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Abstract
INTRODUCTION Despite recommendations for influenza and COVID-19 vaccines, studies have documented gaps and disparities in vaccination coverage for adults and adolescents. Understanding the proportion and demographics of those unvaccinated against influenza and/or COVID-19 is important for tailoring appropriate messaging and strategies to increase confidence and uptake. METHODS Using the 2021 National Health Interview Survey (NHIS), we assessed the prevalence of four vaccination patterns (exclusive influenza vaccination, exclusive COVID-19 vaccination, dual influenza and COVID-19 vaccination, and neither vaccination) by sociodemographic and other characteristics among adults and adolescents 12-17 years. Adjusted multivariable regression analyses were conducted to examine factors associated with each of the four vaccination categories among adults and adolescents. RESULTS In 2021, 42.5% of adults and 28.3% of adolescents received both influenza and COVID-19 vaccines, while approximately a quarter (22.4%) of adults and a third (34.0%) of adolescents did not receive either vaccine. Among adults and adolescents, 6.0% and 11.4% were exclusively vaccinated against influenza and 29.1% and 26.4% were exclusively vaccinated against COVID-19, respectively. Among adults, exclusive COVID-19 or dual vaccination was more likely to be associated with older age, non-Hispanic multi/other race, and having a college degree compared to their respective counterparts. Exclusive influenza or neither vaccination was more likely to be associated with younger age, having a high school diploma or less, living below the poverty level, and having a previous COVID-19 diagnosis. CONCLUSION During the COVID-19 pandemic, approximately two-thirds of adolescents and three-fourths of adults received exclusive influenza or COVID-19 vaccines or both vaccines in 2021. Vaccination patterns differed by sociodemographic and other characteristics. Promoting confidence in vaccines and reducing barriers to access is needed to protect individuals and families from severe health consequences of vaccine-preventable diseases. Being up-to-date with all recommended vaccinations can prevent a future resurgence of hospitalizations and cases.Key messages42.5% of adults and 28.3% of adolescents received both influenza and COVID-19 vaccines in 2021, while approximately a quarter (22.4%) of adults and a third (34.0%) of adolescents did not receive either vaccine; 6.0% of adults and 11.4% of adolescents were exclusively vaccinated against influenza and 29.1% of adults and 26.4% of adolescents were exclusively vaccinated against COVID-19.Among adults, exclusive COVID-19 vaccination or dual vaccination was more likely to be associated with older age, non-Hispanic multi/other race, and having a college degree or higher compared to their respective counterparts; exclusive influenza vaccination or neither vaccination was more likely to be associated with younger age, having a high school diploma or less, living below poverty level, and having a previous COVID-19 diagnosis compared to their respective counterparts.Promoting confidence in vaccines and reducing barriers to access is needed to protect individuals and families from severe health consequences of vaccine-preventable diseases. Being up-to-date with all recommended vaccinations can prevent a future resurgence of hospitalizations and cases, especially as new variants emerge.
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Affiliation(s)
- Kimberly H Nguyen
- Department of Public Health & Community Medicine, Tufts University School of Medicine, Boston, MA, USA
| | - Ruitong Zhao
- Department of Public Health & Community Medicine, Tufts University School of Medicine, Boston, MA, USA
| | - Siyu Chen
- Department of Public Health & Community Medicine, Tufts University School of Medicine, Boston, MA, USA
| | - Robert A Bednarczyk
- Hubert Department of Global Health, Emory University Rollins School of Public Health, Atlanta, GA, USA
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA, USA
- Emory Vaccine Center, Emory University, Atlanta, GA, USA
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Thorisdottir B, Odinsdottir T, Gunnlaugsson G, Eaton S, Fewtrell MS, Vázquez-Vázquez A, Kleinman RE, Thorsdottir I, Wells JC. Metabolizable Energy Content of Breastmilk Supports Normal Growth in Exclusively Breastfed Icelandic Infants to Age 6 Months. Am J Clin Nutr 2023; 118:468-475. [PMID: 37369354 DOI: 10.1016/j.ajcnut.2023.