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J Pediatr. 2014 Mar;164(3):577-83.e1. doi: 10.1016/j.jpeds.2013.11.014. Epub 2013 Dec 25.

Parent health literacy and "obesogenic" feeding and physical activity-related infant care behaviors.

Author information

  • 1Department of Pediatrics, New York University School of Medicine, New York, NY. Electronic address:
  • 2Department of Pediatrics and Center for Health Policy, Stanford University, Stanford, CA.
  • 3Department of Internal Medicine and Pediatrics, Vanderbilt University Medical Center, Nashville, TN.
  • 4Department of Pediatrics, New York University School of Medicine, New York, NY.
  • 5Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN.
  • 6Department of Pediatrics, University of North Carolina at Chapel Hill School of Medicine and Cecil G. Sheps Center for Health Services Research, Chapel Hill, NC.



To examine the relationship between parent health literacy and "obesogenic" infant care behaviors.


Cross-sectional analysis of baseline data from a cluster randomized controlled trial of a primary care-based early childhood obesity prevention program (Greenlight). English- and Spanish-speaking parents of 2-month-old children were enrolled (n = 844). The primary predictor variable was parent health literacy (Short Test of Functional Health Literacy in Adults; adequate ≥ 23; low <23). Primary outcome variables involving self-reported obesogenic behaviors were: (1) feeding content (more formula than breast milk, sweet drinks, early solid food introduction), and feeding style-related behaviors (pressuring to finish, laissez-faire bottle propping/television [TV] watching while feeding, nonresponsiveness in letting child decide amount to eat); and (2) physical activity (tummy time, TV). Multivariate logistic regression analyses (binary, proportional odds models) performed adjusting for child sex, out-of-home care, Women, Infants, and Children program status, parent age, race/ethnicity, language, number of adults/children in home, income, and site.


Eleven percent of parents were categorized as having low health literacy. Low health literacy significantly increased the odds of a parent reporting that they feed more formula than breast milk, (aOR = 2.0 [95% CI: 1.2-3.5]), immediately feed when their child cries (aOR = 1.8 [1.1-2.8]), bottle prop (aOR = 1.8 [1.002-3.1]), any infant TV watching (aOR = 1.8 [1.1-3.0]), and inadequate tummy time (<30 min/d), (aOR = 3.0 [1.5-5.8]).


Low parent health literacy is associated with certain obesogenic infant care behaviors. These behaviors may be modifiable targets for low health literacy-focused interventions to help reduce childhood obesity.

Copyright © 2014 Mosby, Inc. All rights reserved.

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