Matthew Thullen

Breastfeeding and Complementary Food: Randomized Trial of Community Doula Home Visiting

OBJECTIVES: Despite recent efforts to increase breastfeeding, young African American mothers continue to breastfeed at low rates, and commonly introduce complementary foods earlier than recommended. This study examines the effects of a community doula home visiting intervention on infant feeding practices among young mothers. METHODS: Low-income, African American mothers (n = 248) under age 22 years participated in a randomized trial of a community doula intervention. Intervention-group mothers received services from paraprofessional doulas: specialized home visitors trained as childbirth educators and lactation counselors. Doulas provided home visits from pregnancy through 3 months postpartum, and support during childbirth. Control-group mothers received usual prenatal care. Data were obtained from medical records and maternal interviews at birth and 4 months postpartum. RESULTS: Intent-to-treat analyses showed that doula-group mothers attempted breastfeeding at a higher rate than control-group mothers (64% vs 50%; P = .02) and were more likely to breastfeed longer than 6 weeks (29% vs 17%; P = .04), although few mothers still breastfed at 4 months. The intervention also impacted mothers’ cereal/solid food introduction (P = .008): fewer doula-group mothers introduced complementary foods before 6 weeks of age (6% vs 18%), while more waited until at least 4 months (21% vs 13%) compared with control-group mothers. CONCLUSIONS: Community doulas may be effective in helping young mothers meet breastfeeding and healthy feeding guidelines. The intervention’s success may lie in the relationship that develops between doula and mother based on shared cultural background and months of prenatal home visiting, and the doula’s presence at the birth, where she supports early breastfeeding experiences.

Suicide Ideation and Attempts Among Adolescents Engaged in Risk Behaviors: A Latent Class Analysis

This study addressed gaps in the literature regarding how different profiles of adolescent risk behavior relate to suicide. Data came from the 2010 Minnesota Student Survey of 9th and 12th grade students. Latent class analysis derived a set of four classes reflecting unique patterns of eight behaviors: maladaptive dieting, prescription drug misuse, illegal drug use, marijuana use, problem drinking, risky sexual behavior, perpetration of interpersonal violence, and self-injury. A class demonstrating high engagement in all risk behaviors, and a class highest on self-injury and maladaptive dieting but low on several other risk behaviors, showed high risk for suicide. Practitioners should carefully monitor adolescents engaging in multiple risk behaviors for suicide, especially if self-injury and maladaptive dieting are present.

The Association of Breastfeeding Initiation with Sensitivity, Cognitive Stimulation, and Efficacy Among Young Mothers: A Propensity Score Matching Approach

OBJECTIVE This study examined the association between breastfeeding initiation and maternal sensitivity, efficacy, and cognitive stimulation among young, low-income, African American mothers. SUBJECTS AND METHODS Two hundred twenty-one mothers were interviewed during pregnancy, at birth, and at 4 months postpartum regarding breastfeeding and parenting. Medical records were collected after birth, and mother-infant interactions were videotaped at 4 months. Propensity score matching was used to address selection bias by matching breastfeeding and nonbreastfeeding mothers on characteristics measured prior to breastfeeding. RESULTS One hundred twenty-four (56%) mothers initiated breastfeeding. After matching, mothers who initiated breastfeeding reported greater parenting efficacy (effect size, d=0.44) and were observed to be more sensitive with their 4-month-old infants (effect size, d=0.42) than nonbreastfeeding mothers. Breastfeeding was marginally associated with less maternal intrusiveness (effect size, d=0.28) but was not related to parenting attitudes or cognitive stimulation. CONCLUSIONS This study presents evidence supporting the claim that breastfeeding may enhance maternal efficacy and sensitivity. Providing breastfeeding support to young mothers may have effects that extend beyond maternal and child health outcomes to parenting and mother-child interactions.

Co-Parenting Quality, Parenting Stress, and Feeding Challenges in Families with a Child Diagnosed with Autism Spectrum Disorder.

Abstract113 parents of children aged 5–13 with ASD completed online surveys assessing co-parenting quality, parenting stress, and child feeding challenges. Results indicated that food selectivity was both the most frequently reported type of challenging feeding behavior and the most often reported as problematic but was also the only type of challenging feeding behavior that was not associated with parenting stress. Greater parenting stress was reported when co-parenting agreement and support were lower. Child disruptive behavior at mealtime was the only feeding challenge associated with quality of co-parenting. This paper points to the importance of addressing feeding challenges in addition to selectivity, such as disruptive mealtime behaviors, and doing so within the context of the family and home environment.

