Naomi Bartle

Explaining infant feeding: The role of previous personal and vicarious experience on attitudes, subjective norms, self-efficacy, and breastfeeding outcomes

Objectives Breastfeeding confers important health benefits to both infants and their mothers, but rates are low in the United Kingdom and other developed countries despite widespread promotion. This study examined the relationships between personal and vicarious experience of infant feeding, self‐efficacy, the theory of planned behaviour variables of attitudes and subjective norm, and the likelihood of breastfeeding at 6–8 weeks post‐natally. Design A prospective questionnaire study of both first‐time mothers (n = 77) and experienced breastfeeders (n = 72) recruited at an antenatal clinic in South East England. Methods Participants completed a questionnaire at 32 weeks pregnant assessing personal and vicarious experience of infant feeding (breastfeeding, formula‐feeding, and maternal grandmother’s experience of breastfeeding), perceived control, self‐efficacy, intentions, attitudes (to breastfeeding and formula‐feeding), and subjective norm. Infant feeding behaviour was recorded at 6–8 weeks post‐natally. Multiple linear regression modelled the influence of vicarious experience on attitudes, subjective norm, and self‐efficacy (but not perceived control) and modelled the influence of attitude, subjective norm, self‐efficacy, and past experience on intentions to breastfeed. Logistic regression modelled the likelihood of breastfeeding at 6–8 weeks. Results Previous experience (particularly personal experience of breastfeeding) explained a significant amount of variance in attitudes, subjective norm, and self‐efficacy. Intentions to breastfeed were predicted by subjective norm and attitude to formula‐feeding and, in experienced mothers, self‐efficacy. Breastfeeding at 6 weeks was predicted by intentions and vicarious experience of formula‐feeding. Conclusion Vicarious experience, particularly of formula‐feeding, has been shown to influence the behaviour of first‐time and experienced mothers both directly and indirectly via attitudes and subjective norm. Interventions that reduce exposure to formula‐feeding (perhaps by limiting advertising) or cushion mothers from its effects may enable more mothers to meet their breastfeeding goals. Statement of contribution What is already known on this subject? Rates of breastfeeding in the United Kingdom are low and resistant to change. Self‐efficacy may be an important and modifiable factor for breastfeeding initiation and maintenance. What does this study add? Self‐efficacy may only be a relevant factor among mothers who already have personal experience of breastfeeding. Vicarious experience of formula‐feeding has been shown to be related to a lower rate of breastfeeding at 6 weeks.

Emergence and Persistence of Overweight and Obesity in 7- to 11-Year-Old Children

Aim: After dramatic rises in paediatric obesity, the critical period for obesity onset may now be pre-adolescence. Methods: We monitored adiposity over 4 years in 400 children aged 7-9 years recruited from schools in London. Weight, height, waist circumference (WC) and fat mass were measured annually. Weight status was defined using International Obesity Task Force (IOTF) criteria, and standardised scores and percentiles used British 1990 reference data. Results: BMI, WC and fat mass index all tracked strongly over time (average correlation for BMI = 0.95). Emergence of obesity was relatively uncommon: only 2% of the total sample increased from overweight to obese over the 4-year period, and this was nearly matched by the 1.3% that reduced from obese to overweight. However, more children (6%) moved from healthy weight to overweight than the reverse direction (2%). There were greater absolute gains in adiposity in children with higher baseline weight status, but this was disguised in analyses using standardised scores. Obesity was not an emergent trait in middle childhood, but rates were already high and, in absolute terms, adiposity increased more in overweight and obese than healthy weight children. Conclusion: These results highlight the need for active management of obesity in middle childhood.