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Shustak RJ, Huang J, Tam V, Stagg A, Giglia TM, Ravishankar C, Mercer‐Rosa L, Guevara JP, Gardner MM. Neighborhood Social Vulnerability and Interstage Weight Gain: Evaluating the Role of a Home Monitoring Program. J Am Heart Assoc 2023; 12:e030029. [PMID: 37702068 PMCID: PMC10547291 DOI: 10.1161/jaha.123.030029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Accepted: 08/08/2023] [Indexed: 09/14/2023]
Abstract
Background Poor interstage weight gain is a risk factor for adverse outcomes in infants with hypoplastic left heart syndrome. We sought to examine the association of neighborhood social vulnerability and interstage weight gain and determine if this association is modified by enrollment in our institution's Infant Single Ventricle Management and Monitoring Program (ISVMP). Methods and Results We performed a retrospective single-center study of infants with hypoplastic left heart syndrome before (2007-2010) and after (2011-2020) introduction of the ISVMP. The primary outcome was interstage weight gain, and the secondary outcome was interstage growth failure. Multivariable linear and logistic regression models were used to examine the association between the Social Vulnerability Index and the outcomes. We introduced an interaction term into the models to test for effect modification by the ISVMP. We evaluated 217 ISVMP infants and 111 pre-ISVMP historical controls. The Social Vulnerability Index was associated with interstage growth failure (P=0.001); however, enrollment in the ISVMP strongly attenuated this association (P=0.04). Pre-ISVMP, as well as high- and middle-vulnerability infants gained 4 g/d less and were significantly more likely to experience growth failure than low-vulnerability infants (high versus low: adjusted odds ratio [aOR], 12.5 [95% CI, 2.5-62.2]; middle versus low: aOR, 7.8 [95% CI, 2.0-31.2]). After the introduction of the ISVMP, outcomes did not differ by Social Vulnerability Index tertile. Infants with middle and high Social Vulnerability Index scores who were enrolled in the ISVMP gained 4 g/d and 2 g/d more, respectively, than pre-ISVMP controls. Conclusions In infants with hypoplastic left heart syndrome, high social vulnerability is a risk factor for poor interstage weight gain. However, enrollment in the ISVMP significantly reduces growth disparities.
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Affiliation(s)
- Rachel J. Shustak
- Division of Cardiology, Department of Pediatrics, The Children’s Hospital of Philadelphia and Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPAUSA
| | - Jing Huang
- Department of Biomedical and Health Informatics, Data Science and Biostatistics UnitThe Children’s Hospital of PhiladelphiaPhiladelphiaPAUSA
| | - Vicky Tam
- Cartographic Modeling LabUniversity of PennsylvaniaPhiladelphiaPAUSA
| | - Alyson Stagg
- Division of Cardiology, Department of Pediatrics, The Children’s Hospital of Philadelphia and Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPAUSA
| | - Therese M. Giglia
- Division of Cardiology, Department of Pediatrics, The Children’s Hospital of Philadelphia and Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPAUSA
| | - Chitra Ravishankar
- Division of Cardiology, Department of Pediatrics, The Children’s Hospital of Philadelphia and Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPAUSA
| | - Laura Mercer‐Rosa
- Division of Cardiology, Department of Pediatrics, The Children’s Hospital of Philadelphia and Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPAUSA
| | - James P. Guevara
- Division of General Pediatrics, Department of Pediatrics, The Children’s Hospital of PhiladelphiaPerelman School of Medicine at the University of PennsylvaniaPhiladelphiaPAUSA
| | - Monique M. Gardner
- Division of Cardiac Critical Care Medicine, The Children’s Hospital of Philadelphia and Department of Anesthesiology and Critical CarePerelman School of Medicine at the University of PennsylvaniaPhiladelphiaPAUSA
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Endoh K. Some Japanese mothers do not follow package instructions of infant formula: a web-based analytical cross-sectional study. BMC Nutr 2022; 8:126. [PMID: 36319983 PMCID: PMC9628175 DOI: 10.1186/s40795-022-00615-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Revised: 10/12/2022] [Accepted: 10/17/2022] [Indexed: 11/06/2022] Open
Abstract
