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Adams IKR, Meshelemiah JCA, Noble ST, Piperata BA. The complementary feeding practices of low-income Black mothers with infants between 6 and 24 months of age: A qualitative study. J Hum Nutr Diet 2023; 36:1874-1886. [PMID: 37282806 DOI: 10.1111/jhn.13189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 05/18/2023] [Indexed: 06/08/2023]
Abstract
BACKGROUND The period from 6 to 24 months in an infant's life presents a critical window for understanding feeding practices and for designing culturally appropriate interventions. However, little is known about the complementary feeding practices of Black mothers and how this period can be used to optimise the long-term health of their children. The present study aimed to identify factors that influence the complementary feeding practices of low-income Black mothers with children aged 6-24 months. METHODS Participants were recruited through Research Match, Facebook advertising, flyers, and snowballing techniques. Low-income, Black mothers, with a 6-24-month-old infant, and who lived in Franklin County, Ohio, USA, were eligible for the study. A cross-sectional design using in-depth interviews was used. Reflexive thematic analysis was utilised to analyse and interpret the feeding practices of Black mothers. RESULTS Mothers (n = 8) were aged between 18 and 30 years old and most completed college or had some college education (n = 6). Half (n = 4) were married, employed, and rated their diet quality and their children's as very good. Three themes emerged: (a) complementary feeding at ≥ 6 months of age; (b) involvement of health care providers and service organisations in feeding decisions; and (c) use of responsive feeding cues. CONCLUSIONS All mothers breastfed exclusively and most (n = 6) initiated complementary feeding at 6 months. Paediatricians, other health providers and service organisations were instrumental in helping Black mothers adopt complementary feeding practices. Mothers also engaged in responsive feeding practices. These findings point to the critical nature of access and education in helping Black mothers in the study achieve feeding recommendations for their infants.
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Affiliation(s)
- Ingrid K R Adams
- College of Food, Agricultural, and Environmental Sciences, The Ohio State University Extension, Columbus, OH, USA
- Division of Medical Dietetics, School of Health and Rehabilitation Sciences, College of Medicine, Columbus, OH, USA
| | | | - ShyAnne T Noble
- Morehouse Medical Plaza Tower, The Ohio State University, Columbus, OH, USA
| | - Barbara A Piperata
- 4054 Smith Laboratory, Department of Anthropology, College of Arts and Sciences, Columbus, OH, USA
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Bourque SL, Weikel BW, Palmer C, Cataldi JR, Blackwell S, Hwang SS. Prevalence and Predictors of Pediatric COVID-19 Vaccine Acceptance. Am J Perinatol 2023; 40:106-114. [PMID: 35554887 DOI: 10.1055/a-1850-3199] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE As pediatric COVID-19 vaccine eligibility expands, understanding predictors of vaccine intent is critical to effectively address parental concerns. Objectives included: (1) Evaluate maternal COVID-19 vaccine intent for child(ren) and associated predictors of stated intent; (2) Describe attitudes related to hypothetical vaccination policies; (3) Summarize themes associated with intention to vaccinate child(ren) for COVID-19. STUDY DESIGN Mothers enrolled in Heath eMoms, a longitudinal survey project, were recruited for this electronic COVID-19 survey. Chi-square analysis was used to compare proportions of respondent characteristics based on vaccination intent. Population survey logistic regression was used for multivariable modeling to assess the independent association between vaccine intent and demographics. RESULTS The response rate was 65.3% (n = 1884); 44.2% would choose vaccination, 20.3% would not choose vaccination, and 35.5% are unsure whether to have their child(ren) vaccinated for COVID-19. Black mothers (AOR 0.26, 95% CI 0.13, 0.54), respondents with less than high school education (AOR 0.26, 95% 0.12, 0.56) and those in rural areas (AOR 0.28, 95% CI 0.16, 0.48) were less likely to choose vaccination. Commonly cited reasons for vaccine hesitancy include the belief that the vaccine was not tested enough, is not safe, and there are concerns regarding its side effects. CONCLUSION Over 50% of respondents do not intend or are unsure about their intent to vaccinate their child(ren) for COVID-19 with variability noted by demographics. Opportunities exist for perinatal and pediatric providers to educate pregnant people, parents, and caregivers with a focus on addressing concerns regarding vaccine safety and efficacy. KEY POINTS · COVID-19 vaccination rates remain suboptimal, especially in the pediatric population, with variation across states.. · We found that the prevalence of vaccine acceptance for young children is low.. · We highlight opportunities for providers to educate parents, focusing on addressing vaccine safety and efficacy..
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Affiliation(s)
- Stephanie L Bourque
- Department of Pediatrics, Section of Neonatology, University of Colorado School of Medicine, Aurora, Colorado, United States
| | - Blair W Weikel
- Department of Pediatrics, Section of Neonatology, University of Colorado School of Medicine, Aurora, Colorado, United States
| | - Claire Palmer
- Department of Pediatrics, Section of Neonatology, University of Colorado School of Medicine, Aurora, Colorado, United States
| | - Jessica R Cataldi
- Department of Pediatrics, Section of Infectious Diseases, University of Colorado School of Medicine, Aurora, Colorado, United States.,Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, Colorado, United States
| | - Sarah Blackwell
- Colorado Department of Public Health and Environment, Aurora, Colorado, United States
| | - Sunah S Hwang
- Department of Pediatrics, Section of Neonatology, University of Colorado School of Medicine, Aurora, Colorado, United States
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Mothers' Decision Making Concerning Safe Sleep for Preterm Infants: What Are the Influencing Factors? Adv Neonatal Care 2022; 22:444-455. [PMID: 34967776 DOI: 10.1097/anc.0000000000000952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Parental decisions regarding infant sleep practices vary widely, resulting in a lack of adherence to the American Academy of Pediatrics safe sleep recommendations (SSR) and consequently an increased risk of sudden infant death syndrome (SIDS). Preterm infants are among those at a highest risk for SIDS, yet few studies focus on parental decision-making surrounding sleep practices for preterm infants. PURPOSE The purpose of this study was to identify factors influencing decisions concerning infant sleep practices of mothers of preterm infants. METHODS This study used a mixed-methods design. Recruitment was through social media messaging by 2 parent support organizations. An online survey was used to assess factors influencing mothers' decisions regarding sleep practices for preterm infants. FINDINGS/RESULTS Survey participants (n = 98) were from across the United States. Mothers of preterm infants (mean gestational age at birth = 29.42 weeks) most often reported positioning infants on their back to sleep (92.3%) and a low (15.4%) use of a pacifier at sleep time. Three themes emerged for the decisions made: adherence to SSR; nonadherence to SSR; and infant-guided decisions. Regardless of the decision, mothers indicated that anxiety over the infant's well-being resulted in a need for sleep practices that facilitated close monitoring of the infant. IMPLICATIONS FOR PRACTICE AND RESEARCH The findings of this study indicate the need for understanding the underlying anxiety preventing mothers from adhering to SSR despite knowing them, along with tailoring infant sleep messaging and education to improve safety of sleep practices for preterm infants. Research is needed to examine decision making in more diverse populations.