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 05/23/2023] [Accepted: 06/01/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND Neither the global population nor individual countries have reached the World Health Organization (WHO) target of ≥50% of infants exclusively breastfed (EBF) until 6 mo. This may partly be because of the perceptions of insufficient milk and energy supply to meet rapid growth and development needs. OBJECTIVES In a longitudinal observational study, we aimed to determine whether breastmilk energy content is sufficient to support growth during EBF until 6 mo. METHODS A sample of 27 EBF infants was dosed with doubly labeled water (DLW) at 5.6 mo to measure body composition, breastmilk intake, energy intake, and the metabolizable energy (ME) content of their mother's breastmilk over the following week. Z-scores were calculated for anthropometry using WHO reference data and for fat-free mass (FFM) and fat mass (FM) using United Kingdom reference data. RESULTS Anthropometric z-scores from birth indicated normal weight and length growth patterns. At ∼6 mo, the mean ± standard deviation (SD) FFM z-score was 0.22 ± 1.07, and the FM z-score was 0.78 ± 0.70, significantly >0. In the 22 infants with acceptable data, the mean ± SD measured intake of breastmilk was 983 ± 170 g/d and of energy, 318 ± 60 kJ/kg/d, equivalent to 75.9 ± 14.3 kcal/kg/d. The mean ME content of breastmilk was 2.61 kJ/g [standard error (SE) 0.1], equivalent to 0.62 kcal/g (SE 0.02). Mothers were positive toward breastfeeding, on paid maternity leave (planned mean 10 mo), and many (56%) had received specialized breastfeeding support. CONCLUSIONS The evidence from this study confirms that when mothers are motivated and supported without economic restraints, breastmilk intake and the energy supplied by breastmilk to EBF infants at 6 mo of age is sufficient to support normal growth patterns. There was no evidence of constraint on FFM, and other studies show that high FM in EBF infants is likely to be transient. These data further support the recommendation for EBF ≤6 mo of age for body composition. This trial was registered at clinicaltrials.gov as NCT02586571.
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Affiliation(s)
- Birna Thorisdottir
- Faculty of Food Science and Nutrition, University of Iceland, Reykjavik, Iceland; Unit of Nutrition Research, Health Science Institute, University of Iceland, Reykjavik, Iceland.
| | - Tinna Odinsdottir
- Unit of Nutrition Research, Health Science Institute, University of Iceland, Reykjavik, Iceland
| | - Geir Gunnlaugsson
- Faculty of Sociology, Anthropology and Folkloristics, University of Iceland, Reykjavik, Iceland
| | - Simon Eaton
- Developmental Biology and Cancer Department, UCL GOS Institute of Child Health, London, United Kingdom
| | - Mary S Fewtrell
- Department of Population, Policy and Practice Research, and Teaching, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Adriana Vázquez-Vázquez
- Department of Population, Policy and Practice Research, and Teaching, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Ronald E Kleinman
- Department of Pediatrics, Massachusetts General Hospital for Children, Harvard Medical School, Boston, MA, United States
| | - Inga Thorsdottir
- Faculty of Food Science and Nutrition, University of Iceland, Reykjavik, Iceland; Unit of Nutrition Research, Health Science Institute, University of Iceland, Reykjavik, Iceland
| | - Jonathan Ck Wells
- Department of Population, Policy and Practice Research, and Teaching, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
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Wood NK, Barbosa-Leiker C, Odom-Maryon T. Determinants of exclusive direct breastfeeding using constructs from the breastfeeding relationship scale. J Reprod Infant Psychol 2023:1-15. [PMID: 36939003 DOI: 10.1080/02646838.2023.2191113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2023]
Abstract
OBJECTIVES This study examined the relationship among constructs of the Breastfeeding Relationship Scale and exclusive direct breastfeeding (EDBF) while controlling for covariates in US breastfeeding dyads in the first 3 months. BACKGROUND The Breastfeeding Relationship Scale was developed to measure mother-infant mutual responsiveness during breastfeeding in response to perceived insufficient milk, but there is no clear understanding about the relationships between the Breastfeeding Relationship Scale's constructs and EDBF. METHODS A cross-sectional design was used. The convenience sample of 589 directly breastfeeding mothers in the US whose infants were between 1 and 12 weeks of age were included for analysis using a structural equation model. Covariates for EDBF included mother's age, education, marital status, parity, prior breastfeeding experience, infant's age, weight, and sex. RESULTS Mother-Infant Breastfeeding Interaction and Breastfeeding Synchronicity were related (β = 0.33, p < .001), as were Breastfeeding Synchronicity and Perceived Adequate Milk Supply (β = 0.35, p < .001) and Mother-Infant Breastfeeding Interaction and Perceived Adequate Milk Supply (β = 0.08, p = .05). The relationship between Mother-Infant Breastfeeding Interaction and Breastfeeding Synchronicity with EDBF was fully mediated by Perceived Adequate Milk Supply, where the odds of EDBF was higher for mothers with higher scores on Perceived Adequate Milk Supply (OR = 1.61, p < .001) and prior breastfeeding experience (OR = 2.31, p = .006). CONCLUSIONS Perceived Adequate Milk Supply and prior breastfeeding experience are major determinants of EDBF in the first 3 months. Breastfeeding Synchronicity can bolster Mother-Infant Breastfeeding Interaction and promote Perceived Adequate Milk. More attention should be paid to breastfeeding relationship to be the result of EDBF.
