Linda Lange

Provider encouragement of breast-feeding: evidence from a national survey.

Objective To examine the influence of provider encouragement on breast-feeding among women of different social and ethnic backgrounds in the United States. Methods A nationally representative sample of 2017 parents with children younger than 3 years was surveyed by telephone. The responses of the 1229 women interviewed were included in the analysis. Respondents were asked to recall whether their physicians or nurses had encouraged or discouraged them from breast-feeding. The effects of provider encouragement on breast-feeding initiation and duration were evaluated by multivariate logistic regression. The sample was then stratified to allow subset analyses by race and ethnicity, education, income class, age group, and marital status. Results More than one-third (34.4%) of respondents did not initiate breast-feeding. Three-fourths (73.2%) of women reported having been encouraged by their physicians or nurses to breast-feed; 74.6% of women who were encouraged initiated breast-feeding, compared with only 43.2% of those who were not encouraged (P < 0.001). Women who were encouraged to breast-feed were more than four times (relative risk 4.39; 95% confidence interval 2.96, 6.49) as likely to initiate breast-feeding as women who did not receive encouragement. The influence of provider encouragement was significant across all strata of the sample. In populations traditionally less likely to breast-feed, provider encouragement significantly increased breast-feeding initiation, by more than threefold among low-income, young, and less-educated women; by nearly fivefold among black women; and by nearly 11-fold among single women. Conclusion Provider encouragement significantly increases breast-feeding initiation among American women of all social and ethnic backgrounds.

A school salad bar increases frequency of fruit and vegetable consumption among children living in low-income households

OBJECTIVE To measure change in fruit and vegetable (F&V) consumption among elementary-school children after the introduction of a salad bar programme as a lunch menu option in the US Department of Agricultures (USDA) reimbursable lunch programme in Los Angeles Unified School District (LAUSD). DESIGN A cross-sectional sample of children was interviewed before and after a salad bar intervention (1998 and 2000, respectively) utilising a 24-hour food recall questionnaire. Frequencies of F&V consumption were calculated. SETTING The evaluation took place in three LAUSD elementary schools participating in the salad bar programme and the USDA reimbursable lunch programme. SUBJECTS Three hundred and thirty-seven children in 2nd-5th grade (7-11 years old). RESULTS After the salad bar was introduced, there was a significant increase in frequency (2.97 to 4.09, P < 0.001) of F&V consumed among the children studied. The increase in frequency of F&V consumed was almost all due to an increase during lunch (84%). Mean energy, cholesterol, saturated fat and total fat intakes were significantly lower in the children after the salad bar was introduced in the schools compared with the intakes in the children before the salad bar was introduced. CONCLUSION A salad bar as a lunch menu option in the USDA reimbursable lunch programme can significantly increase the frequency of F&V consumption by elementary-school children living in low-income households.

Childbirth education classes: sociodemographic disparities in attendance and the association of attendance with breastfeeding initiation.

Objectives: To examine sociodemographic disparities in attendance at childbirth classes, and to evaluate the association of attendance with breastfeeding initiation. Methods: Parents of a nationally representative, cross-sectional sample of 2068 children ages 4–35 months were surveyed by telephone. The responses of 1540 mothers were included in the analysis. They were asked whether they had attended a childbirth class before giving birth. Disparities in attendance at childbirth classes and the association between attendance and breastfeeding initiation were examined using bivariate and multivariate logistic regression analyses. Results: Two thirds (66%) of the childrens mothers had ever attended a childbirth class. White mothers were twice as likely (OR 2.15, CI 1.39, 3.31) as African American mothers to have ever attended. Attendance also varied by education, household income, and marital status. Attendance at childbirth classes was associated with a 75% increase in the odds that a child will be breastfed (OR 1.75, CI 1.18, 2.60). Conclusions: Significant sociodemographic disparities exist in attendance at childbirth classes. Further research is needed to determine whether improving utilization of childbirth education classes reduces sociodemographic disparities in breastfeeding initiation.

