The importance of community resources for breastfeeding

BACKGROUND

Breastfeeding has long-lasting effects on children's cognition, behavioral, mental and physical health. Previous research shows parental characteristics (e.g., education, race/ethnicity, income level) are associated with breastfeeding initiation and duration. Further, research shows significant variation in access to community resources by race/ethnicity. It is unclear how community resources may impact breastfeeding practices and how this might intersect with maternal race/ethnicity.

METHODS

This study combined nationally-representative data from the Study of Attitudes and Factors Effecting Infant Care (SAFE), which surveyed US mothers immediately after the infant's birth and at two to six months of infant age, with the Child Opportunity Index (COI) 2.0, a census tract measure of community resources associated with child development, to explore the association between community resources and breastfeeding initiation and whether this varies based on maternal race/ethnicity and country of birth. The SAFE Study used a stratified, two-stage, clustered design to obtain a nationally representative sample of mothers of infants, while oversampling Hispanic and non-Hispanic (NH) Black mothers. The SAFE study enrolled mothers who spoke English or Spanish across 32 US birth hospitals between January 2011 and March 2014.

RESULTS

After accounting for individual characteristics, mothers residing in the highest-resourced communities (compared to the lowest) had significantly greater likelihood of breastfeeding. Representation in higher-resourced communities differed by race/ethnicity. Race/ethnicity did not significantly moderate the association between community resources and breastfeeding. In examining within race/ethnic groups, however, community resources were not associated with non-US born Black and Hispanic mothers' rates of breastfeeding, while they were with US born Black and Hispanic mothers.

CONCLUSIONS

Findings suggest that even health behaviors like breastfeeding, which we often associate with individual choice, are connected to the community resources within which they are made. Study implications point to the importance of considering the impact of the contextual factors that shape health and as a potential contributor to understanding the observed race/ethnicity gap.

Laryngeal basement membrane thickening is not a reliable postmortem marker for SIDS: results from the Chicago Infant Mortality Study

It has been suggested that laryngeal basement membrane (LBM) thickening is a pathognomonic postmortem marker for sudden infant death syndrome (SIDS) and is not seen in other causes of explained sudden infant death. To test this hypothesis, we evaluated longitudinal sections of the right hemilarynx taken through the midpoint of the true vocal cord from 129 SIDS cases and 77 postneonatal sudden infant death controls. Using a five-point semi-quantitative scale, maximum LBM thickness (LBMT) for SIDS cases and controls was not statistically different (mean, 2.39 + 0.69 and 2.40 + 0.77, respectively). Likewise, scores based on the average thickness along the entire basement membrane (i.e., "average" score), were not found to be different between SIDS cases and controls. Average and maximum LBMT increased with age in both SIDS cases and controls and were not different between SIDS cases and controls within each age interval. Similar trends in the distribution of maximum and average LBMTs were found between black and Hispanic SIDS and controls; the number of white/non-Hispanic infants was too low for meaningful comparisons. Maximum and average LBMTs were not different in SIDS cases and controls exposed to environmental tobacco compared with unexposed infants. The LBMTs also increased significantly with body weight and length in both SIDS cases and controls. Finally, there were no differences in LBMT in infants intubated prior to death compared with those who were not intubated. From these data, we conclude that LBMT is not pathognomonic of SIDS, is present or absent with equal frequency in SIDS and controls, increases with postnatal age, and does not correlate with passive smoke exposure. Therefore, LBMT should not be used to diagnose SIDS.

Inaccuracy of self-reported weights and heights among American Indian adolescents

To determine the accuracy of self-reported weights and heights and of relative weight status in a sample of American Indian adolescents, a survey was conducted in middle and high schools on or near three Indian reservations-Navajo, Choctaw, and Blackfeet. Self-reported weights and heights were compared with measured weights and heights. Participants were 12 through 19 years old. (N = 806, 47.4% male). Overall, both boys and girls underreported weight (mean difference = self-reported - measured mean values)(-3.4 +/- 13.1 and -4.6 +/- 13.0 lb, respectively) and overreported height (0.6 +/- 2.1 and 0.2 +/- 2.6 in, respectively) However, underweight boys and girls overreported weight (normal: -1.6 +/- 7.9 and -1.4 +/- 6.3; overweight: -7.5 +/- 17.9 and -11.6 +/- 19.0 lb, respectively). Although correlations between measured and reported weight, height, and body mass index (BMI) were high, the sensitivity of relative weight categories based on BMI using self-reported weight and height compared with measured weight and height was poor: 66.7% for underweight (BMI < 15th percentile, based on a national reference population), 88.9% for normal weight, and 73.6% for overweight (> 85th percentile). These results call into question the accuracy of self-reported weight and height measurements among American Indian youth and are similar to findings among non-American Indian adolescents. Therefore, their use in prevalence studies should be avoided, and they should be used cautiously in other types of epidemiologic studies.

