Melanie L. Kornides

Evaluation of breastfeeding promotion, support, and knowledge of benefits on breastfeeding outcomes:

We examined how prenatal exposure to breastfeeding information from various media sources, maternal knowledge of benefits, family and clinician support, and peer practices influence breastfeeding outcomes in early infancy. Initiation of breastfeeding, any breastfeeding at two months, and exclusivity of breastfeeding at two months were examined in a cohort of US women using data from the Infant Feeding Practices Study II. Descriptive statistics, chi-square analyses and logistic regression were conducted. Approximately 85 percent of the women initiated breastfeeding. At two months, 63.8 percent continued breastfeeding, while only 38.1 percent breastfed exclusively. Mothers with greater knowledge about breastfeeding benefits were 11.2 (95% CI: 6.87–18.45) times more likely to initiate breastfeeding and 5.62 (95% CI: 4.19–7.54) times more likely to breastfeed at two months than those with lower levels of knowledge. Women whose families prenatally supported exclusive breastfeeding were 8.21(5.12–13.2) times more likely to initiate and continue breastfeeding (OR 3.21, 95% CI: 2.51–4.11). Clinicians who supported breastfeeding only also increased the odds of a woman initiating breastfeeding (OR 1.95, 95% CI: 1.31–2.88). Interventions to increase maternal knowledge of breastfeeding benefits and family and clinician support of breastfeeding in the prenatal period may help increase breastfeeding rates. The encouragement of breastfeeding needs to be a priority among health care providers to improve the health of mothers and infants.

Prepregnancy body mass index, socioeconomic status, race/ethnicity and breastfeeding practices

Abstract Objective: While socioeconomic status (SES) and race/ethnicity are known predictors of breastfeeding practices, the added disparity caused by the rising rates of obesity among women of childbearing age remains untested. The purpose of this study was to examine differences in breastfeeding initiation and duration among black, white and Hispanic women of low and middle SES within the context of prepregnancy body mass index (BMI). Methods: Data from the Early Childhood Longitudinal Study-Birth Cohort were analyzed. Adjusted logistic regression models were built to examine differences in breastfeeding initiation and duration for the three racial/ethnic groups of low and middle SES. Results: Normal BMI Hispanic women of low SES demonstrated higher rates of breastfeeding initiation (74%) compared to other groups. Overweight/obese black women of low SES had lower rates of breastfeeding initiation. Overweight/obese Hispanic women of middle SES were significantly less likely to continue breastfeeding up to 4 months (OR: 0.65, 95% CI: 0.41, 0.98) compared to their white counterparts. Among women who initiated breastfeeding, overweight/obese white women of low SES had the highest rate of stopping within two months of giving birth (66.7%). Conclusions: Examination of SES and racial/ethnic differences within the context of prepregnancy weight revealed specific groups with low rates of breastfeeding initiation and duration. Interventions tailored for these at-risk groups are needed to increase the overall proportion of mothers and infants who benefit from the positive health outcomes associated with breastfeeding.

Chronic physical health conditions among children of different racial/ethnic backgrounds

OBJECTIVES It is estimated that 20% of children in the USA are affected by at least one chronic disease. Although the burden of chronic conditions is greater for minority populations of children, research that has explored the prevalence and risk factors of chronic disease across different racial/ethnic groups is scarce. The aim of this study was to examine racial/ethnic disparities in the prevalence rates of common physical, chronic diseases in White, Black and Hispanic children; and assess the effect of several factors on the risk of having a chronic disease. METHODS Using the 2007 National Survey of Childrens Health, prevalence estimates were calculated for asthma, hearing impairment, visual impairment, joint/bone/muscle problems, brain injury and other illnesses for each racial/ethnic group. Multivariate logistic regression analyses were conducted to examine the effects of several risk factors on the risk of each of these health conditions. RESULTS The findings show that the prevalence for all health conditions was significantly higher (25.3%) among Black children than White (19.8%) and Hispanic (18.6%) children. Furthermore, 19.5% of Black children have had or currently have asthma compared with 12.2% of White and Hispanic children. More Black and Hispanic children were covered by public health insurance, while 19% of Hispanic children were currently uninsured. White children whose mothers had a health problem were associated with asthma, hearing impairment, visual impairment and joint/bone/muscle problems, while Black children were more likely to report asthma and Hispanics reported visual impairment and joint/bone muscle problems. Hispanic children who were living in poverty or were uninsured were at lower risk for any chronic disease. Regardless of race/ethnicity, children living in a single-parent household were more likely to be associated with any health condition. CONCLUSIONS This study provides evidence that racial/ethnic disparities in chronic physical conditions and health care among US children are extensive. It underscores that uninsured children who do not have access to the healthcare system are not being screened for chronic diseases, or are not obtaining medical care for such health problems. Healthcare providers should educate families about prevention measures and community services that might be able to assist them in improving the health of their children.