Background: Not following the infant formula package instruction endangers infant health. Although infant formula misuse has been reported abroad, its incidence in Japan remains unknown. Furthermore, it is reasonable to assume that experience in childcare reduces the likelihood of making mistakes in using infant formula. This study aimed to examine the association between compliance with infant formula package instruction and childcare experience in Tokyo and surrounding prefectures in Japan. Methods: Using a web-based questionnaire, mothers with infants were analyzed cross-sectionally and surveyed regarding their infants’ nutrition and formula preparation methods in August 2021. Compliance with the infant formula package was determined according to (a) using unlabeled infant formula, (b) preparing infant formula without reading package instructions, (c) giving formula to children ≥ 2 h after preparing, and (d) adding other ingredients to the formula bottle. The association between the misuse of infant formula and childcare experience was examined by grouping the participants by infant age (< 6 months and ≥ 6 months), and by comparing first-born child status with later-born. Of the 333 mothers with infants, 3 were excluded due to out-of-scope responses, and 330 were included in the analysis. Results: The major sources of information on infant feeding methods among the participants were obstetric facilities (92.1%), internet (36.1%), and family (20.9%). The proportions of participants using infant formulas not labeled as “infant formula,” such as follow-up milk, not preparing at prescribed concentrations, feeding infant formulas > 2 h after preparation, and adding additional ingredients to the bottle were 7.9%, 4.1%, 23.1%, and 15.9%, respectively, which suggest the misuse of infant formula. These four answers did not differ significantly between mothers of children aged < 6 months and ≥ 6 months or between those with first-born and later-born children. Conclusion: This study suggested that some Japanese mothers do not follow package instructions of infant formula in Japan. The misuse of infant formula may not be related to the length of time spent in childcare or the presence or absence of childcare experience. Providing appropriate information on the correct use of infant formula to all caregivers, regardless of their parenting experience, is required. Supplementary Information The online version contains supplementary material available at 10.1186/s40795-022-00615-7.
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Affiliation(s)
- Kaori Endoh
- Laboratory of Public Health Nutrition, Department of Food Sciences and Nutrition, Kyoritsu Women's University, 2-2-1 Hitotsubashi, Chiyoda-ku, 101-8437, Tokyo, Japan.
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Appleton J, Russell CG, Fowler C, Jansen E, Burnett AJ, Rossiter C, Denney-Wilson E. Informing Infant Nutrition: Timing of Infant Formula Advice, Infant Formula Choice and Preparation in the First 6 Months of Life. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2022; 54:908-915. [PMID: 36216441 DOI: 10.1016/j.jneb.2022.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 05/22/2022] [Accepted: 06/05/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVE To examine the sources and timing of advice formula feeding parents receive and how this and other factors influence the choice of formula product and formula preparation. DESIGN Components of a cross-sectional survey. SETTING A child and family health service in New South Wales, Australia. PARTICIPANTS Parents (n = 153) who were fully or partially formula feeding infants aged 0-6 months and who visited the service's facilities or its social media site. VARIABLES MEASURED Type of formula, preparation of formula, and use and sources of formula feeding advice. ANALYSIS Descriptive statistics, Mann-Whitney U or Pearson's chi-square tests, and inductive content analysis. RESULTS The most common source of formula feeding advice was the formula tin/packet (96.6%). Although 79.2% received advice from a health professional, only 18.9% reported receiving this advice before using formula. Approximately half (48.0%) of the parents chose a standard cow's milk-based formula. The most common reason for their choice of formula type/brand was a personal recommendation (53.0%). Parents' responses indicated that nearly half (46.3%) incorrectly prepared the formula. CONCLUSION AND IMPLICATIONS Although health professional advice was widely received, this was rarely before starting formula. Despite the current national infant feeding regulations, parents who were not exclusively breastfeeding their infants did not always receive timely, health professional advice about formula feeding.
