1. Texas Pediatric Society Electronic Poster Contest
Early Cognitive Stimulation: Differences by Racial/Ethnic Background & Primary Language
Ana C. Monterrey, MD1; Linzhi Xu, PhD2; Teri L. Turner MD, MPH, Med2; Jean L. Raphael, MD, MPH3
1Academic General Pediatrics Fellow, PGY4, Baylor College of Medicine 2 Department of Pediatrics, Baylor College of Medicine and Texas Children’s Hospital
Introduction
Results
Background:
Cognitive stimulation refers to caregiver efforts to enrich a child’s language and development by engaging the child in activities that promote learning and by offering a language-rich environment
Early cognitive stimulation can influence a child’s development, behavior, school readiness, and long term health
Poverty has been well documented to have a negative effect on the level of cognitive stimulation young children receive, but less well studied are the roles of race/ethnicity and language in early cognitive stimulation
Objectives:
Examine the relationship between racial/ethnic background and early cognitive stimulation
Examine the relationship between primary language spoken at home and early cognitive stimulation
Abstract
Background: Cognitive stimulation early in life is important for child development and academic success. Most studies focus on the relationship between socioeconomic status and cognitive stimulation, but data is lacking on the association between race/ethnicity, language and cognitive stimulation.
Objective: Assess the relationship between race/ethnicity, primary language and cognitive stimulation in early childhood. 
Design/Methods: The National Survey of Children's Health was used to obtain a nationally representative sample of children 0-5 years. Primary outcome variables measuring early cognitive stimulation were 1) number of days the child was read to and 2) number of days the child was sung to or told stories in the previous week. Survey responses were dichotomized to 0-2 days (little/no stimulation) and 3-7 days (significant stimulation). The primary independent variables were race/ethnicity and primary language. Multivariate logistic regression was used to determine the association between race/ethnicity, primary language, and cognitive stimulation while controlling for socio-demographic factors and child and parent health. 
Results: The odds of having been read to in the previous week were lower for African American (AA) (OR 0.50, 95% CI 0.39 – 0.64) and Hispanic (OR 0.65, 95% CI 0.53 – 0.80) children compared to White children. Children who lived in homes where English was not the primary language were also less likely to have been read to in the previous week (OR 0.37, 95% CI 0.30 – 0.45). Significant interactions were found between race/ethnicity and language for reading. Therefore results were stratified according to language. Among those whose primary language was not English, only Hispanics had a lower odds of being read to in the last week (OR 0.28, 95% CI 0.14 – 0.59). Compared to Whites, AA and Hispanic children had lower odds of being sung to or told stories stories (OR 0.72, 95% CI 0.57 – 0.90 and OR 0.78, 95% CI 0.65 – 0.94 and respectively). Children from homes where English was not the primary language also had lower odds of being sung to or told stories (OR 0.47, 95% CI 0.39 – 0.57).  
Conclusions: Racial/ethnic minorities and children from homes with a primary language other than English have lower odds of exposure to cognitively enriching activities such as reading, singing and stories. Promotion of such behaviors in the home environment can enrich the learning process of young minority children in their formative years.
Other factors negatively associated with cognitive stimulation for reading— being uninsured, parental education of only HS or less, ≥ 3 children in the home, only 1 adult in the home, and a household income of < 200% below the FPL.
Other factors negatively associated with cognitive stimulation for singing and stories— parental education of only HS or less, ≥ 2 children in the home.
Methods
Study design: Cross sectional analysis
Data source
National Survey of Children’s Health (NSCH)
Prevalence data on a variety of child health indicators in combination with demographic and household information
Telephone numbers called at random
1 child from each household chosen to be subject of the survey
Participants: Caregivers of 28,611 children 0-5 years old
Primary Outcome measures
Number of days in the previous week the child was read to
Number of days in the previous week the child was sung to or told stories
Responses were dichotomized to
little/no stimulation (0-2 days)
significant stimulation (3-7 days)
Primary Independent variables
Race/Ethnicity: White, African American, Hispanic or Multi-racial/Other
Primary Language spoken at home: English or Other
Covariates
Child: age, gender, health status, presence of special health care needs, history of developmental delay, parental concern for developmental problem, attendance to daycare/preschool, health insurance status
Parent: physical/mental health status, education level
Home environment: number of children in the home, number of adults in the home, household income
Statistical Analysis
Multivariate logistical regression to assess the association between race/ethnicity, primary language and cognitive stimulation
Interactions were assessed for race/ethnicity and primary language
Discussion
AA and Hispanic children, and those with a primary language at home other than English, had lower odds of having been read to in the previous week and lower odds of having been sung to or told stories in the previous week
Limitations of the study included:
A limited number of measures by the NSCH on cognitive stimulation, which may not present the full scope of the home learning environment
The previous week in question may not be representative of the norm
Responses were dichotomized since continuous variables were not available from the NSCH
Information was self reported and relied on recall of events by the caregiver
Conclusion
In a nationally representative sample of children, racial/ethnic minorities and children from homes with a primary language other than English had less exposure to cognitively stimulating activities
Promotion of early cognitive stimulation in the home environment can enrich the learning process of young children in their formative years
Providers should encourage all families, especially minorities and families whose primary language is not English, to engage in activities such as reading, singing and stories
References
Barros AJ, Matijasevich A, Santos IS, Halpern R. Child development in a birth cohort: Effect of child stimulation is stronger in less educated mothers. Int J Epidemiol. 2010;39(1):
Cates CB, Dreyer BP, Berkule SB, White LJ, Arevalo JA, Mendelsohn AL. Infant communication and subsequent language development in children from low-income families: The role of early cognitive stimulation. J Dev Behav Pediatr. 2012;33(7):
Lugo-Gil J, Tamis-LeMonda CS. Family resources and parenting quality: Links to children's cognitive development across the first 3 years. Child Dev. 2008;79(4):
Texas Pediatric Society Electronic Poster Contest