Yvonne Bronner

Breastfeeding Duration among Low Income Women

Breastfeeding has been identified as a possible deterrent to the development of osteoporosis and breast cancer in women. In addition, infants who are breastfed exclusively for at least 4 months reportedly have fewer incidence of SIDS, ear infection, diarrhea, and allergies. Further, low income women who breastfeed may be empowered by the experience. Increasing the frequency and duration of breastfeeding is recognized as a national priority, particularly for low income, minority women. Yet, recent national data indicate that in 1997, only 16.5% of low income mothers breastfed for at least 6 months. Short breastfeeding duration in low income women may be due to problems unique to them; thus, consistent and comprehensive breastfeeding support should be provided by midwives, nurses, lactation consultants, and peer counselors who are skilled in culturally sensitive management of lactation within the context of limited financial and social resources. This article focuses on the benefits of breastfeeding, and factors that may influence its duration. It also explores culturally relevant strategies as well as suggested interventions to increase breastfeeding duration among low-income women.

Breastfeeding peer counseling: results from the National WIC Survey.

The objective of this studywas to examine breastfeeding peer counseling within the context of the organizational structure of state and local Supplemental Nutrition Program forWomen, Infants and Children (WIC) agencies. The National WIC Breastfeeding Peer Counselor Survey was distributed to a convenience sample of state WIC breastfeeding coordinators and breastfeeding project coordinators and to a sample of local agency WIC directors and staff, breastfeeding peer counselor coordinators, and peer counselors. The findings indicate that respondents in the WIC state and local organizations perceive peer counseling to be effective in promoting and sustaining breastfeeding among WIC mothers. There is, however, a lack of consistent policies and procedures concerning the recruitment, training, and counseling phases of peer counseling within and across state WIC agencies.

Breastfeeding Peer Counseling: Rationale for the National WIC Survey

Peer counseling has been recognized as an effective intervention in the promotion of breastfeeding among low-incomewomen. This paper provides a literature reviewdemonstrating the effectiveness of peer counseling in health care settings, especially those concerned with breastfeeding. In addition, barriers identified in the literature that limit the integration of peer counseling in medical settings are examined. The need for The National WIC Breastfeeding Peer Counselor Surveyand background information on this survey are also discussed.

Weight Status in US Youth: The Role of Activity, Diet, and Sedentary Behaviors

OBJECTIVES To assess associations of physical activity, diet, and sedentary behaviors with overweight and obesity. METHODS Analyses of the NHANES 2003-06 were conducted among 2368 US adolescents, ages 12-19. Self-reported diet and sedentary behavior measures were used; physical activity was assessed using accelerometers. RESULTS Television/video viewing (OR=1.84; CI=1.24, 2.69), physical activity (OR=0.75; CI=0.59, 0.95), and fiber intake (OR=0.96; CI=0.92, 0.99) were associated with obesity whereas television/video viewing was a risk factor for overweight (OR=1.57; CI=1.1, 2.63). CONCLUSIONS Findings using accelerometer-measured physical activity are consistent with results from other studies using self-reported measurements. No interactions with ethnicity and gender were found.

Current concepts in infant nutrition

Nutritional needs vary during the first year of life according to the infants individualized pattern of growth and amount of physical activity. After delivery, the infant must make many physiologic adjustments, develop immunologic defenses, and take in adequate nutrients for survival. The type and consistency of foods change as the gastrointestinal system matures and becomes able to metabolize the components and excrete the needed metabolites of increasingly complex foods. The recommended dietary allowance for infancy is based on the amount of nutrients provided to healthy infants in human milk during the first six months of life and on the consumption of formula and increasing amounts of solid food during the second six months. The introduction of solid foods should parallel the developmental changes that occur within the central nervous system throughout the first year; these provide a level of readiness for the infant to manage foods of various textures from full liquid to soft. Even though significant technologic advances have led to changes in the way infants can be fed, human milk is still the optimal choice. Most women can be encouraged to breast-feed regardless of their own nutritional status or dietary intake. Contraindications can be managed on an individual basis. If women do not elect to breast-feed, suitable commercial formulas are available. The important issue in feeding is that of providing a variety of appropriately prepared foods offered in a nonjudgmental atmosphere so that the foundation is laid for the development of good food habits.

Explaining African-Americans’ Depressive Symptoms: a Stress-Distress and Coping Perspective

Findings from five community surveys suggest that the depressive symptom scores of African-Americans are the same as, or lower than, those of Whites. This seems at odds with the minority status hypothesis that predicts higher rates of mental disorders for African-Americans. However, little is known about the role of African-American coping capacity during the life stress process which may shed light on the seeming contradiction. This cross-sectional survey examined the role of spirituality-coping, sense of control, and stress in predicting depressive symptoms among 3570 African-Americans. The findings showed that sense of control mediates the relationship between spirituality, life stressors, and depressive symptoms.

Complementary and alternative medical practice: self-care preferred vs. practitioner-based care among patients with asthma.

