To examine the association between exposure to Reach Out and Read and vocabulary outcomes in children, a consecutive sample of 200 parent/child pairs was studied at two inner-city health centers. Children at clinic A were exposed to Reach Out and Read, a clinic-based literacy intervention, for 3 years at the time of the study; children at clinic B were unexposed. Main outcome measures were the "Expressive and Receptive One Word Picture Vocabulary Tests" to measure vocabulary in the children and the "Home Literacy Orientation" scale and "READ" subscale of the STIMQ, to measure book-sharing activities. A total of 200 subjects participated, and the mean age of children was 3.8 years. Demographic characteristics were comparable for both clinics at baseline. Exposed children scored higher on receptive vocabulary (81.5 vs. 74.3; p = 0.005). They also scored higher on both the Home Literacy Orientation scale (4.3 vs. 3.3; p = 0.002) and the STIMQ-READ (12.6 vs. 11.0; p = 0.056). There were no differences in expressive vocabulary scores between the two sites (79.5 vs. 77.5; p = 0.26). In conclusion, we found a positive association between exposure to Reach Out and Read and better receptive vocabulary scores. We also found higher scores for Reach Out and Read-exposed children on measures of home reading activities.