Laurence M. Grummer-Strawn

Breastfeeding rates in the United States by characteristics of the child, mother, or family: the 2002 National Immunization Survey.

Objective. In the third quarter of 2001, the National Immunization Survey (NIS) began collecting data on the initiation and duration of breastfeeding and whether it was the exclusive method of infant feeding. Using the data from the 2002 NIS, this study estimates breastfeeding rates in the United States by characteristics of the child, mother, or family. Methods. The NIS uses random-digit dialing to survey households nationwide with children 19 to 35 months old about vaccinations and then validates the information through a mail survey of the health care providers who gave the vaccinations. In 2002, ∼3500 households from the NIS were randomized to 1 of the 3 rotating topical modules that covered breastfeeding. Results. More than two thirds (71.4%) of the children had ever been breastfed. At 3 months, 42.5% of infants were exclusively breastfed, and 51.5% were breastfed to some extent. At 6 months, these rates dropped to 13.3% and 35.1%, respectively. At 1 year, 16.1% of infants were receiving some breast milk. Non-Hispanic black children had the lowest breastfeeding rates. Breastfeeding rates also varied by participation in day care or the Women, Infants, and Children program, socioeconomic status, and geographic area of residence. Conclusions. Although the rate of breastfeeding initiation in the United States is near the national goal of 75%, at 6 and 12 months postpartum the rates of breastfeeding duration are still considerably below the national goals of 50% and 25%, respectively. In addition, rates of exclusive breastfeeding are low. Strenuous public health efforts are needed to improve breastfeeding behaviors, particularly among non-Hispanic black women and socioeconomically disadvantaged groups.

Obesity in women from developing countries

Objectives: The key objective was to estimate obesity (≥30 kg/m2) in women 15–49 y from developing countries. A second objective was to study how obesity varies by educational level and by residence in urban and rural areas. A third objective was to investigate how national incomes shape the relationship between obesity and eduction or residence.Design: The analyses use cross-sectional data from nationally representative surveys from developing countries carried out in the last decade. Most of the surveys were Demographic Health Surveys (DHS). Data from a survey from the USA are used for comparison.Setting:The 39 surveys used come from 38 developing countries and the USA.Subjects: A total of 147, 938 non-pregnant women 15–49 y were included in the analyses.Results: The percentage of obese women was 0.1% in South Asia, 2.5% in Sub-Saharan Africa, 9.6% in Latin America and the Caribbean, 15.4% in Central Eastern Europe/Commonwealth of Independent States (CEE/CIS), 17.2% in the Middle East and North Africa, and 20.7% in the USA. Levels of obesity in countries increased sharply until a gross national product of US

Overweight Among Low-Income Preschool Children Associated With the Consumption of Sweet Drinks: Missouri, 1999–2002

1500 per capita (1992 values) was reached and changed little thereafter. In very poor countries, such as in Sub-Saharan Africa, obesity levels were greatly concentrated among urban and higher educated women. In more developed countries, such as those in Latin America and the CEE/CIS regions, obesity levels were more equally distributed in the general population.Conclusions: Based on the analyses presented and on a review of the literature, it is concluded that obesity among women is a serious problem in Latin America and the Caribbean, the Middle East and North Africa, and the CEE/CIS region. Obesity is less of a concern in Sub-Saharan Africa, China and South Asia. Obesity levels increased over time in most of the limited number of countries with data, but at varying rates. Rising national incomes in developing countries and increased ‘Westernization’ will most likely lead to increased levels of obesity in the future.Sponsorship: Financial support was provided by the Food and Nutrition Program of the Pan American Health Organization and by the World Bank.European Journal of Clinical Nutrition (2000) 54, 247–252

