Abstract
Background:
The home literacy environment (HLE) and joint parent–child book reading are key factors in children’s language and literacy acquisition. Child-centered literacy orientation (CCLO) refers to the child’s level of engagement in literacy events.
Aim:
To describe the HLE and identify demographic and HLE variables associated with a poor CCLO at 12 months of age.
Methods:
Parents of Singaporean children enrolled in the Growing Up in Singapore Towards healthy Outcomes (GUSTO; n = 1152, birth cohort 2009–2010) completed a childhood literacy questionnaire at 12 months to obtain scores on HLE (0–17) and CCLO (0–6). Logistic regression analyses were employed to identify predictors of low CCLO.
Results:
Parents of 525 children completed the questionnaire. Mothers were the main caregivers in half the households. Mandarin was the main language (34%). Majority of the respondents had a library card that was used less than weekly, and had fewer than 10 children’s books. 18% of parents read to the child daily, of whom one-quarter read at bedtime. Amongst half of the families who had a CCLO score of 0, two-thirds had the lowest HLE scores (0–2). Correlational analyses indicated significant association between HLE with CCLO at 12 months (p < 0.001). Non-English speaking caregivers and mothers who had only completed primary education were at high risk of a poor 12-month CCLO.
Conclusion:
A literacy-rich home environment is associated with 12-month child-centered literacy orientation. Pediatricians and early years’ professionals may be able to promote benefits of literacy related activities to families at risk of poor child-centered literacy orientation.
Introduction
The home literacy environment (HLE) has been defined either as the frequency of parent–preschooler shared reading or as a multifaceted broad definition to include measures of the duration of shared picture book reading, number of picture books, joint attention, and contextual variables such as family literacy.1–3 It is a key factor in language and literacy acquisition in children,4–7 and a broadly defined HLE accounts for up to one third the variance in an infant’s early language comprehension. 3 The term “orientation to literacy” describes children’s level of interest or engagement in literacy events. 8 Preschool parent–child book reading, a way of engaging in early literacy orientation, is identified to be a critical factor in promoting a child’s language development, emerging literacy skills, and child–caregiver attachment, affecting the child’s cognitive and socio-emotional development.4,5,8–10
Language skills in infancy have received particular attention as they influence overall development, and in particular reading achievement.3,11–20 It was shown in a longitudinal study of British and American infants to be a predictor of language and literacy outcomes at school age.19,20 Effects of phonological awareness, described as the ability of the child to attend to different language sounds on early reading skills, have been well studied as being affected by early language ability, and can be acquired by exposure to alphabet boards and playing rhyming games.21,22 Since the Reach out and Read (ROR) program, reading aloud to infants is identified to be crucial for building the earliest reading and language skills. 18 Studies of book reading have found evidence that children begin to benefit in early language and literacy skills, when regular reading begins as early as 8 months with reading routines that include sensitive and responsive, language-rich interactional routines. 12 Emergent literacy, a term used to describe skills and knowledge that children develop before they begin to read (alphabet knowledge, print concepts and word recognition) is associated with home literacy activities and early oral language comprehension and expression.22,23 It also leads to greater school success.3,10,24,25 With growing evidence of the benefits of developmentally timed interventions to support language and emergent literacy skills,6,11,12,26 it is important to know what literacy activities, and at what ages, help to promote emergent language and literacy skills in infants.
