The effect of employment status on breastfeeding in the United States

Access to Workplace Accommodations to Support Breastfeeding after Passage of the Affordable Care Act

OBJECTIVES

This study examines access to workplace accommodations for breastfeeding, as mandated by the Affordable Care Act, and its associations with breastfeeding initiation and duration. We hypothesize that women with access to reasonable break time and private space to express breast milk would be more likely to breastfeed exclusively at 6 months and to continue breastfeeding for a longer duration.

METHODS

Data are from Listening to Mothers III, a national survey of women ages 18 to 45 who gave birth in 2011 and 2012. The study population included women who were employed full or part time at the time of survey. Using two-way tabulation, logistic regression, and survival analysis, we characterized women with access to breastfeeding accommodations and assessed the associations between these accommodations and breastfeeding outcomes.

RESULTS

Only 40% of women had access to both break time and private space. Women with both adequate break time and private space were 2.3 times (95% CI, 1.03-4.95) as likely to be breastfeeding exclusively at 6 months and 1.5 times (95% CI, 1.08-2.06) as likely to continue breastfeeding exclusively with each passing month compared with women without access to these accommodations.

CONCLUSIONS

Employed women face unique barriers to breastfeeding and have lower rates of breastfeeding initiation and shorter durations, despite compelling evidence of associated health benefits. Expanded access to workplace accommodations for breastfeeding will likely entail collaborative efforts between public health agencies, employers, insurers, and clinicians to ensure effective workplace policies and improved breastfeeding outcomes.

Met Expectations and Satisfaction with Duration: A Patient-Centered Evaluation of Breastfeeding Outcomes in the Infant Feeding Practices Study II

BACKGROUND

Breastfeeding expectations predict breastfeeding duration. The extent to which expectations for duration are met remains unknown.

OBJECTIVES

To evaluate prospective measures of expected breastfeeding duration, changes in expectations over time, and factors associated with meeting expectations.

METHODS

The Infant Feeding Practices Study II followed women from late pregnancy to 1 year postpartum. Expected breastfeeding duration was assessed 5 times. Logistic regression identified factors associated with met prenatal expectations. Subgroup analysis compared met prenatal expectations to satisfaction with breastfeeding duration.

RESULTS

One-year postpartum, 34.7% of 1802 participants had met prenatal expected breastfeeding duration, and 23.9% were still breastfeeding. Fifty-eight percent of women met expectations stated at 7 months postpartum. Modifiable risk factors associated with meeting prenatal expectations included early regular breast pump use (odds ratio [OR], 1.55; 95% confidence interval [CI], 1.18-2.07). Return to work was negatively associated with met expectations (return by 6 weeks postpartum: OR, 0.48; 95% CI, 0.33-0.71; later return: OR, 0.73; 95% CI, 0.56-0.95). Among those who reported on satisfaction with duration (n = 1226), 40.4% were satisfied. Satisfaction was associated with meeting expectations (OR, 10.56; 95% CI, 7.67-14.55), but expectation and satisfaction measures were not equivalent. Elevated body mass index and depressive symptoms at 2 months postpartum were negatively associated with both measures.

CONCLUSION

Most participants did not meet prenatal or postnatal expectations for breastfeeding duration and were unsatisfied with duration. However, at 12 months, more participants felt they had met their expectations and were satisfied with their breastfeeding duration than were actually breastfeeding. Therefore, women may perceive greater breastfeeding progress than suggested by Healthy People 2020 benchmarks.

Lawyer mothers: infant-feeding intentions and behavior

OBJECTIVES

Maternal employment postpartum can have a powerful influence over infant-feeding behaviors. The objective of this cross-sectional online survey was to explore the infant-feeding intentions and behaviors of a convenience sample of lawyer mothers. We compared our findings with those for physician mothers.

METHODS

Lawyers participated in an anonymous online survey. To eliminate the influence of multiple births, only study subjects with one child were reviewed for inclusion in this analysis. We used SPSS for calculation of descriptive statistics, the Mann-Whitney test for comparisons, and the Spearman rank correlation test for testing correlations.

RESULTS

All mothers (29 lawyers and 47 physicians) included in the final analysis reported an intention to breast-feed, with 55% of lawyers wanting to breast-feed for at least 12 months. Physicians' breast-feeding rates were 98% at birth, 83% at 6 months, and 51% at 12 months. Lawyers' breast-feeding rates were 100% at birth, 55% at 6 months, and 17% at 12 months. Their duration of breast-feeding correlated with the support level at work and the sufficiency of time and availability of appropriate places at work to express milk.

CONCLUSIONS

This study did not detect statistically significant differences in infant-feeding intentions and behaviors of lawyer mothers when compared with physician mothers. Although the majority of lawyer mothers intended to breast-feed for at least 12 months, only a minority achieved that goal. Our findings support the development of workplace strategies and programs to promote breast-feeding duration among lawyers returning to work after childbirth.

Workplace lactation support by New Jersey employers following US Reasonable Break Time for Nursing Mothers law

BACKGROUND

Returning to an unsupportive work environment has been identified as a major reason for avoidance or early abandonment of breastfeeding among working mothers.

OBJECTIVE

This study aimed to examine the nature and extent of accommodations offered to breastfeeding employees among New Jersey employers since the US federal Reasonable Break Time for Nursing Mothers law enactment.

METHODS

A cross-sectional survey was conducted to measure current lactation support in the workplace in New Jersey. Using convenience sampling, the survey was sent to managerial personnel in hospitals and nonhospitals. The level of support was assessed on company policy, lactation room, and room amenity. A composite lactation amenity score was calculated based on responses about lactation room amenities.

RESULTS

Respondents (N = 51) completed a 22-item online questionnaire during fall 2011. The support level was compared by type of organization: hospital (n = 37) versus nonhospital (n = 14). The amenity score of hospitals was significantly higher than nonhospitals (1.44 vs 0.45, P = .002). The mean amenity score (score = 0.95) for all employers was far below comprehensive (score = 3.0). Compared to nonhospitals, hospitals were more likely to offer lactation rooms (81% vs 36%, P = .003), have their own breastfeeding policy (35.1% vs 7.1%, P = .01), and provide additional breastfeeding support (eg, education classes, resources; P < .05).

CONCLUSION

Employers, regardless of the type of organization, need to improve their current practices and create equity of lactation support in the workplace.

Maternity leave duration and full-time/part-time work status are associated with US mothers' ability to meet breastfeeding intentions

BACKGROUND

Breastfeeding provides numerous health benefits for infants and mothers; however, many infants are not breastfed as long as recommended or desired by mothers. Maternal employment is frequently cited as a barrier to breastfeeding.

