Health of infant is the main reason for breast-feeding in a WIC population in Hawaii

Breastfeeding attitudes and reported problems in a national sample of WIC participants

Recent reports indicate that breastfeeding rates continue to be dramatically lower among WIC participants, compared with other US mothers. The WIC Infant Feeding Practices Study was a nationally representative 1-year longitudinal study of WIC participants that obtained information about attitudes regarding infant feeding and about infant-feeding practices. Hispanic mothers were most likely to agree with statements about benefits of breastfeeding, and Black mothers were most likely to agree with statements about barriers. Concern about insufficient milk was common in all ethnic groups. Perceived benefits were associated with breastfeeding initiation (P < .05), longer breastfeeding duration (P < .01), and later formula initiation (P < .01); for barriers, the opposite pattern was found. Breastfeeding mothers who reported concern about insufficient milk breastfed for shorter durations (P < .001) and initiated formula earlier (P < .01). These results suggest possible messages that should be communicated as part of a re-energized WIC breastfeeding promotion campaign. In particular, maternal anxiety about insufficient breast milk must be addressed.

Breastfeeding patterns in a community of Native Hawaiian mothers participating in WIC

Although Hawaii has high breastfeeding initiation rates (89%), Native Hawaiian WIC participants have much lower initiation (64%) rates. Little is known about why these disparities occur. The study's aim was to describe the breastfeeding patterns of Hawaiian/part-Hawaiian women enrolled in the WIC who had initiated breastfeeding. Retrospective descriptive data (N=200) were gathered from WIC records. Descriptive and parametric statistics with univariate and multivariate analysis of breastfeeding patterns were completed. Mothers exclusively breastfeeding at initiation weaned significantly later and were significantly more likely to breastfeed for 6 months than were mothers who partially breastfed. Practice and policy implications of these findings are discussed.

Characteristics of teenage mothers and predictors of breastfeeding initiation in the Michigan WIC Program in 1995. Women, Infants, and Children

Although breast milk is recommended as the optimal source of infant nutrition, breastfeeding initiation is below recommended levels, especially among teenage mothers. Breastfeeding initiation rates among Michigan (US) teenage mothers (12-19 y) were compared by demographics and health behaviors. Multivariate analyses determined which factors were significant independent predictors of breastfeeding initiation among teenage mothers enrolled prenatally in the Michigan Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) program in 1995. Significant predictors independently associated with breastfeeding initiation were race/ethnicity, education, marital status, postpartum anemia status, parity, prenatal trimester of WIC enrollment, and smoking. The strongest predictor of breastfeeding initiation differed for white mothers (positive predictor: education beyond high school [OR = 3.13]) and black mothers (negative predictor: multiparous [OR = 0.25]). Initiation rates for this population of teenage mothers fall below the national average for mothers of all ages and the US Healthy People 2010 goals. Research is needed concerning how breastfeeding support and education can be improved to reach the US national health goals.

Feeding preferences and attitudes to breastfeeding and its promotion among teenagers in Northern Ireland

Northern Ireland has one of the lowest breastfeeding initiation rates in the world. Given that attitudes toward infant feeding are formed at an early age and a high rate of teenage pregnancy, it has become necessary to survey attitudes to infant feeding and breastfeeding promotion preferences in teenagers in Northern Ireland. Questionnaires were distributed to teenagers aged 14 to 18 years (n = 419) based in 7 schools selected by type and location throughout Northern Ireland. Attitudes to breastfeeding in public reflected preferred infant-feeding method and were positively influenced by prior exposure to breastfeeding (P = .024). Females were more positive than males both in relation to breastfeeding in public (P = .002) and breastfeeding promotion (P = .003). Recommendations for breastfeeding promotion include specific targeting of young people (both male and female) and enabling contact between teenagers and nursing mothers as much as possible.

Breastfeeding determinants and a suggested framework for action in Europe

This is a background paper for the EURODIET initiative. A number of international initiatives and documents were identified, such as the Baby-Friendly Hospital Initiative, the International Code of Marketing of Breast Milk Substitutes and a number of consensus reports from professional groups, that propose ways forward for breastfeeding promotion. These point at a range of initiatives on different levels. The determinants for successful breastfeeding have to be identified. They can be categorised into five groups; socio-demographic, psycho-social, health care related, community- and policy attributes. A framework for future breastfeeding promoting efforts on European level is suggested, within which these determinants are considered. A common surveillance system needs to be built in Europe, where determinants of breastfeeding are included. There is also a need for a surveillance system which makes it possible to use the collected data on local level, not only on national and supranational level. Combined with a thorough review of the effectiveness of already existing breastfeeding promotion programmes, a co-ordinated EU-EFTA action plan on breastfeeding should be formulated and implemented within a few years. Urgent action could take place in parallel, especially targeting young, low-income, less educated mothers.