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Affiliation(s)
- Natsuko K Wood
- Assistant Professor, Washington State University College of Nursing, Spokane, WA, USA
| | - Celestina Barbosa-Leiker
- Executive Vice Chancellor For Research And Administration, Washington State University Health Sciences Spokane, Spokane, WA, USA
| | - Tamara Odom-Maryon
- Assistant Professor, Washington State University College of Nursing, Spokane, WA, USA.,Biostatistician at Washington State University College of Nursing, Spokane, WA, USA
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Aigner S, Huhn K, Cepek L, Hellwig K, Nickel FT, Bayas A. Breastfeeding in Mothers with Multiple Sclerosis: The German Experience. Breastfeed Med 2023; 18:241-245. [PMID: 36795995 DOI: 10.1089/bfm.2022.0279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
Background: Many female people with multiple sclerosis (pwMS) are in childbearing age; however, only few data exist about the situation of breastfeeding in pwMS. Objective: Our study analyzed breastfeeding rate and duration, reasons for weaning, and the impact of disease severity on successful breastfeeding in pwMS. Methods: The study included pwMS giving birth within 3 years before study participation. Data were collected by structured questionnaire. Results: Compared to published data, we found a significant difference (p = 0.0007) between the nursing rate in the general population (96.6%) and females with MS (85.9%). However, a higher rate of exclusive breastfeeding could be observed in our study population for 5-6 months in 40.6% of pwMS versus 9% for 6 months in the general population. In contrast, total breastfeeding duration in our study population was shorter (18.8% for 11-12 months) than in the general population (41.1% for 12 months). Reasons for weaning were predominantly (68.7%) related to breastfeeding barriers based on MS. No significant impact of prepartum or postpartum education on the breastfeeding rate could be observed. Prepartum relapse rate and prepartum disease-modifying drugs had no effect on breastfeeding success. Conclusion: Our survey provides an insight into the situation of breastfeeding in pwMS in Germany.