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Affiliation(s)
- Jessica Appleton
- Tresillian Family Care Centres, Sydney, New South Wales, Australia; Susan Wakil School of Nursing and Midwifery, University of Sydney, Camperdown, New South Wales, Australia; School of Nursing and Midwifery, Faculty of Health, University of Technology, Sydney, New South Wales, Australia.
| | - Catherine G Russell
- School of Nursing and Midwifery, Faculty of Health, University of Technology, Sydney, New South Wales, Australia; Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, Victoria, Australia
| | - Cathrine Fowler
- Tresillian Family Care Centres, Sydney, New South Wales, Australia; School of Nursing and Midwifery, Faculty of Health, University of Technology, Sydney, New South Wales, Australia
| | - Elena Jansen
- School of Exercise and Nutrition Sciences, Queensland University of Technology, Kelvin Grove, Queensland, Australia; Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Alissa J Burnett
- School of Exercise and Nutrition Sciences, Faculty of Health, Deakin University, Geelong, Victoria, Australia
| | - Christine Rossiter
- Susan Wakil School of Nursing and Midwifery, University of Sydney, Camperdown, New South Wales, Australia; School of Nursing and Midwifery, Faculty of Health, University of Technology, Sydney, New South Wales, Australia
| | - Elizabeth Denney-Wilson
- Susan Wakil School of Nursing and Midwifery, University of Sydney, Camperdown, New South Wales, Australia; Sydney Local Health District, Camperdown, New South Wales, Australia
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Health literacy characteristics of over-the-counter rapid antigen COVID-19 test materials. Res Social Adm Pharm 2022; 18:4124-4128. [PMID: 35987673 PMCID: PMC9376145 DOI: 10.1016/j.sapharm.2022.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 07/14/2022] [Accepted: 08/09/2022] [Indexed: 12/12/2022]
Abstract
Background The United States Food & Drug Administration's emergency authorized use, in December 2020, of over-the-counter (OTC) rapid antigen COVID-19 tests was a pandemic control milestone. Objective To assess health literacy-related characteristics of OTC rapid antigen COVID-19 test materials. Methods Between September–December 2021, we identified eleven (n = 11) OTC rapid antigen COVID-19 tests available for purchase in the US. We assessed readability (Flesch Reading Ease and Fernández-Huerta), formatting and layout features of English- and Spanish-language step-by-step OTC rapid antigen COVID-19 test package insert instructions. Video-based step-by-step OTC rapid antigen COVID-19 test instructions were evaluated for understandability and actionability (Patient Education Materials Assessment Tool for Audiovisual Materials [PEMAT-A/V]), overall quality (Global Quality Scale [GQS]) and cultural diversity and inclusiveness. Descriptive analyses were performed using IBM® Statistical Package for the Social Sciences. Results Nine (81.8%) OTC rapid antigen COVID-19 tests included English-language (≈8th-9th reading grade level) step-by-step instructions, while 4 included Spanish-language (≈10th-12th reading grade level) instructions. On average, instructions were printed on a tabloid sized piece of paper, with text size ranging from 4 to 12 point and including nearly 20 illustrations. English-language step-by-step OTC rapid antigen COVID-19 test video-based instructions (n = 6) ranged from 1:04 to 5:41 min with PEMAT-A/V scores ranging from 80% to 100%. As indicated by GQS scores, English-language videos were of high quality (5 videos scored 5/5; 1 video scored 4/5). One COVID-19 test product manufacturing website included Spanish-language video-based instructions (time = 4:59 min; PEMAT-A/V = 100%; GQS = 5). Conclusions OTC COVID-19 test step-by-step instructions—both package inserts and video-based—included features shown to foster patient understanding and facilitate proper use. Moving forward, greater attention needs to be placed on expanding both Spanish-language and video-based OTC COVID-19 test material availability to improve accessibility across diverse populations.