Breast-feeding practices among WIC participants in Hawaii

OBJECTIVE

To describe breast-feeding practices and identify correlates of breast-feeding among participants in the Hawaii Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) program.

DESIGN

A cross-sectional survey.

SUBJECTS/SETTING

We conducted structured, in-person interviews with 535 women at WIC clinics throughout Hawaii (95% response rate). The interview collected information on maternal characteristics and infant-feeding practices.

STATISTICAL ANALYSES

Breast-feeding prevalence was examined by infant age and predictors of infant-feeding method were examined via bivariate tests and multivariable logistic regression analysis. Reported breast-feeding promotion efforts in health care settings outside of WIC were also examined.

RESULTS

Most women (82%) attempted to breast-feed, albeit for short durations for many women; of the women who breast-fed in combination with formula feeding, 46% introduced formula within the first week after delivery. Significant predictors of breast-feeding initiation included previous breast-feeding experience, having a close relative or friend who breast-fed, multiparity, Asian/Pacific Island ethnicity (other than Filipino), and being foreign-born. Significant predictors of mixed feeding (vs exclusive breast-feeding) included working or attending school, age less than 20 years, Hawaiian/part Hawaiian or Filipino ethnicity, being Hawaiian-born, and residing in Oahu county.

CONCLUSIONS

Although most women in this population initiated breast-feeding, formula was usually introduced at an early age. This study identified several factors associated with breast-feeding initiation and exclusive breast-feeding, factors that may prove useful for the development of appropriate interventions to promote these behaviors.

Feeding outcomes and influences within the neonatal unit

This study examined the feeding intention of mothers (n = 100), and the factors and beliefs, and changes in those factors or beliefs that influenced their choices, in the challenging environment of the neonatal unit. Mothers' experience and the frequency of nurse-assisted feeding activities were examined in mothers intending and not intending to breast-feed on discharge. Eighty-one per cent of mothers were either partially or fully breast-feeding or intending to do so on discharge. The most important factors identified as influencing this feeding choice included personal choice, with other influences being special benefits, more natural and feeling closer to the baby. Experiences such as infants receiving their first sucking feed from either the breast or bottle (inclusive of breast milk) and mothers expressing breast milk more frequently, were found to be significantly different and increased in frequency, in mothers intending to breast-feed. Differences in the mean weighted total daily nurse-assisted feeding score confirmed that these activities varied with gestational age (< or = 32 weeks [2.57], 32 to less than 35 weeks [3.86], and > or = 35 weeks [4.91]; F = 7.04, d.f. 55, P = 0.002), although there was insufficient power to determine differences between breast-feeding and non-breast-feeding mothers. The use of the Feeding Activities Calendar may have contributed to increased activity and high levels of breast-feeding in this preterm group.

Breastfeeding duration in a multiethnic population in Hawaii

BACKGROUND

The increasing ethnic diversity in the United States necessitates a study of variations in infant feeding patterns among ethnic groups. This study was conducted as part of Hawaii's surveillance system to identify infant feeding patterns in Hawaii; specifically, to identify factors influencing duration of breastfeeding among ethnically diverse mothers.

METHODS

All women who delivered an infant in Hawaii between January 1 and March 31, 1989, were mailed surveys 14 to 19 months after delivery. Fifty-one percent (n = 2011) of women responded, of whom 1574 (78%) did some breastfeeding and are included in the analysis of prediction of weaning (cessation of breastfeeding). Cox regression (survival) analysis was used to predict weaning.

RESULTS

The median duration of breastfeeding was 150 days; 45 percent of infants were still breastfeeding at age 6 months and 16 percent at age 1 year. Factors associated with early weaning were Japanese ethnicity; mother born in a country other than the United States, Japan, or the Philippines; first language other than English, or two languages at home; employed full-time outside the home; introduced formula or fruit before age 6 months; received formula from the WIC program; and stopped breastfeeding for convenience, breast problems, problems getting breastfeeding started, insufficient milk, baby refusing the breast, and a sick baby. Factors associated with late weaning were older maternal age; college education; living on a rural island; previous breastfeeding experience; helpful breastfeeding advice from family or friends; receiving WIC for breastfeeding mothers; introducing the cup before age 6 months; and not giving fruit to the baby.

CONCLUSION

In Hawaii, programs that address how and when to introduce foods, use of formula, and management of outside employment and breastfeeding should be made available to those groups of women at risk for early weaning to lengthen their duration of breastfeeding.