Researchers have explored the influence of environmental factors including early home literacy experiences on the development of emergent literacy and language skills.14,27,28 Coleman outlined the role of family capital on children’s literacy development.29,30 Family capital can be differentiated into human capital, social and financial capital. Human capital refers to parental educational level, their knowledge and skills. Social networks and interaction within and between families forms the social capital and financial capital refers to family income and concrete assets. Access to family capital can lead to early literacy orientation and improved reading achievement.31,32 Snow et al. and Bennett et al. examined the theoretical models of the family as educator, resilient family, and parent–school partnership on emergent literacy and language skills in children.15,33 The family as an educator model includes parental reading beliefs, literacy activities, joint reading and parental education. In the resilient family model, the family functions as a protective influence against external stressors. The parent–school partnership model occurs when parents actively support schools’ efforts in promoting their child’s language and literacy achievements. Previous studies have shown that the family as an educator model was significantly associated with emergent literacy and language skills in middle income preschool and school children,16,33 whereas children from families with high levels of stress, poor emotional environments, and financial stressors perform at lower levels than their counterparts from “resilient” homes. 34 The parent–childcare partnership model did not consistently predict literacy and language skills.15,33
Language and literacy development is also influenced by government policies. Singapore government’s bilingual policy makes it mandatory for all Singaporeans to learn two official languages: English as the first language and a mother tongue language as the second language; Mandarin (for Chinese), Malay (for Malays) or Tamil or other Indian languages (for Indians). 35 The home and education sectors play a crucial role in enforcing Singapore’s linguistic structures. Yeo et al. found a moderate relationship between HLE and preschoolers’ reading skills with family literacy activities contributing more to the variance in children’s reading outcomes. 36 HLE contributed to Chinese children’s lexical knowledge, vocabulary, and reading ability, 37 while HLE in English had an impact on word reading in school-aged Malay children in Singapore. 38
In summary, having identified the crucial influence of early language and literacy skills on infant development and the child’s later academic achievement, as well as the effect of HLE on language and literacy skills, this study set out to determine the role of HLE on the early literacy orientation of infants. While there are many studies on effects of HLE on literacy and language promotion in western population,4,14,29–/32,35,39–42 there is relatively little data on the influence of HLE on early childhood literacy orientation at 12 months of age in Singapore. Singapore is a multicultural, multi-ethnic society where families speak a wide range of languages at home. With variability in care-giving arrangements and differences in parental education levels, it is important to understand the extent that home environments are supportive of early language and literacy development. The aim of this study was to describe the HLE and identify demographic and HLE variables that predict a low early childhood literacy orientation at 12 months of age in Singapore.
Methods
Data source
This was a descriptive study involving Singaporean children enrolled in the Growing Up in Singapore Towards healthy Outcomes (GUSTO) birth cohort, which is a general population cohort. The GUSTO study recruited pregnant women aged 18 years and above, attending their first trimester antenatal dating ultrasound scan clinic at Singapore’s two major public maternity units, namely National University Hospital (NUH) and KK Women’s and Children’s Hospital (KKH) between June 2009 and September 2010. 43 The participants were Singapore citizens or permanent residents who were of Chinese, Malay, or Indian ethnicity with homogeneous parental ethnic background and were assessed in mid and last trimester on gestational age and fetal growth. During infancy, the babies were examined at home, at 3 weeks, 3 months, and 3-monthly thereafter until 15 months of age. 43 When the child turned 12 months old, parents completed a childhood literacy questionnaire that explored the HLE (Appendix A) and child’s early literacy orientation. The questionnaire was used to derive the HLE score (HLES) and Childhood Composite Literacy Orientation (CCLO) scores. Information on demographics was also collected. Of the 1152 parents recruited during pregnancy, 525 parents (45.4%) returned the questionnaire and were included in this study.
This study was approved by the institution’s ethical review boards (DSRB: B/2009/584 and CIRB: 2009/1024/E). Written informed consent was obtained from parents or legal guardians of the subjects. The study was undertaken from December 2010 to June 2012.
Outcome variables
The primary outcome was the CCLO score (max score 6) adapted from High et al., 44 a measure of the family’s ability to engage in literacy promoting activities with their child. It was derived from the composite of three component questions: (1) “What are the child’s three most favorite activities?” (2) “What are the three most favorite activities the parent/caregiver does with the child?” (3a) “Does the parent/caregiver read to the child at bedtime?” (3b) “How often is the child read to?”
Questions 1 and 2 were scored 1, if the activities were related to looking at books, children’s magazines, or any other literacy-related activity, otherwise the score given was 0. Question 3a was scored as 1 = Yes, 0 = No; and Question 3b was scored 1–3 based on the frequency of reading to the child, with a score of 3 if the frequency of reading was at least 6–7 times a week.