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Cheng H, Rossiter C, Size D, Denney‐Wilson E. Comprehensiveness of infant formula and bottle feeding resources: A review of information from Australian healthcare organisations. MATERNAL & CHILD NUTRITION 2022; 18:e13309. [PMID: 34913262 PMCID: PMC8932696 DOI: 10.1111/mcn.13309] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 11/15/2021] [Accepted: 11/18/2021] [Indexed: 12/14/2022]
Abstract
The use of infant formula is widespread internationally. In Australia, 55% of infants receive formula before 6 months of age, with higher rates among disadvantaged communities. Infant formula use can contribute to childhood overweight and obesity, through formula composition and feeding behaviours, such as adding cereal to bottles and parental feeding style. While information abounds to promote and support breastfeeding, formula-feeding parents report a paucity of advice and support; many rely on formula packaging for information. This study systematically searched and reviewed online resources for infant formula and bottle feeding from Australian governments, health services, hospitals, and not-for-profit parenting organisations. A comprehensive search strategy located 74 current resources, mostly for parents. Researchers evaluated the resources against best practice criteria derived from Australian government and UNICEF guidelines on six topics. They assessed how comprehensively the resources addressed each topic and whether the resources provided all the information necessary for parents to understand each topic. The mean 'comprehensiveness' rating for topics across all resources was 54.36%. However, some topics were addressed more fully than others. Information on 'discussing infant formula with health workers' and on 'preparing infant formula' was more frequently accurate and comprehensive. However, there was much less comprehensive information on 'using infant formula', including amounts of formula to feed, use of bottle teats, appropriate bottle-feeding practice and responsiveness to infant satiety cues. Over half the resources were written at an acceptable reading level.
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Affiliation(s)
- Heilok Cheng
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and HealthThe University of SydneySydneyNew South WalesAustralia
| | - Chris Rossiter
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and HealthThe University of SydneySydneyNew South WalesAustralia
| | - Donna Size
- Child and Family Health NursingSydney Local Health District, NSW HealthCamperdownNew South WalesAustralia
- Women and BabiesRoyal Prince Alfred Hospital, Sydney Local Health District, NSW HealthCamperdownNew South WalesAustralia
| | - Elizabeth Denney‐Wilson
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and HealthThe University of SydneySydneyNew South WalesAustralia
- Sydney Institute for Women, Children and their FamiliesSydney Local Health District, NSW HealthCamperdownNew South WalesAustralia
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Bhavsar D, Hohman C, Stinson HE, Wallace LS. Child Dehydration Management: A Health Literacy-Focused Resource Analysis. AMERICAN JOURNAL OF HEALTH EDUCATION 2021. [DOI: 10.1080/19325037.2021.1973618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Anderson CE, Martinez CE, Ventura AK, Whaley SE. Potential overfeeding among formula fed Special Supplemental Nutrition Program for Women, Infants and Children participants and associated factors. Pediatr Obes 2020; 15:e12687. [PMID: 32558255 DOI: 10.1111/ijpo.12687] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 05/19/2020] [Accepted: 05/26/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND The Special Supplemental Nutrition Program for Women, Infants and Children (WIC) provides enough formula to meet the known nutritional needs of infants up to 6 months of age whose mothers report not breastfeeding, but many mothers report WIC providing insufficient formula, indicating potential overfeeding. OBJECTIVE To estimate the prevalence of potential overfeeding among formula-feeding WIC participants and identify associated factors. METHODS Potential overfeeding was identified among participants of the longitudinal Infant and Toddler Feeding Practices Study-2 (ITFPS-2) receiving the fully formula-feeding WIC infant package at 1 month of age (n = 1235, weighted n = 197 079). Associations of potential overfeeding with caloric intake, weight and participant characteristics were assessed. RESULTS Potential overfeeding was identified among 37.41% (95% CI = 33.57-41.25%) of fully formula-feeding infants. Potentially overfed infants were 0.18 kg heavier (P-value = .01), consumed 26 more calories daily (P-value = .004) and were more likely Non-Hispanic White or English-speaking Hispanic (P-value = .007) and highly active at 5 months of age (P-value = .01). Mothers of potentially overfed infants were less likely to agree that breastfeeding is easier than bottle feeding, only mothers can feed breastfed infants, turning away from the bottle indicates satiation, and crying always indicates hunger (P-values .04, .002, .04 and .04 respectively), and more likely to report WIC provides insufficient formula early (1-5 months, P-value <.0001) and late (6-13 months, P-value = .007) in infancy. CONCLUSIONS Potential overfeeding occurs in 37% of fully formula-feeding infant WIC-participants <6 months old. Mothers of these infants may benefit from additional education about the formula needs of their infants and how to recognize infant satiation cues.
