Infant Sleep and Parent Health Literacy

Sleep Duration Is Associated with Household Food Insecurity and Sugar-Sweetened Beverage Intake Among Women, Infants and Children Participating Children Ages 0-5

PURPOSE

To determine associations between child and household characteristics and sleep duration among low-income children in Los Angeles County.

DESIGN

Cross-sectional study.

SETTING

Survey data collected in 2017 and 2020 in Los Angeles County, California.

SAMPLE

Special Supplemental Nutrition Program for Women, Infants and Children (WIC) households with children ages 4-60 months.

MEASURES

Sleep duration for children 4-60 months old (less than recommended (LTR), recommended range, more than recommended (MTR)), household food insecurity (HFI), sociodemographics, and daily servings of sugar-sweetened beverages (SSB).

ANALYSIS

Multinomial logistic regression, stratified by child age, was used to calculate odds ratios (OR) and 95% confidence intervals (CI) for associations between household/child characteristics and LTR or MTR sleep compared to recommended duration among WIC participating children 4-60 months old.

RESULTS

The final sample included 3512 children ages 4-23 months and 6035 children ages 24-60 months. In the study population, 32% (3-5 years old) to 44% (4-11months) of children under 5 did not meet the recommended hours of sleep per night. HFI was associated with higher odds of LTR (OR 1.27, CI 1.12-1.45) and MTR (OR 1.46, CI 1.15-1.87) sleep among 24-60 month-old children. Each additional daily SSB serving was associated with higher odds of LTR sleep (4-23 months: OR 1.10, CI 1.02-1.19; 24-59 months: OR 1.12, CI 1.08-1.17).

CONCLUSIONS

HFI and SSB intake are associated with not getting the recommended amount of sleep among low-income WIC participating children. Nutrition assistance program participants may benefit from receiving information about recommended sleep duration for young children and how to establish sleep routines to optimize sleep duration.

Maternal Perceptions of Evidence-Based Early Childhood Sleep Health Promotion Recommendations: An Explanatory Sequential Study

OBJECTIVES

The purpose of this explanatory sequential design study was to better understand caregivers' perceptions about and interest in evidence-based early childhood sleep health promotion recommendations.

METHOD

A purposeful sample of mothers of 20 1-5-year-old children (10 children exhibiting optimal sleep and 10 children exhibiting insufficient/fragmented sleep) attending a preschool serving a low socio-economic (SES) status metropolitan community were invited to participate in qualitative interviews. Data were coded according to a grounded theory approach and themes were identified within the optimal and suboptimal sleeper groups.

RESULTS

Mothers reported different approaches to managing electronics by optimal/suboptimal sleeper group, with mothers of optimal sleepers limiting access to electronics more than mothers in the suboptimal sleep group. Other themes of sleep health practices did not differ meaningfully between groups.

CONCLUSIONS

Maternal perspectives about early childhood sleep health were similar across optimal and suboptimal sleepers on most elements of child sleep health. Managing child sleep was contextually influenced and these results highlight the complexities of how families living in lower SES environments perceive common sleep recommendations. Thus, sleep health education efforts should be tailored to the needs and values of specific families and communities.

Health literacy and parenting infants at home: protocol for a qualitative systematic review of parents' experiences

OBJECTIVE

This systematic review will identify and synthesize the available qualitative evidence regarding parents' experiences of health literacy in parenting infants at home.

INTRODUCTION

Parental health literacy, which is essential for parents' and children's health, is associated with parents' health knowledge, parenting practices, and children's health outcomes. Parents face difficulties pertaining to their health literacy skills in daily health education and health care for their infants; therefore, understanding their parenting experience with infants from a health literacy perspective is important for health professionals. This review will evaluate and integrate qualitative evidence regarding parental experiences of health literacy in daily parenting of infants at home.

INCLUSION CRITERIA

This review will include qualitative data from empirical studies describing parents' experiences of health literacy in parenting infants at home. Parents of infants (0-1 year of age) living at home in Organisation for Economic Co-operation and Development member countries will be included.

METHODS

This review will follow the JBI approach for qualitative systematic reviews. The following databases will be searched for published and unpublished studies: MEDLINE (EBSCOhost), CINAHL (EBSCOhost), PsycINFO (EBSCOhost), and ProQuest Health and Medical Collection (in English and Japanese); Open Access Theses and Dissertations (in English); and Ichushi-Web, CiNii, and the Institutional Repositories Database (in Japanese). Study selection, data extraction, and critical appraisal of the methodological quality of studies will be undertaken by 2 reviewers independently. Data synthesis will be conducted using the meta-aggregation approach, and the synthesized findings will be assessed using the ConQual approach.