Predictor variables
We considered demographic and HLE variables and HLES as predictors. The HLES was derived from a composite of nine questions. Each question was scored between 0 and 2. This adapted score had a maximum score of 17, with a higher score indicating a more literacy-rich home environment. 4 The demographic variables that were analyzed were caregiver main language, mother’s education, household income, mother’s age and ethnic group, mother’s occupation, mother’s employment status, mother’s marital status, child’s gender, accommodation, and main caregiver.
Statistical analysis
Demographic and HLE variables were summarized for the entire cohort as frequency counts (%) for categorical variables, and as mean (standard deviation) and median (interquartile range) for continuous variables. In addition, demographic and HLE variables were compared statistically among CCLO score categories of 0, 1–3, and 4–6 using Fisher’s exact test for categorical variables (Monte Carlo approximation for variables with ⩾4 response categories). The Kruskal–Wallis test was used to analyze the continuous variables. Univariate logistic regression on the outcome CCLO = 0 versus CCLO > 0 was used to screen for potential predictors of CCLO = 0 from a list of demographic variables and the HLE score, for potential inclusion in a multiple logistic regression analysis. Variables significant at p < 0.20 in the univariate analysis were included in a multiple logistic stepwise regression analysis to identify a parsimonious subset of clinically relevant variables that can characterize children at high risk for CCLO = 0. Significance levels to enter and stay in the stepwise regression were 0.20 and 0.25, respectively. Variables identified using the stepwise selection algorithm were retained as the final model. Imputation of missing values was used on a limited basis for variables exhibiting “missing-ness” of <7%. This was done to preserve complete variable profiles in cases where missing values were few and scattered among participants. Missing values for categorical variables were randomly imputed across categories on the basis of observed response frequencies, while missing values for continuous variables were imputed using the median. There were no missing outcomes among continuous variables. In addition to analysis of binary CCLO score outcome (0, >0), polytomous logistic regression was used to predict the probability of a 12-month old child being in a ternary CCLO category of 0, 1–3, or 4–6 as a function of HLES category (0–2, 3–5, 6–17), caregiver main language, and mother’s highest education. In consideration of possible interactions among the factors selected, we analyzed the data using three models: (1) a full model (3 main effects, 2-way and 3-way interactions), (2) a model with 3 main effects and 2-way interactions only, and (3) a main effect model. Final model selection was based upon comparison of Akaike information criterion values (smaller is better) and likelihood ratio tests. The statistical software SAS version 9.4 was used to perform all analyses.
Results
Demographic characteristics are presented in Table 1(a) and (b). Parents who participated in the study had a slightly different ethnic profile to those who did not, with predominantly Chinese parents continuing in the study. Our study also had parents with higher maternal education, maternal age, household income, and who differed on occupation profile compared to non-respondents (Table 2).
(a) Demographic characteristics. (b) Mother’s age, number of children, and adults at home.
(a).
SGD – Singapore dollars; HDB – Public housing managed and developed by the Housing Development Board, Singapore.
Parental occupation according to the Singapore Standard Occupation Classification 2015.
The person whom the child spends majority of the day with.
(b).
Univariate analysis of demographic variables among those continuing in study vs non participants.
p-value estimated by Fisher’s exact test.
Monte Carlo estimation of exact p-values.
Majority of the infants (51%) were males. The mean (standard deviation) age of mothers was 31.1 (5.0) years and the predominant ethnic group was Chinese (62.9%) followed by Malay (23.2%). 37% of mothers had completed university education and 59.8% were born in Singapore. 30% of mothers identified with a professional job and the majority (95%) were married and living with their husbands. The household income was less than 2000 Singapore dollars in 14% of families, while 60% of the families were living in a 4–5-bedroom public flat. The mother was the main caregiver in 51.2% of households. The main language spoken was Mandarin (34%), followed by English (30%).
Home environment characteristics are presented in Table 3.
Home literacy environment characteristics.
77.9% of families reported having a library card and a third of the homes used the card more frequently than once per month. 62% had fewer than 10 children’s books. The mother read to the child in 40% of households, followed by a combination of caregivers in 24%. Nearly half of the households (43%) subscribed to newspapers or magazines.