OBJECTIVE

This study aimed to assess whether maternity leave duration and return status (full-time [FT], part-time [PT]) were associated with not meeting a mother's intention to breastfeed at least 3 months.

METHODS

We used data from the Infant Feeding Practices Study II, a cohort study. Analyses were limited to women employed prenatally who intended to breastfeed 3 months or longer (n = 1172). Multivariable logistic regression was used to assess the relationship between maternity leave duration and return-to-work status (< 6 weeks/FT, < 6 weeks/PT, 6 weeks-3 months/FT, 6 weeks-3 months/PT, not working by 3 months) and meeting a mother's intention to breastfeed at least 3 months.

RESULTS

Overall, 28.8% of mothers did not meet their intention to breastfeed at least 3 months. Odds of not meeting intention to breastfeed at least 3 months were higher among mothers who returned to work FT before 3 months (< 6 weeks/FT: adjusted odds ratio = 2.25, 95% confidence interval, 1.23-4.12; 6 weeks-3 months/FT: adjusted odds ratio = 1.82, 95% confidence interval, 1.30-2.56), compared with mothers not working at 3 months.

CONCLUSION

Returning to work full-time before 3 months may reduce a mother's ability to meet her intention to breastfeed at least 3 months. Employer support for flexible work scheduling may help more women achieve their breastfeeding goals.

Fatores associados ao aleitamento materno nas diferentes Regiões do Brasil

Objetivos: identificar os fatores que determinam o aleitamento materno nas diferentes regiões do país. Métodos: os dados fazem parte da Pesquisa de Orçamento Familiar de 2002-2003 realizada no Brasil. A amostra foi de 2958 crianças de zero a um ano, representativas da população nacional. Um modelo de regressão linear (GLM) com família binomial e ligação logarítmica foi criado para cada região, com um intervalo de confiança de 90%. Resultados: o aumento do número de moradores no domicilio é o principal fator negativo para a amamentação em todas as regiões do Brasil. Foram considerados como fatores desfavoráveis, no conjunto da amostra: mães com idade avançada, ter quatro ou mais moradores no domicílio, maior renda, maior escolaridade materna e uso de creche. Os fatores favoráveis foram: ter dois ou mais filhos menores de cinco anos em casa e mães de cor preta ou parda. Conclusões: as regiões que apresentaram um número maior de fatores desfavoráveis ao aleitamento materno foram Sudeste e Sul, sendo que o maior número de moradores no domicílio foi a pior situação para a efetivação da amamentação nas regiões do Brasil.

In the United States, a Mother's Plans for Infant Feeding Are Associated with Her Plans for Employment

BACKGROUND

The American Academy of Pediatrics recommends 6 months of exclusive breastfeeding, however, only 16% of US infants meet this recommendation. Shorter exclusive/predominant breastfeeding durations have been observed from women who return to work early and/or full-time.

OBJECTIVE

We assessed the relationship between prenatal plans for maternity leave duration and return to full-time/part-time status and plans for exclusive breastfeeding.

METHODS

This study included 2348 prenatally employed women from the Infant Feeding Practices Study II (2005-2007) who planned to return to work in the first year postpartum. Bivariate analysis and logistic regression were used to describe the association of maternity leave duration and return status with plans for infant feeding.

RESULTS

Overall, 59.5% of mothers planned to exclusively breastfeed in the first few weeks. Mothers planning to return to work within 6 weeks had 0.60 times the odds (95% confidence interval [CI], 0.46-0.77) and mothers planning to return between 7 and 12 weeks had 0.72 times the odds (95% CI, 0.56-0.92) of planning to exclusively breastfeed compared with mothers who were planning to return after 12 weeks. Prenatal plans to return full-time (≥ 30 hours/week vs part-time) were also associated with lower odds of planning to exclusively breastfeed (adjusted odds ratio = 0.61; 95% CI, 0.51-0.77).

CONCLUSION

Mothers planning to return to work before 12 weeks and/or full-time were less likely to plan to exclusively breastfeed. Longer maternity leave and/or part-time return schedules may increase the proportion of mothers who plan to exclusively breastfeed.

Using mPINC data to measure breastfeeding support for hospital employees

BACKGROUND

Employer support is important for mothers, as returning to work is a common reason for discontinuing breastfeeding. This article explores support available to breastfeeding employees of hospitals that provide maternity care.

OBJECTIVES

This study aimed to describe the prevalence of 7 different types of worksite support and changes in these supports available to breastfeeding employees at hospitals that provide maternity care from 2007 to 2011.

METHODS

Hospital data from the 2007, 2009, and 2011 Centers for Disease Control and Prevention Survey on Maternity Practices in Infant Nutrition and Care (mPINC) were analyzed. Survey respondents were asked if the hospital provides any of the following supports to hospital staff: (1) a designated room to express milk, (2) on-site child care, (3) an electric breast pump, (4) permission to use existing work breaks to express milk, (5) a breastfeeding support group, (6) lactation consultant/specialist available for consult, and (7) paid maternity leave other than accrued vacation or sick leave. This study was exempt from ethical approval because it was a secondary analysis of a publicly available dataset.

RESULTS

Of the 7 worksite supports in hospitals measured, 6 increased and 1 decreased from 2007 to 2011. Across all survey years, more than 70% of hospitals provided supports for expressing breast milk, whereas less than 15% provided direct access to the breastfeeding child through on-site child care, and less than 35% offered paid maternity leave. Results differed by region and hospital size and type. In 2011, only 2% of maternity hospitals provided all 7 worksite supports; 40% provided 5 or more.

CONCLUSION

The majority of maternity care hospitals (> 70%) offer breastfeeding supports that allow employees to express breast milk. Supports that provide direct access to the breastfeeding child, which would allow employees to breastfeed at the breast, and access to breastfeeding support groups are much less frequent than other supports, suggesting opportunities for improvement.