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Bouchard KL, Grigsby-Toussaint DS, Fox K, Amin S, Vadiveloo M, Greaney ML, Tovar A. Maternal Experiences with Discussing Complementary Feeding in Primary Care. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12061. [PMID: 36231363 PMCID: PMC9566633 DOI: 10.3390/ijerph191912061] [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: 08/03/2022] [Revised: 09/15/2022] [Accepted: 09/20/2022] [Indexed: 06/16/2023]
Abstract
Complementary feeding practices promote healthy eating habits and food preferences later in life. Little is known about how US pediatricians communicate infant feeding practices to caregivers or how caregivers respond to this information. The purpose of this study is to explore mothers' experiences and perceptions of the complementary feeding recommendations they receive in primary care settings. English- and Spanish-speaking mothers of infants were recruited from Special Supplemental Nutrition for Women, Infants, and Children offices in Rhode Island, US, and snowball sampling. Semi-structured telephone interviews were conducted to investigate mothers' discussions with pediatricians about complementary feeding and their overall impressions of wellness visits. Thematic analysis was informed by the Fundamentals of Care theoretical framework. The mean age of the sample (n = 13) was 30.5 years and 62% self-identified as Latina. Four themes emerged from the analysis: (1) wellness visits are mostly positive experiences, (2) not all infant feeding recommendations are easy to follow, (3) alternative sources of infant feeding recommendations can be just as helpful, and (4) there is room for improvement at wellness visits. Improving the content, delivery, and cultural relevance of infant feeding recommendations in primary care settings with more specific and tailored information may promote adherence to evidence-based practices.
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Affiliation(s)
- Kelly Lynn Bouchard
- Department of Nutrition and Food Sciences, College of Health Sciences, University of Rhode Island, Kingston, RI 02881, USA
| | - Diana S. Grigsby-Toussaint
- Department of Behavioral and Social Sciences, Center for Health Promotion and Health Equity, Brown University School of Public Health, Providence, RI 02912, USA
| | - Katelyn Fox
- Department of Nutrition and Food Sciences, College of Health Sciences, University of Rhode Island, Kingston, RI 02881, USA
| | - Sarah Amin
- Department of Nutrition and Food Sciences, College of Health Sciences, University of Rhode Island, Kingston, RI 02881, USA
| | - Maya Vadiveloo
- Department of Nutrition and Food Sciences, College of Health Sciences, University of Rhode Island, Kingston, RI 02881, USA
| | - Mary L. Greaney
- Department of Health Studies, College of Health Sciences, University of Rhode Island, Kingston, RI 02881, USA
| | - Alison Tovar
- Department of Behavioral and Social Sciences, Center for Health Promotion and Health Equity, Brown University School of Public Health, Providence, RI 02912, USA
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Guyol GG, Kerr SM, Colson E, Corwin MJ, Smith LA, Heeren T, Kiviniemi MT, Parker MG. The Impact of Maternal Worry on Infant Care Practices. Acad Pediatr 2022; 22:935-941. [PMID: 35307603 PMCID: PMC9357110 DOI: 10.1016/j.acap.2022.02.001] [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: 08/31/2021] [Revised: 02/03/2022] [Accepted: 02/04/2022] [Indexed: 02/08/2023]
Abstract
OBJECTIVES Examine the 1) prevalence of worries among US mothers of infants; 2) association between worries and American Academy of Pediatrics recommended infant care practices (breastfeeding, supine sleep, roomsharing without bedsharing); 3) association of maternal and household characteristics with worries. METHODS We analyzed a nationally representative sample of 3165 mothers who were surveyed regarding safe sleep and breastfeeding when infants were 2 to 6 months of age in 2011-2014. We examined the prevalence of 8 maternal worries (housing, job, income, neighborhood, family relationships, health, baby's health, family member health). We used multivariable logistic regression to examine associations of A) both overall number of worries and individual worries with each infant care practice; and B) maternal and household characteristics with worries. RESULTS Twenty-six percent of mothers reported 0 worries, 26% reported 1-2 worries, 23% reported 3-4 worries, and 25% reported 5-8 worries. Compared to those with 0 worries, mothers with 5-8 worries had increased odds of bedsharing (adjusted odds ratio = 1.60 [1.19-2.14]) and non-supine sleep (aOR = 1.37 [1.07-1.74]). Specific worries associated with increased odds of bedsharing included: housing (aOR = 1.39 [1.09-1.78]), income (aOR = 1.35 [1.09-1.67]), neighborhood (aOR = 1.37 [1.05-1.78]), family relationships (aOR = 1.43 [1.10-1.86]), and health of a family member (aOR = 1.24 [1.06-1.46]). Maternal worries were not associated with infant feeding practices. CONCLUSIONS We found a high prevalence of worries regarding basic needs, family relationships, and health among US mothers. Greater total worries and several individual worries were associated with higher odds of bedsharing. The "cognitive load" of maternal worries may impact adherence to safe sleep practices and requires further investigation.
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Affiliation(s)
- Genevieve G Guyol
- Department of Pediatrics (GG Guyol, MJ Corwin, LA Smith, and MG Parker), Boston Medical Center and Boston University School of Medicine, Boston, Mass; Department of Pediatrics, Division of Newborn Medicine (GG Guyol), Boston Children's Hospital and Harvard Medical School, Boston, Mass.
| | - Stephen M Kerr
- Slone Epidemiology Center (SM Kerr, MJ Corwin), Boston University, Boston, Mass
| | - Eve Colson
- Department of Pediatrics (E Colson), Yale University, New Haven, Conn; Department of Pediatrics (E Colson), School of Medicine, Washington University in St. Louis, St. Louis, Mo
| | - Michael J Corwin
- Department of Pediatrics (GG Guyol, MJ Corwin, LA Smith, and MG Parker), Boston Medical Center and Boston University School of Medicine, Boston, Mass; Slone Epidemiology Center (SM Kerr, MJ Corwin), Boston University, Boston, Mass
| | - Lauren A Smith
- Department of Pediatrics (GG Guyol, MJ Corwin, LA Smith, and MG Parker), Boston Medical Center and Boston University School of Medicine, Boston, Mass; CDC Foundation (LA Smith), Atlanta, Ga
| | - Timothy Heeren
- Department of Biostatistics (T Heeren), Boston University School of Public Health, Boston, Mass
| | - Marc T Kiviniemi
- Department of Health, Behavior & Society (MT Kiviniemi), College of Public Health, University of Kentucky, Lexington, Ky
| | - Margaret G Parker
- Department of Pediatrics (GG Guyol, MJ Corwin, LA Smith, and MG Parker), Boston Medical Center and Boston University School of Medicine, Boston, Mass
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Mery JN, Vladescu JC, Day-Watkins J, Sidener TM, Reeve KF, Schnell LK. Training medical students to teach safe infant sleep environments using pyramidal behavioral skills training. J Appl Behav Anal 2022; 55:1239-1257. [PMID: 35854197 DOI: 10.1002/jaba.942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 05/31/2022] [Indexed: 11/09/2022]
Abstract
Medical personnel play a critical role in caregiver safe infant sleep education. However, training outcomes in the safe infant sleep training literature have been mixed. Promising approaches that warrant further investigation are the use of behavioral skills training and pyramidal training. The current study consisted of two experiments. Experiment 1 extended Carrow et al. (2020) and Vladescu et al. (2020) by teaching medical students safe infant sleep practices using behavioral skills training. Discriminated responding was examined across trained and untrained environmental arrangements using a multiple-baseline design. All participants arranged safe sleep environments following behavioral skills training. In Experiment 2, we used pyramidal behavioral skills training to train medical students to teach others safe sleep practices. Results indicated high procedural integrity scores following training and generalization of skills.