Factors Associated With Obesity in Latino Children: A Review of the Literature

Various factors influence the high prevalence of obesity among Latino children. The purpose of this article was to review the current literature on the factors associated with overweight and obesity in Latino children, provide nursing implications, and suggest direction for future research. Twenty-four studies were selected. The findings of this review indicated that factors related to activity, diet, genetics, the environment, and acculturation influence overweight and obesity in Latino children. Parental body mass index (BMI) was consistently found to be one of the strongest predictors of pediatric weight. There was conflicting evidence for the association of activity, diet, and environmental factors with obesity. There was also inconclusive evidence for the relationship between acculturation and BMI in Latino children. The strengths of the studies reviewed included analyses by Latino subgroup, large Latino sample sizes, and inclusion of both English and Spanish speakers. Limitations included inadequate sample sizes in some studies and lack of data on potential confounding factors such as acculturation and immigration status. Future research is needed to determine how factors associated with obesity can be used in prevention efforts targeting Latino children. Varios factores influyen la alta prevalencia de obesidad en los ninos latinos. El proposito de este articulo fue analizar la literatura relacionada con factores asociados con el sobrepeso y la obesidad en los ninos latinos, analizar las implicacias para enfermeria, y sugerir direcciones para investigaciones futuras. Veinticuatro estudios fueron seleccionados para el analisis. Indice de masa corporal (IMC) parental fue encontrada para ser uno de los predictores mas fuertes de peso pediatricos. Las hallazgos de este revision indican que factores relacionado a la actividad, dieta, genetica, ambiente y aculturacion influyen en la obesidad de los ninos latinos. Los estudios revisados poseen diversas fortalezas como son el incluir analisis por subgrupos de poblacion latina, utilizar muestras con un numero importante de participantes latinos, y la inclusion de participantes que hablaban ingles y espanol. Las limitaciones incluyeron tamanos inadecuados de la muestra en algunos estudios, y la falta de datos sobre factores que en potencia pueden ser confundentes como son el estatus de inmigracion y aculturacion. Nuevas investigaciones son necesarias para determinarcomo los factores asociados con la obesidad pueden ser utilizados en la prevencion de obesidad con ninos latinos.

Factors associated with young adults pregnancy likelihood.

INTRODUCTION Although progress has been made to reduce adolescent pregnancies in the United States, rates of unplanned pregnancy among young adults aged (aged 18-29 years) remain high. In this study, we assessed factors associated with perceived likelihood of pregnancy (likelihood of getting pregnant/getting partner pregnant in the next year) among sexually experienced young adults who were not trying to get pregnant and had previously used contraceptives. METHODS We conducted a secondary analysis of 660 young adults, aged 18 to 29 years in the United States, from the cross-sectional National Survey of Reproductive and Contraceptive Knowledge. Logistic regression and classification tree analyses were conducted to generate profiles of young adults most likely to report anticipating a pregnancy in the next year. RESULTS Nearly one-third (32%) of young adults indicated that they believed they had at least some likelihood of becoming pregnant in the next year. Young adults who believed that avoiding pregnancy was not very important were most likely to report pregnancy likelihood (odds ratio [OR], 5.21; 95% confidence interval [CI], 2.80-9.69), as were young adults who considered avoiding a pregnancy to be important but who were not satisfied with their current contraceptive method (OR, 3.93; 95% CI, 1.67-9.24) and who attended religious services frequently (OR, 3.0; 95% CI, 1.52-5.94), were uninsured (OR, 2.63; 95% CI, 1.31-5.26), and were likely to have unprotected sex in the next 3 months (OR, 1.77; 95% CI, 1.04-3.01). DISCUSSION These results may help guide future research and the development of pregnancy-prevention interventions targeting sexually experienced young adults.

Content of web-based continuing medical education about HPV vaccination

BACKGROUND Addressing low HPV vaccination coverage will require U.S. health care providers to improve their recommendation practices and vaccine delivery systems. Because readily available continuing medical education (CME) could be an important tool for supporting providers in this process, we sought to assess the content of web-based CME activities related to HPV vaccination. METHODS We conducted a content analysis of web-based CME activities about HPV vaccination available to U.S. primary care providers in May-September 2016. Using search engines, educational clearinghouses, and our professional networks, we identified 15 activities eligible for study inclusion. Through a process of open coding, we identified 45 commonly occurring messages in the CME activities, which we organized into five topic areas: delivering recommendations for HPV vaccination, addressing common parent concerns, implementing office-based strategies to increase HPV vaccination coverage, HPV epidemiology, and guidelines for HPV vaccine administration and safety. Using a standardized abstraction form, two coders then independently assessed which of the 45 messages each CME activity included. RESULTS CME activities varied in the amount of content they delivered, with inclusion of the 45 messages ranging from 17% to 86%. Across activities, the most commonly included messages were related to guidelines for HPV vaccine administration and safety. For example, all activities (100%) specified that routine administration is recommended for ages 11 and 12. Most activities (73%) also noted that provider recommendations are highly influential. Fewer activities modeled examples of effective recommendations (47%), gave specific approaches to addressing common parent concerns (47%), or included guidance on office-based strategies to increase coverage (40%). CONCLUSIONS Given that many existing CME activities lack substantive content on how to change provider practice, future activities should focus on the practical application of interpersonal and organizational approaches for improving HPV vaccine delivery in the clinical setting.