Association of child care providers breastfeeding support with breastfeeding duration at 6 months

Many lactating mothers participate in the workforce and have their infants cared for outside of their home, yet little is known about their child care providers' (CCPs') support of breastfeeding. This study examines the association between CCPs' breastfeeding support as reported by mothers at 3 months and mother's breastfeeding at 6 months. Infant Feeding Practices Study II, a longitudinal study, followed mothers of infants via mail questionnaires almost monthly from late pregnancy throughout the first year. This study consisted of 183 mothers who breastfed and had their infant in child care at 3 months and answered 5 questions regarding CCPs' supports. Total number of CCPs' support was a summary of responses to individual items and categorized into 3 levels (0-2, 3-4, or 5 total supports). Multiple logistic regressions examined how each breastfeeding support and total number were associated with breastfeeding at 6 months. Breastfeeding at 6 months was significantly associated with CCP support to feed expressed breast milk (AOR = 4.55; 95% CI = 1.09, 18.95) and allow mothers to breastfeed at the child care place before or after work (AOR = 6.23; 95% CI = 1.33, 29.16). Compared to mothers who reported fewer than 3 total supports, mothers who reported 5 supports were 3 times as likely to be breastfeeding at 6 months (AOR = 3.00, 95% CI = 1.11, 8.13). Our findings suggest that CCPs' breastfeeding support at 3 months, particularly feeding expressed breast milk and allowing mothers to breastfeed before or after work, may help mothers maintain breastfeeding at 6 months.

Mothers' expectations and other factors affecting breastfeeding at six months in Greece

The objective of this study is to determine the factors influencing breastfeeding duration in Greece. A total of 145 women were interviewed, on the third day post-partum. Women were followed up by telephone interviews at three and six months post-partum. Chi-square test and binomial sequential logistic regression analysis were used for statistical analysis. Results from this study show that baby-friendly hospital, antenatal courses, mother's perception of her capability to successfully breastfeed her infant, mother's intention to breastfeed for a duration of six months or more, mother's and father's education level, introduction of complementary foods or fluids, caesarean delivery, smoking and ethnicity were significantly associated with the duration of breastfeeding. In conclusion, additional antenatal and postnatal framework is necessary. Mothers' prediction of the duration of breastfeeding is an additional tool for identification of women with a high probability for early weaning.

Work-place predictors of duration of breastfeeding among female physicians

OBJECTIVE

To identify work-related predictors of breastfeeding duration among female physicians.

STUDY DESIGN

Data on 238 children were obtained from 50 female physicians, whose main affiliation was with Johns Hopkins University (Baltimore, MD), and 80 female physicians, whose main affiliation was with the University of Florida (Gainesville, FL). We used a mixed linear model to determine which variables were significant predictors of breastfeeding duration when controlling for maternal demographics and taking into account the clustering of observations on study location and mothers.

RESULTS

Although female physicians intended to breastfeed 56% of the infants for at least 12 months and 97% of infants were breastfed at birth, only 34% of infants continued to receive breast milk at 12 months. Duration of lactation among female physicians correlated with the following work-related factors: (1) not having to make up missed call/work that occurred as result of pregnancy or maternity leave; (2) longer length of maternity leave; (3) sufficiency of time at work for milk expression; and (4) perceived level of support for breastfeeding efforts at work from colleagues, program director, or division/section chiefs.

CONCLUSION

Our findings support the importance of work-related factors in breastfeeding maintenance among female physicians and suggest that a tailored intervention, providing time and institutional encouragement, might result in significant improvement in their breastfeeding duration.

Who pays for the health benefits of exclusive breastfeeding? An analysis of maternal time costs

BACKGROUND

The benefits of exclusive breastfeeding, including public health cost savings, are widely recognized, but breastfeeding requires maternal time investments.

OBJECTIVE

This study investigates the time taken to exclusively breastfeed at 6 months compared with not exclusively breastfeeding.

METHODS

Time use data were examined from an Australian survey of new mothers conducted during 2005-2006. Data from 139 mothers with infants age 6 months were analyzed using chi-square tests of independence to examine socioeconomic and demographic characteristics and 2-sided t tests to compare average weekly hours spent on milk feeding, feeding solids, preparing feeds, and the total of these. The comparison was of exclusively breastfeeding mothers with other mothers. We also compared exclusively breastfeeding with partially breastfeeding and formula feeding mothers using a 1-way between-groups analysis of variance (ANOVA).

RESULTS

The exclusively breastfeeding (vs other) mothers spent 7 hours extra weekly on milk feeding their infants but 2 hours less feeding solids. These differences were statistically significant. ANOVA revealed significant differences between exclusively breastfeeding mothers, breastfeeding mothers who had introduced solids, and mothers who fed any formula, in time spent feeding milk, and solids, and preparing feeds.

CONCLUSION

Exclusive breastfeeding is time intensive, which is economically costly to women. This may contribute to premature weaning for women who are time-stressed, lack household help from family, or cannot afford paid help. Gaining public health benefits of exclusive breastfeeding requires strategies to share maternal lactation costs more widely, such as additional help with housework or caring for children, enhanced leave, and workplace lactation breaks and suitable child care.

The impact of prenatal employment on breastfeeding intentions and breastfeeding status at 1 week postpartum

BACKGROUND

Postpartum employment is associated with non-initiation and early cessation of breastfeeding, but less is known about the relationship between prenatal employment and breastfeeding intentions and behaviors.

OBJECTIVE

This study aimed to estimate the relationship between prenatal employment status, a strong predictor of postpartum return to work, and breastfeeding intentions and behaviors.

METHODS

Using data from the Listening to Mothers II national survey (N = 1573), we used propensity score matching methods to account for non-random selection into employment patterns and to measure the impact of prenatal employment status on breastfeeding intentions and behaviors. We also examined whether hospital practices consistent with the Baby-Friendly Hospital Initiative (BFHI), assessed based on maternal perception, were differentially associated with breastfeeding by employment status.

RESULTS

Women who were employed (vs unemployed) during pregnancy were older, were more educated, were less likely to have had a previous cesarean delivery, and had fewer children. After matching, these differences were eliminated. Although breastfeeding intention did not differ by employment, full-time employment (vs no employment) during pregnancy was associated with decreased odds of exclusive breastfeeding 1 week postpartum (adjusted odds ratio = 0.48; 95% confidence interval, 0.25-0.92; P = .028). Higher BFHI scores were associated with higher odds of breastfeeding at 1 week but did not differentially impact women by employment status.

CONCLUSION

Women employed full-time during pregnancy were less likely to fulfill their intention to exclusively breastfeed, compared to women who were not employed during pregnancy. Clinicians should be aware that employment circumstances may impact women's breastfeeding decisions; this may help guide discussions during clinical encounters.

Determinants of exclusive breastfeeding in an urban population of primiparas in Lebanon: a cross-sectional study

Background

The proportion of mothers who exclusively breastfeed their babies up to 6 months remains low. Determinants of breastfeeding practices have been largely documented in high-income countries. Little evidence exists on possible predictors of breastfeeding behaviors in the Middle East. Our aim was to assess the prevalence of breastfeeding in Beirut and determine the factors that impact breastfeeding behavior in this population.