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Salm Ward TC, Yasin T. Hospital-Based Inpatient Quality Improvement Initiatives on Safe Infant Sleep: Systematic Review and Narrative Synthesis. Sleep Med Rev 2022; 63:101622. [DOI: 10.1016/j.smrv.2022.101622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 02/28/2022] [Accepted: 03/01/2022] [Indexed: 11/25/2022]
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Supthanasup A, Yiengprugsawan VS, Kelly M, Banwell C. Social networking sites: a new source of child feeding information for parents in Thailand. Health Promot Int 2021; 37:6345377. [PMID: 34363659 DOI: 10.1093/heapro/daab133] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Social networking sites (SNSs) provide opportunities for health and nutrition communication. Data are lacking on whether these SNSs influence Thai parent's food provisioning to young children. In the current study, we examined the prevalence and characteristics of Thai parents who reported participating in child food and nutrition-SNSs and investigated the association between participation in these sites and parents' perceptions and feeding practices. A sample of 379 Thai parents completed a survey about the use of child food and nutrition-SNSs, and feeding practices and child eating behavior. Around 70% of participants, especially female millennials with their first child, have participated in SNSs that provide information about children's diets. High engagement was more common among younger and less educated participants, as well as rural dwellers and those with abnormal body mass index. Among these SNSs' participants, those with higher engagement had higher levels of trust in the nutritional information shared on SNSs. Further analyses showed that parents who have joined these sites had positive associations with not only providing children with more fresh fruits and vegetable but also more processed meats. Further investigations are needed to explore the information these SNSs provided and what influences they have on parents' perceptions around feeding children.
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Affiliation(s)
- Abhirat Supthanasup
- Research School of Population Health, Australian National University, Building 62 Mills Rd, Acton, ACT 2601, Australia.,School of Human Ecology, Sukhothai Thammathirat Open University, Chaengwattana Rd. Bangpood, Pakkret, Nonthaburi 11120, Thailand
| | - Vasoontara Sbirakos Yiengprugsawan
- Research School of Population Health, Australian National University, Building 62 Mills Rd, Acton, ACT 2601, Australia.,Australian Research Council Centre of Excellence in Population Ageing Research, University of New South Wales, 223 Anzac Parade, Kensington, NSW 2033, Australia
| | - Matthew Kelly
- Research School of Population Health, Australian National University, Building 62 Mills Rd, Acton, ACT 2601, Australia
| | - Cathy Banwell
- Research School of Population Health, Australian National University, Building 62 Mills Rd, Acton, ACT 2601, Australia
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Understanding the barriers and facilitators to safe infant sleep for mothers of preterm infants. J Perinatol 2021; 41:1992-1999. [PMID: 33288866 PMCID: PMC8855739 DOI: 10.1038/s41372-020-00896-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 10/30/2020] [Accepted: 11/20/2020] [Indexed: 01/31/2023]
Abstract
OBJECTIVE To identify barriers and facilitators to adherence to safe sleep practices (SSP) among mothers of preterm infants using qualitative methodology. DESIGN We conducted 23 in-depth interviews in English or Spanish with mothers of preterm infants who were recently discharged from four hospitals, utilizing a grounded-theory approach and framework of the Theory of Planned Behavior (attitudes, perceived control, social norms). RESULTS For attitudes, mothers' fear about their infants' vulnerable preterm state related to suffocation, apnea of prematurity, and reflux influenced infant sleep practices. For social norms, education received in the NICU and advice from other health care providers, family, friends, and media impacted their choices. For perceived control, mothers adapted infant sleep practices to meet their own needs and address the perceived safety and comfort of infants. CONCLUSION Factors identified that influence maternal decision-making about infant sleep practices can inform interventions to address sudden unexpected infant death reduction in preterm infants.
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Comparison of Patient Versus Trained Observer Assessments of Healthcare Providers' Use of Motivational Interviewing Techniques for Patients Experiencing Depression and Anxiety in the Dominican Republic. J Clin Psychol Med Settings 2021; 29:206-219. [PMID: 34143354 PMCID: PMC8211715 DOI: 10.1007/s10880-021-09781-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2021] [Indexed: 11/17/2022]
Abstract
In settings with limited mental health system capacity, integrated care and the improvement of patient-provider communication surrounding common mental disorders is critical to advancing treatment outcomes. We trained primary care providers in the Dominican Republic in motivational interviewing (MI) to improve communication with patients experiencing depression and anxiety. Providers were randomized to an intervention group, which received MI training, or a control group. To evaluate the training’s effectiveness, patients assessed their clinical encounters using the Motivational Interviewing Measure of Staff Interaction (MIMSI). Trained research assistants (RAs) rated a sub-set of those interactions using an adapted MIMSI instrument. Overall, patients (n = 36) perceived their interactions with providers (n = 10) very positively; however, the RAs’ ratings strongly indicated that providers’ application of MI behaviors was insufficient. Patients generally could not distinguish between intervention and control providers. Findings underscore the need to carefully consider optimal training delivery and cultural influences surrounding the implementation of MI mental health interventions in settings where directive communication is highly valued.
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Feasibility and Acceptability of a Tailored Infant Safe Sleep Coaching Intervention for African American Families. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18084133. [PMID: 33919783 PMCID: PMC8070675 DOI: 10.3390/ijerph18084133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 04/10/2021] [Accepted: 04/12/2021] [Indexed: 11/23/2022]
Abstract
Background: Approximately 3600 infants die suddenly and unexpectedly annually in the United States. Research suggests limitations of current behavioral interventions to reduce the risk for sleep-related deaths among African American families living in under-resourced neighborhoods. Guided by the theory of planned behavior and the socio-ecological model, the My Baby’s Sleep (MBS) intervention intends to reduce the risk for sleep-related infant deaths while addressing complex needs of African American families living in under-resourced neighborhoods. Objective: To assess feasibility and acceptability of MBS, a 7-month intervention that includes four home visits and multiple check-ins via phone and text message. Methods: This was a single-arm feasibility and acceptability study with quantitative and qualitive measures. African American families were recruited from community agencies that served an under-resourced metropolitan area. Results: Eight families (eight mothers, nine co-caregivers) completed the intervention. Families reported high acceptability of MBS content, process, and format, as evidenced by qualitative data and mean evaluation scores. Conclusion: MBS is feasible and acceptable among African American families living in under-resourced neighborhoods. These results suggest further investigation of MBS intervention efficacy in a large-scale randomized controlled trial.
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Cornwell B, Yan X, Carlin RF, Fu L, Wang J, Moon RY. Social network influences on new mothers' infant sleep adjustments. Soc Sci Med 2021; 269:113585. [PMID: 33333376 PMCID: PMC7794038 DOI: 10.1016/j.socscimed.2020.113585] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 11/24/2020] [Accepted: 12/03/2020] [Indexed: 11/27/2022]
Abstract
Despite public awareness campaigns, some parents continue to engage in infant sleep practices that are considered risky by health experts, such as bedsharing or placing their infants on their stomachs. This study examines the role their social networks play in shaping parents' responsiveness to new information and/or suggestions about how they should place their infants for sleep, paying attention to the respective effects of health professionals and their close interpersonal ties. We collected data from a sample of 323 new mothers in Washington, D.C., who described their infant sleep practices and perceived personal social networks. We find evidence that mothers' social networks play a significant role in the likelihood that they adjust their infant sleep practices within the first few months of their infants' lives. Mothers are more likely to change sleep practices when health professionals and/or (lay) family members advise them to do so. The influence of network members is not always positive. For mothers who initially follow safe practices, their probability of change increases if their network members substantially espouse unsafe practices. Among mothers with initially unsafe practices, network members' level of support for safe sleep practices is not predictive of the likelihood of sleep practice change. Implications for potential interventions are discussed.