Effect of Maternity-Care Practices on Breastfeeding

Objective. To examine the association between sweet drink consumption and overweight among preschool children. Methods. A retrospective cohort design was used to examine the association between sweet drink consumption and overweight at follow-up among 10904 children who were aged 2 and 3 years and had height, weight, and Harvard Service Food Frequency Questionnaire data collected between January 1999 and December 2001 and height and weight data collected 1 year later. Sweet drinks included vitamin C-containing juices, other juices, fruit drinks, and sodas as listed on the Harvard Service Food Frequency Questionnaire. Logistic regression was used to adjust for age; gender; race/ethnicity; birth weight; and intake of high-fat foods, sweet foods, and total calories. Results were stratified by baseline BMI. Results. Among children who were normal or underweight at baseline (BMI <85th percentile), the association between sweet drink consumption and development of overweight was positive but not statistically significant. Children who were at risk for overweight at baseline (BMI 85th–<95th percentile) and consumed 1 to <2 drinks/day, 2 to <3 drinks/day, and ≥3 drinks/day were, respectively, 2.0 (95% confidence interval [CI]: 1.3–3.2), 2.0 (95% CI: 1.2–3.2), and 1.8 (95% CI: 1.1–2.8) times as likely to become overweight as the referent (<1 drink/day). Children who were overweight at baseline (BMI ≥95th percentile) and consumed 1 to <2 drinks/day, 2 to <3 drinks/day, and ≥3 drinks/day were, respectively, 2.1, 2.2, and 1.8 times as likely to remain overweight as the referent. Conclusions. Reducing sweet drink consumption might be 1 strategy to manage the weight of preschool children. Additional studies are needed to understand the mechanism by which such consumption contributes to overweight.

Increasing Prevalence of Overweight Among US Low-income Preschool Children: The Centers for Disease Control and Prevention Pediatric Nutrition Surveillance, 1983 to 1995

OBJECTIVE. Our goal was to assess the impact of “Baby-Friendly” hospital practices and other maternity-care practices experienced by mothers on breastfeeding duration. METHODS. This analysis of the Infant Feeding Practices Study II focused on mothers who initiated breastfeeding and intended prenatally to breastfeed for >2 months, with complete data on all variables (n = 1907). Predictor variables included indicators of 6 “Baby-Friendly” practices (breastfeeding initiation within 1 hour of birth, giving only breast milk, rooming in, breastfeeding on demand, no pacifiers, fostering breastfeeding support groups) along with several other maternity-care practices. The main outcome measure was breastfeeding termination before 6 weeks. RESULTS. Only 8.1% of the mothers experienced all 6 “Baby-Friendly” practices. The practices most consistently associated with breastfeeding beyond 6 weeks were initiation within 1 hour of birth, giving only breast milk, and not using pacifiers. Bringing the infant to the room for feeding at night if not rooming in and not giving pain medications to the mother during delivery were also protective against early breastfeeding termination. Compared with the mothers who experienced all 6 “Baby-Friendly” practices, mothers who experienced none were ∼13 times more likely to stop breastfeeding early. Additional practices decreased the risk for early termination. CONCLUSIONS. Increased “Baby-Friendly” hospital practices, along with several other maternity-care practices, improve the chances of breastfeeding beyond 6 weeks. The need to work with hospitals to implement these practices continues to exist, as illustrated by the small proportion of mothers who reported experiencing all 6 of the “Baby-Friendly” hospital practices measured in this study.

Infant Feeding Practices Study II: Study Methods

Objective. To determine whether the prevalence of overweight in preschool children has increased among the US low-income population. Design. Analysis using weight-for-height percentiles of surveillance data adjusted for age, sex, and race or ethnicity. Setting. Data from 18 states and the District of Columbia were examined. a Subjects. Low-income children <5 years of age who were included in the Centers for Disease Control and Prevention Pediatric Nutrition Surveillance System. Results. The prevalence of overweight increased from 18.6% in 1983 to 21.6% in 1995 based on the 85th percentile cutoff point for weight-for-height, and from 8.5% to 10.2% for the same period based on the 95th percentile cutoff point. Analyses by single age, sex, and race or ethnic group (non-Hispanic white, non-Hispanic black, and Hispanic) all showed increases in the prevalence of overweight, although changes are greatest for older preschool children. Conclusion. Overweight is an increasing public health problem among preschool children in the US low-income population. Additional research is needed to explore the cause of the trend observed and to find effective strategies for overweight prevention beginning in the preschool years.