US adolescents at risk for not meeting physical activity recommendations by season

BackgroundWe sought to identify regional and seasonal variation in not meeting physical activity (PA) recommendations of ≥60 min a day of moderate-to-vigorous PA (MVPA) and 3 h of vigorous PA per week (VPA) in a longitudinal cohort of United States (US) adolescents.MethodsParticipants in the Growing Up Today Study 2, a prospective study of 10,918 adolescents, self-reported season-specific weekly hours of MVPA and VPA from 2004 through 2011. To assess variation in PA by climate, we grouped the contiguous US into nine climatically consistent geographic regions. We also examined MVPA and VPA by season, sex, ethnicity, weight status, and age group.ResultsThe majority (85%) of adolescents did not meet the MVPA recommendation, and 91% did not meet the VPA recommendation, for one or more seasons over the four study years. Across all climate regions, adolescents were two times more likely to not meet the MVPA recommendation during the winter compared to summer (odds ratio 2.02, 95% confidence interval: 1.96–2.08).ConclusionRegardless of climate region, gender, ethnicity, or age group, adolescents were more likely not to meet MVPA or VPA recommendations in the winter than the summer. Adolescents may benefit from interventions aimed at increasing PA in the winter.

U.S. Primary Care Clinics’ Experiences During Introduction of the 9-Valent HPV Vaccine

Changes in the routine immunization schedule are common and may pose challenges to primary care clinics. We sought to assess the experiences of U.S. providers and clinic staff during the introduction of 9-valent HPV vaccine. In 2015–2016, we conducted a survey in a probability sample of 127 pediatric (40%) and family medicine (60%) clinics in three U.S. states. The 211 respondents included clinicians (63%) and staff (37%). Overall, 83% of clinics stocked 9-valent HPV vaccine, with adoption ranging from 60% among early respondents to 100% among later respondents. Almost all respondents believed that providers in their clinics would recommend the 9-valent vaccine as strongly as (66%) or more strongly than (33%) the quadrivalent vaccine. Over half (61%) had no concerns about the 9-valent vaccine, while others reported concerns about increased parental hesitancy (29%), private insurance coverage (17%), or other issues (10%). Respondents from pediatric versus family medicine clinics more often reported a concern (OR = 2.06, 95% CI 1.02–4.15). Among the 169 respondents who stocked 9-valent vaccine, about half (56%, n = 94) anticipated that providers in their clinics would recommend a “booster” dose of 9-valent HPV vaccine for adolescents who had completed the 3-dose series with prior versions. Among the 42 respondents who did not stock 9-valent vaccine, few (17%, n = 7) believed providers would recommend adolescents delay vaccination until it was available. In conclusion, providers and staff generally had positive views of 9-valent HPV vaccine and many had no concerns. For others, responses regarding parental hesitancy, insurance coverage, and the use of booster doses suggests opportunities for enhancing future educational support.

Parental Support for Age-based Indoor Tanning Restrictions

INTRODUCTION Regulatory agencies, including the U.S. Food and Drug Administration, are considering policies to ban indoor tanning for youth aged <18 years. Using data from a nationally representative sample, this study assessed parental support for age-based bans as well as less restrictive parental permission requirements. METHODS Data came from an online survey completed by 1,244 parents of adolescents aged 11-17 years. Weighted multivariable logistic regression models assessed correlates of supporting an indoor tanning ban for youth aged <18 years. Data collection and analysis occurred in 2016. RESULTS Almost two thirds (65%) of parents agreed with indoor tanning bans for youth, with smaller proportions having no opinion (23%) or disagreeing (12%). Support for bans increased with greater perceived harm of indoor tanning for adolescents (OR=2.66, 95% CI=1.97, 3.59) and decreased with greater perceived benefits (OR=0.49, 95% CI=0.36, 0.67). Compared with support for bans, support for parental permission requirements was somewhat higher, with 79% of parents agreeing with the policy. Most parents (60%) agreed with both policies; only 4% disagreed with both. CONCLUSIONS Age-based indoor tanning restrictions, including bans, engender broad-based support among parents. Communicating the harm of indoor tanning may facilitate the implementation of these policies.