Weight perceptions and weight control practices in American Indian and Alaska Native adolescents. A national survey

OBJECTIVE

To assess weight perceptions and weight control practices among American Indian-Alaska Native adolescents.

DESIGN

Survey.

SETTING

Nonurban schools from eight Indian Health Service areas.

PARTICIPANTS

A total of 13,454 seventh- through 12th-grade American Indian-Alaska Native youths.

MAIN OUTCOME MEASURES

A revised version of the Adolescent Health Survey, a comprehensive, anonymous self-report questionnaire with eating- and body image-related questions.

RESULTS

Forty-one percent of the adolescent girls reported feeling overweight, 50% were dissatisfied with their weight, and 44% worried about being overweight. Almost half (48%) had been on a weight-loss diet in the past year, with 27% reporting that they had self-induced vomiting at some time to try to lose weight. Eleven percent reported using diet pills. Girls who reported feeling overweight were more likely to engage in unhealthy weight control practices than were those who felt they were of normal weight or underweight. A larger proportion of boys were satisfied with their weight (68%), with 22% worrying about being overweight. However, compared with rural Minnesota youth, both American Indian girls and boys had greater dissatisfaction with body weight.

CONCLUSIONS

Our study shows that American Indian youth, particularly girls, are dissatisfied with their weight and are worried about being overweight, and that unhealthy weight control practices are common. More attention needs to be placed on developing culturally appropriate weight management programs for Indian youths.

Trends in anthropometric measurements among Mescalero Apache Indian preschool children. 1968 through 1988

OBJECTIVE

To determine if there were trends in underweight, short stature, and obesity among 1- through 5-year-old Mescalero (NM) Apache Indian children from 1968 through 1988.

DESIGN

Cross-sectional review of hospital clinic charts for five cohorts.

SETTING

General pediatric outpatient clinic at the Mescalero Indian Health Service Hospital.

PARTICIPANTS

Sixty-nine patients aged 1 through 5 years in 1968, 1973, 1978, 1983, or 1988 for whom weight and height were recorded during a well-child visit that occurred in the respective year.

SELECTION PROCEDURES

Approximately half the charts were screened for eligibility through systematic sampling for all years except 1988; for 1988 all available charts were screened for eligibility for the study.

INTERVENTIONS

None.

MEASUREMENTS AND RESULTS

We found trends of decreasing prevalence of both underweight (defined as weight-for-height below the fifth percentile) and short stature (defined as height-for-age below the fifth percentile) based on the Centers for Disease Control/World Health Organization growth reference. We found no secular trends in obesity (weight-for-height above the 95th percentile), although the prevalences throughout the 21-year period were as much as two to four times higher than expected when compared with the Centers for Disease Control/World Health Organization reference. There has been an upward shift in both weight-for-height and height-for-age distributions since 1968, indicating that Mescalero children today are, on average, heavier and taller.

CONCLUSIONS

Underweight and short stature decreased among Mescalero preschool children from 1968 through 1988, suggesting nutritional improvements. However, given the current high prevalence of obesity, it is recommended that surveillance of nutritional status be continued and appropriate interventions be developed to treat and prevent obesity in this population.

Obesity among Mescalero preschool children. Association with maternal obesity and birth weight

The prevalence of obesity among native American children ranks with the highest in the United States. However, little is known about associated risk factors for obesity among these children. We conducted a medical record review of 261 preschool children enrolled in the Mescalero Apache tribe to determine the prevalence of obesity and associated risk factors. The prevalence of obesity (weight for height greater than 95th percentile) in this population was 19.5%. The prevalence of obesity (body mass index greater than 95th percentile) in their mothers was 23%. Children with obese mothers were more than twice as likely to be obese than children of nonobese mothers. Children with a high birth weight were three times as likely to be obese as children of low or normal birth weight. The high prevalence of obesity may be due to both life-style and dietary patterns on the reservation. Family-based interventions are needed to prevent obesity and its long-term consequences in this population.

Patient perceptions of humanism in physicians: effects on positive health behaviors

Although humanism has emerged as an important issue in medical education and practice, there is no standardized definition of humanism or an instrument that measures patients' perceptions of their physician's level of humanism. This study addressed these three issues: 1) A definition of physician humanism was developed based on the current literature; 2) an instrument was designed that measured patients' perceptions of humanism in their family physicians; and 3) health outcome variables were measured relative to these perceptions. The design was a cross-sectional survey of 185 randomly selected patients from two family practice sites. The questionnaire consisted of a humanism scale, in addition to items to assess patient satisfaction and patients' adherence to medical advice regarding exercise, diet, and smoking cessation. A positive association was found between perceived physician humanism and patient satisfaction. Greater success in patients' attempts to quit smoking was associated with higher physician humanism. The implications of these findings for evaluation and training of health care providers and patients' use of health care services are discussed.

Treating childhood respiratory illness in developing countries: mist therapy without electricity

We have developed an effective and well-accepted method of providing mist for children with acute respiratory distress. This method can be especially useful in areas of the world where resources are limited.