The influence of maternal health literacy and child's age on participation in social welfare programs.

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.

Measurement of maternal instrumental support: findings from three population-based cohort studies.

To advance the conceptualization and measurement of mother-reported instrumental support, the degree to which an individual receives assistance in the completion of daily life tasks. The psychometric properties of a 9-item instrumental support scale were evaluated using classical (descriptive statistics, factor analyses, evaluation of construct validity) and modern (Rasch modeling, differential item functioning) methods. Differences in perceived instrumental support were evaluated as a function of mothers' socio-demographic characteristics. Factor analytic and differential item functioning analyses provided support for two components of instrumental support, household and childcare assistance. Instrumental support is distinct from structural support and the quality of mothers' social relationships. Socio-demographic characteristics (e.g., marital status, education level, income) are associated with access to instrumental support. Differentiating appropriately between support subtypes may reveal important differences in mother's qualitative instrumental support experiences and facilitate effective targeting of social support interventions.

A family psychosocial risk questionnaire for use in pediatric practice.

The objective of this study is to develop new methods to better identify psychosocial risk such that children with the greatest risk of poor future outcomes receive more intensive preventive health services. Based on structured literature review and secondary data analysis, a 52-item psychosocial risk questionnaire was administered to 2,083 families of children (<36 months). To quantify the questionnaire's construct validity, developmental concern was assessed with the Ages and Stages Questionnaire version II (ASQ) [n = 1,163]. An iterative model selection process was used to produce the most parsimonious predictive model. Model fit was examined using c-statistics, the Hosmer-Lemeshow test, and a heuristic measure of model overfit based on the fitted log-likelihood values and associated number of degrees of freedom. We found 13 items easily obtained from parental report produced a regression model with a c-statistic of 0.70. Using an integer scoring system derived from the regression model, we calculated stratum specific likelihood ratios to revise a given prior probability of ASQ failure. The posterior probability of ASQ failure was 44.9 % for a child in the highest risk group (score >25) on the questionnaire, more than double our observed average failure rate of 19.5 %, while it was less than 7 % for a child with the lowest possible score on the questionnaire. Thirteen parent-reported items can be compiled into a summary psychosocial risk questionnaire that predicts failure on developmental screening among preschool children. With further validation, this questionnaire could conceivably be used by clinicians to tailor pediatric preventive care to children at varying levels of risk.

Reading level of Medicaid renewal applications.

OBJECTIVE: To examine compliance of Medicaid-renewal applications to established state guidelines for reading level of Medicaid-related materials. METHODS: We assessed the reading level of the 2008 Medicaid renewal applications by using 3 readability tests: Flesch-Kincaid Grade Level Index, New Fog Count, and FORCAST. RESULTS: In 2008, 45 states and the District of Columbia had reading level guidelines for Medicaid-related materials. Of these, 24 (52.2%) states' Medicaid renewal applications failed to meet their guidelines on all 3 readability tests; in particular, 41 states (89.1%) failed the Flesch-Kincaid Grade Level Index. Only one state's application had a Flesch-Kincaid score below a 5th-grade reading level. CONCLUSIONS: As health care reform unfolds, complying with established reading level guidelines for Medicaid-related materials is one simplification strategy that should be implemented to improve access for Medicaid-eligible families and prevent eligible children from losing coverage unnecessarily.

Transdermal contraception as a model for adolescent use of new methods.

PURPOSE: To examine the factors related to adolescents' decisions to use the transdermal contraceptive patch (patch) so as to develop a model for understanding how adolescents decide to use new contraceptive methods. METHODS: We conducted in-depth semi-structured interviews with 18 young women aged 15-21 years who had experience using the patch. Data were analyzed using a two-stage method informed by grounded theory. RESULTS: We constructed a two-level model, encompassing individual, social, and environmental factors, to explain adolescents' decisions to use a new method of hormonal contraception. Social and environmental influences on the decision-making process included media, social network experiences and opinions, healthcare providers, and partner relationships. These in turn affected the following individual factors in the decision to use the patch: individual characteristics, method knowledge and beliefs, method support, and past contraceptive experience. The newness of the patch permeated all levels of the decision-making process. CONCLUSIONS: This model provides a framework for understanding the use of new contraceptive methods and can inform clinical strategies for contraceptive counseling with adolescents.