REVIEW REGISTRATION

PROSPERO CRD42022345187.

Health Disparities in Pediatric Sleep

This article reviews disparities in pediatric sleep health and sleep disorders from early childhood through adolescence (birth to age 18 years). Sleep health is a multidimensional construct including sleep duration, consolidation, and other domains, whereas sleep disorders reflect both behaviorally (eg, insomnia) and medically based (eg, sleep disordered breathing) sleep diagnoses. Using a socioecological framework, we review multilevel (ie, child, family, school, health-care system, neighborhood, and sociocultural) factors linked to sleep health disparities. Mechanistic research and studies using an intersectional lens to understand overlapping marginalized identities are needed to inform multilevel interventions to promote sleep health equity in pediatrics.

Can cry tolerance be increased in mothers of infants with sleep problems, and why does it matter? A quasi-experimental study

STUDY OBJECTIVES

Infant sleep problems are one of the most common complaints of new parents. Research to date has demonstrated a relationship between low parental cry tolerance and infant sleep problems. The aim of this study was to explore whether three emotion regulation strategies could increase parental cry tolerance.

METHODS

This study utilised a quasi-experimental design. We recruited 83 females (Mage= 32, SD= 5.26) comprising 3 groups: mothers of good sleeping infants aged 6-24 months, mothers of poor sleeping infants aged 6-24 months, and good sleeping women aged 23-40 years without children. Participants were instructed to listen to crying audio segments and indicate when they felt the child needed to be tended to (measured in seconds). This crying audio was paired with one of three emotion-regulation strategies (i.e., music, gaming, reappraisal). Each participant completed all 4 cry conditions which were counterbalanced to control for order effects.

RESULTS

We found that all three strategies yielded significantly longer reaction times (indicating higher cry tolerance) compared to the control condition (p <.001). We also found that mothers of poor sleepers and good sleeping women benefitted from all three emotion regulation strategies compared to control (p <.001 and p= <.05, respectively). The cry tolerance of mothers of good sleepers, on the other hand, did not differ between the control condition and any of the strategies (all ps >.05).

CONCLUSIONS

This demonstrates that cry tolerance can be increased using emotion regulation strategies, such as distraction via music or gaming, and reappraisal. This has clinical implications for families implementing behavioural sleep interventions.

Health Literacy of Parents and Carers in a Regional Community: A Cross-Sectional Study

BACKGROUND

Supporting a child's healthy development is determined, in part, by a parent's ability to seek, access, interpret and effectively utilize health information. This aspect of parenting draws on a set of skills referred to as health literacy.

OBJECTIVE

To assess the level of health literacy among parents/carers in a regional South Australian community.

METHODS

Parents/carers of primary school-aged children, residing in Whyalla, South Australia, were invited to complete the 13-item All Aspects of Health Literacy Survey.

RESULTS

155 parents/carers completed the survey (79% mothers). Most participants were English-speaking (97%), employed (62%) and had 2-3 children (62%), with 52% completing tertiary education. Median total health literacy scores were mostly in the moderate-high range (median 27, IQR 26,27), as were critical health literacy scores (median 7, IQR 6,8). Higher scores were reported for functional health literacy (median 8, IQR 7,9), communicative health literacy (median 9, IQR 8,9) and empowerment health literacy (median 4, IQR 3,5).

CONCLUSIONS

Our findings reveal modest levels of health literacy among a sample of parents/carers of primary school-aged children in a regional South Australian community. Further work is needed to understand the differential effect of parental health literacy on child health outcomes, and the types of strategies that may mitigate the impact of these barriers on a child's healthy development.

Health disparities in pediatric sleep-disordered breathing

Sleep-disordered breathing reflects a continuum of overnight breathing difficulties, ranging from mild snoring to obstructive sleep apnea syndrome. Sleep-disordered breathing in childhood is associated with significant adverse outcomes in multiple domains of functioning. This review summarizes the evidence of well-described ethnic, racial, and socioeconomic disparities in pediatric sleep-disordered breathing, from its prevalence to its treatment-related outcomes. Research on potential socio-ecological contributors to these disparities is also reviewed. Critical future research directions include the development of interventions that address the modifiable social and environmental determinants of these health disparities.