Health-enhancing behaviors correlated with breastfeeding among a national sample of mothers

Participation in health-enhancing behaviors not only influences the health of the mother, but of the newborn child as well. Characteristics of the mother, especially with regard to the practice of health-enhancing behaviors, have typically been excluded from studies examining breastfeeding. The purpose of this study was to identify health-enhancing behaviors correlated with breastfeeding among a national sample of mothers. The third National Health and Nutrition Examination Survey (NHANES III) provided the sample for this study. All mothers between the ages of 17 and 45 (n = 578) with children aged 3 or younger at the time of the interview, who breastfed, were included. Seven health-enhancing behaviors served as the independent variables in a logistic regression analysis. Odds ratios and 95% confidence intervals were calculated from the estimated regression coefficients, and comparison of proportions were made using Pearson chi-square tests of homogeneity. Smoking less than 100 cigarettes in a lifetime, consuming five or more fruits and/or vegetables daily, and visiting a dentist annually were significantly associated with breastfeeding among the mothers in this sample. The results of this study point to a connection between the health-enhancing behaviors of the mother and breastfeeding. This information can be used to help professionals and practitioners gain a clearer picture of the breastfeeding mother. Multicomponent education programs targeted at new mothers can use this information to guide program development. Breastfeeding mothers may have better overall health as compared to mothers who do not breastfeed, therefore, they may serve as role models in peer-structured activities.

Influences on breastfeeding rates in low income communities in Ontario

The purpose of this paper was to identify factors associated with breastfeeding among mothers of children born in 1994 in five of the low income communities participating in the longitudinal prevention initiative "Better Beginnings, Better Futures." Household income was < or = poverty line for 76%, 63% had completed high school or beyond, and 29% were born outside of Canada. The breastfeeding initiation rate was 77% (380 of 493). Of the 270 women who initiated breastfeeding and were interviewed up to five months postpartum, 63% continued for at least three months. Women with higher education, married, not experiencing financial stress and who attended prenatal classes were more likely to initiate breastfeeding. Continuation of breastfeeding was associated with older age, higher education, not smoking, and participation in a home visitor program. Breastfeeding promotion strategies should include ongoing support as well as education components.

A breast feeding education and promotion program: effects on knowledge, attitudes, and support for breast feeding

This study was undertaken to determine the effects of a partner-support, incentive-based educational program on breast feeding knowledge, attitudes and support and to examine the relationship between feeding intentions and feeding behavior among low-income women. Women who expressed a willingness to participate in the intervention were randomly assigned to "intervention" and "usual breast feeding" (control) groups. Sixty-eight primipara women with expected due dates between May and December, 1992, volunteered to participate in the study. Of these, 34 were randomly assigned to each of the two groups. Approximately 81 percent of the women completed the study, leaving n = 29 in the control group and n = 26 in the intervention group. The intervention consisted of special incentives (prizes) for women and their partners to participate in several breast feeding education and promotion activities. Intervention group women and their partners experienced positive changes in breast feeding knowledge and attitudes. Furthermore, the intervention seemed to have influenced more women in the treatment group to breast feed despite their prenatal feeding intentions. In addition, the partners of intervention group women were perceived to be more supportive of breast feeding than control group partners. These findings suggest that incentives, such as donated prizes, can be used to attract lower socioeconomic group women and their partners to breast feeding promotion interventions. Participation in such interventions can produce positive changes in breast feeding knowledge, attitudes, and support, and can have a dramatic effect in promoting breast feeding.

Influences on breast-feeding by lower-income women: an incentive-based, partner-supported educational program

OBJECTIVE

To determine the effects of a partner-supported, incentive-based educational program on rates and duration of breast-feeding among low-income women.

DESIGN

Women who expressed a willingness to participate in the breast-feeding educational program were randomly assigned to one of two groups: an intervention group and a control group who received usual breast-feeding education.

SETTING

Clinics of the Special Supplemental Food Program for Women, Infants, and Children in Flagstaff, Ariz.

SUBJECTS

Sixty-eight primiparous pregnant women with expected due dates between May 1992 and December 1992 were willing to participate in the study. Of these, 34 were randomly assigned to the intervention group and 34 to the control group. Approximately 81% of the women completed the study: 29 in the control group and 26 in the intervention group.

INTERVENTION

The intervention consisted of special incentives (prizes) for women and their partners to participate in a breast-feeding class for expectant couples and an educational series on childbirth. Women were also encouraged to use a breast-feeding support program in which peers serve as role models.

MAIN OUTCOME MEASURES

The primary outcome measure was infant feeding method. Data were collected from mothers in both groups at the time of discharge from the hospital and at 2 weeks, 6 weeks, and 3 months postpartum.

STATISTICAL ANALYSES PERFORMED

Binomial proportional analyses of the feeding data were performed.

RESULTS

Women in the intervention group reported a higher percentage of breast-feeding at all measurement times.

APPLICATIONS

These findings suggest that incentives, such as donated prizes, can be used to attract primiparous women from lower socioeconomic groups, along with their partners, to participate in educational interventions designed to promote breast-feeding. Participation by couples in breast-feeding promotion activities can dramatically increase the rate and duration of breast-feeding.