Methods

Data for this longitudinal study is nested within a randomized controlled trial (RCT) assessing the impact of a 24-hour hotline and postpartum support film on postpartum stress. Healthy first-time mothers delivering in the capital Beirut between March and July 2009, were interviewed at 1–3 days and 8–12 weeks post delivery. A multiple logistic regression analysis was used to determine the factors associated with exclusive breastfeeding at 8–12 weeks postpartum.

Results

The overall breastfeeding rate at 8–12 weeks postpartum was 67%. The exclusive breastfeeding rate was 27.4%. Factors associated with exclusive breastfeeding included maternal work (OR=3.92; p-value<0.001), planned pregnancy (OR=2.42, p-value=0.010), intention to breastfeed (OR=3.28; p-value=0.043), source of maternal emotional support (OR = 1.87, p-value=0.039) and the use the postpartum support video, the hotline service or both (OR=2.55, p-value=0.044; OR=3.87, p-value=0.004 and OR=4.13, p-value=0.003).

Conclusions

The proportion of healthy first-time mothers who exclusively breastfeed in Beirut is extremely low. Factors associated with breastfeeding behavior are diverse. Future research and interventions should target different levels of the maternal-child pair’s ecosystem.

Trial registration

ClinicalTrials.gov, NCT00857051

Impact of a breastfeeding-friendly workplace on an employed mother's intention to continue breastfeeding after returning to work

BACKGROUND

Ever-increasing populations of women in their childbearing years are choosing to become employed. Breastfeeding provides unique health advantages to both the infant and mother. A breastfeeding-friendly workplace might be an important factor for predicting breastfeeding rates among working women. To explore the impact of breastfeeding-friendly support on the intention of working mothers to continue breastfeeding, we conducted a survey at a female labor-intensive electronics manufacturer in Taiwan.

SUBJECTS AND METHODS

A structured questionnaire survey was administered to 715 working mothers employed in an electronics manufacturing plant in Tainan Science Park in Southern Taiwan. Questionnaire content included female employee demographics, employment characteristics, continued breastfeeding behavior after returning to work, access to lactation rooms, and employee perception of the breastfeeding policy and support when raising their most recently born child.

RESULTS

A higher education level (odds ratio [OR]=2.66), lower work load (8 work hours/day) (OR=2.66), lactation room with dedicated space (OR=2.38), use of breast pumping breaks (OR=61.6), and encouragement from colleagues (OR=2.78) and supervisors (OR=2.44) to use breast pumping breaks were significant predictors of continued breastfeeding for more than 6 months after returning to work.

CONCLUSIONS

The findings of the present study suggest that to encourage and increase the rate of continued breastfeeding, workplaces should establish dedicated breastfeeding rooms and maintain a comfortable and clean environment. Furthermore, employers should provide encouragement and support for working mothers to continue breastfeeding after returning to work.

Breastfeeding support for mothers in workplace employment or educational settings: summary statement

The Academy of Breastfeeding Medicine is a worldwide organization of physicians dedicated to the promotion, protection, and support of breastfeeding and human lactation. Our mission is to unite into one association members of the various medical specialties with this common purpose.

Breastfeeding and health outcomes for the mother-infant dyad

Worldwide, breastfeeding saves the lives of infants and reduces their disease burden. Breastfeeding also reduces the disease burden for mothers. This article examines who chooses to breastfeed and for how long in the United States. It also reviews the latest evidence about the consequences of breastfeeding for the health of the infant and mother. This review provides support for current national and international recommendations that support breastfeeding.

Employers' readiness for the mother-friendly workplace: an elicitation study

Currently over half of mothers of infants under 1-year-old are in the workforce in the United States. These women face challenges to continue breastfeeding when they return to work 3 to 6 months post-partum. This study explored the perspectives of employers on mother-friendly environments to assess their readiness to provide breastfeeding accommodation using the elicitation under the theory of planned behaviour. Researchers conducted phone/in-person interviews with a convenient sample of 20 human resource managers from companies that had 500 or more employees in the New York metropolitan area in 2009. Content analyses identified the common concepts that represent underlying beliefs of the constructs of the theory. The demography of the participants is 40% male and 80% White, with mean ages of 34.3±8.5 years. 'Happy employees' and 'high retention rate and improved loyalty' were the most frequently mentioned (95%) benefits to the company (behavioural beliefs). Supporters of a mother-friendly environment (normative beliefs) in the workplace included 'mothers and expectant mothers (70%)', and 'managers supervising women and new mothers (55%)'. Most frequently mentioned company drawbacks (control beliefs) were 'not cost effective (65%)' and 'time consuming (65%)', followed by 'perception of special favours for some (50%)'. Workplace breastfeeding promotion efforts can be successful by reinforcing positive beliefs and addressing the challenges associated with implementation of breastfeeding accommodation through education and other incentives such as recognition of model companies and tax breaks. The identified beliefs provide a basis for the development of a quantitative instrument to study workplace breastfeeding support further.

Development, content validity, and piloting of an instrument designed to measure managers' attitude toward workplace breastfeeding support

Manager attitude is influential in female employees' perceptions of workplace breastfeeding support. Currently, no instrument is available to assess manager attitude toward supporting women who wish to combine breastfeeding with work. We developed and piloted an instrument to measure manager attitudes toward workplace breastfeeding support entitled the "Managers' Attitude Toward Breastfeeding Support Questionnaire," an instrument that measures four constructs using 60 items that are rated agree/disagree on a 4-point Likert rating scale. We established the content validity of the Managers' Attitude Toward Breastfeeding Support Questionnaire measures through expert content review (n=22), expert assessment of item fit (n=11), and cognitive interviews (n=8). Data were collected from a purposive sample of 185 front-line managers who had experience supervising female employees, and responses were scaled using the Multidimensional Random Coefficients Multinomial Logit Model. Dimensionality analyses supported the proposed four-construct model. Reliability ranged from 0.75 to 0.86, and correlations between the constructs were moderately strong (0.47 to 0.71). Four items in two constructs exhibited model-to-data misfit and/or a low score-measure correlation. One item was revised and the other three items were retained in the Managers' Attitude Toward Breastfeeding Support Questionnaire. Findings of this study suggest that the Managers' Attitude Toward Breastfeeding Support Questionnaire measures are reliable and valid indicators of manager attitude toward workplace breastfeeding support, and future research should be conducted to establish external validity. The Managers' Attitude Toward Breastfeeding Support Questionnaire could be used to collect data in a standardized manner within and across companies to measure and compare manager attitudes toward supporting breastfeeding. Organizations can subsequently develop targeted strategies to improve support for breastfeeding employees through efforts influencing managerial attitude.