BACKGROUND Interest in disease self-management has increased as the US population ages, as health care costs skyrocket, and as more evidence is gathered on the etiologic basis of most chronic diseases. This study uses National Health Interview Survey (NHIS) data to analyze the association between asthma episode during the past 12 months and patterns of complementary and alternative medicine (CAM) use within the same period among adults, controlling for comorbid conditions. METHODS Using questions taken from the adult sample questionnaire and the Alternative Supplement of the 2002 NHIS, responses of those ever having asthma (N=3327) were analyzed in this cross-sectional, correlational study. The chi2 test of independence was used to examine the relationships between experiencing an asthma episode in the past year, coexisting comorbidity, and the use of self-care based CAM compared to practitioner-based CAM. RESULTS Overall CAM use differed significantly by asthma status, with 49% of those with asthma episodes using CAM compared with 42% of those who did not have an episode in the past year. Self-care based therapies were more likely to be used than practitioner-based therapies by individuals with single comorbid condition compared to those with 2 or more comorbidities. CONCLUSION Although this study supports previous work indicating that disease severity--in this instance, asthma within the past year--is significantly associated with CAM use, it did not support studies showing greater CAM use in the presence of a greater number of comorbidities, suggesting that disease burden is a limiting factor when it comes to self-care based CAM use.

Breastfeeding Peer Counseling: Policy Implications

Recent changes in federal and state welfare policies play an important role in the health and wellness discussion surrounding women and children who participate in the Supplemental Nutrition Program for Women, Infants and Children (WIC). Although federal and state welfare laws have not imposed restrictions on WIC benefits, many WIC beneficiaries are affected. While these laws restrict length of time on welfare, they do hold the potential to promote self-sufficiency for this population. The path to self-sufficiency requires a “career ladder” for those who are indigent. Minimum wage opportunities offer neither financial security nor training for the high-skilled positions that provide financial security. In addition, beneficiaries of public assistance need training, job skills, and employment preparation to navigate the job market in a technology-driven economy. Breastfeeding peer counseling may provide a model that can be useful in achieving Healthy People 2010 objectives while also accomplishing welfare-to-work objectives. Breast milk has been recognized by the Department of Health and Human Services, the American Academy of Pediatrics, and the American Dietetic Association as the superior form of nutrition for infants through the first year of life. Unfortunately, while there have been great strides made among women who participate in WIC, their rates still lag behind the national average in the initiation and duration of breastfeeding. Peer counseling has been identified as an effective intervention in the area of breastfeeding promotion among low-income women. This intervention has been analyzed comprehensively in the context of the local and state WIC agencies. The National WIC Breastfeeding Peer Counselor Survey examined breastfeeding peer counseling in WIC from the following perspectives: (1) effectiveness, (2) quality control, (3) recruitment of peer counselors and clients, (4) specific roles of peer counselors, (5) peer counselor training curriculum, and (6) interactions across levels of organization/environment. Many of these factors form the basis for discussing how the breastfeeding peer counseling model of WIC might relate to particular welfare reform, World Health Organization (WHO), and United Nations International Children’s Emergency Funds (UNICEF) policies. The Personal Responsibility Work Opportunity and Reconciliation Act (PWORA) of 1996 brought about significant changes in the lives of many WIC beneficiaries and signaled a shift in the goals of entitlement programs for the poor. PWORA was designed to promote

Racial Disparities in Unmet Need for Family Planning among Men Ages 15-44 in the United States.

T Healthy People 2020 goal with respect to family planning is to improve pregnancy planning and spacing, and prevent unintended pregnancy in the United States.1 Several studies have documented that men were underserved in terms of sexual and reproductive health care service utilization and prompted advocacy for such services.2,3,4 This suggests that unmet family planning needs of men and the role they have in family formation require further investigation. The literature on the issues of sexual and reproductive health of men has primarily focused on men’s sexual behavior and the prevention of sexually transmitted infections.5,6,7 In the U.S., these studies have shown men to be at risk for poor health outcomes, as they are more likely than women to engage in risky sexual health behaviors and initiate sexual experiences at earlier ages. Another study documented that men start engaging in sex at earlier ages, with the average age of first sexual intercourse being 17.8 In addition, 53% of African American men and 42% of men from lowincome backgrounds have had intercourse by the age of 15. Eightytwo percent of men have had sexual intercourse by age 20.9,10 Men are also more likely than women to have multiple sexual partners, increasing their risk of sexually transmitted infections.8 Despite these risky and unhealthy behaviors, men still lag behind women in the access and utilization of reproductive health care services, particularly the use of contraceptives and other family planning methods. The purposes of this paper are (1) to provide a framework in which unmet need for family planning for men is defined; and (2) to explore factors associated with unmet family planning needs for men across different racial/ ethnic backgrounds, including the impact of poverty, using National Survey of Family Growth (NSFG) data. Family planning among women and men. Much is known about family planning needs for women, including contraceptive use, birth spacing, and accessibility of famORIGINAL PAPER

Adoption of a Healthy Lifestyle Following Gestational Diabetes Mellitus

Women with gestational diabetes (GDM) have increased risk of type 2 diabetes and recurrent GDM. There are several established risk factors for developing type 2 diabetes following a pregnancy complicated by GDM. Interventions targeting these risk factors, namely a reduction in body fat, increased physical activity and a healthy diet can substantially reduce type 2 diabetes risk. Nevertheless, observational studies show that most women do not engage in these behaviors even when there is a history of GDM. This paper is a review of lifestyle interventions and a discussion of factors that contribute to adoption of a healthy lifestyle following GDM. Risk perception, psychological well-being, social support, and access to health care were important determinants of a woman’s ability to adhere to a healthy lifestyle post GDM. Future research should focus on testing novel approaches to adopting lifestyle health behaviors that address barriers relevant to women with previous GDM.