Elizabeth F. Racine

How Motivation Influences Breastfeeding Duration Among Low-Income Women

In-depth interviews were conducted with 44 low-income breastfeeding women to explore the incentives and disincentives to breastfeeding experienced within 6 months postpartum. Using an individual net benefit maximization (INBM) framework based on economic theory, we assessed womens motivations, incentives, and disincentives for breastfeeding. Based on the framework and their experience breastfeeding, women fell into 3 groups: intrinsically motivated, extrinsically motivated, and successfully experienced with both intrinsic and extrinsic motivation. Successfully experienced women were most likely to breastfeed to 6 months. Intrinsically motivated women valued breastfeeding but often required information and instruction to reach breastfeeding goals. Extrinsically motivated women were least likely to continue breastfeeding even with support and instruction. Providers can screen women to determine their experience and motivation then tailor interventions accordingly. Intrinsically motivated women may need support and instruction, extrinsically motivated women may benefit from motivational interviewing, and successfully experienced women may need only minimal breastfeeding counseling. J Hum Lact. 25(2):173-181

The effect of home-delivered Dietary Approach to Stop Hypertension (DASH) meals on the diets of older adults with cardiovascular disease

BACKGROUND Many older adults with hyperlipidemia or hypertension participate in the Older Americans Act Nutrition Program, which serves meals in community settings and delivers meals to homes. However, there is little information regarding whether therapeutic meals designed around Dietary Approach to Stop Hypertension (DASH) principles have a beneficial effect on the diets of these older adults. OBJECTIVE The objective of this study was to determine the degree to which dietary change is influenced by providing 7 home-delivered therapeutic meals weekly to adults aged > or = 60 y. DESIGN We conducted a 1-y randomized controlled trial in 298 persons with hyperlipidemia or hypertension, in which 50% of participants received 7 therapeutic meals per week for 12 mo. Those in need of dietary change at baseline (n = 210) were examined. Changes in intermediate DASH accordance, DASH accordance, and the nutrients that make up the DASH diet were measured by using 24-h food recalls at baseline, 6 mo, and 12 mo. Chi-square tests, t tests, and multiple regression were used to examine the association between receipt of meals and dietary change over time. RESULTS Participants who received meals were 20% (P = 0.001) more likely to reach intermediate DASH accordance at 6 mo and were 18% (P = 0.007) more likely to meet saturated fat accordance at 12 mo than were those who did not receive meals. When stratified by race and income, gains were marginally larger for whites and higher-income individuals. CONCLUSION Delivery of 7 DASH meals per week was found to increase compliance with dietary recommendations among noncompliant older adults with cardiovascular disease.

Girls on the Run: A Quasi-Experimental Evaluation of a Developmentally Focused Youth Sport Program

BACKGROUND Evidence supporting the effectiveness of a developmental-focused youth sport (DYS) program designed exclusively for elementary school aged girls is mounting. The purpose of this study was to evaluate the impact of on the Girls on the Run program on psychological and physical assets among 3rd- to 5th-grade girls. METHODS A longitudinal quasi-experimental study was conducted to evaluate intervention effects among 877 participants categorized into 1 of 3 groups (never, newly, and previously exposed). A 64-item self-report survey measured developmental assets at 3 time-points. Nested random effects ANOVA models were used to compare demographic factors and psychological and physical assets between exposure groups and to compare longitudinal differences in these assets. RESULTS After adjustment for multiple comparisons, previous program participants had significantly higher physical activity commitment (P = .006) and physical activity levels (P = .047) at preintervention than never exposed. From pre- to postintervention body image improved in newly exposed participants (P = .03). Physical activity increased from preintervention to follow-up among never and newly exposed participants (all P < .05). CONCLUSIONS Although we were unable to fully confirm the study hypotheses, the results of the current study provide new evidence to support future long-term studies examining the effectiveness of an innovative DYS program for 3rd- to 5th-grade girls.

