Mary Beth Flanders Stepans

Influence of intention and self-efficacy levels on duration of breastfeeding for midwest rural mothers

OBJECTIVES The purpose of this study was to explore the relationship of two modifiable factors (intention to breastfeed for 6 months and breastfeeding self-efficacy) with the duration of breastfeeding in primiparous women. FINDINGS Analyzed by logistic regression in a single prediction model, stronger intention (odds ratio = 1.89) and higher levels of self-efficacy at 2 weeks postpartum (odds ratio = 1.04) were significantly (p < .05) associated with an increased probability of breastfeeding for 6 months. CONCLUSIONS The combined influence of higher intention and self-efficacy increased the likelihood of breastfeeding for the recommended 6 months. Interventions to reinforce both should be designed and evaluated.

Measuring infant exposure to environmental tobacco smoke.

Methods to measure infant exposure to environmental tobacco smoke (ETS) are needed to identify infants at highest risk for ETS-related health problems. The purpose of this study was to validate measures sensitive to changes in levels of infant exposure to ETS and to develop a predictive model of infant exposure to ETS. Fifteen infants of smoking mothers were followed from birth to 6 weeks of age. Exposure to ETS was measured by using a smoking habits questionnaire, cigarette “butt” collection, infant urine nicotine and cotinine levels, and ambient nicotine (personal air monitors). The 24-hour cigarette butt collection was the best predictor of acute (adjusted r2 = .83) and chronic exposure (adjusted r2 = .47) measured by infant urinary nicotine and cotinine levels when the infants were 2 weeks of age. Including scores on the smoking habits questionnaire and ambient nicotine levels increased the adjusted r2 to .88 and .61, respectively.

The Relationship Between Breastfeeding Test Weights and Postpartum Breastfeeding Rates

This secondary analysis was conducted to determine the relationship between test weights and days of breastfeeding. Test weights were performed with a scale (accurate to 2 grams) before and after feeding. Days of breastfeeding was measured by self-reporting. All test weights were interrelated and were associated with higher days of breastfeeding. Test weights at day 2 to 4 and at 2 weeks were not correlated significantly with either intention or self-efficacy at any time. However, 6-week test weights were correlated with intention at all 3 times, and self-efficacy at 6 weeks. Women with higher breastfeeding self-efficacy scores tended to report higher intention to breastfeed for 6 months.

Screening for asthma: results from a rural cohort.

Background: Asthma, the leading cause of chronic illness in children, must be managed in both the home and school environments. Identification of children who have risk factors associated with asthma is the first step toward achieving one of the Healthy People 2010 (2000) objectives, which identifies that 25 states will establish a system of surveillance to track asthma mortality, morbidity, access to care, and asthma management. Purpose: The purposes of this research were to: a) identify rural children who are at risk for asthma through written screening; b) assess parameters of respiratory health status of rural school-aged children as indicated by forced expiratory volume at l second (FEV1), forced vital capacity (FVC), peak expiratory flow (PEF), mean mid-expiratory flow (FEF25–75); and c) identify the number of rural school-aged children who sought and obtained follow-up from their primary health care provider and were given a definitive diagnosis of asthma. Framework: The Vulnerable Populations Framework () was used to organize this study. Methodology: A prospective descriptive design was utilized for this research. Results: Approximately 12% of the children screened were referred to their primary care provider (PCP) for follow-up care. Of these approximately half of the children were seen by their PCP. Barriers to seeking follow-up care were: a) the child was not symptomatic all the time, b) reluctance to be diagnosed with asthma, and c) others, such as cost and time. Children who were not well controlled identified that they ran out of medicine and their parents did not refill their prescription. Conclusion: Results from this descriptive study indicate that screening for asthma in school may be a way to identify those children who are at risk for asthma, and who are not diagnosed as well as those who are diagnosed with asthma but are not optimally managed. While many parents wanted their children to be screened, follow-up care was not critical to them. Implications: Nurses working in a school setting are in a prime position to help identify those children with signs and symptoms of asthma. In addition, use of written screenings with or without spirometry may be helpful in identifying children at risk for asthma. Further studies need to be undertaken to determine if written screening is as efficacious as spirometry for school and other ambulatory care settings.

Testing protocols: care of biological samples in a rural setting.

The purpose of this study is to evaluate collection, transport, and storage protocols of urine and air allergen samples from infants in a rural setting. Infant urine and aeroallergen samples (n = 21) are collected in the home setting in rural areas where time and distance to the central laboratory is a consideration. Urine samples are analyzed using ELISA tests after being transported using three different techniques: (a) ambient temperature, (b) dry ice, and (c) packaged on dry ice and shipped commercially. Following initial ELISA testing for levels of cytokines, urine samples are frozen at -70 degrees Celsius for 6 months. Samples are then reanalyzed for levels of cytokines. Dust samples are analyzed for levels of aeroallergens, stored at 4 degrees for 6 months, and reanalyzed. The integrity of samples varies by biomarker, shipment temperature, and storage time, creating a high degree of variability in results.