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Affiliation(s)
- Stefanie Aigner
- Department of Neurology, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Konstantin Huhn
- Department of Neurology, University of Erlangen-Nuremberg, Erlangen, Germany
| | | | - Kerstin Hellwig
- Department of Neurology, St. Josef Hospital, Ruhr University Bochum, Bochum, Germany
| | | | - Antonios Bayas
- Department of Neurology, University of Erlangen-Nuremberg, Erlangen, Germany.,Department of Neurology, Medical Faculty, University of Augsburg, Augsburg, Germany
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Ajabnoor SM, Attar A, BinJahlan N, Almutairi N, Bashmail S, Hashim A, Forbes A, Jawa H. Enteral Nutrition Prescription in Children and Adults with Inflammatory Bowel Diseases: Gaps in Current Gastroenterology Practice in Saudi Arabia. Nutrients 2023; 15. [PMID: 36615890 DOI: 10.3390/nu15010232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 12/28/2022] [Accepted: 12/29/2022] [Indexed: 01/03/2023] Open
Abstract
Background: Evidence for the effectiveness of enteral nutrition (EN) for the management of patients with inflammatory bowel disease (IBD) is well-established. However, there is considerable global variation in EN practices. This study aimed to characterize the practices and perceptions of gastroenterologists regarding the use of EN in patients with IBD in one of the largest countries in the Gulf region. Methods: A cross-sectional study was conducted on pediatric and adult gastroenterologists working in Saudi Arabia who are involved in IBD management. A self-administered web-based survey was distributed via social media platforms and mailing lists of national gastroenterology societies. Results: A total of 80 gastroenterologists completed the survey. However, only 55 reported that they were currently practicing EN in any form. EN was mostly indicated by gastroenterologists who “sometimes” recommend EN for: the prevention and correction of undernutrition (50.9%), preoperative optimization (50.9%), and the induction of remission in patients with active and long-standing CD (36.4%), at initial diagnosis (34.5%), during the management of complications (61.8%), and after failing to respond to pharmacological therapy (58.2%). Exclusive enteral nutrition (EEN) is regularly recommended by 14.5% of gastroenterologists. The prescription of EEN was significantly associated with the pediatric profession (p < 0.01), IBD specialty (p < 0.05), level of nutrition education during training (p < 0.01), and previous training in a unit with regular EN use (p < 0.01). The most reported barriers to using EN were patients’ lack of acceptance (73.8%) and poor adherence (65%). A lack of dietitian support and a lack of standardized protocols were also reported as barriers by many physicians. Pediatric gastroenterologists were more likely to use at least one assessment method to evaluate EN success. Conclusion: EN practices differ between gastroenterologists working in Saudi Arabia. Future EN protocols should be optimized to support both children and adults with IBD. Gastroenterology training programs should offer nutrition support-focused training to help physicians better utilize EN.
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Wood NK, Odom-Maryon T, Smart DA. Factors Associated With Exclusive Direct Breastfeeding in the First 3 Months. Nurs Womens Health 2022; 26:299-307. [PMID: 35714762 DOI: 10.1016/j.nwh.2022.05.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 03/01/2022] [Accepted: 05/19/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To identify factors associated with exclusive direct breastfeeding in the first 3 months among mother and infant dyads living in the United States. DESIGN A secondary analysis of data collected using a cross-sectional online survey completed over a 4-month period in late 2019. PARTICIPANTS We recruited a convenience sample of 370 mothers with healthy full-term singleton infants between 1 and 12 weeks of age whose feeding methods consisted of direct breastfeeding at least once a day. Mothers had not returned to work/school at the time of the survey completion. MEASUREMENTS The questionnaire consisted of 34 questions about maternal and infant factors that influence decisions about infant feeding, professional support, and parental preferences. RESULTS Mothers who practiced feeding on demand (adjusted OR [aOR] = 35.76, 95% confidence interval [CI] [2.04, 500.00]) and mothers of infants 1 to 4 weeks of age (aOR = 2.74, 95% CI [1.54, 4.85]) were more likely to use exclusive direct breastfeeding. The odds of exclusive direct breastfeeding decreased with mothers who breastfed with a nipple shield while in the hospital/birth center/home (aOR = 0.13, 95% CI [0.05, 0.35]), used pacifiers (aOR = 0.31, 95% CI [0.21, 0.65]), or had perceptions of insufficient milk (aOR = 0.11, 95% CI [0.04, 0.26]). CONCLUSION Demand feeding and an infant's age of 1 to 4 weeks contributed to exclusive direct breastfeeding. Lower rates of exclusive direct breastfeeding were associated with the use of nipple shields immediately after birth, pacifier use, and perceptions of insufficient milk. Further investigation is warranted to fully differentiate exclusive direct breastfeeding from exclusive breastfeeding.