The Japanese version of the children's sleep habits questionnaire (CSHQ-J): A validation study and influencing factors

SUBJECT

This study aimed to validate the Japanese version of the Child's Sleep Habits Questionnaire (CSHQ-J) and identify which factors affect the CHSQ-J total score.

METHODS

The participants were 3158 children (aged 4-12 years) and their parent/guardian, as community samples from large, medium-sized, and small cities. Each parent/guardian filled in the questionnaire set (CSHQ-J, Pittsburgh Sleep Quality Index, demographic data: family structure, sleep environment, participants' present illness, and economic information); we also collected 51 clinical samples from our facility to calculate the cutoff score. According to the age of the participants in the original CSHQ (4-10 years), validation was assessed statistically via exploratory and confirmatory factor analyses and internal consistency (verified by Cronbach's α). Multivariate analysis was conducted to identify factors affecting the CSHQ-J total score.

RESULTS

We received responses from 2687 participants (response rate: 85%) and analyzed 1688 participants who were the age of the original CSHQ participants. The alpha coefficients of each subscale of the CSHQ-J ranged from 0.43 to 0.68. The cutoff score was 48 (sensitivity: 0.69, specificity: 0.79). The confirmatory and exploratory factor analyses did not converge. Multivariate analysis showed that the factors that significantly influenced the CSHQ-J total score were co-sleeping, supplemental sleep, and child's age. Present illness, especially adenoids, also significantly influenced CSHQ total score.

CONCLUSIONS

The CSHQ-J has adequate internal consistency and is useful for screening for pediatric sleep disorders. Supplemental sleep, habit of co-sleeping, and child's age should be considered when using the CSHQ-J as a screening tool for sleep problems in children.

Correlates of a caregiver-reported child sleep problem and variation by community disadvantage

BACKGROUND

Previous studies of sleep patterns and perceived problems in early childhood indicate variation by family socioeconomic status. The purpose of this study was to examine variation in correlates of a caregiver-perceived child sleep problem across and within levels of community disadvantage in a large US sample.

METHODS

Caregivers of 14,980 young children (ages 0-35.9 months) in the US completed the Brief Infant Sleep Questionnaire-Revised (BISQ-R) on the freely and publicly available Johnson's® Bedtime® Baby Sleep App. Zip code was used to identify a Distressed Communities Index (DCI) score, which represents community disadvantage based on neighborhood indicators.

RESULTS

Across all levels of community disadvantage, caregivers who reported greater impact of child sleep on their own sleep, bedtime difficulty, more frequent and longer night wakings, and increased total nighttime sleep were more likely to endorse a child sleep problem. These associations varied by level of community disadvantage. For caregivers living in more disadvantaged communities, impact of child sleep on their own sleep and night wakings were the strongest correlates of endorsing a child sleep problem, whereas for those in more advantaged communities the impact of child sleep on their own sleep and night wakings as well as additional aspects of sleep health, such as short sleep duration, were associated with endorsement of a child sleep problem.

CONCLUSIONS

Findings suggest that families living in more distressed communities are most likely to identify the impact of child sleep on their own sleep and night wakings in reporting a child sleep problem, whereas those from more prosperous communities consider these factors as well as other sleep parameters, including sleep duration. Clinicians should consider expanding screening questions for child sleep problems to include the perceived impact on caregiver sleep.

Development of a classifier to screen for severe sleep disorders in children

This study aimed to develop an automatic classifier for the identification of severe sleep disorders that require immediate intervention in children. Our study assessed 7,008 children (age: 0-83 months) in Japan, whose parents and nursery teachers recorded their 14-day sleep patterns. Sleep quality was assessed by pediatricians and scored as 1 (no severe sleep disorder) or 0 (severe sleep disorder). Discriminant analysis was performed for each age group using sleep quality (0 or 1) as the dependent variable and variables in the 14-day sleep log as independent variables. A stepwise method was used to select the independent variables to build the best model. The accuracy of the discriminant analysis for the age groups ranged from 71.3 to 97.3%. In summary, we developed an automatic classifier with sufficient application value to screen for severe sleep disorders in children. In the future, this classifier can be used to rapidly determine the presence or absence of severe sleep disorders in children based on their 14-day sleep logs, thus allowing immediate intervention.