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Affiliation(s)
| | - Xuewen Yan
- Department of Sociology, Cornell University, Ithaca, NY, USA
| | - Rebecca F Carlin
- Goldberg Center for Community Pediatric Health, Children's National Health System, Washington, D.C., USA; Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington, D.C., USA
| | - Linda Fu
- Goldberg Center for Community Pediatric Health, Children's National Health System, Washington, D.C., USA; Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington, D.C., USA
| | - Jichuan Wang
- Center for Translational Science Children's National Health System, Washington, D.C., USA; Department of Epidemiology and Biostatistics George Washington University, Washington, D.C., USA
| | - Rachel Y Moon
- Department of Pediatrics University of Virginia, Charlottesville, VA, USA
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Moon RY, LoCasale-Crouch J, Turnbull KLP, Colson E, Kellams A, Heeren T, Kerr S, Hauck FR, Corwin MJ. Investigating Mechanisms for Maternal Education Disparities in Enacting Health-Promoting Infant Care Practices. Acad Pediatr 2020; 20:926-933. [PMID: 32201345 PMCID: PMC7483851 DOI: 10.1016/j.acap.2020.03.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 03/10/2020] [Accepted: 03/14/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Although higher education and healthier practices are positively associated, the explanatory mechanisms for this association remain unclear. The purpose of this study was to better understand mechanisms underlying this association by examining maternal adherence to 2 health-promoting infant care practices: supine placement and breastfeeding. METHODS We analyzed nationally representative data from the Study of Attitudes and Factors Effecting Infant Care, which surveyed US mothers after infant birth and 2 months thereafter. Using the Theory of Planned Behavior as a framework, we used structural equation models to elucidate mediational pathways from maternal education to supine infant placement or any breastfeeding. RESULTS Data from 3297 mothers demonstrated 77.0% of infants usually were placed supine, and 57.8% received any breastfeeding. The overall direct effect of maternal educational level on supine placement and any breastfeeding was odds ratio (OR) 1.31 (95% confidence interval [CI] 1.11-1.54) and OR 2.82 (95% CI 2.35-3.37), respectively. In pathway analyses, the strongest associations with both supine position and breastfeeding were seen with positive attitudes (supine: aOR 18.96, 95% CI 9.00-39.92; breastfeeding: aOR 3.86, 95% CI 2.19-6.82) and positive social norms (supine: aOR 6.69, 95% CI 4.52-9.89; breastfeeding: aOR 5.17, 95% CI 4.28-6.23). Mothers with more education had higher odds of both positive attitudes and positive norms for the 2 practices. CONCLUSIONS The associations linking educational attainment with health practices are intricate, with multiple mediating pathways. Attitudes and social norms are powerful forces that mediate the association between maternal educational attainment and both infant supine positioning and breastfeeding, and may be important mediators for other health behaviors.
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Affiliation(s)
- Rachel Y Moon
- Department of Pediatrics, University of Virginia School of Medicine (RY Moon and A Kellams), Charlottesville, Va.
| | - Jennifer LoCasale-Crouch
- Curry School of Education and Human Development, University of Virginia (J LoCasale-Crouch and KLP Turnbull), Charlottesville, Va
| | - Khara L P Turnbull
- Curry School of Education and Human Development, University of Virginia (J LoCasale-Crouch and KLP Turnbull), Charlottesville, Va
| | - Eve Colson
- Department of Pediatrics, Washington University School of Medicine (E Colson), St. Louis, Mo
| | - Ann Kellams
- Department of Pediatrics, University of Virginia School of Medicine (RY Moon and A Kellams), Charlottesville, Va
| | - Timothy Heeren
- Slone Epidemiology Center, Boston University (T Heeren, S Kerr, and MJ Corwin), Boston, Mass; Department of Biostatistics, Boston University School of Public Health (T Heeren), Boston, Mass
| | - Stephen Kerr
- Slone Epidemiology Center, Boston University (T Heeren, S Kerr, and MJ Corwin), Boston, Mass
| | - Fern R Hauck
- Department of Family Medicine, University of Virginia School of Medicine (FR Hauck), Charlottesville, Va
| | - Michael J Corwin
- Slone Epidemiology Center, Boston University (T Heeren, S Kerr, and MJ Corwin), Boston, Mass
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Laudato N, Yagiela L, Eggly S, Meert KL. Understanding parents' informational needs in the pediatric intensive care unit: A qualitative study. PROGRESS IN PEDIATRIC CARDIOLOGY 2020. [DOI: 10.1016/j.ppedcard.2019.101172] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Kellams A, Hauck FR, Moon RY, Kerr SM, Heeren T, Corwin MJ, Colson E. Factors Associated With Choice of Infant Sleep Location. Pediatrics 2020; 145:e20191523. [PMID: 32034081 PMCID: PMC7049941 DOI: 10.1542/peds.2019-1523] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/18/2019] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To assess the prevalence of and factors associated with actual recent practice and near-future intention for infant sleep location in a national sample. METHODS There were 3260 mothers from 32 US hospitals who responded to a survey at infant age 2 to 6 months regarding care practices, including usual and all infant sleep locations in the previous 2 weeks and intended location for the next 2 weeks. Mothers were categorized as (1) having practiced and/or intending to practice exclusive room-sharing without bed-sharing, (2) having practiced anything other than exclusive room-sharing but intending to practice exclusive room-sharing, (3) intending to have the infant sleep in another room; and (4) intending to practice bed-sharing all night or part of the night. Multivariable multinomial logistic regression examined associations between sleep-location category, demographics, feeding method, doctor advice, and theory of planned behavior domains (attitudes, social norms, and perceived control). RESULTS Fewer than half (45.4%) of the mothers practiced and also intended to practice room-sharing without bed-sharing, and 24.2% intended to practice some bed-sharing. Factors associated with intended bed-sharing included African American race and exclusive breastfeeding; however, the highest likelihood of bed-sharing intent was associated with perceived social norms favoring bed-sharing (adjusted odds ratio [aOR] 5.84; 95% confidence interval [CI] 4.14-8.22) and positive attitudes toward bed-sharing (aOR 190.1; 95% CI 62.4-579.0). Women with a doctor's advice to room-share without bed-sharing intended to practice bed-sharing less (aOR 0.56; 95% CI 0.36-0.85). CONCLUSIONS Sleep-location practices do not always align with the recommendation to room-share without bed-sharing, and intention does not always correspond with previous practice. Attitudes, perceived social norms, and doctor advice are factors that are amenable to change and should be considered in educational interventions.