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Affiliation(s)
- Christopher E Anderson
- Department of Research and Evaluation, Public Health Foundation Enterprises (PHFE) WIC, Irwindale, California, USA
| | - Catherine E Martinez
- Department of Research and Evaluation, Public Health Foundation Enterprises (PHFE) WIC, Irwindale, California, USA
| | - Alison K Ventura
- Department of Kinesiology and Public Health, College of Science and Mathematics, California Polytechnic State University, San Luis Obispo, California, USA
| | - Shannon E Whaley
- Department of Research and Evaluation, Public Health Foundation Enterprises (PHFE) WIC, Irwindale, California, USA
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Modifications to Infant Formula Instructions Improve the Accuracy of Formula Dispensing. Nutrients 2020; 12:nu12041150. [PMID: 32325958 PMCID: PMC7230650 DOI: 10.3390/nu12041150] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 04/14/2020] [Accepted: 04/15/2020] [Indexed: 01/17/2023] Open
Abstract
Readability of infant formula preparation instructions is universally poor, which may result in inaccurate infant feeding. Given that inaccurate formula dispensing can lead to altered infant growth and increased adiposity, there is an increased need for easy to follow instructions for formula preparation. We hypothesize that altering infant formula instruction labels using feedback from iterative focus groups will improve the preparation accuracy of powdered infant formula in a randomized controlled trial. Participants were recruited from the community, 18 years of age or older, willing to disclose demographic information for focus group matching, and willing to participate freely in the first (n = 21) or second (n = 150) phase of the study. In the second phase, participants were randomized to use the standard manufacturer instructions or to use the modified instructions created in the first phase. Accuracy was defined as the percent error between manufacturer-intended powder formula quantity and the amount dispensed by the participant. Participants who were assigned to the modified instructions were able to dispense the powdered formula more accurately than participants who used the standard manufacturer instructions (−0.67 ± 0.76 vs. −4.66 ± 0.74% error; p < 0.0001). Accuracy in powdered formula dispensing was influenced by bottle size (p = 0.02) but not by body mass index (p = 0.17), education level (p = 0.75), income (p = 0.7), age (p = 0.89) or caregiver status (p = 0.18). Percent error of water measurement was not different between the groups (standard: −1.4 ± 0.6 vs. modified: 0.7 ± 0.6%; p = 0.38). Thus, caloric density was more accurate in the modified instructions group compared to the standard manufacturer instructions group (−0.3 ± 0.6 vs.−2.9 ± 0.9%; p = 0.03). Infant formula label modifications using focus group feedback increased infant formula preparation accuracy.