Cross‐Sectional Study

OBJECTIVE. Our goal is to describe the methods used in the Infant Feeding Practices Study II (IFPS II), a study of infant feeding and care practices throughout the first year of life. Survey topics included breastfeeding, formula and complementary feeding, infant health, breast-pump use, food allergies, sleeping arrangements, mothers employment, and child care arrangements. In addition, mothers’ dietary intake was measured prenatally and postnatally. PARTICIPANTS AND METHODS. The IFPS II sample was drawn from a nationally distributed consumer opinion panel of 500000 households. All questionnaires were administered by mail, 1 prenatally and 10 postpartum. Qualifying criteria were used to achieve the sample goals of mothers of healthy term and late preterm singleton infants. In addition to the questionnaires about the infants, women were sent a diet-assessment questionnaire prenatally and at ∼4 months after delivery; this questionnaire was also sent to members of a comparison group who were neither pregnant nor postpartum. RESULTS. A sample of 4902 pregnant women began the study, and ∼2000 continued through their infants first year. Response rates ranged from 63% to 87% for the different questionnaires. Compared with adult mothers of singletons from the nationally representative sample of the National Survey of Family Growth, IFPS II participants had a higher mean education level; were older; were more likely to be middle income, white, and employed; were less likely to smoke; and had fewer other children. Compared with women who participated in the National Immunization Survey who gave birth in 2004, IFPS II mothers were more likely to breastfeed and to breastfeed longer. CONCLUSIONS. The IFPS II provides a valuable database because of its large sample size, the frequency of its questionnaires, and its wide coverage of issues salient to infant feeding.

Intention or Experience? Predictors of Continued Breastfeeding

Cross-sectional studies estimate the distribution of quantities at a certain moment in time. Only one set of observations is taken from each subject in a cross-sectional study. Cross-sectional studies may be used to estimate prevalence of a disease or risk factor, make inferences about the association between variables such as an outcome and explanatory variable, or to make inferences about disease incidence. If population characteristics are constant over time, then analysis of the age distribution of a quantity of interest can describe age-specific incidence. Multiple cross-sectional studies may be used to monitor trends in the distribution of a variable. Cross-sectional prevalence of a transient state early in disease can be used to measure disease incidence. Although cross-sectional studies may reveal suggestive associations between explanatory variables and outcomes, causality cannot usually be inferred from cross-sectional data. Cross-sectional data may also be subject to sampling biases like length-biased sampling or recall bias. Keywords: target population; longitudinal study, explanatory variable; monitoring; disease incidence; retrospective study; cost

Reasons for Earlier Than Desired Cessation of Breastfeeding

Despite the known benefits of breastfeeding, many women do not breastfeed their infants or stop breastfeeding early. This study examines the effects of prenatal intention and initial breastfeeding experiences on breast-feeding initiation and duration among 1,665 U.S. women completing questionnaires on infant feeding practices. Outcomes included no initiation of breastfeeding at birth and termination at < 10 weeks, 10 to < 20 weeks, or 20 to < 30 weeks. Predictor variables included intended breast feeding duration and early breast feeding experiences with analyses controlling for demographic characteristics, previous breastfeeding experience, and prenatal intentions to work after delivery. Prenatal intentions to never initiate or to stop breastfeeding early were significant risk factors for all breastfeeding outcomes. Initial breastfeeding experiences were significant risk factors for early termination. This study supports using the intention construct from the theory of reasoned action to predict initiation of behavior but suggests the need to include initial experience when predicting maintenance of behavior.

Assessment of iron deficiency in US preschool children and nonpregnant females of childbearing age: National Health and Nutrition Examination Survey 2003–2006

OBJECTIVE: To describe the prevalence and factors associated with not meeting desired breastfeeding duration. METHODS: Data were analyzed from 1177 mothers aged ≥18 years who responded to monthly surveys from pregnancy until their child was 1 year old. When breastfeeding stopped, mothers were asked whether they breastfed as long as they wanted (yes or no) and to rate the importance of 32 reasons for stopping on a 4-point Likert scale. Multiple logistic regressions were used to examine the association between the importance of each reason and the likelihood of mothers not meeting their desired breastfeeding duration. RESULTS: Approximately 60% of mothers who stopped breastfeeding did so earlier than desired. Early termination was positively associated with mothers’ concerns regarding: (1) difficulties with lactation; (2) infant nutrition and weight; (3) illness or need to take medicine; and (4) the effort associated with pumping milk. CONCLUSIONS: Our findings indicate that the major reasons why mothers stop breastfeeding before they desire include concerns about maternal or child health (infant nutrition, maternal illness or the need for medicine, and infant illness) and processes associated with breastfeeding (lactation and milk-pumping problems). Continued professional support may be necessary to address these challenges and help mothers meet their desired breastfeeding duration.