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Kaushal M, Sasidharan K, Kaushal A, Augustine P, Alex M. Increasing the exclusive breastfeeding rate in a private hospital in UAE through quality improvement initiatives. J Neonatal Perinatal Med 2022; 15:179-186. [PMID: 34120921 DOI: 10.3233/npm-210703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
BACKGROUND Mother's milk is the best, and ideal method for infant feeding. We found that this practice was not being followed in our hospital. A survey was conducted in the unit with regards to breastfeeding practices which revealed that most babies who were discharged from our nursery were on formula supplements. Our goal was to improve established breastfeeding rates in the unit by increasing the number of full-term healthy babies who were discharged on exclusive Breastfeeding. METHOD A project team was formed, and data were collected through direct observations and direct interviews with postnatal mothers. Exclusive Breastfeeding at discharge was defined as a baby being fully on breastfeed with no additional formula supplements for at least 12 hours prior to discharge. The primary outcome was to increase the percentage of babies being discharged on exclusive Breastfeeding. We used the FOCUS PDCA model to measure improvements and 8 PDCA cycles of 4 weeks duration were implemented to test the changes. RESULTS The interventions we put in place led to a considerable nine times overall improvement in the established breastfeeding rates. Among all the interventions, the most promising results were observed during the PDCA cycles involving staff education, the introduction of antenatal classes for mothers, skin to skin contact and rooming in. CONCLUSION Breastfeeding rates in the private sector with nursery services can be improved by reinforcing breastfeeding education for mothers in addition to training the maternal care staff, empowering them to promote and assist in breastfeeding.
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Siraneh Y, Woldie M, Birhanu Z. Effectiveness of Positive Deviance Approach to Promote Exclusive Breastfeeding Practice: A Cluster Randomized Controlled Trial. Risk Manag Healthc Policy 2021; 14:3483-3503. [PMID: 34466041 PMCID: PMC8403074 DOI: 10.2147/rmhp.s324762] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 08/05/2021] [Indexed: 11/23/2022] Open
Abstract
Background Suboptimal breastfeeding (BF) contributes to a significant number of infant deaths. A positive deviance approach (PDA) was not studied in Ethiopia, whether it improve exclusive breastfeeding (EBF) practice. Therefore, we determined the effectiveness of positive deviant approached intervention in increasing the proportion of EBF practice. Methods A cluster-randomized controlled trial was employed in Jimma town from February 01 to September 30, 2018. Six randomly selected clusters (kebeles) were randomized into two arms. Then, 260 mothers who met the eligibility criteria were enrolled in either the intervention or control arm depending on where they lived. Women in the intervention group received counseling and social support in addition to the usual service to promote EBF, from women identified and trained as positive deviants in their community, while those in the control groups received the usual community-based services from urban health extension professionals. Data on primary and secondary outcome variables were collected at three points, and statistical difference was estimated using Chi-X2 or Fisher exact test. The net effect of the intervention was calculated. The magnitude of the intervention effect was estimated using the relative risk. For all statistical tests, 95% CI with a P-value of <0.05 was used. Results The overall response rate at the endline was 98.8%. Exclusive BF was significantly different between the groups at mid and end points, while no difference at baseline. A higher proportion of mothers in the intervention group reported EBF compared to the control group at mid and end-line. The rate of EBF increased by 18.5% (P=0.01) in the intervention group while 0.2% in the counterparts, with a net effect of +18.2%. The probability of practicing EBF was significantly higher for the intervention group compared to the control group. At baseline, the relative risk of avoiding EBF (RR:1.112) was similar among the two groups. However, at follow-up, mothers in the intervention group were 2 times more likely to practice EBF (RR: 2.294) compared to those in the control group. Conclusion and Recommendation The PD approach is an effective intervention to promote EBF and also positively affected frequency and duration of BF. Therefore, we recommend the promotion and use of positive deviance approach as a strategy to improve EBF practice in urban settings. Trial Registration Number Clinical trial PACTR201805003379263, 23 May 2018.
