A Preliminary Examination of Cognitive Factors that Influence Interest in Quitting During Pregnancy

Maternal eating behaviour differs between ethnic groups: Considerations for research and practice

Maternal eating behaviours such as cognitive restraint, uncontrolled, and emotional eating styles can have important implications for both maternal own weight, and the weight and eating behaviour of her children. Maternal eating style can affect her feeding interactions with her child, which in turn can influence their weight and eating behaviour. However, despite a body of research examining these relationships, research examining differences in maternal eating behaviour between ethnic groups is sparse with much of the research, particularly in the UK, conducted with White British samples. The aim of the current research was therefore to explore how maternal eating behaviour may differ between ethnic groups in the UK; 659 UK mothers with a child aged 5-11 years completed a self-report questionnaire. Items included ethnicity, demographic data, and the 3-factor eating questionnaire to measure maternal cognitive restraint, uncontrolled, and emotional eating. Mothers from Chinese backgrounds were significantly higher in cognitive restraint and lower in emotional and uncontrolled eating compared with all groups. Conversely, mothers from South Asian backgrounds were the highest in emotional and uncontrolled eating and lower in cognitive restraint than all other groups. Black mothers were also higher in uncontrolled eating compared with White British and Chinese mothers. Variations in maternal eating behaviours vary between ethnic groups. Understanding how cultural factors may influence these variations is important, as maternal eating behaviours can influence her own and her child's weight. Maternal eating behaviour may therefore be a contributor to higher levels of overweight among South Asian and Black children living in the UK.

Significant differences in maternal child-feeding style between ethnic groups in the UK: the role of deprivation and parenting styles

BACKGROUND

Nonresponsive maternal child-feeding interactions, such as restricting, pressurising and emotional feeding, can affect the ability of a child to self-regulate intake and increase the risk of becoming overweight. However, despite findings that South Asian and Black children living in the UK are more likely to be overweight, UK research has not considered how maternal child-feeding style might differ between ethnic groups. The present study aimed to explore variations in maternal child-feeding style between ethnic groups in the UK, taking into account associated factors such as deprivation and parenting style.

METHODS

Six hundred and fifty-nine UK mothers with a child who was aged 5-11 years old completed a questionnaire. Items included ethnicity and demographic data, as well as copies of the Child Feeding Questionnaire, Parental Feeding Styles Questionnaire and Parenting Styles and Dimensions Questionnaire.

RESULTS

Significant differences in perceived responsibility (P = 0.002), restriction (P = 0.026), pressure to eat (P = 0.045), instrumental feeding (P = 0.000) and emotional feeding (P = 0.000) were found between the groups. Mothers from South Asian backgrounds reported higher levels of pressure to eat, emotional feeding and indulgent feeding styles, whereas mothers from Chinese backgrounds reported greater perceived responsibility and restriction. Mothers from Black and White British backgrounds were not significantly higher with respect to any behaviour. Maternal child-feeding style was also associated with deprivation and parenting style, although these did not fully explain the data.

CONCLUSIONS

Understanding cultural factors behind maternal child-feeding style, particularly around pressurising and indulgent feeding behaviours, may play an important part in reducing levels of children who are overweight and obese in the UK.

Financial Incentives Alone Versus Incentivized Partner Support for Promoting Smoking Cessation During Pregnancy and Postpartum: Protocol for a Non-Randomized Single-Blinded Study

Background

Smoking tobacco remains the most significant modifiable cause of adverse pregnancy outcomes and contributor to ongoing maternal and infant ill-health. Pregnancy for many is a time of heightened health focus, with the primary motivation being the well-being of the unborn child. Yet, many women continue to smoke throughout their pregnancy. Despite this heightened motivation and known health risks, interventions to date have not effectively curbed the rate of smoking during pregnancy and they remain as high as rates among the general population. One promising strategy has been to incentivize these women to quit. However, incentives-based studies have not shown or reported long-term efficacy. Here, we present the protocol of a trial exploring the effect of incentivized partner support on pre- and postpartum smoking cessation.

Objective

The aim of this study is to determine whether providing incentives to both the expectant mother and her support person in promoting short- and long-term smoking cessation during pregnancy is more effective than incentives to the expectant mother alone.

Methods

This protocol is designed as a non-randomized, single-blinded trial to determine the efficacy of incentivized partner support, compared to participant incentive only, in promoting smoking cessation during pregnancy and postpartum. All eligible pregnant women receiving antenatal care via the Tasmanian Health Service (Australia) will be invited to participate. Participants will be eligible for monthly quit-contingent shopping vouchers if they verify, via carbon monoxide breath sample, as being abstinent from smoking. Participating women will be eligible for vouchers until 6-months postpartum and will be followed up at 12-months postpartum.

Results

The recruitment phase of this study has concluded. Results are expected to be published by the end of 2018.

Conclusions

This study protocol extends the current literature on incentivized smoking cessation interventions for pregnant women by assessing the influence of incentivizing a support partner on short- and long-term abstinence. Key ethical considerations are discussed including potential for receipt (or not) of quit-contingent vouchers impacting negatively on the participant’s relationship with their partner. The findings of the study may have important implications for the role support partners are assigned in smoking cessation programs targeting pregnant women.

