Researchers gave 557 parents the Short Test of Functional Health
Literacy. Then they asked them if they had
a TV in the room where their child sleeps. Those who scored below the
“adequate” range for health literacy were more likely to have a TV in the
child’s room, and more likely to report their child slept less than the
reported mean. So the child’s inadequate sleep and related behavioral problems, poor school
performance and obesity s are attributed to parents “inadequate” or “marginal”
health literacy. This report reminds me of the classic example in statistics
class: Research shows that men with hair in their ears are significantly more
likely to have heart attacks. The quiz: Does hair in the ears cause heart
attacks? Should we recommend removing hair from the ears to reduce risk? Should
we test all men with hairy ears for atherosclerosis? Of course not You’re right. The lesson is that association does not equate to
cause. Despite statistical significance, hair in the ears is not a reliable
indicator of elevated risk of heart attack. You can imagine the disservice to
men with hairy ears: anxiety, needless testing, unnecessary tweezing. I
wondered then, and still, why was that study published? Statistically significant, practically meaningless The TOFHLA is a
timed (7-minute maximum) reading comprehension test on instructions to
prepare for a medical procedure. Despite it’s name, it is widely criticized as
a test of health-related literacy and not a measure of the broader
concept of health literacy. TOFHLA
scores predicted the location of the TV, just as hairy ears predicted heart
attack. Publishing the association as if it matters suggests that if
those parents could read better, they would know pediatricians recommend
against a TV in the nursery; and knowing that, they would comply; and therefore
the child would sleep more; and therefore, the child would be healthier. That is a long line of assumptions that disrespects parents and
offers little guidance for improving their reading ability or their health
literacy, or for supporting
unskilled readers to be good parents, or for communicating more clearly that
location of the TV matters to the child’s heath. It should be noted that nearly
half of parents who performed well on the test also reported a TV in the
nursery; and a third of those who performed poorly on the test placed the TV
elsewhere. More than half of infants with a TV in the room had normal sleep
duration. I have high respect for these researchers and their
contributions to the field. Still, this study is one that should not have been
published. It places way too much faith in a reading test that has long been criticized as an inadequate
measure, and not nearly enough
faith in parents. Reference Bathory E1, Tomopoulos S2, Rothman R3, Sanders L4, Perrin EM5, Mendelsohn A2, Dreyer B2, Cerra M2, Yin HS2. Infant Sleep and Parent Health Literacy. Acad Pediatr. 2016 Mar 12. pii: S1876-2859(16)30046-8. doi:
10.1016/j.acap.2016.03.004. [Epub ahead of print] |
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CategoriesHealth LiteracyMaternal Child Health Test |
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