Beth H. Olson

High-Soluble-Fiber Foods in Conjunction With a Telephone-Based, Personalized Behavior Change Support Service Result in Favorable Changes in Lipids and Lifestyles After 7 Weeks

OBJECTIVE To evaluate whether an intervention of foods high in soluble fiber from psyllium and/or oats plus a telephone-based, personalized behavior change support service improves serum lipids and elicits cholesterol-managing lifestyle changes vs usual care. DESIGN 7-week randomized, controlled intervention. SUBJECTS/SETTING 150 moderately hypercholesterolemic men and women, age range 25 to 70 years. INTERVENTION The intervention group consumed 4 servings/day of high-fiber foods and had weekly telephone conversations with a personal coach who offered support and guidance in making lifestyle changes consistent with the National Cholesterol Education Programs (NCEP) cholesterol-lowering guidelines. The usual care group received a handout describing the NCEP Step-1 diet. MAIN OUTCOME MEASURES Serum lipids and lipoproteins and self-reported lifestyle changes. STATISTICAL ANALYSES For physiologic and dietary changes, mixed linear models for repeated measures were applied. Models were simplified using analysis of covariance where age in years was the covariate. Traditional general linear models were used to assess lifestyle changes. RESULTS In the intervention group total cholesterol (TC) decreased 5.6%, low-density lipoprotein (LDL) cholesterol 7.1%, LDL/high-density lipoprotein (HDL) cholesterol ratio 5.6%, and triglycerides (TG) 14.2% (P<.0167); decreases in TC and LDL were significantly different from the usual care group. In the usual care group TC decreased 1.9%, LDL 1.2%, LDL/HDL 1.9%, and TG 4.4% (all not significant). The intervention group also reported an increase in their knowledge, ability, and confidence to make cholesterol-managing diet and exercise changes compared with the usual care group (P<.05). The intervention group had a greater decrease in energy intake from saturated fat (-1.6%) and increase in soluble fiber intake (7.3%) than the usual care group (P<.05). The intervention group reported an increase in exercise vs the usual care group (P<.05). Both intervention and control groups had a minimal reduction (<1%) in body weight compared with baseline (P<.0167). APPLICATIONS/CONCLUSIONS A 7-week intervention that includes both functional foods and individualized, interactive support for behavior change could be an effective model for dietitians to use with patients at risk for CVD, pending results of long-term studies.

Characteristics Associated With Longer Breastfeeding Duration: An Analysis of a Peer Counseling Support Program

Breastfeeding peer counseling support programs for low-income women have been implemented across the United States. Data from one such program were used to examine participant and program characteristics, of those enrolled prenatally (n = 2168) or postnatally (n = 2899), and to determine how these characteristics affected breastfeeding outcomes. Shorter breastfeeding duration was significantly predicted by introduction of formula on day 1 postpartum in participants enrolled prenatally (—37.9 days [95% CI: —57.9 to —17.9]) as well as postnatally (—49.1 days [95% CI: —63.4 to —34.8]). In both groups, increasing maternal age and previous breastfeeding experience were associated with significantly longer breastfeeding duration. Breastfeeding duration may be improved in programs by targeting younger mothers, those without breastfeeding experience, and focusing on delaying the introduction of formula. J Hum Lact. 25(1):18-27.

Low-income mothers' decisions regarding when and why to introduce solid foods to their infants: influencing factors.

Preventive measures for long-life illnesses such as asthma, obesity, and diabetes can start as early as in infant feeding practices. The American Academy of Pediatrics recommends introducing babies to solid foods, anything other than breast milk or formula, no earlier than 4–6 months of age (Kleinman, 2004). This studys 1 purpose was to assess beliefs and attitudes of mothers enrolled in Medicaid about the introduction of solid foods and other infant feeding behaviors. Six focus groups (N = 23) were conducted with Black and Caucasian mothers with infants under 1 year old. The Theory of Planned Behavior was used as a framework for moderator questions and interpretation of themes. Maternal knowledge about infant feeding, maternal perceptions of applicability of infant feeding guidelines, and manner and type of information useful for infant feeding decisions emerged as themes. Implications of themes for informing an educational program for mothers to delay the introduction of solid foods are discussed. 1Funded by the Michigan Department of Community Health and Michigan State University.

Health professionals' perspectives on the infant feeding practices of low income mothers.