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Affiliation(s)
- Yibeltal Siraneh
- Department of Health Policy and Management, Faculty of Public Health, Jimma University, Jimma, Ethiopia
| | - Mirkuzie Woldie
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Zewdie Birhanu
- Department of Health, Behavior and Society, Faculty of Public Health, Jimma University, Jimma, Ethiopia
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Iliadou M, Lykeridou K, Prezerakos P, Tzavara C, Tziaferi SG. Reliability and Validity of the Greek Version of the Iowa Infant Feeding Attitude Scale Among Pregnant Women. Mater Sociomed 2019; 31:160-165. [PMID: 31762695 PMCID: PMC6853719 DOI: 10.5455/msm.2019.31.160-165] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Introduction: A modifiable factor related to breastfeeding is breastfeeding attitudes. The Iowa Infant Feeding Attitude Scale (IIFAS) is used to evaluate this factor. Although the breastfeeding rates in Greece are declined there is not available any validated instrument to evaluate infant feeding attitudes. Aim: to determine the psychometric properties of the Greek adaptation of the IIFAS in a sample of pregnant women. Materials and Methods: Pregnant women (N=203) from a University Hospital in Athens, Greece, were administered the Greek version of the IIFAS, while being in hospital, and their infant feeding mode at six months postpartum was recorded by telephone. The reliability of the scale was assessed by using corrected item-total correlations and Cronbach’s alpha. Construct validity of the scale was assessed by using confirmatory factor analysis and predictive validity by using t-tests. Multiple linear regression analyses in a stepwise method (p for removal was set at 0.1 and p for entry was set at .05) was performed in order to find variables independently associated with IIFAS total score. Results: The mean IIFAS score was 70.0 (SD=7.6). The corrected item-total correlation ranged from 0.22 to 0.51. Cronbach’s alpha was equal to 0.71. The confirmatory factor analysis indicated an adequate fit of the one-factor model. Concerning the predictive validity of IIFAS it was significant for breastfeeding at six months. The mean IIFAS score was significantly greater (p=0.001) for women that had exclusive breastfeeding at six months (mean (SD): 68.4(6.6)) as compared with those that did not (mean (SD): 64.0(7.5)). Higher IIFAS scores were found in older women, with higher educational level and in those that had breastfed children in their social environment. Conclusion: The Greek version of the IIFAS demonstrated satisfying reliability and validity for measuring women’s infant feeding attitudes in the Greek context. Also, the results of the present study provide further evidence of the international applicability of the IIFAS.
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Affiliation(s)
- Maria Iliadou
- Department of Nursing, Laboratory of Integrated Health Care, Faculty of Human Movement and Quality of Life Sciences, University of Peloponnese, Sparti, Greece.,Department of Midwifery, Faculty of Health and Care Sciences, University of West Attica, Athens, Greece
| | - Katerina Lykeridou
- Department of Midwifery, Faculty of Health and Care Sciences, University of West Attica, Athens, Greece
| | - Panagiotis Prezerakos
- Department of Nursing, Laboratory of Integrated Health Care, Faculty of Human Movement and Quality of Life Sciences, University of Peloponnese, Sparti, Greece
| | - Chara Tzavara
- Department of Hygiene, Epidemiology and Medical Statistics, Centre for Health Services Research, National and Kapodistrian University of Athens, Athens, Greece
| | - Styliani G Tziaferi
- Department of Nursing, Laboratory of Integrated Health Care, Faculty of Human Movement and Quality of Life Sciences, University of Peloponnese, Sparti, Greece
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Odar Stough C, Khalsa AS, Nabors LA, Merianos AL, Peugh J. Predictors of Exclusive Breastfeeding for 6 Months in a National Sample of US Children. Am J Health Promot 2018; 33:48-56. [PMID: 29732899 DOI: 10.1177/0890117118774208] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To explore predictors of breastfeeding behavior and seek to replicate prior findings using a recent nationally representative United States (US) sample, which has not been done previously. DESIGN Secondary data analysis using the National Survey of Children's Health 2011 to 2012. SETTING Households in the 50 US states, the District of Columbia, and the US Virgin Islands. PARTICIPANTS Caregivers with a child between 6 months and 6 years of age (n = 26 552). MEASURES Caregiver-reported child breastfeeding behavior, child birth weight, child/maternal/family demographics, maternal physical and mental health, and household tobacco exposure. ANALYSIS A multinomial logistic regression explored whether child, maternal, and family characteristics predicted exclusive breastfeeding for 6 months or breastfeeding for a suboptimal duration. RESULTS Approximately 79% and 17% of the sample-initiated breastfeeding and exclusively breastfed for 6 months, respectively. Child ethnicity/race, maternal education, household tobacco exposure, family composition, and family income predicted odds of both exclusive breastfeeding for 6 months and breastfeeding for a suboptimal duration or not exclusively. Normal or high child birth weight and better maternal physical health predicted greater odds of exclusive breastfeeding for 6 months. CONCLUSION Rates of exclusive breastfeeding for 6 months remain low in the United States. Single-parent and step-families, lower income families, non-Hispanic black children, children with exposure to tobacco, and children of mothers with lower education are at greatest risk.