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Affiliation(s)
| | - Fern R Hauck
- Family Medicine, University of Virginia, Charlottesville, Virginia
| | | | - Stephen M Kerr
- Slone Epidemiology Center, Boston University, Boston, Massachusetts; and
| | - Timothy Heeren
- Department of Biostatistics, School of Public Health and
| | - Michael J Corwin
- Slone Epidemiology Center, Boston University, Boston, Massachusetts; and
| | - Eve Colson
- Department of Pediatrics, School of Medicine, Washington University in St Louis, St Louis, Missouri
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Dennis CL, Brown HK, Brennenstuhl S, Haddad S, Marini FC, Stremler R. Prevalence and Predictors of Postpartum Maternal and Infant Bed-Sharing Among Chinese-Canadian Women. Behav Sleep Med 2020; 18:120-130. [PMID: 30585091 DOI: 10.1080/15402002.2018.1546179] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Objective/Background: Our primary objective was to describe and identify predictors of any and predominant bed-sharing at 4 and 12 weeks postpartum among Chinese-Canadian mothers. Participants: We conducted a longitudinal study of 570 Chinese immigrant and Canadian-born women in Toronto, Ontario. Methods: Any bed-sharing, defined as sharing a bed or mattress for any part of the night on any night in the previous week, and predominant bed-sharing, defined as sharing a bed or mattress for most of the night, on more than half the nights of the previous week, were evaluated at 4 and 12 weeks postpartum. Predictors of bed-sharing, evaluated in multivariable logistic regression models, were background (age, parity, education, household size, delivery mode, social support), cultural (immigrant status, acculturative stress, acculturation, postpartum ritual uptake), and postpartum variables (mental health, breastfeeding problems, fatigue, sleep knowledge, plans for bed-sharing, perceptions of infant sleep problems, cognitions about infant sleep). Results: One in five women (20.7%) reported bed-sharing as the predominant sleep location for their infant at 4 weeks postpartum, with nearly half (45.6%) reporting any bed-sharing at this time. The prevalence of any bed-sharing remained relatively stable at 12 weeks postpartum (46.5%), while predominant bed-sharing increased to 30.1%. The most consistent predictors of any and predominant bed-sharing at 4 and 12 weeks postpartum were lower education level, greater acculturative stress, and predelivery plans to bed-share. Conclusions: These findings have implications for the development of clinical recommendations given to expectant and new parents to promote infant sleep practices that are consistent with American Academy of Pediatrics recommendations.
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Affiliation(s)
- Cindy-Lee Dennis
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada
| | - Hilary K Brown
- Department of Psychiatry, University of Toronto, Toronto, Canada
- Interdisciplinary Center for Health & Society, University of Toronto Scarborough, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Women's College Research Institute, Women's College Hospital, Toronto, Canada
| | - Sarah Brennenstuhl
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
| | - Summer Haddad
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
| | - Flavia C Marini
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
| | - Robyn Stremler
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
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Kowalska M, Gajda M, Barański K, Braczkowska B. Sources of parental knowledge about the safety of vaccinations in Poland. Health Promot Int 2019; 34:1191-1199. [PMID: 30476112 DOI: 10.1093/heapro/day096] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
There has been a recent increase in the number of parents refusing vaccination for their children in many European countries, including Poland. This observation necessitates the need to understand parental knowledge in regard to mandatory vaccination of children in these countries. A cross-sectional survey was conducted in 2016 on 1239 parents or legal guardians of preschool and school children in the Silesian Voivodship (Poland) to evaluate their hesitancy in acquiescing to their children mandatory immunization and the relation to this habit in regard to the use of informational sources on children vaccination system in Poland. Medical doctors often provide the basic source of information about vaccination to parents. About one-third (29%) of the respondents from the survey deemed the qualification system for vaccination as either inadequate or bad. 16.9% of the respondents surveyed declared that information received from physicians regarding vaccinations were either incomplete or unconvincing. Results of multivariable analyses confirmed that respondents are less likely to seek information about mandatory vaccinations from medical professionals and more often to misjudged vaccination's qualification system. Participants who used less informative sources (e.g. leaflets) and those with a lower level of education were more likely to avoid vaccination. Greater emphasis on the quality of information provided by medical professionals is crucial in order to avoid doubts about vaccination and to create proper attitudes and adherence to vaccination schedules.
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Affiliation(s)
- Małgorzata Kowalska
- Department of Epidemiology, School of Medicine in Katowice, Medical University of Silesia, Medyków 18 Str., Katowice 40-752, Poland
| | - Maksymilian Gajda
- Department of Epidemiology, School of Medicine in Katowice, Medical University of Silesia, Medyków 18 Str., Katowice 40-752, Poland
| | - Kamil Barański
- Department of Epidemiology, School of Medicine in Katowice, Medical University of Silesia, Medyków 18 Str., Katowice 40-752, Poland
| | - Bogumiła Braczkowska
- Department of Epidemiology, School of Medicine in Katowice, Medical University of Silesia, Medyków 18 Str., Katowice 40-752, Poland
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18
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Diversity in pediatric behavioral sleep intervention studies. Sleep Med Rev 2019; 47:103-111. [DOI: 10.1016/j.smrv.2019.07.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 06/28/2019] [Accepted: 07/22/2019] [Indexed: 11/23/2022]
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19
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Moon RY, Mathews A, Oden R, Carlin R. Mothers' Perceptions of the Internet and Social Media as Sources of Parenting and Health Information: Qualitative Study. J Med Internet Res 2019; 21:e14289. [PMID: 31290403 PMCID: PMC6647756 DOI: 10.2196/14289] [Citation(s) in RCA: 80] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 06/03/2019] [Accepted: 06/03/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Traditionally, guidance and support to new parents have come from family, friends, and health care providers. However, the internet and social media are growing sources of guidance and support for parents. Little is known about how the internet and social media are used by parents of young infants and specifically about parental perceptions of the internet and social media as sources of parenting and infant health information. OBJECTIVE The aim of this study was to explore, using qualitative methods, parental perceptions of the advantages and disadvantages of the internet and social media as sources of parenting and health information regarding their infant. METHODS A total of 28 mothers participated in focus groups or individual interviews. Probing questions concerning parenting and health information sources were asked. Themes were developed in an iterative manner from coded data. RESULTS The central themes were (1) reasons that mothers turn to the internet for parenting and health information, (2) cautionary advice about the internet, and (3) reasons that mothers turn to social media for parenting and health information. Mothers appreciated the ability to gather unlimited information and multiple opinions quickly and anonymously, but recognized the need to use reputable sources of information. Mothers also appreciated the immediacy of affirmation, support, and tailored information available through social media. CONCLUSIONS The internet and social media are rapidly becoming important and trusted sources of parenting and health information that mothers turn to when making infant care decisions.
