Joan E. Dodgson

Factors associated with very early weaning among primiparas intending to breastfeed.

Objectives: The major objective of this study was to identify predictor variables that accurately differentiated breastfeeding women who weaned during the first 4 weeks, those who weaned between 5 and 26 weeks, and those who weaned after 26 weeks. Predictors were demographic variables, Theory of Planned Behavior (TPB) variables, breastfeeding knowledge, and difficulties experienced during the first month. Methods: Primiparas who delivered healthy infants in an urban midwestern hospital provided initial data prior to discharge. Follow-up occurred at 1,3,6,9, and 12 months. Following appropriate bivariate analyses, polychotomous logistic regression was used to determine predictors of weaning group. Linear multiple regression was used to predict intended duration. Results: Most of the 84 women who weaned very early had intended to breastfeed considerably longer. According to the multivariate analysis, women who weaned earlier were younger, had completed fewer years of education, had a more positive bottle-feeding attitude and a less positive breastfeeding attitude, intended to breastfeed less time, had lower knowledge scores, had higher perceived insufficient milk scores, and planned to work outside the home. Variables postulated by the TPB to be direct predictors of intention explained 36% of the variance in intended duration. Conclusions: Women at risk for early weaning can be identified with reasonable accuracy using a TPB-based conceptual framework expanded to include breastfeeding specific variables. Casefinding using empirically derived screening methods and careful postpartum follow-up, along with professional intervention, should be used to avert unintended early weaning.

Theory of planned behavior-based models for breastfeeding duration among Hong Kong mothers.

BackgroundThe theory of planned behavior (TPB) has been used to explain breastfeeding behaviors in Western cultures. Theoretically-based investigations in other groups are sparse. ObjectiveTo evaluate cross-cultural application of TPB-based models for breastfeeding duration among new mothers in Hong Kong. MethodFirst-time breastfeeding mothers (N = 209) with healthy newborns provided self-reports of TPB predictor variables during postpartum hospitalization and information about breastfeeding experiences at 1, 3, 6, 9, and 12 months postdelivery or until they weaned. Three predictive models were proposed: (a) a strict interpretation of the TPB with two added proximal predictors of breastfeeding duration; (b) a replication with modification of the TPB-based model for more fully employed breastfeeding mothers from a previous study (Duckett et al., 1998); and (c) a model that posited perceived control (PC) as a mediating factor linking TPB motivational variables for breastfeeding with breastfeeding intentions and behavior. LISREL was used for the structural equation modeling analyses. ResultsExplained variance in PC and duration was high in all models. Overall fit of the strict TPB model was poor (GOFI = 0.85). The TPB for breastfeeding employed women and the PC-mediated models fit equally well (GOFI = 0.94; 0.95) and residuals were small (RMSR = 0.07). All hypothesized paths in the PC-mediated model were significant (p < .05); explained variance was 0.40 for perceived control and 0.36 for breastfeeding duration. DiscussionModels were interpreted in light of the TPB, previous findings, the social context for breastfeeding in Hong Kong, and statistical model-building. Cross-cultural measurement issues and the need for prospective designs are continuing challenges in breastfeeding research.

Uncertainty in Childhood Chronic Conditions and Family Distress in Families of Young Children

The objective of this study was to identify the relationship between the degree of uncertainty in the child’s chronic condition and family distress. Data were collected from parents (173 mothers, 150 fathers) of young children (12 to 30 months old) who had been diagnosed with a chronic physical health impairment within the past 12 months. Children were divided into separate groups, first based on the predictability of their symptoms and next based on the degree of certainty in their life expectancy. Using analysis of covariance, sex-stratified comparisons were made between the predictability groups and then between the life expectancy groups and five subscales of the Impact-on-Family Scale. Parents of young children with chronic conditions with intermittently unpredictable symptoms reported significantly more family distress than parents of children with more predictable symptoms. No significant differences were found for mothers or fathers between the degree of uncertainty in the child’s life expectancy and family distress.

Indigenous Women’s Voices: Marginalization and Health

Marginalization may affect health care delivery. Ways in which indigenous women experienced marginalization were examined. Data from 57 indigenous women (18 to 65 years) were analyzed for themes. Three themes emerged: historical trauma as lived marginalization, biculturalism experienced as marginalization, and interacting within a complex health care system. Experienced marginalization reflected participants’ unique perspective and were congruent with previous research. It is necessary for health care providers to assess the detrimental impact of marginalization on the health status of individuals and/or communities.

TRADITIONAL BREASTFEEDING PRACTICES OF THE OJIBWE OF NORTHERN MINNESOTA

The Ojibwe have transitioned over the past 100 years from a woodland people moving with the seasons, to forced confinement on rural reservations, to inner-city poverty. Traditionally, Ojibwe womens knowledge has been passed through the generations orally. Using ethnographic methods, data were gathered on traditional infant feeding practices from Ojibwe women (N = 44). Few of these traditions have been documented previously. Some traditions are similar to other indigenous cultures while others are culturally specific. Understanding traditional breastfeeding practices can provide valuable information for those working with indigenous people in a variety of settings, so that they create services that are consistent with traditional values.

Breastfeeding in the workplace. Building a support program for nursing mothers.

B reastfeeding is widely regarded .as the best nutrition and as a major preventive health measure for infants through their first birthday. A national health promotion goal for the year 2000 is that 75% of women leave the hospital breastfeeding, with 50% of these women continuing to breastfeed through their infants sixth month (US DHHS, 1990). The American Academy of Pediatrics (1992) recommends breastmilk as the only nutrition for infants during their first 6 months and, in addition to other foods, during their second 6 months. In Minnesota, 66% of new mothers leave the hospital breastfeeding (Suzukamo, L.B. Lactation tolerant. Pioneer Press, July 18, 1996, p. 2B). This is higher than the national average of 56.9% (Stahl, 1995). However, after 6 months only 22% of mothers in Minnesota are still nursing (Suzukamo, L.B. Lactation tolerant. Pioneer Press, July 18, 1996, p. 2B). Today, women with infants and toddlers are the fastest growing segment of the work force (Maume, 1991). Fifty-three percent of new mothers return to work within their infants first year (U.S. Department of Com-