Co-parenting and feeding in early childhood: Reflections of parent dyads on how they manage the developmental stages of feeding over the first three years

Family-level influences on the development of healthy eating behaviors start in infancy and toddlerhood with how families manage developmental stages of feeding. Little research on home feeding environments for young children has examined how mothers and fathers collaborate around feeding issues or contribute jointly to feeding. The purpose of this qualitative study is to examine co-parenting with regard to infant/toddler feeding practices. Twenty-four sets of co-resident, biological parents with a child between 6 months and 3 years were interviewed together about their feeding practices and how they discussed and collaborated on feeding during the main stages of feeding development in the first three years. Analyses illuminate themes related to how specific domains of co-parenting (satisfaction with labor, support, agreement, conflict) factor into infant and toddler feeding as well as how additional factors such as having older children and employment schedules shape how both food parenting practices and co-parenting are managed in relation to feeding. Mothers were the primary managers of feeding labor. Fathers participated in feeding in different ways and levels starting in infancy and increased involvement in feeding over the first few years requiring an ongoing negotiation around co-parenting related to feeding. Overall, this study develops insights into how multiple caregivers construct a family environment specifically related to early feeding - a perspective missing from current conceptualizations of home feeding environment. Attention to the concept of co-parenting within home feeding environments should help inform more effective approaches to intervene with families on issues around childhood obesity and family health.

Domain-Specific Trajectories of Involvement Among Fathers of Children Born to Young, Low-Income, African American Mothers

Although research on low-income, nonresidential fathers is expanding, fathers’ involvement with their children over time has mainly been studied using composite measures of involvement. This study examines 3 domains of father involvement (financial support, child care, decision making) with a sample of young, low-income African American mothers (N = 248). These domains are examined separately to assess the extent to which unique patterns and predictors of involvement emerge over time from 4 months to 2 years postpartum. Trajectory analyses provide a similar set of trajectories for child care and decision making, and suggest that stability in either high or low levels of involvement was more common than decline over time. We identify only 2 trajectories of financial support. Relationship features, both prenatal and at 4-months postpartum, significantly predicted high involvement versus sustained low involvement for all 3 domains; however, a unique set of predictors of trajectory membership was found for each domain. Domain-specific findings are compared with findings from a supplemental, composite involvement approach to evaluate the utility of a domain-specific approach.

Influences on Infant Feeding: Perceptions of Mother-Father Parent Dyads

Purpose: The purpose of this study was to examine interrelational-, organizational-, and community-level influences on how coparents collaborate about infant and toddler feeding. Study Design and Sample: Using qualitative methods, we interviewed mother–father parent dyads to explore the potential influences on infant and toddler feeding. Participants were purposively recruited from two Midwest, rural, university-system pediatric clinics. Thematic analysis was used to code the data. Measures: Mother–father dyadic interviews were conducted using a semistructured interview schedule. Twenty-four mother–father dyads who had a child between the ages of 6 and 36 months were interviewed together. Results: Major themes include interpersonal factors (peer behavior reinforcement, dyad and important others infant feeding conflict, conflict resolution proactiveness), organizational factors (healthcare provider infant-feeding support, workplace flexibility), and community factors (public perception on breastfeeding and social media influence). Clinical Implications: Community-based collaboration can be a platform for mother–father dyads, researchers, public health nurses, and other healthcare providers to proactively create interventions that include opportunity for building coparenting skills and infant-feeding knowledge that promote team management of common early childhood feeding challenges.

Community Leadership Development: Perspectives of Graduates of a Low-Income Leadership Development Program on Family Relations

ABSTRACT Drawing mostly on qualitative data, this article explores how members of low-income communities experience and recognize changes in family relationships after participation in a community leadership program. Semistructured interviews were conducted with 55 program graduates and surveys were completed by 80 graduates. Content analysis and descriptive statistics were used to analyze the data. Qualitative findings suggest that although community leadership programs emphasize the enhancement of individual leadership skills, valuable secondary benefits on familial relations also occur. Quantitative analyses corroborated the perception of graduates on increased leadership development and the improvement in relational knowledge and skills.