There were 256 respondents (48.8%) with a CCLO score of 0, 230 (43.8%) with a score of 1–3, while 29 (5.5%) scored between 4 and 6. 159 respondents (30.3%) had the lowest HLE score of 0–2, 223(42.5%) a score of 3–5, and 143 (27.2%) scored between 6 and 17. There were 108 parents (21%) who reported that sharing books was one of three child’s favorite activity, while 155 parents (30%) reported that sharing books was one of three favorite activities they did with their child. The child was read to daily in 94 families (18.5%), several times a week in 193 (38%), and less than once weekly in 192 families (38%). In 145 families (29%), caregivers read to the child at bed time. Of these, caregivers in 28 families (19%) read to the child 6–7 nights/week, while in 77 families (53%) the frequency was less than three nights weekly.
Figure 1 shows the correlation between the HLES and CCLO scores. As shown, a low HLES had a high predictive probability of a low CCLO.
Predicted probability of a 12-month old child belonging to a particular CCLO category for a given HLES category.
Table 4 summarizes the univariate and multivariable logistic regression analyses performed to identify predictors of the outcome CCLO = 0 versus CCLO > 0. From stepwise multiple logistic regression analysis, HLES (p < 0.0001), caregiver language (p < 0.0001), and maternal education (p < 0.0091) were found to be significant predictors of CCLO = 0. Using polytomous multiple logistic regression to analyze the ternary CCLO outcome (0, 1–3, 4–6), the predicted probability of a 12-month old child being in any of the CCLO categories as a function of the HLES category, caregiver main language and mother’s highest education level is given in Figure 2.
Summary of logistic regression analyses to identify predictors of Childhood Centered Literacy Orientation (CCLO) score = 0.
Obtained using stepwise multiple logistic regression with p = 0.20/0.25 to enter/stay.
p-value for global hypothesis on variables with >2 levels.
Mother’s occupation/ occupation category: Legislators, Senior Officials – 1, Professional – 2, Associated Professionals and Technicians – 3, Clerical worker – 4, Service worker – 5, Agricultural worker – 6, Craftsman – 7, Plant and machine operators – 8, Homemaker – 9, Retired – 10, Student– 11, Unemployed – 12, Others – 13; Accommodation type/accommodation category: 1–2 HDB flat – 1, 2–3 HDB flat – 2, 4–5 HDB flat – 3, Condominium – 4, Executive – 5, Landed property – 6, Others – 7.
Association of HLES category, caregiver main language and mother’s highest education level with predicted probability of a 12-month old child being in CCLO categories 0, 1–3, 4–6 based on a polytomous multiple logistic regression model.
Tables 5 and 6 give comparisons of the CCLO categories 0, 1–3, and 4-6 for results based on the non-imputed data. Comparisons among categorical variables for which missing values were imputed are given in Table 7, which can be compared with those of Table 5 to assess the effect of imputation.
Comparison of demographic and home literacy environment characteristics among CCLO score categories, n (%).
Note: Counts in ‘Not answered’ category were excluded from significance tests.
Main caregiver – the person whom the child spends majority of the day with.
Fisher’s exact test p-value.
Monte Carlo estimate of Fisher’s exact test p-value.
Univariate analysis of continuous variables.
Kruskal–Wallis p-value.
Comparison of demographic and home literacy environment characteristics among CCLO score categories, n (%).
Table 7 gives comparisons among CCLO groups on variables for which missing values were imputed. These results can be compared with the non-imputed results in Table 5 to assess the effect of imputation.
Fisher’s exact test p-value.
Monte Carlo estimate of Fisher’s exact test p-value.
Discussion
We found that a literacy rich home environment highly correlates with the 12-month child-centered literacy orientation.
