Division of Primary Care Pediatrics, Department of Pediatrics, Stony Brook Long Island Children’s Hospital, Health Sciences Center T11-020, Stony Brook University, Stony Brook, NY, 11794-8111, USA

    Susmita Pati, Angie T. Wong & Rose E. Calixte

  2. Statistically Speaking Consulting, Wylie, TX, USA

    Elizabeth Siewert

  3. School of Medicine and Health Sciences, George Washington University, Washington, DC, USA

    Suraj K. Bhatt

  4. Departments of Pediatrics, Epidemiology and Biostatistics, School of Medicine and Health Sciences, George Washington University, Washington, DC, USA

    Avital Cnaan

Authors
  1. Susmita Pati
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Elizabeth Siewert
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Angie T. Wong
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Suraj K. Bhatt
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Rose E. Calixte
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Avital Cnaan
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Susmita Pati.

Appendices

Appendix 1

See Fig. 2.

Fig. 2
figure 2

Study enrollment protocol

Full size image

Appendix 2

See Table 4.

Table 4 Population characteristics for participants and non-participants
Full size table

Appendix 3

See Table 5.

Table 5 Population characteristics for analytic sample vs. subjects with incomplete data
Full size table

Appendix 4: Selected Portions of the Follow-up Survey

Health Care Access: Maternal, Child and Policy Factors

Section 4: Maternal demographic information

1.

What is your marital status?

 

a. Single

 

b. Married

 

c. Widowed

 

d. Don't know

 

e. No response

2.

What is your current living situation?

 

a. Living in own housing

 

b. Living with relatives or friends

 

c. Living in a shelter

 

d. Other (specify)

 

f. No response

3.

How many other people (like family or friends) are currently living with you or staying in your home?

4.

How many other children do you have?

5.

How many of them are living with you?

6.

What is your current employment status?

 

a. Working full-time

 

b. Working part-time

 

c. Unemployed, looking for work

 

d. Unemployed, not looking for work

 

e. Student

 

f. Don’t know

 

g. No response

7.

What is your current monthly household income:

 

a. Under $250 per month (under $3,000 per year)

 

b. $251-$500 per month ($3,012-$6,000 per year)

 

c. $501-$999 per month ($6,012-$11,988 per year)

 

d. $1,000-$1,499 per month ($12,000-$17,988 per year)

 

e. $1,500-$1,999 per month ($18,000-$23,988 per year)

 

f. $2,000-$2,499 per month ($24,000-$29,988 per year)

 

g. $2,500-$2,999 per month ($30,000-$35,988 per year)

 

h. $3,000 or above per month ($36,000 or above per year)

 

i. Don’t know

 

j. No response

Section 7: Family TANF status and other benefits

1.

Are there any other benefits that you or your family receive?a

 

a. Medical assistance (Yes/No)

 

b. Cash assistance (Yes/No)

 

c. Child care benefits (Yes/No)

 

d. WIC (Yes/No)

 

e. Housing benefits (Yes/No)

 

f. SSI (Yes/No)

2.

Have you ever enrolled a child in medical assistance/Medicaid?

 

a. Yes

 

b. No

 

c. Don’t know

 

d. No response

3.

Has anyone you know, like a friend or family member, had experience registering a child for medical assistance?

 

a. Yes (specify person)

 

b. No

 

c. Don’t know

 

d. No response

4.

How many of your children are enrolled in medical assistance?

 

a. All of them

 

b. Some of them

 

c. One of them

 

d. None

 

e. Don’t know

 

f. No response

  1. aWhen the survey was administered in person with a laptop, a pop-up window with an explanation of the program (see below) appeared for this question. When the survey was administered over the phone, the research assistants explained the programs to the mother if needed

Medical assistance (Medicaid)

Medical assistance in Pennsylvania provides payment for health care services on behalf of eligible people. Payments are made directly to the health care providers.

Cash Assistance

Pennsylvania offers cash assistance to any person or family, based on rules and standards established by the Department of Public Welfare. There are two major categories of cash assistance. They are:

  • Temporary Assistance for Needy Families (TANF): provides money for children and their parents or other relatives with whom they live, and for pregnant women.

  • General Assistance (GA): provides money for persons who do not meet the requirements for TANF. Most GA recipients are individuals or couples with no children, who have temporary or permanent disabilities that prevent their employment.

Food Stamps

Food stamp benefits are used to buy food and help eligible households obtain more nutritious diets.

WIC

WIC provides nutritious foods, nutrition counseling, and referrals to health and other social services to participants at no charge. WIC serves eligible women, infants and children up to age 5.

Child Care Benefits

In Pennsylvania, Child Care Works helps eligible families pay for child care.

Housing Assistance

For example, Public Housing, Low-Rent Housing, or Housing Choice Vouchers (formerly called “Section 8”).

Public Housing is apartments for eligible people, operated by local housing agencies.

  • Low-rent housing: The government provides funds directly to apartment owners, who lower the rents they charge tenants.

  • Housing Choice Vouchers (formerly called “Section 8”) let you find your own place to rent, using the voucher to pay for all or part of the rent.

SSI

Supplemental Security Income is a Federal income supplement program funded by general tax revenues (not Social Security taxes).

  • It is designed to help aged, blind, and disabled people, who have little or no income; and

  • It provides cash to meet basic needs for food, clothing, and shelter.

Appendix 5

See Table 6.

Table 6 Comparison of unemployment rates across health literacy levels by the Marascillo procedure
Full size table

Rights and permissions

Reprints and permissions

About this article

Cite this article

Pati, S., Siewert, E., Wong, A.T. et al. The Influence of Maternal Health Literacy and Child’s Age on Participation in Social Welfare Programs. Matern Child Health J 18, 1176–1189 (2014). https://doi.org/10.1007/s10995-013-1348-0

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10995-013-1348-0

Keywords

Search

Navigation