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Affiliation(s)
- Rachel Y Moon
- University of Virginia, Charlottesville, VA, United States
| | - Anita Mathews
- Children's National Health System, Washington, DC, United States
| | - Rosalind Oden
- Children's National Health System, Washington, DC, United States
| | - Rebecca Carlin
- Children's National Health System, Washington, DC, United States
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Cesar JA, Marmitt LP, Carpena MX, Pereira FG, Neto JDM, Neumann NA, Acevedo JD. Maternal Knowledge and Unsafe Baby Sleep Position: A Cross-Sectional Survey in Southern Brazil. Matern Child Health J 2019; 23:183-190. [PMID: 30105515 DOI: 10.1007/s10995-018-2613-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Objective to evaluate women's knowledge about the best baby sleeping position and to identify factors associated with a greater probability of putting infants to sleep in an unsafe position, in Rio Grande, Southern Brazil. Method This is a cross-sectional population-based study that included all women who bore children in 2013 in this municipality. A single, standardized questionnaire was given within 48 h after delivery in the only two local maternity hospitals. The outcome was that women reported the lateral and the ventral decubitus as the best sleeping positions for babies. A Chi square test was used for proportions and Poisson regression was used with robust variance adjustment in the multivariate analysis. The prevalence ratio was the measure of effect used. Results We included 2624 women in this study. Of these, 82.1% (95% CI 80.6-83.6) stated that the baby should sleep in the lateral or ventral decubitus positions. 76.4% reported having acquired this knowledge from their mothers and 34.7% were willing to adopt the correct (supine) sleeping position for their child if recommended by doctors. The adjusted analysis showed that the lower the schooling of the mothers and the greater the number of people per bedroom and number of children, the greater the probability of women choosing an unsafe baby sleeping position. Conclusions for Practice This study showed that the percentage of women who are unaware of the correct baby sleeping position is very high, that doctors should be convinced to recommend the supine baby sleeping position, and that campaigns on this subject should also include grandparents as a priority intervention group.
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Affiliation(s)
- Juraci A Cesar
- Programa de Pós-graduação em Saúde Pública, Universidade Federal do Rio Grande (FURG), Rio Grande, Rio Grande do Sul, 96200-400, Brazil
| | - Luana P Marmitt
- Programa de Pós-graduação em Ciências da Saúde, Universidade Federal do Rio Grande (FURG), Rio Grande, Rio Grande do Sul, 96200-400, Brazil.
| | - Marina X Carpena
- Programa de Pós-graduação em Saúde Pública, Universidade Federal do Rio Grande (FURG), Rio Grande, Rio Grande do Sul, 96200-400, Brazil
| | - Franciele G Pereira
- Programa de Pós-graduação em Saúde Pública, Universidade Federal do Rio Grande (FURG), Rio Grande, Rio Grande do Sul, 96200-400, Brazil
| | - Jose D Macedo Neto
- Programa de Pós-graduação em Saúde Pública, Universidade Federal do Rio Grande (FURG), Rio Grande, Rio Grande do Sul, 96200-400, Brazil
| | - Nelson A Neumann
- Coordenação Nacional da Pastoral da Criança, Curitiba, Paraná, 80810-900, Brazil
| | - Jayshlyn D Acevedo
- Divisão de População & Saúde, Faculdade de Medicina da Universidade Federal do Rio Grande (FURG), Rio Grande, Rio Grande do Sul, 96200-400, Brazil
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21
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Moon RY, Corwin MJ, Kerr S, Heeren T, Colson E, Kellams A, Geller NL, Drake E, Tanabe K, Hauck FR. Mediators of Improved Adherence to Infant Safe Sleep Using a Mobile Health Intervention. Pediatrics 2019; 143:e20182799. [PMID: 31015374 PMCID: PMC6564062 DOI: 10.1542/peds.2018-2799] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/01/2019] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To determine mediators of improvements in infant safe-sleep (SS) practices in a mobile health intervention. METHODS In a cluster-randomized controlled trial, mothers received SS intervention or breastfeeding control videos for 60 days. Maternal responses about infant sleep position and location (outcomes) and mediators (attitudes, perceived social norms, and perceived control) from the theory of planned behavior were assessed. Intervention effects on mediators and association between mediators and outcomes were examined. RESULTS Of 1600 recruited, 1263 mothers participated. Mothers receiving SS videos were more likely to have positive attitudes and norms for supine sleep (attitudes: adjusted odds ratio [aOR] = 2.35 [95% confidence interval (CI) 1.72 to 3.20]; norms: aOR = 1.75 [95% CI 1.27 to 2.42]) and recommended sleep location (attitudes: aOR = 1.91 [95% CI 1.54 to 2.36]; norms: aOR = 1.37 [95% CI 1.13 to 1.66]). Positive attitudes and norms toward supine sleep and room-sharing without bed-sharing were associated with higher odds of both practices (supine: aOR = 8.25 [95% CI 4.72 to 14.43] for positive attitudes and aOR = 6.67 [95% CI 4.25 to 10.46] for norms; room-sharing: aOR = 7.14 [95% CI 5.35 to 9.53] for positive attitudes and aOR = 4.44 [95% CI 3.03 to 6.51] for norms). Both positive attitudes and positive norms mediated the effect of the intervention. CONCLUSIONS The intervention achieved success in improving adherence to SS recommendations by changing maternal attitudes and norms about supine sleeping and room-sharing without bed-sharing. Recognition that these attitudes and norms appear to be the main drivers of mothers' choices regarding infant-sleep practices should inform health messaging strategies to promote SS.
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Affiliation(s)
| | | | | | - Timothy Heeren
- Slone Epidemiology Center and
- Department of Biostatistics, School of Public Health, Boston University, Boston, Massachusetts; and
| | - Eve Colson
- Department of Pediatrics, Yale University, New Haven, Connecticut
| | | | | | - Emily Drake
- Department of Family, Community, and Mental Health Systems, School of Nursing, University of Virginia, Charlottesville, Virginia
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Kallem S, Gruver RS, Virudachalam S, Fiks AG. Mothers' Facebook posts about infant health: findings from the Grow2Gether study. BMC Pediatr 2018; 18:341. [PMID: 30382827 PMCID: PMC6208013 DOI: 10.1186/s12887-018-1315-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Accepted: 10/19/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Social media is a common way for mothers to seek advice about their infants. However, little is known about how low-income urban mothers use social media to obtain infant health information and whether this information is consistent with expert pediatric recommendations. OBJECTIVES (1) identify the types of health questions asked by low-income mothers of infants in a social media parenting group; (2) describe whether peer answers are consistent with or contradict AAP guidelines; (3) identify the practices that mothers post about that are inconsistent with AAP guidelines. METHODS Forty-three low-income mothers were enrolled in Grow2Gether, a private Facebook group intervention focused on infant care and moderated by a psychologist. All health questions posted by mothers were coded thematically; answers to questions from the group were assessed for consistency with American Academy of Pediatrics (AAP) guidelines related to infant feeding, sleep, screen time, and safety. Additionally, all unique posts that contained practices inconsistent with these AAP guidelines were thematically coded. RESULTS In total, 215 posts were coded. Participants posted 61 questions related to infant health, most commonly solid food introduction (8/61), teething (8/61), and breastfeeding (7/61). Of the 77 answers given by peers, 6 contradicted guidelines. Separately, mothers had 73 posts demonstrating practices inconsistent with AAP guidelines [safe sleep (43/73) and screen time (21/73)]. CONCLUSIONS Mothers' Facebook group interactions in the context of an infant care intervention revealed that when mothers posed direct questions regarding infant health, their peers generally gave answers that did not contradict AAP guidelines. In contrast, mothers' posts simply describing sleep and screen time practices commonly contradicted guidelines.