Home literacy environment
In 30% of the families, the HLES was in the lowest (0–2) group. Even though 77% of parents reported having a library card, only 30% of the homes used it more frequently than once per month. The 2015 national literary reading and writing survey by the National Arts Council, Singapore found that only 44% of Singaporeans read one or more literary books in the year prior, 77% purchased books from a physical bookstore and that they purchased an average of seven books. 45 Although there was no data on borrowing library books in this study, it is possible that Singaporeans prefer to buy, rather than borrow books for their own reading. Mee and Gan, 46 in their study exploring home literacy practices in Singapore, also found that 80% of parents were members of a library and the majority of the children were read to by the mother, as were 40% of children in our study using materials borrowed from public libraries. The variation in library use between our study and that of Mee and Gan could be due to differences in demographics. The majority of respondents in Mee and Gan’s study were young English speaking parents with an average income of between S$2000-S$4000 a month and majority (96%) were literate in English, 48% in Chinese, 9%in Tamil, with 45% literate in Malay.
The preference for borrowed children’s materials may be a reason why most families (62%) own few children’s books (<10) or it could be because parents may consider buying toys rather than books for their infant. In our study, 44% of the parents subscribed to newspapers and magazines, whereas only 12% of parents in Mee and Gan’s study were book club and magazine subscribers.
CCLO
Almost half (48.8%) the households in this study had a CCLO score of 0 of whom two-thirds had the lowest HLE score of 0–2. This shows that children from poor HLEs are less likely to have early literacy experiences. About half the parents in this study reported reading to the child at least daily or several times weekly, while a third read to their child at bedtime.
Early onset of shared reading is found to be a good predictor of later language and literacy development, school readiness and fosters a love of reading.12,47,48 In their meta-analysis of the relationship between book reading to preschoolers and emergent literacy, Bus et al. found that children who were read to at home have more advanced emergent literacy skills (effect size 0.59), 1 and the frequency and age of onset of reading had an impact.1,12,49 Shared book reading creates an interactional context that promotes the child’s reading interest and learning.9,13,50 It allows the mother/caregiver to ask open-ended questions, clarify abstract language, and focus on print concepts. 24 Shared reading between infants and their mothers involves a greater emphasis on use of paralinguistic communication strategies as most infants at that age are likely to be in the pre-linguistic stage. Makin examined the linguistic and paralinguistic features of the interactions between 10 mother–infant dyads during book reading. 13 Strategies used by parents were child directed speech and exaggerations facial expression, volume, and an acute responsiveness to babies’ interest in a book. 13 Parents who focus on interaction patterns encouraging active child participation, as much as on the process of reading, foster better language and literacy skills.13,26
While 30% of parents in Mee and Gan’s study read aloud to their children daily, two thirds engaged in direct instruction to help the child learn to read as they prioritized school achievement rather than reading for leisure. 46 Hence, a low CCLO score in our study could be because parents are not aware of the benefits of exposing their child to literacy related activities at an early age, and may not be concerned about literacy-related issues until the child starts formal preschool. Majid and Tan’s study of reading habits of primary school children in Singapore also concurred with that view. 51 Parental work patterns may also limit the time to get involved in reading activities with their children and a high-quality nursery system may compensate for the time constraint. 46 As the caregiver’s main language was non-English in among 61% of respondents in our study, this subgroup of bilingual or non-English speaking parents might not have utilized the availability of non-English books in public libraries and book stores.
High et al., 44 in their study on child-centered literacy orientation found that 39% of low income families had a low early childhood literacy orientation which was a similar finding in 38% of our families with a monthly income less than S$2000. They found that parents who were married or living together, English-speaking households, parents who themselves read books at least a few times weekly, and homes with more than 10 children’s books were significantly associated with the presence of CCLO. Our study yielded similar findings to those in High et al.’s study, with regard to the influence of caregiver language, mother’s education, and HLE.
Our study went further than the study by High et al, by using a cumulative score that would determine the degree of early childhood literacy orientation, rather than the presence or lack of it. As shown in Figure 1, examining the association of a cumulative CCLO score with HLES helped to identify probability of a child being in the CCLO category of 0. Tracking CCLO scores from infancy will help us examine the relationship between early CCLO and later language and literacy outcomes.