Pathways linking parental health literacy with health behaviours directed at the child: a scoping review

Health literacy (HL) is thought to be crucial for the management of the manifold demands relating to child health which parents are faced with. Albeit many studies have investigated parental HL and health behaviours (HBs) directed at the child, knowledge about the pathways which link parental HL with HB is scarce. The aim of this scoping review was to identify and comprehensively describe the variety of pathways linking parental HL with HBs directed at the child which were empirically analysed in previous studies. Following established scoping review methods database searches were conducted in MEDLINE, EMBASE, PsycINFO and WebofScience on 5 March 2020. Eligibility criteria included primary, empirical studies assessing parental HL and HB directed at the child in the general parent population. Titles and abstracts were screened independently by six reviewers for potentially relevant publications and data were extracted using standardized data extraction forms. The search identified 6916 articles for title and abstract screening. After full-text review, 50 studies were included in this review. Most studies (N = 24) assumed a direct association between HL and HBs and only few studies (N = 4) used more complex models investigating different pathways or mediation and/or moderation models. Overall, the evidence on the underlying pathways linking parental HL and HBs directed at the child is mixed and fairly limited. Therefore, hypothesis-driven research and integration of results into theoretical frameworks is needed for advancing both the research on HL and public health practice.

Health literacy for children and families

The relationship between reading ability and health, known as health literacy, broadly reflects the skills and competencies required to operate within the healthcare environment. It is only recently that we have seen attempts to conceptualize health literacy in the context of medication use by using terms such as medication literacy. Health literacy changes over one's lifetime and is dependent on factors such as numeracy, education, income, gender and country. Low health literacy and low medication literacy have been identified as significant risk factors for poor health outcomes of adults and children. With an evaluation of common tools used to assess health literacy and medication literacy, the aim of this review is to describe the shared responsibility between patients and healthcare providers for the communication of health and medication information. Key strategies and interventions to improve two-way communication between patients and healthcare providers are highlighted, with a focus on how health literacy can impact child health outcomes.

Correlates of Sleep Duration in Early Childhood: A Systematic Review

OBJECTIVE

This systematic review aimed to summarize correlates of sleep duration in children under 5 years of age.

METHODS

Six electronic databases (PubMed, PsycINFO, MEDLINE, CINAHL, SPORTDiscus, and Scopus) were searched from inception to May 2019. Observational studies and intervention studies reporting cross-sectional results from baseline data were considered. Data were extracted using a predesigned form and potential correlates were categorized following a sociological framework.

RESULTS

One-hundred and sixteen studies, representing 329,166 children, met the inclusion criteria, with a high risk of bias in 62 included studies. A total of 83 correlates of sleep duration were identified. Among the associations studied four or more times, correlates of nap duration were child's age and nighttime sleep onset/bedtime; correlates of nighttime sleep duration were household income, parent marital status, parental adiposity level, nighttime sleep duration at younger age, nighttime sleep onset/bedtime, nighttime sleep wakeup time, and frequency of current bedtime routine; correlate of total sleep duration was screen time.

CONCLUSIONS

Young children from low-income households, single families, or having overweight parents may be at risk for short sleep duration. Promoting healthy sleep duration from an early age appears essential. Effective practices may include encouraging an earlier bedtime, limiting screen time, and establishing a regular bedtime routine. The absence of consistent evidence in the psychological, cognitive, and emotional domain as well as the physical environmental domain warrants further research.

Relationship between parents' health literacy and children's sleep problems in Japan

Background

Sleep problems in preschool children can stunt their health and growth. However, the factors that cause sleep problems in children are not well understood. The aim of this study was to determine the relationship between parents’ health literacy (HL) and children’s sleep problems. The study was conducted at two kindergartens, two nursery schools, and a center for early childhood education in Chitose-city, Hokkaido, Japan.

Method

This study used a multicenter cross-sectional design. The sample comprised 354 preschoolers (aged 3–6 years) and their parents. In families with two or more children attending the same facility, only the oldest child was asked to participate in the study. Exclusion criteria included participants whose completed questionnaires had missing values. Children’s sleep problems were assessed using the Japanese version of the Children’s Sleep Habits Questionnaire (CSHQ-J). Parents’ HL was assessed using the 14-item Health Literacy Scale (HLS-14). The parents were classified into two groups (high HL group and low HL group). Multiple regression modelling was used to determine the association between HLS-14 and CSHQ-J scores.