Development and piloting of an instrument that measures company support for breastfeeding

BACKGROUND

Maternal employment has been cited as a barrier to continued breastfeeding, yet there have been few studies identifying company breastfeeding support.

OBJECTIVES

The study objectives were to develop and pilot an instrument that measures formal breastfeeding support in companies.

METHODS

A survey of company breastfeeding supports was developed, based on the literature and expert review, and the survey piloted with Michigan-based companies.

RESULTS

Completion of the surveys and open-ended comments indicated survey items were generally well understood. In the study sample (N = 151), significantly more support was offered in companies having more employees as compared to fewer, and in companies from the health care versus all other sectors (P < .01). More support was also found in companies reporting requests for support, upper management combining breastfeeding and work, and a population that they felt likely to require breastfeeding support (P < .01). Few companies (3%) had written policies on breastfeeding or pumping at work. However, the majority of companies allow women to pump milk at the worksite (94%), and provide time (73%) and nonrestroom space to pump (78%). Fewer companies allow breastfeeding at the company (22%) or designate a room solely for breastfeeding or pumping (32%).

CONCLUSIONS

The survey instrument is appropriate to determine breastfeeding supports in companies. In Michigan, larger companies and those in the health care sector provide more supports, most companies provide some type of space and time to pump, but other supports are limited.

Type of milk feeding affects hematological parameters and serum lipid profile in Japanese infants

BACKGROUND

Type and volume of infant feeding determines infant growth, hematological parameters, and serum lipids.

METHODS

Study subjects consisted of 103 infants who were born vaginally at term, with birthweight >2200 g. Milk feeding amount, type, and anthropometry were measured at 1 and 6 months. Hematological tests and serum lipid profile were assessed at 1 and 6 months. Thirty-four infants were breast-fed and 36 were formula-fed at 6 months.

RESULTS

Breast-fed infants demonstrated similar growth patterns compared with partially breast-fed or formula-fed infants, despite the lower milk intake. Infants with higher breast milk intake at 6 months, however, tended to have lower hemoglobin levels. In contrast, higher formula intake at 6 months was related to lower serum total cholesterol.

CONCLUSIONS

Japanese breast-fed infants were more likely to be anemic at 6 months, while formula-fed infants were likely to have low serum lipid levels. Iron-fortified infant foods may be useful to prevent anemia in breast-fed infants. Fat quality of infant formulas should be improved to enhance lipid status of formula-fed infants.

Working mothers: how much working, how much mothers, and where is the womanhood?

Motherhood confers upon a woman the responsibility of raising a child. This process also changes the way in which she is perceived in society and at her workplace. It can necessitate her to take more than available leave options, and job security can be at risk. Significant social and personal adjustments are necessary to cope with such a situation. A working mother, especially one who has the good fortune to be able to balance her home and work, enjoys the stimulation that a job or career provides. She develops the ability of raising a useful member of society and at the same time gains financial independence. Along with motherhood, work adds to the completeness of being a woman.

Impact of lack of breast feeding during neonatal age on the development of clinical signs of pneumonia and hypoxemia in young infants with diarrhea

Background

Hypoxemia is a grave sequel of pneumonia, and an important predictor of a fatal outcome. Pneumonia in the neonatal period is often associated with lack of breast feeding. However, there is no published report on the impact of the cessation of breast feeding in the neonatal period on the development of pneumonia and hypoxemia. The purpose of our study was to assess the impact of non-breast feeding or stopping breast feeding during the neonatal period (henceforth to be referred to as non-breast fed) on clinical features of pneumonia and hypoxemia in 0–6-month-old infants with diarrhea admitted to an urban hospital in Bangladesh.

Methods

We prospectively enrolled all infants (n = 107) aged 0 to 6 months who were admitted to the Special Care Ward (SCW) of the Dhaka Hospital of the International Centre for Diarrhoeal Disease Research Bangladesh (ICDDR,B) with diarrhea and pneumonia from September 2007 through December 2007.We compared the clinical features of pneumonia and hypoxemia of breast fed infants (n = 34) with those who were non-breast fed (n = 73).

Results

The median (inter-quartile range) duration of hypoxemia (hours) in non-breast-feds was longer than breast-fed infants [0.0 (0.0, 12.0) vs. 12.0 (0.0, 21.75); p = 0.021]. After adjusting for potential confounders such as inability to drink, fever, head nodding, cyanosis, grunting respiration, and lower chest wall in drawing, the non-breast-fed infants with pneumonia along with diarrhea had a higher probability of cough (OR 9.09; CI 1.34–61.71; p = 0.024), hypoxemia (OR 3.32; CI 1.23–8.93; p = 0.017), and severe undernutrition (OR 3.42; CI 1.29–9.12; p = 0.014).

Conclusions and Significance

Non-breast feeding or cessation of breast feeding during the neonatal period may substantially increase the incidence of severe malnutrition, incidence of cough, and both the incidence and duration of hypoxemia in young infants presenting with pneumonia and diarrhea. The findings emphasize the paramount importance of the continuation of breast feeding in the neonatal period and early infancy.

Balancing work and family: effect of employment characteristics on breastfeeding

This article describes an investigation of the effect of postpartum employment and occupational type on breastfeeding initiation and duration. Data were from the Early Childhood Longitudinal Study-Birth Cohort. Postpartum employment status was classified as full-time, part-time, and not employed. Among postpartum workers, occupational type was classified as management, professional, service, sales, administrative, and "other." In adjusted analysis, professional women had a 20% greater likelihood of initiating breastfeeding than administrative workers (risk ratio [RR] 1.20; 95% confidence interval [CI], 1.06-1.30). Full-time workers had a 10% lower likelihood of initiating breastfeeding than those not employed (RR 0.90; 95% CI, 0.82-0.97). Among breastfeeding initiators, full-time workers had a 19% lower likelihood of any breastfeeding beyond 6 months than those not employed (RR 0.81; 95% CI, 0.65-0.99). To improve breastfeeding initiation and duration in the United States, part-time options may be an effective solution for working mothers.