The purpose of this study was to determine the perspectives of health professionals on assisting low income mothers with infant feeding. Low income mothers interact with a variety of health professionals through medical care and public health programs. Mothers indicate that health professionals are an important source of infant feeding information; however, they also report this information to be conflicting or difficult to follow. Five focus groups were conducted with 36 health professionals (pediatricians, nurses, WIC professionals, and Cooperative Extension nutrition educators). Individual interviews were also conducted with WIC professionals who were unavailable to meet as a group. Focus groups and interviews were audio taped, transcribed, and analyzed for common content categories. Six major content categories emerged from focus groups and individual interviews with health professionals: (1) Mothers’ sources of infant feeding information, (2) Helping mothers deal with multiple sources of infant feeding advice, (3) Use of infant feeding recommendations by health professionals and their clients (4) Reasons mothers introduce cereal early to their infants (5) Mothers feeding infants in poor mealtime environments, and (6) Ways of providing education to mothers on infant feeding. Conclusions: A better understanding of health professionals’ perspectives on working with low income mothers on infant feeding will inform nutrition education for these mothers, and may also inform strategies to improve communication between mothers and health professionals, subsequently improving infant health.

Perspectives of Managers Toward Workplace Breastfeeding Support in the State of Michigan

Managers’ attitudes influence female employees’ perceptions of workplace breastfeeding support. Five focus groups were conducted with managers in the state of Michigan (N = 25) to assess their attitudes toward supporting breastfeeding. All focus group discussions were recorded, transcribed verbatim, and analyzed for themes. Participants supported efforts by managers and companies to assist breastfeeding employees, but the extent of accommodations they supported varied. Most participants reported no company breastfeeding policy or were unaware of their company having one and showed mixed attitudes about needing a policy. Participants acknowledged the potential for lower productivity and coworker jealousy toward time for breastfeeding or expressing milk but believed that benefits of support included employee recruitment and retention. Participants demonstrated some understanding of breastfeeding benefits. They identified barriers and facilitators for breastfeeding support at both the organizational and individual levels. Results of this study will be used for instrument development to measure managers’ attitudes toward supporting breastfeeding.

Healthy babies through infant-centered feeding protocol: an intervention targeting early childhood obesity in vulnerable populations

BackgroundPoor feeding practices during infancy contribute to obesity risk. As infants transition from human milk and/or formula-based diets to solid foods, these practices interfere with infant feeding self-regulation and healthy growth patterns. Compared with other socioeconomic groups, lower-income mothers are more likely to experience difficulty feeding their infants. This may include misinterpreting feeding cues and using less-than-optimal feeding styles and practices, such as pressuring infants during mealtimes and prematurely introducing solid food and sweetened beverages. The Healthy Babies trial aims to determine the efficacy of a community-based randomized controlled trial of an in-home intervention with economically and educationally disadvantaged mother-infant dyads. The educational intervention is being conducted during the infants first 6 months of life to promote healthy transition to solids during their first year and is based on the theory of planned behavior.Methods/DesignWe will describe our study protocol for a multisite randomized control trial being conducted in Colorado and Michigan with an anticipated sample of 372 economically and educationally disadvantaged African American, Hispanic, and Caucasian mothers with infants. Participants are being recruited by county community agency staff. Participants are randomly assigned to the intervention or the control group. The intervention consists of six in-home visits by a trained paraprofessional instructor followed by three reinforcement telephone contacts when the baby is 6, 8, and 10 months old. Main maternal outcomes include a) maternal responsiveness, b) feeding style, and c) feeding practices. Main infant outcome is infant growth pattern. All measures occur at baseline and when the infant is 6 and 12 months old.DiscussionIf this project is successful, the expected outcomes will address whether the home-based early nutrition education intervention is effective in helping mothers develop healthy infant feeding practices that contribute to improving infant health and development and reducing the risk of early-onset childhood obesity.Trial RegistrationCurrent Controlled Trials ACTRN126100000415000

Key Theoretical Frameworks for Intervention: Understanding and Promoting Behavior Change in Parent–Infant Feeding Choices in a Low-Income Population

The early introduction of solids to infants is a risk factor associated with later health problems including allergies, overweight, and diabetes. The Infant Feeding Series (TIFS), a newly designed curriculum that promotes the appropriate transition to solids through parenting education and behavior change among low-income mothers, used the Theory of Planned Behavior and the Transtheoretical Model of Change to develop TIFS curricular foci and activities. Using a pre-post design, pilot study results indicate that after exposure to the TIFS curriculum, mothers had significantly increased knowledge about appropriate infant feeding, could more accurately identify developmental indicators of infants’ readiness for solids, and reported greater feelings of self efficacy about initiating and maintaining healthy feeding practices. Editors’ Strategic Implications: Replication is necessary, but TIFS appears to be a promising prevention program based on short-term knowledge and long-term behavioral outcomes (i.e., healthy feeding practices).