Trial Registration

Australian New Zealand Clinical Trials Registry (ACTRN): 12615001158550; https://www.anzctr.org.au/ Trial/Registration/TrialReview.aspx?id=367981 (Archived by WebCite at http://www.webcitation.org/6tGKO28uh)

Profile of Maternal Smokers Who Quit During Pregnancy: A Population-Based Cohort Study of Tasmanian Women, 2011-2013

Introduction

Smoking remains the single-most significant preventable cause of poor pregnancy outcomes, yet around 12% of Australian women smoke during pregnancy. Many women are motivated to quit when they find out they are pregnant, yet few are successful. While previous studies have examined the profile of the maternal smoker compared to her nonsmoking counterpart (Aim 1), little is known about what differentiates women who quit during pregnancy to those who do not (Aim 2). Here, we present results from a study investigating the characteristics of women who were able to quit during pregnancy.

Methods

Data were drawn from the Tasmanian Population Health database of women who had received antenatal care between 2011 and 2013 (n = 14300). Data collected included age, relationship status and ethnicity of expectant mothers, antenatal details, mental health conditions, and drug use. Independent samples t tests were used to compare differences between women who had, and those who had not, quit during pregnancy. The 19.4% of women who self-reported as smoking in the first half (first 20 weeks) of their pregnancy were further grouped and analyzed comparing those who reported still smoking in the second half of their pregnancy (smokers: n = 2570, 92.4%) to those who quit (quitters: n = 211, 7.6%).

Results

Quitters (57.8%) were more likely to be in a relationship than their non-quitting counterparts (49.6%, p = .022) and were less likely to suffer from postnatal depression (2.4% vs. 6.0%, p = .029). No other differences between quitters and smokers were observed.

Conclusions

Determining the profile of women who are able to quit during pregnancy may be important to improve the relatively poor cessation rates among maternal smokers and may assist in more effectively targeting at-risk women.

Implications

Smoking cessation interventions have traditionally targeted socially disadvantaged women, for good reason: the majority of smoking pregnant women fall into this category. However, despite the significant attention and resources dedicated to antenatal smoking cessation interventions, most are ineffective with only 7.6% of the present sample quitting smoking during pregnancy. This paper may assist in developing more effective antenatal smoking cessation interventions by more clearly describing the profile of maternal smokers who successfully quit during pregnancy. Specifically, this paper highlights the need to acknowledge and address women's relationship status and mental health in order to promote smoking cessation in pregnancy.

What Do Women Really Want? Lessons for Breastfeeding Promotion and Education

BACKGROUND

Promoting breastfeeding is a strategic priority, but breastfeeding rates remain low in the United Kingdom. Women value breastfeeding promotion and education, but a different strategy may be needed to continue to raise breastfeeding rates. New mothers, as the experts, are best placed to inform these changes. The current study explored new mothers' attitudes toward breastfeeding education and promotion, evaluating experiences and examining ideas for change.

MATERIALS AND METHODS

One thousand one hundred thirty mothers with a baby aged 0-2 years old who had planned to breastfeed at birth completed a questionnaire consisting of both closed and open-ended questions exploring their attitudes to breastfeeding promotion and support.

RESULTS

Overall, the findings showed that mothers valued breastfeeding information, but believed that changes needed to be made to current messages. Key themes included a move away from the perception that breastfeeding is best (rather than normal), emphasis on wider values other than the health benefits of breastfeeding, and a message that every feed, rather than just 6 months exclusive breastfeeding, matters. Mothers also highlighted the need for promotion and education to target family members and wider society rather than simply mothers themselves, all of whom influenced both directly or indirectly maternal decision and ability to breastfeed. Mothers suggested ideas for promotional campaigns or how specific groups or methods could be used to increase support, including education for children, TV adverts, and using established online sources of breastfeeding information.

CONCLUSIONS

The findings are important both for those supporting new mothers to breastfeed and those involved in breastfeeding policy and promotional messages.

Nicotine Dependence Measures for Perinatal Women

This integrative review provides an overview of nicotine dependence measures used with perinatal women and an evaluation of their psychometric properties. Fifty-five articles that met inclusion and exclusion criteria were identified from five different databases. Most of the studies used the Fagerström Test for Nicotine Dependence (FTND). Other approaches included diagnostic tests, the Wisconsin Inventory of Smoking Dependence Motives (WISDM), the Tobacco Dependence Screener, and single-item measures. This review indicated that the FTND may not be the best option for measuring nicotine dependence in this population. The WISDM is a newer instrument that has excellent psychometric properties and captures nonnicotinic dimensions of nicotine dependence relevant to women. Future research is needed to assess its reliability in the perinatal population. Other recommendations from this review include the use of biomarker validation, thorough psychometric reporting on nicotine dependence instruments, and the use of multiple instruments to maximize comparability between nicotine dependence instruments.