Results

Of the 354 parents, 255 (72%) were in the high HL group and 99 (28%) in the low HL group. The mean CSHQ-J score was significantly lower in the high HL group than in the low HL group (45.3 ± 6.0 points vs. 46.8 ± 5.9 points, p = 0.043). In multiple regression analyses, parents’ HL was independently associated with their CSHQ-J score after adjusting for all confounding factors (adjusted R² = 0.22, β = − 0.11; p = 0.043).

Conclusions

Parents’ HL appears to affect their children’s sleep problems. This finding suggests that parents’ HL may be a target for intervention to improve children’s sleep problems.

Cumulative socio-demographic risk factors and sleep outcomes in early childhood

STUDY OBJECTIVES

To examine associations between cumulative socio-demographic risk factors, sleep health habits, and sleep disorder symptoms in young children.

METHODS

Two hundred five caregiver-child dyads (child mean age ± SD: 3.3 ± 1.1 years; 53.7% girls; 62.9% black, 22.4% non-Hispanic/Latinx white, 4.4% Hispanic/Latinx; 85.4% maternal caregiver reporter) completed caregiver-rated sleep measures (Brief Child Sleep Questionnaire [BCSQ]; Pediatric Sleep Questionnaire [PSQ] snoring subscale), which were used to generate indexes of poor sleep health habits, pediatric insomnia symptoms, and obstructive sleep apnea (OSA) symptoms. A cumulative risk index was created reflecting caregiver, family, and neighborhood risks.

RESULTS

Overall, 84.5% of children had ≥ 1 poor sleep health habit, 62.9% had ≥ 1 insomnia symptom, and 40.0% had ≥ 1 OSA symptom. Poisson regression indicated that each increase in the number of cumulative risk factors was associated with a 10% increase in poor sleep health habits, a 9% increase in insomnia symptoms, and an 18% increase in OSA symptoms. Specific caregiver risks (depressive symptoms, lower educational attainment) and family risks (single caregiver, crowded home) were most predictive of poor sleep outcomes.

CONCLUSIONS

Poor sleep health habits and sleep disorder symptoms are highly prevalent in early childhood, particularly among families experiencing cumulative socio-demographic risks. Findings underscore the need for targeted screening and prevention for modifiable sleep behaviors and efforts to tailor such strategies for at-risk children and families, especially those living in crowded conditions, or with caregivers who are single or have a lower educational attainment or depressive symptoms.

Socioeconomic disadvantage and sleep in early childhood: Real-world data from a mobile health application

OBJECTIVES

To examine whether increased socioeconomic disadvantage, indexed using a measure of community distress, was associated with variation in caregiver-reported early childhood sleep patterns and problems in a large US sample using a mobile health application (app).

DESIGN

Cross-sectional.

SETTING

Data were collected using the free, publicly available Johnson's Bedtime© baby sleep app.

PARTICIPANTS

A total of 14,980 caregivers (85.1% mothers) of children ages 6-35.9 months (M = 13.88 months; 52.6% boys) participated in this study.

MEASURES

Caregivers reported on child sleep using the Brief Infant Sleep Questionnaire-Revised. Socioeconomic disadvantage was indexed by zip code using the Distressed Communities Index (DCI), which combines seven US census indicators of socioeconomic disadvantage. DCI scores range from prosperous (lowest quintile) to distressed (highest quintile).

RESULTS

Socioeconomic disadvantage was significantly associated with later bedtimes, longer sleep onset latency, and shorter nighttime and 24-hour (total) sleep duration, with children living in distressed communities showing the poorest sleep. However, caregivers living in distressed communities reported a significantly lower prevalence of overall child sleep problems (43% vs 58% in prosperous communities), and more confidence in managing child sleep (42% vs 34% in prosperous communities).

CONCLUSIONS

Children living in the most distressed communities have the poorest reported sleep patterns and bedtime behaviors; however, their caregivers are less likely to report problematic child sleep. These findings highlight the need for community-level sleep health promotion interventions, as well as further investigation of caregiver perceptions about child sleep and sleep health promotion among families living in socioeconomically disadvantaged contexts.

Early Childhood Sleep Intervention in Urban Primary Care: Caregiver and Clinician Perspectives

BACKGROUND

Despite significant income-related disparities in pediatric sleep, few early childhood sleep interventions have been tailored for or tested with families of lower socio-economic status (SES). This qualitative study assessed caregiver and clinician perspectives to inform adaptation and implementation of evidence-based behavioral sleep interventions in urban primary care with families who are predominantly of lower SES.