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Affiliation(s)
- Stacey Kallem
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA USA
- Divison of General Pediatrics, Children’s Hospital of Philadelphia, 2716 South Street, Philadelphia, PA 19146 USA
- PolicyLab, Children’s Hospital of Philadelphia, 2716 South Street, Room 10-323, Philadelphia, PA 19146 USA
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA USA
| | - Rachel S. Gruver
- Divison of General Pediatrics, Children’s Hospital of Philadelphia, 2716 South Street, Philadelphia, PA 19146 USA
- PolicyLab, Children’s Hospital of Philadelphia, 2716 South Street, Room 10-323, Philadelphia, PA 19146 USA
- Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia, 2716 South Street, Room 10-471, Philadelphia, PA 19146 USA
| | - Senbagam Virudachalam
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA USA
- Divison of General Pediatrics, Children’s Hospital of Philadelphia, 2716 South Street, Philadelphia, PA 19146 USA
- PolicyLab, Children’s Hospital of Philadelphia, 2716 South Street, Room 10-323, Philadelphia, PA 19146 USA
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA USA
- Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia, 2716 South Street, Room 10-471, Philadelphia, PA 19146 USA
| | - Alexander G. Fiks
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA USA
- Divison of General Pediatrics, Children’s Hospital of Philadelphia, 2716 South Street, Philadelphia, PA 19146 USA
- PolicyLab, Children’s Hospital of Philadelphia, 2716 South Street, Room 10-323, Philadelphia, PA 19146 USA
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA USA
- Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia, 2716 South Street, Room 10-471, Philadelphia, PA 19146 USA
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23
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Implementation of safe sleep practices in Massachusetts NICUs: a state-wide QI collaborative. J Perinatol 2018; 38:593-599. [PMID: 29410541 DOI: 10.1038/s41372-018-0046-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Revised: 11/29/2017] [Accepted: 12/12/2017] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To increase the use of safe sleep practices (SSP) among high-risk infants discharged from Massachusetts (MA) NICUs to 90% in 2 years. DESIGN/METHODS The Neonatal Quality Improvement Collaborative of MA (NeoQIC) is a consortium of neonatal providers that provides infrastructure to lead and manage state-wide quality improvement initiatives. The safe sleep initiative was started in July 2015 with participation of all 10 MA level III NICUs. Based upon the project algorithm, infants are eligible for two sleep practices: SSP or NICU therapeutic positioning (NTP) depending on their gestational age, weight, and clinical illness. Compliance with SSP is defined as: (1) supine positioning, (2) in a flat crib with no incline, (3) without positioning devices, and (4) without soft objects. NTP comprised usual NICU care. Local improvement teams devise intervention strategies, perform weekly crib audits for all NICU infants, and submit data on overall compliance and compliance with each SSP component on a monthly basis to NeoQIC. RESULTS From July 2015 to June 2017, 7261 cribs were audited. Statistical process control charts showed significant improvement in the primary outcome of interest, overall compliance with SSP, for all participating NICUs. Compliance increased from 47.7% at the start of the project to 75.5% by the end of year 1 and to 81.0% by June 2017. CONCLUSIONS This state-wide collaborative has improved SSP compliance in all level III MA NICUs and demonstrated that on a state-wide level, SSPs can be routinely integrated into the care of high-risk infants.
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Austin JE, Nashban CJ, Doering JJ, Davies WH. Prevention Messages in Parent-Infant Bed-Sharing: Message Source, Credibility, and Effectiveness. Glob Pediatr Health 2017; 4:2333794X17743403. [PMID: 29201949 PMCID: PMC5700781 DOI: 10.1177/2333794x17743403] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Accepted: 10/20/2017] [Indexed: 11/15/2022] Open
Abstract
Objective. Despite educational outreach, bed-sharing prevalence is rising. Mothers’ and fathers’ bed-sharing practices, prevention message source, perceived source credibility, and the effectiveness of the prevention message were evaluated. Methods. Data were collected from 678 community parents via an online survey. Results were analyzed using descriptive statistics and phi tests. Results. Bed-sharing reasons focused on comfort and ease. Mothers were more likely to receive prevention messages from individual professionals or organizations, whereas fathers were more likely to hear prevention messages from spouses/coparents and grandfathers. Physicians were the most common source, and physicians and grandmothers were rated as the most credible and effective. Conclusions. Prevention message source varies between mothers and fathers, highlighting the need for continued research with fathers. Grandmothers and physicians are effective and credible sources of prevention messages. Although less frequent, prevention messages from grandmothers were most effective. There was no evidence of effective messages from educational campaigns.
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Affiliation(s)
- Jillian E Austin
- University of Wisconsin-Milwaukee, WI, USA.,Nemours Children's Specialty Care, Jacksonville, FL, USA
| | - Chad J Nashban
- Wisconsin School of Professional Psychology, Milwaukee, WI, USA
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25
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Hwang SS, Rybin DV, Kerr SM, Heeren TC, Colson ER, Corwin MJ. Predictors of Maternal Trust in Doctors About Advice on Infant Care Practices: The SAFE Study. Acad Pediatr 2017; 17:762-769. [PMID: 28315416 DOI: 10.1016/j.acap.2017.03.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Revised: 03/06/2017] [Accepted: 03/07/2017] [Indexed: 01/18/2023]
Abstract
OBJECTIVE To determine predictors of maternal trust in doctors about advice on infant care practices. METHODS Using probability sampling methods, we recruited mothers from 32 US maternity hospitals. Mothers completed a survey 2 to 6 months postpartum that included questions about maternal trust in doctors regarding 6 infant care practices and physician characteristics (doctor asked mother's opinion, doctor is qualified, infant sees 1 main doctor who is/is not of the same ethnicity/race). Prevalence estimates and 95% confidence intervals were calculated for maternal trust in physician advice for each infant care practice. Multivariate logistic regression was used to calculate the independent association of maternal and physician characteristics and trust for each infant care practice, controlling for sociodemographic characteristics. RESULTS Of the 3983 mothers enrolled from January 2011 to March 2014, 3297 (83%) completed the follow-up survey. Maternal trust in the doctor varied according to infant care practice with highest trust for vaccination (89%) and lowest trust for pacifier use (56%). In the adjusted analyses, for all infant care practices, mothers were more likely to trust their doctors if they reported that the doctors were qualified (adjusted odds ratio [AOR], >3.0 for all practices) or if the doctor had asked their opinion (AOR, 1.76-2.43). For mothers who reported seeing 1 main doctor, white mothers were more likely to trust physicians for almost all infant care practices if they reported the doctor was the same race (AOR, 1.54-2.19). CONCLUSIONS Physician characteristics and ways of communication were significantly associated with maternal trust in doctors about advice on infant care practices.