Joint literacy activities other than shared book reading are known to correlate with later reading success. 52 In our study, we differentiated families based on the presence or absence of any joint literacy-related activity at 12 months, and did not differentiate based on the type of activity. Wood investigated the type of joint parent-child literacy activities and its correlation with differences in literacy scores and found that the families that engaged in variety of joint literacy activities had higher scores on vocabulary and reading ability as compared to those who sang nursery rhymes or songs or did not participate in any literacy related activity. 52 We are keen to find out, if the nature of the joint-literacy activities other than book reading has an effect on the child’s literacy orientation in our cohort at 18 months. This will enable early years’ educators to give the right advice to caregivers on the range of literacy activities at routine health contacts, as part of literacy promotion.
Association of HLE with CCLO
We found that a literacy-rich home environment had a strong association with early childhood literacy orientation (p <0.001) with a high predicted probability of CCLO being 0 when HLES was the lowest (0–2) at 12 months of age. Schmitt et al. examined the effect of HLE on language comprehension in 50 infants after controlling for socioeconomic status and found that HLE supported receptive and expressive vocabulary in the second and third year of life. 3 Research has shown the benefits of book distribution programs on language and literacy. In an interventional study on providing developmentally-appropriate books and educational materials to parents of children between 12 and 38 months, High et al. found that the intervention was effective in promoting child-centered literacy activities (OR 4.7). 53 A similar intervention by the same authors involving 205 low income families with 5–11 month old children at baseline, found a 40% increase in CCLO in the intervention group with higher receptive and expressive vocabulary scores in older intervention toddlers. 54 This shows that a CCLO of a child in a family with less access to social and financial capital can be increased after a simple intervention of distributing children’s books, thereby promoting literacy environment. Evaluations of the Reach Out and Read program in the US found that children scored higher in receptive and expressive language with mothers listing book reading as their favorite activity and reported reading frequently. 55 Owens and Strong studied the role of student nurses in educating pregnant mothers on the benefits of emergent literacy and described the benefits of enrolling mothers in book distribution programs soon after birth. 11 Simple interventions such as this to promote early literacy have shown links to greater health literacy as adults and to greater health equities. 56 Book distribution programs in the UK such as Book Start and Kirklees’ “Babies into Books” have demonstrated the value of early book sharing and the need to educate and support caregivers in book reading activities with babies as young as 4 months. 57
Predictor variables for low CCLO
This study identified predictor variables associated with low CCLO that would enable us to identify a high-risk group for low early childhood literacy orientation. In the multivariate analysis, we found that caregiver language, HLES, and mother’s education significantly influences the CCLO score. The effect of caregiver language, maternal education on the predicted probability of getting a low or high CCLO was consistent across HLES categories.
Karrass et al., 58 in their study examining parental contextual factors and infant characteristics that predicted whether parents read aloud to their 8-month old infants, found family income and parenting stress as significant predictors. Dixon found home factors including caregiver language and mother tongue vocabulary predicted English vocabulary in bilingual kindergarteners when controlling for family income and mother’s years of education in the multilingual context of Singapore. 37 While the univariate analysis in our study suggests that mother’s age when leaving full-time education, parental ethnicity, mother’s birth residence, parental accommodation type, parental personal income, household income and mother’s reading habits were associated with a low CCLO, the multivariate analysis showed that the independent predictive value of these variables were rendered non-significant. Children from families where the caregiver’s language was not English (especially Mandarin), were from homes with poor HLEs, and had mothers who had only completed primary school were more likely to belong to a high-risk CCLO (CCLO = 0) group. Identifying such a group will enable pediatricians and early years’ professionals to focus their efforts on promoting the benefits of literacy-related activities at an early age and emphasize to caregivers that literacy promoting activities could take place through any language. It will enable public health officials to target specific literacy interventions such as the provision of developmentally appropriate books. This has been studied by High et al., 54 who found the effects of intervention stronger when parents have less education. We are unable to explain the reason for low CCLO in Mandarin speaking families and could be because of the lack of awareness that exposure to literacy activities could also happen in Mandarin.