METHODS

Semi-structured interviews were conducted with (a) 23 caregivers (96% mothers; 83% Black; 65% ≤125% U.S. poverty level) of toddlers and preschoolers with insomnia or insufficient sleep and (b) 22 urban primary care clinicians (physicians, nurse practitioners, social workers, and psychologists; 87% female; 73% White). Guided by the Consolidated Framework for Implementation Research, the interview guide assessed multilevel factors across five domains related to intervention implementation. Qualitative data were analyzed using an integrated approach to identify thematic patterns across participants and domains.

RESULTS

Patterns of convergence and divergence in stakeholder perspectives emerged across themes. Participants agreed upon the importance of child sleep and intervention barriers (family work schedules; household and neighborhood factors). Perspectives aligned on intervention (flexibility; collaborative and empowering care) and implementation (caregiver-to-caregiver support and use of technology) facilitators. Clinicians identified many family barriers to treatment engagement, but caregivers perceived few barriers. Clinicians also raised healthcare setting factors that could support (integrated care) or hinder (space and resources) implementation.

CONCLUSIONS

Findings point to adaptations to evidence-based early childhood sleep intervention that may be necessary for effective implementation in urban primary care. Such adaptations could potentially reduce significant pediatric sleep-related health disparities.

Disparities in Sleep Health and Potential Intervention Models: A Focused Review

Disparities in sleep health are important but underrecognized contributors to health disparities. Understanding the factors contributing to sleep heath disparities and developing effective interventions are critical to improving all aspects of heath. Sleep heath disparities are impacted by socioeconomic status, racism, discrimination, neighborhood segregation, geography, social patterns, and access to health care as well as by cultural beliefs, necessitating a cultural appropriateness component in any intervention devised for reducing sleep health disparities. Pediatric sleep disparities require innovative and urgent intervention to establish a foundation of lifelong healthy sleep. Tapping the vast potential of technology in improving sleep health access may be an underutilized tool to reduce sleep heath disparities. Identifying, implementing, replicating, and disseminating successful interventions to address sleep disparities have the potential to reduce overall disparities in health and quality of life.

Association of health literacy and sleep problems with mental health of Chinese students in combined junior and senior high school

OBJECTIVES

The aim of this study was to examine the association between health literacy (HL) and sleep problems with mental health of Chinese students in combined junior and senior high school.

METHODS

A cross-sectional study was conducted among seven hundred and seventy-five students from a combined junior and senior high school in Shenyang on December 16, 2016. HL, sleep problems, anxiety symptoms and depressive symptoms were measured by self-reported validated instruments. Multiple logistic regression models were used to examine the association of HL and sleep problems with mental health problems.

RESULTS

The prevalence of anxiety symptoms and depressive symptoms was 24.6% and 45.2%, respectively. Low HL was significantly associated with anxiety symptoms (OR = 2.457, 95%CI: 1.493-4.045) and depressive symptoms (OR = 5.164, 95%CI: 3.233-8.250). Sleep problems were significantly positively correlated with anxiety symptoms (OR = 4.237, 95%CI: 2.831-6.341) and depressive symptoms (OR = 3.170, 95%CI: 2.084-4.823). The students who had sleep problems with low HL had the highest risks of anxiety symptoms (OR = 11.440, 95%CI: 5.564-23.520) and depressive symptoms (OR = 19.470, 95%CI: 8.143-46.558).

CONCLUSION

Our findings suggest that Chinese students in combined junior and senior high school who had sleep problems with low HL are at risk of exhibiting anxiety symptoms and depressive symptoms. Intervention programs of mental health problems should enhance HL level and improve sleep quality.

Health Literacy: Implications for Child Health

Health literacy is an important issue to consider in the provision of health-care to children. Similar to the adult population, most parents face health literacy challenges. Of particular concern, 1 in 4 parents have low health literacy, greatly affecting their ability to use health information to make health decisions for their child. High expectations are placed on parents and children to achieve effective disease management and positive health outcomes in the context of complex health-care systems and disease treatment regimens. Low health literacy affects parent acquisition of knowledge, attitudes, and behaviors, as well as child health outcomes across the domains of disease prevention, acute illness care, and chronic illness care. The effect of low health literacy is wide ranging, including 1) poor nutrition knowledge and behaviors, 2) higher obesity rates, 3) more medication errors, 4) more emergency department use, and 5) poor asthma knowledge, behaviors, and outcomes. Health-care providers can mitigate the effects of health literacy by seeking to align health-care demands with the health literacy skills of families. Effective health literacy-informed interventions provide insights into methods that can be used by providers and health systems to improve health outcomes. Health literacy-informed communication strategies should be used with all families in a "universal precautions approach" because all parents likely benefit from clear communication. As scientific advances are made in disease prevention and management, unless families understand how to follow provider recommendations, the benefit of these advances will not be realized and disparities in outcomes will be exacerbated.