The association between reported childhood sexual abuse and breastfeeding initiation.

This study examined the association between self-identified childhood sexual abuse and breastfeeding initiation. A nationally representative sample of 2017 parents with children younger than 3 yearswas surveyed by telephone about child-rearing needs. Respondents were asked to report childhood sexual abuse and breastfeeding practices. Responses of 1220 biological mothers were analyzed. A possible association between self-reported childhood sexual abuse and breastfeeding initiation was investigated through multivariate logistic regression. Seven percent of the respondents reported experiencing childhood sexual abuse. Women who reported childhood sexual abuse were more than twice (adjusted odds ratio = 2.58; 95% confidence interval = 1.14, 5.85; P= .02) as likely to initiate breastfeeding compared with women who did not report childhood sexual abuse. Parenting attitudes and behaviors were compared to consider whether greater concern with parenting is an explanation for this association. In this nationally representative sample, self-identified childhood sexual abuse is associated with an increased likelihood of breastfeeding initiation.

Breast milk expression in the workplace: A look at frequency and time

The objective of this article is to study a barrier for breastfeeding women working full-time outside the home: breast milk expression in the workplace. Data are from a large corporation that provides employee benefits. Mothers express breast milk about twice a day when infants are 4 months old (x = 2.2 ± 0.8) and 6 months old (x = 1.9 ± 0.6), with a significant decline in frequency (P < .05) comparing the 2 age groups. Most mothers spend 1 hour or less expressing breast milk when infants are 3 (82%) or 6 months old (96%), with a significant difference (P < .05) between the 2 age groups. Mothers of younger infants were no more likely to work fewer days per week than were mothers of older infants. Most women can express breast milk for 3- and 6-month-old infants in less than an hour, distributed in about 2 separate portions, in an employment environment supportive of breastfeeding.

Predictors of Breastfeeding Duration for Employees of the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC)

During the past decade there has been increasing breastfeeding support within the Women, Infants, and Children (WIC) program. For this study, it was hypothesized that employees at WIC would initiate and continue to breastfeed significantly longer than the National averages. Female employees, mostly paraprofessionals, from six Los Angeles County WIC agencies participated in the study to determine breastfeeding rates and predictors of breastfeeding success. As expected, 99% of WIC employees initiated breastfeeding and 68.6% continued to breastfeed to one year, significantly exceeding National averages. Four variables accounted for 30% of the variance in duration of breastfeeding: intent to exclusively breastfeed, delayed introduction of infant formula, attendance at breastfeeding support groups and availability of work-site breastpumps. Given that nearly 70% of the study participants reached the American Academy of Pediatrics goal of breastfeeding to 12 months or more, it is clear that full-time employment and breastfeeding can be compatible given appropriate work-site support.

Participatory prevention research model promotes environmental change for healthier schools.

Barriers exist to healthy eating and physical activity for children in the school environment. Modifiable school environmental factors have led to the development of the Nutrition Friendly Schools and Communities (NFSC) model to prevent the development of overweight in school children and adolescents. The design of the NFSC environmental intervention is to actively engage the school community to prevent overweight in school-aged children. This article presents data measuring the environmental changes achieved by the Los Angeles Unified School District (LAUSD) elementary schools participating in a 3-year participatory research pilot study funded by the Centers for Disease Control and Prevention (CDC). An objective of the pilot study is to determine whether any or all of the 15 steps developed for the NFSC model could be implemented. Further, researchers want to know if any of the study schools could implement the NFSC model as a whole during the allotted time of the pilot study.

The Differential Effect of Hospital-Based Provider Encouragement to Breastfeed among White, Hispanic and African American Mothers: Evidence from the Commonwealth Survey of Parents with Young Children

The Differential Effect of Hospital-Based Provider Encouragement to Breastfeed among White, Hispanic and African American Mothers: Evidence from the Commonwealth Survey of Parents with Young Children