Laura J. Duckett

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.

Women's Experiences With Combining Breast‐Feeding and Employment

A group of primiparas who combined breast-feeding and employment are described in terms of how they felt about the experience, the difficulties they encountered, factors that affected their total duration of breast-feeding, and patterns of feeding while separated from their infant. These women are contrasted with primiparas who weaned prior to returning to work and those who remained homemakers. Of the 619 women included in the analyses, 499 (80.6%) of the women returned to work or school by 12 months postpartum and 288 (46.5%) continued to breast-feed after returning to work. Women who combined breast-feeding and employment were older, had more years of education, worked fewer hours per week, and more worked in professional jobs than those who weaned prior to returning to work. A number of women who chose to express breast milk only at home thought they would have had problems with having enough time and finding a place to express and to store expressed milk had they tried to express breast milk at work. The overwhelming majority of women who combined breast-feeding and employment felt that it was worth the trouble, that they would recommend it to others, and that they had done something special for their infants that no one else could do. The findings suggest that nursing interventions and workplace accommodations could assist more women to experience the benefits and rewards of continuing to breast-feed after returning to employment.

Progress in the Moral Reasoning of Baccalaureate Nursing Students between Program Entry and Exit

Changes in moral reasoning between entry into and exit from a baccalaureate nursing program and the relationship between student characteristics and moral reasoning at entry and exit were explored in this descriptive study. The moral reasoning of four cohorts of students was measured using the Defining Issues Test (DIT). Admission grade point average, prior college credits, and gender accounted for 10% of the variance in DIT P% scores at entry and 14% of the variance at exit from the program. Female students had significantly higher moral reasoning scores than men. Age did not contribute significantly to explaining DIT score variance. DIT P% scores at entry for all four cohorts were within the range of reported norms for college students. Exit scores for all four cohorts were between the normative means for undergraduate students and graduate students. DIT P% score gains between entry and exit were significant for all four cohorts. Students whose entry scores were in the lowest categories had the greatest mean gains.

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-

Perceptions of health among immigrant Latino adolescents from Mexico.

Purpose: This ethnographic study describes the health-related perceptions of immigrant Latino adolescents from Mexico. Method: Fourteen adolescents, purposively recruited from two non-health-based community settings, participated. Each was interviewed twice and completed a visual narrative project using disposable cameras. Audiotaped transcripts and photographs were inductively analyzed. Findings: Being healthy is holistically perceived by these adolescents and includes physical, mental, spiritual, social, and environmental factors. Pictures portrayed healthy and unhealthy influences and behaviors, including eating habits, exercise, self-care, relationships, garbage, and pollution. Personal responsibility was important in being healthy and in promoting ones health. Family was identified as an important source of health-related information. Implications: Nurses recognizing the holistic, comprehensive health-related perceptions of immigrant Latino adolescents can promote their health and design culturally and developmentally appropriate educational strategies and health interventions aimed at eliminating health disparities.