Perspectives of managers toward workplace breastfeeding support in the state of Michigan

Managers' attitudes influence female employees' perceptions of workplace breastfeeding support. Five focus groups were conducted with managers in the state of Michigan (N = 25) to assess their attitudes toward supporting breastfeeding. All focus group discussions were recorded, transcribed verbatim, and analyzed for themes. Participants supported efforts by managers and companies to assist breastfeeding employees, but the extent of accommodations they supported varied. Most participants reported no company breastfeeding policy or were unaware of their company having one and showed mixed attitudes about needing a policy. Participants acknowledged the potential for lower productivity and coworker jealousy toward time for breastfeeding or expressing milk but believed that benefits of support included employee recruitment and retention. Participants demonstrated some understanding of breastfeeding benefits. They identified barriers and facilitators for breastfeeding support at both the organizational and individual levels. Results of this study will be used for instrument development to measure managers' attitudes toward supporting breastfeeding.

Perceptions of breastfeeding and planned return to work or school among low-income pregnant women in the USA

AIMS AND OBJECTIVES

To describe the perceptions of breastfeeding in low-income pregnant women to understand their needs better as they plan to return to work or school.

BACKGROUND

Maternal employment has a negative impact on breastfeeding duration. Yet there is insufficient research on challenges and facilitators regarding breastfeeding and employment issue among low-income women in the USA. Knowing the perceptions of breastfeeding among low-income pregnant women and their plan to return to work or school may have implications for nurses and midwives in providing quality care.

DESIGN

Qualitative study using focus group interviews.

METHODS

The research setting consisted of three Women, Infants and Children clinics (WIC) in a midwestern city of the USA. Seventeen pregnant women (aged 19-35) participated in focus group interviews. Data were coded and analysed for themes and patterns using the QSR software - NVivo 6.

RESULTS

Eleven participants were single. Ten women were primigravida, and seven were multipara. The following five themes were identified: (1) perceived benefits of breastfeeding; (2) general perceptions of breastfeeding; (3) maternal concerns; (4) having the right support; and (5) anticipated challenges of combining breastfeeding and work. Conclusions.  Low-income women anticipated substantial barriers for breastfeeding when they planned to combine breastfeeding and work or school. The results of this study have many implications for public health practice, research and policy. Educating employers and the public at large about the health and economic benefits derived from long-term breastfeeding could help promote breastfeeding awareness.

RELEVANCE TO CLINICAL PRACTICE

Strategies supporting breastfeeding among low-income working women must be provided at multiple levels to help overcome the barriers they concern. Health care providers should help women gain confidence by minimising their uncertainties and fears about breastfeeding to prepare them to continue breastfeeding successfully after returning to work.

Working mothers, breastfeeding, and the law

Workplace barriers contribute to low rates of breastfeeding. Research shows that supportive state laws correlate with higher rates, yet by 2009, only 23 states had adopted any laws to encourage breastfeeding in the workplace. Federal law provided virtually no protection to working mothers until the 2010 enactment of the "reasonable break time" provision of the Patient Protection and Affordable Care Act. This provision nonetheless leaves many working mothers uncovered, requires break time only to pump for (not feed) children younger than 1 year, and exempts small employers that demonstrate hardship. Public health professionals should explore ways to improve legal support for all working mothers wishing to breastfeed. Researchers should identify the laws that are most effective and assist policymakers in translating them into policy.

Breastfeeding intentions of female physicians

BACKGROUND

It is known that physician mothers' breastfeeding behavior impacts their anticipatory guidance to their patients, which in turn influences patients' breastfeeding initiation and continuation. Therefore, studying physician mothers' breastfeeding behavior is important, as it impacts not only the well-being of themselves and their families, but eventually the well-being of their patients and patients' families. However, previous studies of breastfeeding among physician mothers in the United States have not explored their breastfeeding intentions. We therefore sought to explore infant feeding intentions of physician mothers.

METHODS

We report data gathered from 50 physician volunteers, mainly affiliated with Johns Hopkins University (Baltimore, MD), using a questionnaire.

RESULTS

Consistent with previous physician studies, we found high breastfeeding initiation rates among our participants. However, the breastfeeding continuation rates of mothers in our study at 6 and 12 months were higher than those reported in previous physician studies. Our data showed that while physician mothers intended to breastfeed 64% of the infants for at least 12 months and while 97% of infants were breastfed at birth, only 41% continued to receive breastmilk at 12 months. This discrepancy suggests that work-related factors may influence physician mothers' breastfeeding behavior and might have a larger impact than these mothers' education and intentions on breastfeeding duration.

CONCLUSION

This finding supports implementing workplace strategies and programs to promote breastfeeding duration among physician mothers returning to work.

Sociocultural influences on the determinants of breast-feeding by Latina mothers in the Cincinnati area

While breast-feeding initiation and duration among US Latina women appear to decrease with acculturation, health care providers in the Greater Cincinnati area have noted lower rates of breast-feeding among even first-generation Latina immigrants. This study's purpose was to identify determinants of breast-feeding for Latina mothers in Cincinnati through qualitative interviews and Spanish Breastfeeding Self-Efficacy Scale ratings. Our findings suggest that, along with similar levels of breast-feeding self-confidence, foreign-born Latina women in the Greater Cincinnati area share similar breast-feeding determinants with the general population. However, characteristics of these determinants and their impact vary because of unique pressures experienced by this community.

Breast ptosis: causes and cure

Breast ptosis is one of the most common conditions treated by plastic surgeons, but the causes are not clearly defined. A review was conducted of 132 consecutive patients presenting for breast augmentation or mastopexy. Information was obtained by chart review and telephone interview. Standardized photographs were examined to determine degree of ptosis by the Regnault classification. Of patients who had at least one pregnancy, 85% reported adverse changes in breast shape following pregnancy, 35% reported a reduction in breast size, and 30% reported an increase in size. Upon logistic regression, age, history of significant (>50 lbs) weight loss, higher body mass index, larger bra cup size, number of pregnancies, and smoking history were found to be significant risk factors for breast ptosis (P < 0.05). History of breast-feeding, weight gain during pregnancy, and lack of participation in regular upper body exercise were not found to be significant risk factors for ptosis.

Factors associated with breastfeeding duration among Connecticut Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) participants

This retrospective study aimed to identify factors associated with breastfeeding duration among women enrolled in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) of Hartford, Connecticut. The authors included mothers whose children were younger than 5 years and had stopped breastfeeding (N = 155). Women who had planned their pregnancies were twice as likely as those who did not plan them to breastfeed for more than 6 months (odds ratio, 2.15; 95% confidence interval, 1.00-4.64). One additional year of maternal age was associated with a 9% increase on the likelihood of breastfeeding for more than 6 months (odds ratio, 1.09; 95% confidence interval, 1.02-1.17). Time in the United States was inversely associated with the likelihood of breastfeeding for more than 6 months (odds ratio, 0.96; 95% confidence interval, 0.92-0.99). Return to work, sore nipples, lack of access to breast pumps, and free formula provided by WIC were identified as breastfeeding barriers. Findings can help WIC improve its breastfeeding promotion efforts.