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Affiliation(s)
| | - Amrik S Khalsa
- 2 Division of General and Community Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Laura A Nabors
- 3 School of Human Services, College of Education, Criminal Justice, and Human Services, University of Cincinnati, Cincinnati, OH, USA
| | - Ashley L Merianos
- 3 School of Human Services, College of Education, Criminal Justice, and Human Services, University of Cincinnati, Cincinnati, OH, USA
| | - James Peugh
- 4 Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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Haile ZT, Elmasry M, Chavan B, Azulay Chertok IR. Association Between Type of Health Professional at Birth and Exclusive Breastfeeding. J Midwifery Womens Health 2017; 62:562-571. [PMID: 28940707 DOI: 10.1111/jmwh.12657] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Revised: 06/27/2017] [Accepted: 07/06/2017] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Although benefits of breastfeeding for infants, women, and society are well established, breastfeeding rates in the United States remain below the Healthy People 2020 goals. Various factors are known to influence breastfeeding practices. Limited research has been conducted to examine the influence of type of birth attendant on exclusive breastfeeding. METHODS A cross-sectional analysis was conducted using data from the Infant Feeding Practices Study II collected between May 2005 and June 2007. RESULTS The study sample included 2026 women, aged 18 years or older. At discharge, 74.6% of women exclusively breastfed, and 27.6% exclusively breastfed at 3 months postpartum. Bivariate analysis showed a statistically significant association between type of health professional at birth and exclusive breastfeeding at discharge (P = .001) and 3 months postpartum (P < .001). After adjusting for potential confounders, the association between type of health professional at birth and exclusive breastfeeding at discharge was no longer significant. However, the odds of exclusive breastfeeding at 3 months postpartum were higher among women whose birth was attended by a midwife or nurse-midwife compared to those whose birth was attended by an obstetrician (odds ratio [OR], 1.87; 95% confidence interval [CI], 1.34-2.61; P < .001). DISCUSSION Exclusive breastfeeding continuation may be influenced by the type of health professional attending the birth. In addition to having a skilled workforce, health care professionals involved in perinatal care need to be educated and trained to promote and support exclusive breastfeeding as recommended. The complex and multifactorial nature of the maternal decision to exclusively breastfeed requires broader understanding of contextual factors.
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Kellams AL, Gurka KK, Hornsby PP, Drake E, Riffon M, Gellerson D, Gulati G, Coleman V. The Impact of a Prenatal Education Video on Rates of Breastfeeding Initiation and Exclusivity during the Newborn Hospital Stay in a Low-income Population. J Hum Lact 2016; 32:152-9. [PMID: 26289058 DOI: 10.1177/0890334415599402] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Accepted: 07/11/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND Guidelines recommend prenatal education to improve breastfeeding rates; however, effective educational interventions targeted at low-income, minority populations are needed as they remain less likely to breastfeed. OBJECTIVE To determine whether a low-cost prenatal education video improves hospital rates of breastfeeding initiation and exclusivity in a low-income population. METHODS A total of 522 low-income women were randomized during a prenatal care visit occurring in the third trimester to view an educational video on either breastfeeding or prenatal nutrition and exercise. Using multivariable analyses, breastfeeding initiation rates and exclusivity during the hospital stay were compared. RESULTS Exposure to the intervention did not affect breastfeeding initiation rates or duration during the hospital stay. The lack of an effect on breastfeeding initiation persisted even after controlling for partner, parent, or other living at home and infant complications (adjusted odds ratio [OR] = 1.05, 95% CI, 0.70-1.56). In addition, breastfeeding exclusivity rates during the hospital stay did not differ between the groups (P = .87). CONCLUSION This study suggests that an educational breastfeeding video alone is ineffective in improving the hospital breastfeeding practices of low-income women. Increasing breastfeeding rates in this at-risk population likely requires a multipronged effort begun early in pregnancy or preconception.