Understanding the relationship between breastfeeding and postnatal depression: the role of pain and physical difficulties

AIMS

To examine the relationship between specific reasons for stopping breastfeeding and depressive symptoms in the postnatal period.

BACKGROUND

Difficulty breastfeeding has been connected to postnatal depression although it is unclear whether difficulty breastfeeding precedes or succeeds a diagnosis. However, the concept of 'breastfeeding difficulty' is wide and includes biological, psychological and social factors.

DESIGN

A cross-sectional self-report survey.

METHODS

Data were collected between December 2012 and February 2013. 217 women with an infant aged 0-6 months who had started breastfeeding at birth but had stopped before 6 months old completed a questionnaire examining breastfeeding duration and reasons for stopping breastfeeding. They further completed a copy of the Edinburgh Postnatal Depression Scale.

RESULTS

A short breastfeeding duration and multiple reasons for stopping breastfeeding were associated with higher depression score. However, in a regression analysis only the specific reasons of stopping breastfeeding for physical difficulty and pain remained predictive of depression score.

CONCLUSIONS

Understanding women's specific reasons for stopping breastfeeding rather than breastfeeding duration is critical in understanding women's breastfeeding experience and providing women with emotional support. Issues with pain and physical breastfeeding were most indicative of postnatal depression in comparison to psychosocial reasons highlighting the importance of spending time with new mothers to help them with issues such as latch.

Infant sleep and night feeding patterns during later infancy: association with breastfeeding frequency, daytime complementary food intake, and infant weight

Infant sleep is a common concern for new parents. Although many expect a newborn infant to wake frequently, encouraging a baby to sleep through the night by a few months of age is seen as both a developmental aim and a parenting success. Many new mothers believe that their infants' diet is related to their sleep; formula milk or increased levels of solid food are often given in an attempt to promote sleep. However, the impact of these in later infancy is not understood. In the current study 715 mothers with an infant 6-12 months of age reported their infants' typical night wakings and night feeds alongside any breastfeeding and frequency of solid meals. Of infants in this age range, 78.6% still regularly woke at least once a night, with 61.4% receiving one or more milk feeds. Both night wakings and night feeds decreased with age. No difference in night wakings or night feeds was found between mothers who were currently breastfeeding or formula feeding. However, infants who received more milk or solid feeds during the day were less likely to feed at night but not less likely to wake. The findings have important implications for health professionals who support new mothers with infant sleep and diet in the first year. Increasing infant calories during the day may therefore reduce the likelihood of night feeding but will not reduce the need for parents to attend to the infant in the night. Breastfeeding has no impact on infant sleep in the second 6 months postpartum.

Maternal and infant factors associated with reasons for introducing solid foods

The current UK Department of Health advice is to introduce solid foods to infants at around 6 months of age, when the infant is showing signs of developmental readiness for solid foods. However, many mothers introduce solid foods before this time, and for a wide variety of reasons, some of which may not promote healthy outcomes. The aim of the current study was to examine infant and maternal characteristics associated with different reasons for introducing solid foods. Seven hundred fifty-six mothers with an infant aged 6-12 months old completed a questionnaire describing their main reason for introducing solid foods alongside demographic questions, infant weight, gender, breast/formula feeding and timing of introduction to solid foods. The majority of mothers introduced solid foods for reasons explicitly stated in the Department of Health advice as not signs of readiness for solid foods. These reasons centred on perceived infant lack of sleep, hunger or unsettled behaviour. Maternal age, education and parity, infant weight and gender and breast/formula feeding choices were all associated with reasons for introduction. A particular association was found between breastfeeding and perceiving the infant to be hungrier or needing more than milk could offer. Male infants were perceived as hungry and needing more energy than female infants. Notably, signs of readiness may be misinterpreted with some stating this reason for infants weaned prior to 16 weeks. The findings are important for those working to support and educate new parents with the introduction of solid foods in understanding the factors that might influence them.

Fathers' experiences of supporting breastfeeding: challenges for breastfeeding promotion and education

Increasing breastfeeding rates is a strategic priority in the UK and understanding the factors that promote and encourage breastfeeding is critical to achieving this. It is established that women who have strong social support from their partner are more likely to initiate and continue breastfeeding. However, little research has explored the fathers' role in breastfeeding support and more importantly, the information and guidance he may need. In the current study, 117 men whose partner had given birth in the previous 2 years and initiated breastfeeding at birth completed an open-ended questionnaire exploring their experiences of breastfeeding, the information and support they received and their ideas for future breastfeeding education and promotion aimed at fathers and families. Overall, the findings showed that fathers were encouraging of breastfeeding and wanted to be able to support their partner. However, they often felt left out of the breastfeeding relationships and helpless to support their partner at this time. Many reported being excluded from antenatal breastfeeding education or being considered unimportant in post-natal support. Men wanted more information about breastfeeding to be directed towards them alongside ideas about how they could practically support their partner. The importance of support mechanisms for themselves during this time was also raised. The results highlight the need for health professionals to direct support and information towards fathers as well as the mother-infant dyad and to recognise their importance in promoting and enabling breastfeeding.