Psychometric evaluation of the Employer Support for Breastfeeding Questionnaire (ESBQ)

The purpose of this descriptive methodological study was to develop and evaluate the psychometric properties of the Employer's Support for Breastfeeding Questionnaire (ESBQ). The convenience sample consisted of 380 business owners, managers, or supervisors from the Midwestern United States. Data were collected using Web and paper-based questionnaires from January to March 2008. Psychometric evaluation included item analysis, scale reliability, and construct validity. The ESBQ subscales had Cronbach's alphas ranging from 0.85 to 0.92. Most inter-item and item-to-total correlations were above the recommendation of 0.30. The test-retest reliability of each subscale ranged from 0.93 to 1.0. Confirmatory factor analysis supported the construct validity of the scale. The comparative fit index (CFI) and the non-normal fit index (NNFI) were 0.90 and 0.91, respectively, and the root mean square error of approximation (RMSEA) was 0.05. Findings supported the ESBQ as reliable, valid, and theoretically consistent with the theory of planned behavior.

Physician mothers: an unlikely high risk group-call for action

Breastfeeding rates have been improving in the United States. However, current rates, especially those of exclusive breastfeeding and breastfeeding duration, are still below the Healthy People 2010 objectives. Furthermore, gaps in breastfeeding rates continue to exist among different racial and socioeconomic groups. Physician mothers' breastfeeding behavior has been studied because it impacts their anticipatory guidance to their patients, which in turn influences patients' breastfeeding initiation and continuation. In this paper, we review available literature regarding breastfeeding among female physicians in the United States. The current data suggest that female physicians are initiating breastfeeding more often than the general population but their continuation rates are lower. In other words, working as a physician might be a newly identified maternal characteristic associated with low breastfeeding maintenance rates. We also review possible factors that might affect breastfeeding decisions and behaviors of physician mothers. Once modifiable factors are further identified, programs can be suggested and implemented to improve breastfeeding continuation in this newly identified high-risk group.

Satisfaction of women urologists with maternity leave and childbirth timing

PURPOSE

Women physicians must consider many conflicting issues when timing childbirth. We characterized maternity leave, breast-feeding practices and satisfaction associated with pregnancy timing in women urologists.

MATERIALS AND METHODS

A 114-item anonymous survey including questions on maternity leave duration for firstborn children, workplace policies, attitudes and satisfaction was mailed to all 365 American board certified women urologists in May and July 2007. Logistic regression was used to identify factors associated with greater satisfaction.

RESULTS

A total of 243 women urologists (69%) responded, of whom 158 had at least 1 biological child. Average maternal age at first birth was 32.6 years. Of the children 10%, 32% and 52% were born before, during and after residency, respectively. Only 42% of women reported the existence of a formal maternity leave policy. Of the women 70% took 8 weeks or less of leave. Those with 9 weeks or greater were 3.8 times more likely to report satisfaction (p = 0.001). Although women in practice were 2.0 times more likely to take 9 weeks or greater compared to those in training or earlier (p = 0.046), only 30% in practice took this much time. Dissatisfaction with leave was not related to birth timing (residency vs practice) or maternal age at delivery but to work/residency related issues in 69% of respondents, financial concerns in 13% and personal/other in 18%. For breast-feeding 67% of respondents were satisfied with the duration and 22% were not. Dissatisfaction was secondary to work factors.

CONCLUSIONS

Satisfaction with leave was related to the amount of maternity leave with women with 9 weeks or greater more likely to report satisfaction. Women in practice were more likely to take 9 weeks or greater but most did not due to strong stressors related to work, partners/peers or finances. Work factors were cited for dissatisfaction with breast-feeding.

The Family and Medical Leave Act: implications for occupational and environmental health nursing

The Family and Medical Leave Act (FMLA) was enacted in 1993 to balance the demands of the workplace with the needs of families. Balancing work and family responsibilities will affect most workers as they experience their own serious illness or care for a child or a parent. The FMLA continues to present challenges regarding medical certifications, recordkeeping, intermittent leave management, and lack of understanding by employees and employers about rights and responsibilities under the law. This article discusses the rights and responsibilities of both parties. It also discusses how the occupational and environmental health nurse can bridge the gap between meeting the needs of the employee and those of the employer by serving as educator, advocate, and liaison/collaborator, leading to measurable cost savings for the employer and immeasurable benefits for the employee.

Evaluation of lactation support in the workplace or school environment on 6-month breastfeeding outcomes in Yolo County, California

Six-month breastfeeding outcomes (almost exclusive breastfeeding, partial breastfeeding, and not breastfeeding) were analyzed for 201 infants born to Yolo County, California, mothers who returned to work or school. Twenty-two percent of workplaces and 17% of schools did not provide a lactation room. Although part- or full-time status, knowledge of breastfeeding rules, and support from colleagues were independently associated with the outcome, they were not significant in the multivariate analysis. In the selected model, maternal age (odds ratio [OR] = 2.3; 1.3-3.9 for a 10-year difference), college or above versus <or= high school education (OR = 9.1; 4.2-19.6), and exclusive breast milk feeding in the hospital (OR = 2.1; 1.1-4.0) were associated with better breastfeeding outcomes at 6 months postpartum. Receipt of discharge gift packs containing formula (OR = 0.5; 0.3-1.0) was inversely associated with the degree of breastfeeding exclusivity. The 2 latter findings underscore the importance of hospitals adhering to specific guidelines of the Baby-Friendly Hospital Initiative.

Reasons for in-hospital formula supplementation of breastfed infants from low-income families

In-hospital formula supplementation of breastfed infants negatively impacts breastfeeding duration. Infants from low-income families have some of the lowest exclusive breastfeeding rates in the United States. The objectives of this study were to identify (1) reasons low-income breastfeeding mothers begin in-hospital formula supplementation and (2) risk factors for in-hospital formula supplementation. We surveyed 150 low-income mothers in a Washington, DC, clinic. Sixty percent had initiated breastfeeding, and 78% of these breastfed infants received formula supplementation in the hospital. There was no clear medical need for supplementation for 87% of the breastfed infants receiving supplementation. Infants of mothers who did not attend a prenatal breastfeeding class were almost 5 times more likely to receive in-hospital formula supplementation than those infants whose mothers had attended a class (OR, 4.7; 95% CI, 1.05-21.14). Improved knowledge about breastfeeding among nursing and medical providers is important to minimize unnecessary formula supplementation for breastfed infants.