The Relationship Between Media Use and Psychological and Physical Assets Among Third- to Fifth-Grade Girls

BACKGROUND Media use is associated with an increased risk of chronic disease and reduced quality of life among children. This study examined the relationship between media use during discretionary hours after school and psychological and physical assets among preadolescent girls. METHODS A cross-sectional analysis was conducted using data from a larger quasi-experimental evaluation of a positive youth development program through sport for third- to fifth-grade girls. Indicators of media use were the number of hours per school day spent watching television and videos and using computers. Psychological assets included global self-esteem, body size satisfaction, and commitment to physical activity; physical assets included physical activity. Nested random effects analysis of variance (ANOVA) models were used to examine the relationship between media use and psychological and physical assets controlling for relevant confounding factors. RESULTS The analytic sample included 1027 participants; most were ≥10 years old, non-White; 27% self-reported ≥4 hours of media use on school days. In adjusted results, media use was inversely associated with self-esteem (p = .008) and commitment to physical activity (p < .001). Time spent using media was not associated with body size satisfaction or physical activity in this age group. CONCLUSIONS Media use was negatively associated with self-esteem and commitment to physical activity. It may be useful for school professionals to encourage after-school programs that offer opportunities for girls to reduce sedentary pursuits and improve important psychological and physical assets.

Perceived Infant Feeding Preferences of Significant Family Members and Mothers’ Intentions to Exclusively Breastfeed

Background: Breastfeeding intention is a significant predictor of initiation and duration. The decision to breastfeed may be influenced by the opinions of family and friends. Objective: This study aimed to examine the relationship between maternal perception of the infant feeding preferences of the baby’s father and the maternal grandmother and the woman’s intention to breastfeed. Methods: This study analyzed data from the Infant Feeding Practices Survey II (2005-2007). Results: The sample included 4690 women, of whom approximately 82% were white, 67% were married, 68% were multiparous, and 66% had some college education or beyond. In adjusted analyses, the odds of intending to exclusively breastfeed in the first few weeks postpartum were higher among mothers who perceived that the baby’s father or the maternal grandmother preferred exclusive breastfeeding (vs preferred other feeding) (fathers: odds ratio [OR] = 7.44; 95% confidence interval [CI], 6.20-8.92; maternal grandmothers: OR = 2.45; 95% CI, 2.01-2.99). Mothers in each of the racial/ethnic groups examined were more likely to intend to exclusively breastfeed in the first few weeks postpartum if they perceived that the expectant father preferred exclusive breastfeeding (vs preferred other feeding methods) (white: OR = 7.67; 95% CI, 6.25-9.41; black: OR = 11.76; 95% CI, 4.85-28.51; Hispanic: OR = 7.01; 95% CI, 3.44-14.28; other: OR = 7.51; 95% CI, 3.39-16.67). Conclusion: These results suggest that significant family members should be counseled on the benefits of breastfeeding and the risks of formula feeding along with pregnant mothers.

Family Meals and Diet Quality Among Children and Adolescents in North Carolina

OBJECTIVE To examine the relationship between diet quality and frequency of family meals throughout childhood and adolescence. METHODS Cross-sectional study of children ages birth through 17 years (n = 1,992) using data from the 2010 North Carolina Child Health and Monitoring Program. Multiple logistic regression was used to estimate the associations between family meals and fruit intake, vegetable intake, and sugar-sweetened beverage intake among younger children, older children, and adolescents. RESULTS In adjusted analyses, participating in ≥ 5 family meals/wk was associated with less sugar-sweetened beverage intake among younger (OR 2.04; CI 1.06-3.93) and older children (OR 2.12; 95% CI 1.27-3.55), greater vegetable intake among older children (OR 1.87; 95% CI 1.08-3.24) and adolescents (OR 1.81; 95% CI 1.14-2.88), and greater fruit intake among adolescents (OR 2.11; 95% CI 1.40-3.19). CONCLUSIONS AND IMPLICATIONS Strategies to encourage families to establish regular family meals early in life and continue them throughout childhood and adolescence is warranted.