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Altazan AD, Gilmore LA, Guo J, Rosenberg DM, Toupo D, Gowins A, Burton JH, Beyl RA, Chow CC, Hall KD, Redman LM. Unintentional error in formula preparation and its simulated impact on infant weight and adiposity. Pediatr Obes 2019; 14:e12564. [PMID: 31347776 PMCID: PMC6834868 DOI: 10.1111/ijpo.12564] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 05/20/2019] [Accepted: 06/11/2019] [Indexed: 12/28/2022]
Abstract
BACKGROUND Accelerated weight gain in infancy is a public health issue and is likely due to feeding behaviours. OBJECTIVES To test the accuracy of individuals to dispense infant formula as compared with recommended serving sizes and to estimate the effect of dispensing inaccuracy on infant growth. METHODS Fifty-three adults dispensed infant formula powder for three servings of 2, 4, 6, and 8 fl oz bottles, in random order. The weight of dispensed infant formula powder was compared with the recommended serving size weight on the nutrition label. A novel mathematical model was used to estimate the impact of formula dispensing on infant weight and adiposity. RESULTS Nineteen percent of bottles (20 of 636) prepared contained the recommended amount of infant formula powder. Three percent were underdispensed, and 78% of bottles were overdispensed, resulting in 11% additional infant formula powder. Mathematical modelling feeding 11% above energy requirements exclusively for 6 months for male and female infants suggested infants at the 50th percentile for weight at birth would reach the 75th percentile with increased adiposity by 6 months. CONCLUSIONS Inaccurate measurement of infant formula powder and overdispensing, which is highly prevalent, specifically, may contribute to rapid weight gain and increased adiposity in formula-fed infants.
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Affiliation(s)
- Abby D. Altazan
- Reproductive Endocrinology and Women’s Health, Pennington Biomedical Research Center, Baton Rouge, LA 70808
| | - L. Anne Gilmore
- Reproductive Endocrinology and Women’s Health, Pennington Biomedical Research Center, Baton Rouge, LA 70808
| | - Juen Guo
- National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health (NIH), Bethesda MD, 20892
| | - David M. Rosenberg
- National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health (NIH), Bethesda MD, 20892
| | - Danielle Toupo
- National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health (NIH), Bethesda MD, 20892
| | - Aaron Gowins
- National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health (NIH), Bethesda MD, 20892
| | - Jeffrey H. Burton
- Reproductive Endocrinology and Women’s Health, Pennington Biomedical Research Center, Baton Rouge, LA 70808
| | - Robbie A. Beyl
- Reproductive Endocrinology and Women’s Health, Pennington Biomedical Research Center, Baton Rouge, LA 70808
| | - Carson C. Chow
- National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health (NIH), Bethesda MD, 20892
| | - Kevin D. Hall
- National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health (NIH), Bethesda MD, 20892
| | - Leanne M. Redman
- Reproductive Endocrinology and Women’s Health, Pennington Biomedical Research Center, Baton Rouge, LA 70808
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Informed choice or guessing game? Understanding caregivers’ perceptions and use of infant formula labelling. Public Health Nutr 2018; 22:273-286. [DOI: 10.1017/s1368980018003178] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractObjectiveAlthough breast-feeding is the recommended way to feed an infant, a safe and nutritious substitute for breast milk is needed for infants who are not breast-fed. Labelling information on infant formula (IF) products aims to enable caregivers (who have already made the decision to use IF) to make informed product choices. Yet, there is limited data on how caregivers understand and use the information provided on IF packaging. The present study aimed to increase understanding of caregivers’ interpretation and use of the following label elements on IF products: the nutrition information statement; the ingredients list; and statements around nutrition content and health claims.DesignQualitative data were obtained from twenty-one focus group discussions. To enable comparison of findings by education level and ethnicity, focus group participants were homogeneous with respect to educational attainment (Australian groups) or ethnic background (New Zealand groups).SettingFocus groups were conducted in metropolitan and regional areas of Australia and New Zealand.ParticipantsCaregivers (n 136) of formula-fed infants.ResultsFramework analysis revealed that caregivers commonly experience difficulties when using labelling information, particularly when trying to identify and understand key differences between products. Moreover, comparing products can be a complex task regardless of education level and ethnicity.ConclusionsFurther research is required to determine the most effective strategies for meeting information needs of caregivers and allowing easier identification and understanding of product differences. This is especially important given that the vast range of IF products across large price ranges in the market adds to the complexity of purchase decisions.
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