Success of strategies for combining employment and breastfeeding

OBJECTIVE

Return to work is associated with diminished breastfeeding intensity and duration. Although more mothers breastfeed after returning to work now than earlier, research has not documented the strategies that mothers use for combining paid work and breastfeeding or their effect on breastfeeding outcomes. This study examined which strategies are associated with smaller decrements in breastfeeding intensity and longer durations.

PARTICIPANTS AND METHODS

We analyzed 810 mothers from the Infant Feeding Practices Study II who worked and breastfed. We used regression and censored regression models to analyze 4 strategies that mothers used to combine these 2 activities: (1) feed directly from the breast only; (2) both pump and feed directly; (3) pump only; and (4) neither pump nor breastfeed during the work day. Outcomes were the difference in percentage of milk feeds that were breast milk between the month before and after return to work and duration of breastfeeding after return to work.

RESULTS

Forty-three percent of mothers pumped milk at work only; 32% fed the infant directly from the breast only. These 2 strategies, along with pumping and feeding directly, were statistically similar and superior to neither pumping nor breastfeeding during the work day for the outcome of change in breastfeeding intensity. For the outcome of breastfeeding duration, the 2 strategies that included directly feeding from the breast were associated with longer duration than pumping only, whereas the strategy of neither pumping nor breastfeeding during the work day was associated with the shortest duration.

CONCLUSIONS

Feeding the infant from the breast during the work day is the most effective strategy for combining breastfeeding and work. Ways to enable direct feeding include on-site child care, telecommuting, keeping the infant at work, allowing the mother to leave work to go to the infant, and having the infant brought to the work site. Establishing ways for mothers to feed from the breast after return to work is important to meet US breastfeeding goals.

Maternal breastfeeding attitudes: association with breastfeeding intent and socio-demographics among urban primiparas

Breastfeeding is associated with improved developmental and social outcomes for an infant. Despite these health benefits, only 54% of women breastfeed in the early postpartum period. Although an understanding of socio-demographic characteristics, breastfeeding intent, and breastfeeding attitudes can facilitate breastfeeding initiatives, these factors have not been characterized particularly for urban and immigrant mothers. The objectives of this study are to provide a descriptive analysis of the socio-demographic characteristics, breastfeeding intent, and breastfeeding attitudes of primiparas presenting to an inner city prenatal clinic and determine if breastfeeding attitudes are associated with breastfeeding intent and socio-demographic variables. Of 100 primiparas, 79 reported the intent to breastfeed. Breastfeeding intent was associated with 1) positive breastfeeding attitudes, 2) higher household incomes, 3) being born outside the US, 4) being Afro-Caribbean as opposed to African American, 5) having family, peer, and partner support for breastfeeding, 6) attending breastfeeding classes, and 7) greater years of education. These findings suggest that targeting breastfeeding initiatives towards low-income, less educated, US born mothers who lack breastfeeding support from their loved ones may improve breastfeeding rates among urban primiparas.

Maternal employment and breastfeeding: results from the longitudinal study of Australian children

AIM

To investigate the effect of maternal postnatal employment on breastfeeding duration in Australia in the first 6 months after birth.

METHOD

Secondary data analysis of the infant data (2004) from the Longitudinal Study of Australian Children (LSAC). Complete maternal and breastfeeding data were available for 3,697 infants. Multivariable logistic regression was used to investigate the effect of timing of resumption of maternal employment and maternal employment status on breastfeeding at 6 months postpartum after adjustment for maternal education, maternal age, maternal smoking during pregnancy and socioeconomic status of the child's area of residence.

RESULTS

Fewer women employed full-time were breastfeeding their infants at 6 months (39%) than nonemployed women (56%). Participation in full-time employment before 6 months had a strong, negative effect on the likelihood of continuing breastfeeding for 6 months, adjusted OR = 0.35 (95%CI: 0.22-0.55). Compared to nonemployed women, fewer women in part-time employment were breastfeeding at 6 months (44%), adjusted OR = 0.49 (95% CI: 0.37-0.64).

CONCLUSIONS

Results from this large representative cohort of Australian infants confirm that maternal employment in the first 6 months of life contributes to premature cessation of breastfeeding even when known risk factors for breastfeeding cessation are controlled for.

Infant growth and hostility in adult life

OBJECTIVE

Hostility may confer a risk of cardiovascular disease and all-cause mortality, but why is uncertain. A common origin in suboptimal fetal and early postnatal life may lie beneath. This study tested whether prenatal and postnatal growth predicts hostility in adult life.

METHODS

Women (n = 939) and men (n = 740) born in Helsinki, Finland, from 1934 through 1944 filled out the Cook-Medley Hostility Scale at an average age of 63.4 years. Growth was estimated from birth, child welfare clinic, and school records. Adult body size was measured in a clinic.

RESULTS

Men and women who had higher levels of hostility in adulthood were born lighter and thinner, showed slower weight gain from birth to 6 months of age, were lighter throughout childhood (standardized regression coefficients (beta) <-0.05; 95% confidence intervals (95% CI), -0.14 to -0.00; p values <.05), but were heavier in adulthood (beta values > 0.06; 95% CIs, 0.02-0.14; p values <.01). They were also shorter from 6 months until the age of 1 year (beta values <-0.09; 95% CIs, -0.14 to -0.03; p values <.003), and tended to be shorter in adulthood (beta = -0.05; 95% CI, -0.09 to 0.00; p = .06). The latter effects were largely attributable to slower growth in stature from birth to 6 months (beta = -0.08; 95% CI, -0.14 to -0.02; p = .005). The associations were not explained by major confounders.

CONCLUSIONS

Our study suggests that slow prenatal and infant growth is linked with hostility in adult life.

Optimizing breastfeeding promotion and support in adolescent mothers

The United States has the highest teen birth rate in the industrialized world, and adolescents continue to have the lowest rates of breastfeeding. Although individual pregnancy and parenting experiences in adolescents are modified by a variety of factors, common themes of adolescent psychology and behavior may help plan effective strategies for breastfeeding promotion and support. Breastfeeding promotion and support in adolescents need to be developmentally appropriate, patient centered, and linked to multidimensional support.