Caregiver-child shared reading improves literacy skills, school readiness, familial relationships, and social-emotional development. This multi-year study seeks to evaluate the effect of exposure to Reach Out and Read (ROR) on caregiver reading frequency and behaviors. Caregivers of children six months to five years in 427 primary care clinics in North and South Carolina were asked to complete the Reach Out and Read Parent Feedback Survey. Caregivers not previously exposed to ROR were categorized as "new" and those who had previously been exposed to ROR as "returning" to compare reading behaviors between groups. From 2014-2019, caregivers completed 100,656 surveys. Returning caregivers were more likely to report reading or looking at books every day. (AOR=1.27, 95% CI: 1.22-1.33). Returning caregivers were more likely to perform behaviors like letting the child turn pages (AOR=1.71, 95% CI: 1.62-1.79), making up stories about the pictures (AOR=1.46, 95% CI: 1.39-1.53), asking what is happening in the pictures (AOR=1.39, 95% CI: 1.32-1.47), helping identify things in the pictures (AOR=1.57, 95% CI: 1.50-1.65), reading to the child 30 minutes every day (AOR=1.39, 95% CI: 1.33-1.46), and taking the child to the library (AOR=1.26, 95% CI: 1.20-1.34). This study shows a significant association between caregivers' exposure to ROR, high frequency reading and positive reading behaviors, and is consistent for all six years studied. This study demonstrates the effectiveness of the Reach Out and Read model in increasing frequency of positive reading behaviors when implemented in a non-controlled clinical environment. It also shows that this effect is consistent over multiple years of observation.