Onur Altindag

Telephone Peer Counseling of Breastfeeding Among WIC Participants: A Randomized Controlled Trial

OBJECTIVE: The US Surgeon General has recommended that peer counseling to support breastfeeding become a core service of the Supplemental Nutrition Program for Women, Infants, and Children (WIC). As of 2008, 50% of WIC clients received services from local WIC agencies that offered peer counseling. Little is known about the effectiveness of these peer counseling programs. Randomized controlled trials of peer counseling interventions among low-income women in the United States showed increases in breastfeeding initiation and duration, but it is doubtful that the level of support provided could be scaled up to service WIC participants nationally. We tested whether a telephone peer counseling program among WIC participants could increase breastfeeding initiation, duration, and exclusivity. METHODS: We randomly assigned 1948 WIC clients recruited during pregnancy who intended to breastfeed or were considering breastfeeding to 3 study arms: no peer counseling, 4 telephone contacts, or 8 telephone contacts. RESULTS: We combined 2 treatment arms because there was no difference in the distribution of peer contacts. Nonexclusive breastfeeding duration was greater at 3 months postpartum for all women in the treatment group (adjusted relative risk: 1.22; 95% confidence interval [CI]: 1.10–1.34) but greater at 6 months for Spanish-speaking clients only (adjusted relative risk: 1.29; 95% CI: 1.10–1.51). The likelihood of exclusive breastfeeding cessation was less among Spanish-speaking clients (adjusted odds ratio: 0.78; 95% CI: 0.68–0.89). CONCLUSIONS: A telephone peer counseling program achieved gains in nonexclusive breastfeeding but modest improvements in exclusive breastfeeding were limited to Spanish- speaking women.

Son Preference, Fertility Decline, and the Nonmissing Girls of Turkey

Couples in Turkey exhibit son preference through son-biased differential stopping behavior that does not cause a sex ratio imbalance in the population. Demand for sons leads to lower ratios of boys to girls in larger families but higher ratios in smaller families. Girls are born earlier than their male siblings, and son-biased fertility behavior is persistent in response to decline in fertility over time and across households with parents from different backgrounds. Parents use contraceptive methods to halt fertility following a male birth. The sibling sex composition is associated with gender disparities in health. Among third- or later-born children, female infant mortality is 1.5 percentage points lower if the previous sibling is male. The female survival advantage, however, disappears if the previous sibling is female. Having an older female sibling shifts the gender gap in infant mortality rate by 2 percentage points in favor of males. The improvement in infant mortality is strongest in favor of males who have no older male siblings.

The Great Recession, Older Workers with Disabilities, and Implications for Retirement Security

Evidence suggests that older workers with disabilities have been hit particularly hard by the recent recession. The increased difficulty in finding a job faced by individuals with disabilities, combined with the longer spells of unemployment experienced by all workers in this recession, could mean that laid-off disabled workers in their pre-retirement years may never return to work. In this paper, we use data from the 2004-2010 waves of the Health and Retirement Study to examine how the great recession has affected workers with chronic health conditions that put them at greater risk of disability. Our results suggest that increases in job losses were 30% greater for those with greater underlying risk of disability than for the general HRS population, and decreases in consumption were 20% greater. These results have important implications for the well-being of disabled individuals nearing retirement.

Judicial Bypass for Minors Seeking Abortions in Arkansas Versus Other States

Objectives To describe demographic characteristics and abortion timing of minors in Arkansas who obtained an abortion through a judicial bypass, and to contrast the frequency of judicial bypass in other states in the United States. Methods We used individual-level data on all abortions to minors (n = 2624) performed in Arkansas from 2005 to 2014 and aggregated data from 10 additional states on abortions obtained through a judicial bypass. We characterized correlates of the judicial bypass and its association with the timing of abortion. Results Minors in Arkansas who used the courts were more likely to be 17 years of age, nonresidents of Arkansas, Hispanic, and with fewer previous pregnancies than their younger, resident, non-Hispanic White, and multigravida counterparts; 7.7% of abortions to minors were obtained via a bypass in 11 states, but only 2% if Texas and Arkansas are excluded. Conclusions The demographics of minors who obtain an abortion through a judicial bypass differ significantly from those who have parental consent, and there is widespread variation in the proportion of bypass cases across states.