Understanding Characteristics of Families Who Buy Local Produce

OBJECTIVE To examine individual characteristics associated with local produce purchasing among North Carolina families with children. DESIGN Cross-sectional analysis using data from the 2008 North Carolina Child Health Assessment and Monitoring Program (NC CHAMP), a representative sample of adults who have land-line telephones. SETTING North Carolina. PARTICIPANTS Families with children who participated in the NC CHAMP (n = 2,932). MAIN OUTCOME MEASURE Frequency of buying local produce from local vendors in the past year. ANALYSIS Bivariate and multivariate zero-inflated negative binomial regression identified characteristics associated with not buying local produce and, among those who purchased local produce, the frequency of purchasing. RESULTS About half of families reported buying local produce on average once a month during the past year. In adjusted results, buying local produce was more likely among white families, lower income families, families living in rural areas, families with children who ate 5 or more servings of fruits and vegetables per day, and families with children in poor health. CONCLUSIONS AND IMPLICATIONS Findings suggest that it may be useful for dietitians and health promotion professionals to assess the availability of local produce in urban areas and to focus interventions to promote local produce purchases among black families.

Use of Complementary and Alternative Medicine For Physical Performance, Energy, Immune Function, and General Health Among Older Women and Men in the United States

We examined use of complementary and alternative medicine (CAM) for health and well-being by older women and men. Data were from the 2007 National Health Interview Survey, representing 89.5 million Americans ages 50+. Multivariate logistic regression accounted for the survey design. For general health, 52 million people used CAM. The numbers for immune function, physical performance, and energy were 21.6, 15.9, and 10.1 million respectively. In adjusted results, women were much more likely than men to use CAM for all four reasons, especially energy. Older adults, particularly women, could benefit from research on CAM benefits and risks.

Serum Micronutrient Concentrations and Risk of Uterine Fibroids

BACKGROUND Although uterine fibroids are among the most common gynecologic conditions affecting women in the United States, research on uterine fibroids is sparse. This study explored the association between micronutrients and uterine fibroids. METHODS We conducted a population-based, cross-sectional analysis of 887 women aged 20-49 who participated in the 2003-2004 National Health and Nutrition Examination Survey (NHANES). Serum micronutrient levels were collected during the health examinations, and information on uterine fibroids was assessed on self-reported questionnaires. Multivariate logistic regression was used to calculate odds ratios (ORs) and 95% confidence intervals (CIs) while controlling for confounders. RESULTS A statistically significant dose-response relationship was observed between vitamin A and uterine fibroids, after adjustment for age, race, education, body mass index (BMI), and oral contraceptive (OC) use (middle vs. low: OR 2.43, 95% CI 1.35-4.37; high vs. low: OR 2.66, 95% CI 1.16-6.10, p for trend=0.02). After adjustment, a dose-response relationship also emerged for vitamin C, although these associations were not statistically significant. CONCLUSIONS It is possible that certain micronutrients affect uterine fibroid development. If this is confirmed in large prospective studies, clinicians could advise susceptible populations on dietary changes to reduce their risk of uterine fibroids.

The Characteristics and Concentration of SNAP-Approved Stores and Community Health

We conducted a cross-sectional, ecological study of the Supplemental Nutrition Assistance Program (SNAP) food environment in a large US Southeastern urban county, examining types of stores that accept SNAP, foods sold, and store locations. Negative binomial regression examined associations between the concentration of SNAP-approved full-service and limited-service stores and premature death to due heart disease and diabetes. Most SNAP-approved stores in low-income communities offered limited food choice; less than 1% sold fresh fruits and vegetables. In adjusted analysis, each additional limited-service SNAP store was associated with 23% more premature deaths due to heart disease.