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Affiliation(s)
- Ann L Kellams
- Department of Pediatrics, University of Virginia, Charlottesville, VA, USA
| | - Kelly K Gurka
- Department of Epidemiology, West Virginia University, Morgantown, WV, USA
| | - Paige P Hornsby
- Department of Public Health Sciences, University of Virginia, Charlottesville, VA, USA
| | - Emily Drake
- School of Nursing, University of Virginia, Charlottesville, VA, USA
| | - Mark Riffon
- Department of Biostatistics, West Virginia University, Morgantown, WV, USA
| | | | - Gauri Gulati
- Department of Pediatrics, Virginia Commonwealth University, Richmond, VA, USA
| | - Valerie Coleman
- Institute of Women's Health, Virginia Commonwealth University, Richmond, VA, USA
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McGaffin G, Harper K, Stirling D, McLintock L. JAK2 V617F and CALR mutations are not mutually exclusive; findings from retrospective analysis of a small patient cohort. Br J Haematol 2014; 167:276-8. [PMID: 24935260 DOI: 10.1111/bjh.12969] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Affiliation(s)
- Gillian McGaffin
- Department of Haematology, Royal Infirmary of Edinburgh, Edinburgh, UK.
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14
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Pager SR, Davis J, Harrigan R. Prevalence of breastfeeding among a multiethnic population in Hawaii. Ethn Dis 2008; 18:S2-218. [PMID: 18646352 PMCID: PMC2637391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023] Open
Abstract
INTRODUCTION The purpose of this study, conducted in a multiethnic population in Hawaii, was to estimate the prevalence of breastfeeding at six months of age, exclusive and otherwise, as well as to identify positively and negatively associated factors. METHODS A content-valid survey was conducted among a random stratified sample, and a printed questionnaire was sent to mothers of infants aged 7-10 months. A response rate of 70% yielded 701 completed surveys. RESULTS At six months after birth, some breastfeeding was practiced by 54% of respondents. The rate of exclusive breastfeeding was approximately 16% at six months. Race and ethnicity assessment showed that Whites had the highest rates and Filipinos the lowest. Formula use in the hospital was most significantly associated with lower breastfeeding rates at six months. CONCLUSIONS Exclusive breastfeeding for six months, even in a state with extremely high initiation rates, is seldom achieved. Formula use in the maternity units should be reduced, and intensive targeted study and education of the Filipino community should be undertaken.
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Affiliation(s)
- Sylvia R Pager
- Department of Pediatrics, John A. Burns School of Medicine, University of Hawaii, 1380 Lusitana St, Ste 90, Honolulu, HI 96813, USA.
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15
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Al-Amoud MM. Breastfeeding practice among women attending primary health centers in riyadh. J Family Community Med 2003; 10:19-30. [PMID: 23011977 PMCID: PMC3425754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
OBJECTIVES (1) To study the patterns of breastfeeding of last children, duration, factors and reasons for it. (2) To study the factors affecting breastfeeding among mothers who are breastfeeding and the reasons for continuing or failure to continue, at the primary health care centers (PHC) in Riyadh. METHOD A cross-sectional study was conducted by distributing 1000 questionnaires in 10 PHC centers. The breastfeeding practices were categorized on WHO terms. RESULTS Most of the studied last children (95.1%) were breastfed. Exclusive breastfeeding rate from birth was 62.9%, for up to four months was 13.2% and for six months was 3.3% . The mixed breastfeeding rate from birth was 32.2%, up to age of four months was 53.1% and for children more than six months old it was 20.3%. The mean age of the introduction of solid food was 4.6 ±1.4 months. Artificial feeding rate was 4.9% at birth , 30.3% up to four months and 49.7% for children more than six months old. The most frequent reason for the continuation of breastfeeding was Quranic instruction (55.1%) and its failure was inadequate milk (60.8%). The exclusive breastfeeding and the duration of breastfeeding had statistically significant association with the mothers' residence, marital status, number of children alive, occupation and the level of education. In addition, there was significant association of exclusive breastfeeding and the non-introduction of artificial feeding at the hospital but not with health education on breastfeeding at the centers . RECOMMENDATIONS To promote the education of mothers on breastfeeding, promote the training of PHC center health professionals and modify the policy of hospitals in the Kingdom on the feeding of newborns.
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Affiliation(s)
- Maysoon M Al-Amoud
- Family and Community Medicine Postgraduate Training Center, Ministry of Health, Riyadh, Saudi Arabia
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