Researchers have studied the variability in effect of HLE on language and literacy skills as a function of SES. Whilst some have shown the benefit of higher SES and more books at home on higher vocabulary and reading achievement,50,55,56,59,60,61 others have shown null effects on vocabulary in first three years of life,3,16,17 suggesting that the consequences of lower SES may accumulate with time. In our study, household income (which was used as a proxy for socioeconomic status) did not have a predictive effect on CCLO score and could be explained by the variation in the type of joint literacy activities undertaken by families across the income group. In addition, families in Singapore with higher household income tend to have foreign domestic workers as main caregivers for majority of the day. Singapore, driven by the national policy to encourage reading in children has an excellent network of libraries, making it accessible for families to borrow, rather than buy books.
Strengths and limitations
To our knowledge, this is one of the few studies exploring association of HLE with early childhood literacy orientation at 12 months of age in Singapore.
There was a difference in the distribution of ethnic groups between families who were recruited, and those who continued in the study and is a limitation. However, we believe that the association between HLES and CCLO does remain substantially the same. This study was also limited by the recruitment of families who attended public hospitals; therefore findings from this study cannot be generalized. Many children in Singapore are exposed to literacy activities through electronic media and this study did not examine the effect of electronic media exposure on early literacy orientation.
Conclusion
A literacy-rich home environment has a significant association with child-centered literacy orientation at 12 months. We identified the caregiver’s spoken language, HLES, and mother’s education as the variables that affect the 12-month child-centered literacy orientation. This information has implications for practice, as pediatricians and early years’ professionals may be able to enhance early literacy outcomes by identifying families at risk of low early childhood literacy orientation. In households where families are non-English speaking, the mothers only completed primary education, and where the HLE is poor, there is a higher risk of low child-centered literacy orientation. Further studies are needed to see how early childhood literacy orientation translates to better literacy outcomes at later ages in Singapore.
Footnotes
Appendix A
Acknowledgements
The GUSTO study group includes Allan Sheppard, Amutha Chinnadurai, Anne Eng Neo Goh, Anne Rifkin-Graboi, Anqi Qiu, Arijit Biswas, Bee Wah Lee, Birit F.P. Broekman, Boon Long Quah, Borys Shuter, Chai Kiat Chng, Cheryl Ngo, Choon Looi Bong, Christiani Jeyakumar Henry, Cornelia Yin Ing Chee, Yam Thiam Daniel Goh, Doris Fok, Fabian Yap, George Seow Heong Yeo, Helen Chen, Hugo P S van Bever, Iliana Magiati, Inez Bik Yun Wong, Ivy Yee-Man Lau, Jeevesh Kapur, Jenny L. Richmond, Jerry Kok Yen Chan, Joanna D. Holbrook, Joshua J. Gooley, Keith M. Godfrey, Kenneth Kwek, Kok Hian Tan, Krishnamoorthy Niduvaje, Leher Singh, Lin Su, Lourdes Mary Daniel, Lynette Pei-Chi Shek, Marielle V. Fortier, Mark Hanson, Mary Foong-Fong Chong, Mary Rauff, Mei Chien Chua, Michael Meaney, Mya Thway Tint, Neerja Karnani, Ngee Lek, Oon Hoe Teoh, P. C. Wong, Peter D. Gluckman, Pratibha Agarwal, Rob M. van Dam, Salome A. Rebello, Seang-Mei Saw, Shang Chee Chong, Shirong Cai, Shu-E Soh, Sok Bee Lim, Chin-Ying Stephen Hsu, Victor Samuel Rajadurai, Walter Stunkel, Wee Meng Han, Wei Pang, Yap-Seng Chong, Yin Bun Cheung, Yiong Huak Chan, and Yung Seng Lee. The authors thank Sheryl Quek for a critical review of the manuscript.
Declaration of conflicting interest
The authors declare that there are no conflicts of interest.
Funding
This work was supported by the Singapore National Research Foundation under its Translational and Clinical Research (TCR) Flagship Programme and administered by the Singapore Ministry of Health’s National Medical Research Council (NMRC), Singapore (grant numbers NMRC/TCR/004-NUS/2008 and NMRC/TCR/012-NUHS/2014). Additional funding is provided by the Singapore Institute for Clinical Sciences, Agency for Science Technology and Research (A*STAR), Singapore.