Shared Reading and Television Across the Perinatal Period in Low-SES Households

The American Academy of Pediatrics recommends that shared reading commence as soon as possible after birth and screen-based media be discouraged for those less than 18 months old. Early routines can predict long-term use and health outcomes. This longitudinal study involved low-socioeconomic status mothers (n = 282) enrolled in home visiting. Surveys were administered prenatally and at 2 months old regarding shared reading and infant television viewing, and health literacy was screened prenatally. Planned age to initiate reading decreased from 2.8 to 1.8 months old, 80% reading by 2 months old, averaging 1 to 3 days per week, with "too busy" being the major barrier. Planned age for infant TV decreased from 13.2 to 4.3 months old, 68% viewing by 2 months old and more than half daily. TV was observed in 70% of infant sleep environments. Health literacy was correlated with perceived developmental benefits of shared reading (positively) and TV viewing (negatively), 43% of mothers scoring at risk for inadequate levels. A majority cited the prenatal period as opportune to discuss reading and TV.

Associations between Parents' Health Literacy and Sleeping Hours in Children: A Cross-Sectional Study

Background: Sleep in preschool children is an important factor for their health and active lives. The lack of adequate sleep in preschool children is a serious public problem in Japan. The relationship between health literacy (HL) and health status is well recognized. The purpose of this study was to investigate the association between the sleep duration of preschool children and the HL of their parents. Methods: In the present study, participants were preschool children (3–6 years) and their parents. We assessed the HL of the parents with the 14-item Health Literacy Scale (HLS-14) questionnaire. Sleep duration of the children was reported by their parents. We divided parents into two groups according to HLS-14 score and analyzed children’s sleeping time separately. Results: Data from 279 parents and their children were ultimately analyzed. The high HL group comprised 210 families (75.3%) and the low HL group comprised 69 families (24.7%). Average children’s sleep duration was significantly longer in the high HL group (9.5 ± 0.9 h) than in the low HL group (9.1 ± 1.1 h) (p = 0.013). A positive correlation was found in the low HL group between parents’ HL and their children’s sleeping times (p < 0.01, r = 0.32) but the difference was not significant in the high HL group (p = 0.98, r = −0.0009). Conclusion: The HL of parents appears to affect their children’s sleep duration, suggesting that parental HL may be an appropriate target for interventions aiming to lengthen children’s sleeping time.

Parental Health Literacy and Outcomes of Childhood Nephrotic Syndrome

OBJECTIVE

Determine the association of parental health literacy with treatment response among children with nephrotic syndrome.

METHODS

This was a cohort study of children aged 1-18 with nephrotic syndrome and their parent. Health literacy was measured using the validated Short Test of Functional Health Literacy in Adults assessing reading comprehension and numeracy. Outcomes included initial relapse-free period, frequently relapsing disease, relapse rate, second-line medication use, and complete remission after therapy.

RESULTS

Of 190 parents, 80% had adequate health literacy (score >67 of 100), and higher scores were not correlated with higher education. Almost all achieved perfect numeracy scores (>86%); numeracy was not associated with outcomes. After adjusting for immigration, education, and income, higher reading comprehension scores (tertile 3) compared with lower scores (tertile 1) were significantly associated with lower risk of first relapse (hazard ratio 0.67, 95% confidence interval [CI] 0.48-0.94, P trend = .02), lower odds of frequently relapsing disease (odds ratio [OR] 0.38, 95% CI 0.21-0.70, P trend = .002), lower relapse rate (rate ratio 0.77, 95% CI 0.73-0.80, P trend < .001), and higher odds of complete remission after both initial steroids and cyclophosphamide (OR 2.07, 95% CI 1.36-3.16, P trend = .003; OR 5.97, 95% CI 2.42-14.7, P trend < .001).

CONCLUSIONS

Lower parental health literacy, specifically reading comprehension, is associated with higher relapse rates among children with nephrotic syndrome and fewer achieving complete remission. This underscores the importance of assessing and targeting health literacy for chronic management of childhood-onset diseases.