A Qualitative Study to Understand Cultural Factors Affecting a Mother’s Decision to Breast or Formula Feed:

Background: The presence of barriers is not sufficient to explain breastfeeding rate disparities. A relatively unexplored area in coping with breastfeeding barriers is culture. Objective: This research aims to better understand the role of culture in a woman’s infant feeding decision by using race and socioeconomic status as indicators of culture. Methods: Focus groups and individual interviews were conducted with 42 pregnant women or mothers of infants younger than 12 months. Focus group composition was determined by self-identified African American or white race and self-reported eligibility for the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) or ineligibility (non-WIC). Results: Most participants acknowledged that breastfeeding was best, yet differences arose between groups in the perception of, and reaction to, breastfeeding barriers. WIC and non-WIC participants of both races indicated that some circumstances necessitated formula use. WIC participants felt that this was personally and socially acceptable due to need, whereas non-WIC participants felt that this was personally and socially unacceptable. When a barrier arose, WIC participants of both races felt that the infant feeding choice was not theirs and formula use might be inevitable. In contrast, non-WIC participants of both races expressed that they persevered to continue breastfeeding and did so by establishing small, achievable goals and seeking mentors. Conclusion: Educational and public health efforts to reduce breastfeeding disparities may be enhanced if support is tailored to acknowledge cultural differences among women and address factors that make either breastfeeding or formula feeding acceptable, or even preferable, within their communities.

Self-Reported Reasons for Breastfeeding Cessation among Low-Income Women Enrolled in a Peer Counseling Breastfeeding Support Program

Background: Peer counseling programs have demonstrated efficacy in improving breastfeeding rates in the low-income population, but there is little research concerning why women enrolled in these programs ultimately discontinue breastfeeding. Objective: This study aimed to describe the self-reported reasons for discontinuing breastfeeding among women who are receiving peer counseling support by participant characteristics and timing of discontinuation. Methods: This study is a secondary analysis of data collected from 7942 participants who discontinued breastfeeding while enrolled in a peer counseling breastfeeding support program from 2005 to 2011. Reasons for discontinuing breastfeeding were assessed in relation to participant characteristics and weaning age using chi-square analyses and Kruskall-Wallis analyses of variance. Results: The most common reasons reported for discontinuing breastfeeding were mother’s preference (39%) and low milk supply (21%), although reasons differed by age of infant weaning (P < .001). Among participants who discontinued the earliest, the most commonly cited reasons were breastfeeding challenges [median duration (interquartile range), 4.7 (2.0, 13.4) weeks], followed by low milk supply [8.9 (4.6, 19.1) weeks] and mother’s preference [12.9 (5.0, 25.7) weeks]. Women who were younger, were less educated, were non-Hispanic black, were unmarried, and had no prior breastfeeding experience were the most likely to discontinue breastfeeding due to mother’s preference. Conclusion: Peer counselors are in a unique position to offer breastfeeding education and encouragement and may be able to use evidence presented here to anticipate specified concerns either prenatally or postpartum, to prevent early breastfeeding discontinuation.

Assessing the Validity of Measures of an Instrument Designed to Measure Employees' Perceptions of Workplace Breastfeeding Support

OBJECTIVE Breastfeeding rates among working mothers are lower than among mothers who are not employed. An ecological framework suggests that health behaviors, such as breastfeeding, are influenced by intrapersonal and environmental factors. There is no existing instrument to measure womens perception of the workplace environment in providing breastfeeding support. The objective of this study was to pilot an instrument measuring perceptions of the work climate for breastfeeding support among working women. STUDY DESIGN Data were collected from self-administered mailed questionnaires filled out by 104 pregnant women or women who had recently given birth and were employed and breastfeeding. RESULTS Dimensionally analyses supported the two-dimensional model suggested by the literature. Internal consistency reliability coefficients were high (near 0.90), and the correlation between the subscales was moderately strong (0.68). CONCLUSIONS Only a single item exhibited misfit to the scaling model, and that item was revised after review.