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Affiliation(s)
- Sunah S Hwang
- Section of Neonatology, Children's Hospital Colorado, Aurora; Pediatrics, University of Colorado School of Medicine, Aurora.
| | - Denis V Rybin
- Data Coordinating Center, Boston University School of Public Health, Mass
| | - Stephen M Kerr
- Data Coordinating Center, Boston University School of Public Health, Mass; Slone Epidemiology Center, Boston University, Mass
| | | | - Eve R Colson
- Pediatrics, Yale University School of Medicine, New Haven, Conn
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Veerasingam P, Grant CC, Chelimo C, Philipson K, Gilchrist CA, Berry S, Carr PA, Camargo CA, Morton S. Vaccine Education During Pregnancy and Timeliness of Infant Immunization. Pediatrics 2017; 140:peds.2016-3727. [PMID: 28821625 DOI: 10.1542/peds.2016-3727] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/01/2017] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Pregnant women routinely receive information in support of or opposing infant immunization. We aimed to describe immunization information sources of future mothers' and determine if receiving immunization information is associated with infant immunization timeliness. METHODS We analyzed data from a child cohort born 2009-2010 in New Zealand. Pregnant women (N = 6822) at a median gestation of 39 weeks described sources of information encouraging or discouraging infant immunization. Immunizations received by cohort infants were determined through linkage with the National Immunization Register (n = 6682 of 6853 [98%]). Independent associations of immunization information received with immunization timeliness were described by using adjusted odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS Immunization information sources were described by 6182 of 6822 (91%) women. Of these, 2416 (39%) received information encouraging immunization, 846 (14%) received discouraging information, and 565 (9%) received both encouraging and discouraging information. Compared with infants of women who received no immunization information (71% immunized on-time), infants of women who received discouraging information only (57% immunized on time, OR = 0.49, 95% CI 0.38-0.64) or encouraging and discouraging information (61% immunized on time, OR = 0.51, 95% CI 0.42-0.63) were at decreased odds of receiving all immunizations on time. Receipt of encouraging information only was not associated with infant immunization timeliness (73% immunized on time, OR = 1.00, 95% CI 0.87-1.15). CONCLUSIONS Receipt, during pregnancy, of information against immunization was associated with delayed infant immunization regardless of receipt of information supporting immunization. In contrast, receipt of encouraging information is not associated with infant immunization timeliness.
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Affiliation(s)
- Priya Veerasingam
- General Paediatrics, Starship Children's Hospital, Auckland, New Zealand
| | - Cameron C Grant
- General Paediatrics, Starship Children's Hospital, Auckland, New Zealand; .,Growing Up in New Zealand.,Center for Longitudinal Research - He Ara ki Mua, and.,Department of Paediatrics, Child and Youth Health, The University of Auckland, Auckland, New Zealand; and
| | - Carol Chelimo
- Growing Up in New Zealand.,Center for Longitudinal Research - He Ara ki Mua, and.,Department of Paediatrics, Child and Youth Health, The University of Auckland, Auckland, New Zealand; and
| | - Kathryn Philipson
- Department of Paediatrics, Child and Youth Health, The University of Auckland, Auckland, New Zealand; and
| | - Catherine A Gilchrist
- Department of Paediatrics, Child and Youth Health, The University of Auckland, Auckland, New Zealand; and
| | - Sarah Berry
- Growing Up in New Zealand.,Center for Longitudinal Research - He Ara ki Mua, and
| | - Polly Atatoa Carr
- Growing Up in New Zealand.,Center for Longitudinal Research - He Ara ki Mua, and
| | - Carlos A Camargo
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Harvard University, Boston, Massachusetts
| | - Susan Morton
- Growing Up in New Zealand.,Center for Longitudinal Research - He Ara ki Mua, and
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Abstract
Although the incidence of sudden unexpected infant death declined by nearly 50% in the 1990s, there has been little improvement in the past 15 years. Significant disparities in infant sleep practices and sleep-associated death exist, particularly by maternal race/ethnicity. This article provides a brief overview of recent observational and intervention studies related to infant sleep practices to describe the context and motivation for the population-based Study of Attitudes and Factors Effecting Infant Care (SAFE). [Pediatr Ann. 2017;46(8):e291-e296.].
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Moon RY, Hauck FR, Colson ER, Kellams AL, Geller NL, Heeren T, Kerr SM, Drake EE, Tanabe K, McClain M, Corwin MJ. The Effect of Nursing Quality Improvement and Mobile Health Interventions on Infant Sleep Practices: A Randomized Clinical Trial. JAMA 2017; 318:351-359. [PMID: 28742913 PMCID: PMC5593130 DOI: 10.1001/jama.2017.8982] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Inadequate adherence to recommendations known to reduce the risk of sudden unexpected infant death has contributed to a slowing in the decline of these deaths. OBJECTIVE To assess the effectiveness of 2 interventions separately and combined to promote infant safe sleep practices compared with control interventions. DESIGN, SETTING, AND PARTICIPANTS Four-group cluster randomized clinical trial of mothers of healthy term newborns who were recruited between March 2015 and May 2016 at 16 US hospitals with more than 100 births annually. Data collection ended in October 2016. INTERVENTIONS All participants were beneficiaries of a nursing quality improvement campaign in infant safe sleep practices (intervention) or breastfeeding (control), and then received a 60-day mobile health program, in which mothers received frequent emails or text messages containing short videos with educational content about infant safe sleep practices (intervention) or breastfeeding (control) and queries about infant care practices. MAIN OUTCOMES AND MEASURES The primary outcome was maternal self-reported adherence to 4 infant safe sleep practices of sleep position (supine), sleep location (room sharing without bed sharing), soft bedding use (none), and pacifier use (any); data were collected by maternal survey when the infant was aged 60 to 240 days. RESULTS Of the 1600 mothers who were randomized to 1 of 4 groups (400 per group), 1263 completed the survey (78.9%). The mean (SD) maternal age was 28.1 years (5.8 years) and 32.8% of respondents were non-Hispanic white, 32.3% Hispanic, 27.2% non-Hispanic black, and 7.7% other race/ethnicity. The mean (SD) infant age was 11.2 weeks (4.4 weeks) and 51.2% were female. In the adjusted analyses, mothers receiving the safe sleep mobile health intervention had higher prevalence of placing their infants supine compared with mothers receiving the control mobile health intervention (89.1% vs 80.2%, respectively; adjusted risk difference, 8.9% [95% CI, 5.3%-11.7%]), room sharing without bed sharing (82.8% vs 70.4%; adjusted risk difference, 12.4% [95% CI, 9.3%-15.1%]), no soft bedding use (79.4% vs 67.6%; adjusted risk difference, 11.8% [95% CI, 8.1%-15.2%]), and any pacifier use (68.5% vs 59.8%; adjusted risk difference, 8.7% [95% CI, 3.9%-13.1%]). The independent effect of the nursing quality improvement intervention was not significant for all outcomes. Interactions between the 2 interventions were only significant for the supine sleep position. CONCLUSIONS AND RELEVANCE Among mothers of healthy term newborns, a mobile health intervention, but not a nursing quality improvement intervention, improved adherence to infant safe sleep practices compared with control interventions. Whether widespread implementation is feasible or if it reduces sudden and unexpected infant death rates remains to be studied. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01713868.
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Affiliation(s)
- Rachel Y Moon
- Department of Pediatrics, School of Medicine, University of Virginia, Charlottesville
| | - Fern R Hauck
- Department of Family Medicine, School of Medicine, University of Virginia, Charlottesville
| | - Eve R Colson
- Department of Pediatrics, Yale University, New Haven, Connecticut
| | - Ann L Kellams
- Department of Pediatrics, School of Medicine, University of Virginia, Charlottesville
| | - Nicole L Geller
- Slone Epidemiology Center, Boston University, Boston, Massachusetts
| | - Timothy Heeren
- Department of Biostatistics, School of Public Health, Boston University, Boston, Massachusetts
| | - Stephen M Kerr
- Slone Epidemiology Center, Boston University, Boston, Massachusetts
| | - Emily E Drake
- Department of Family, Community, and Mental Health Systems, School of Nursing, University of Virginia, Charlottesville
| | - Kawai Tanabe
- Department of Family Medicine, School of Medicine, University of Virginia, Charlottesville
| | - Mary McClain
- Slone Epidemiology Center, Boston University, Boston, Massachusetts
| | - Michael J Corwin
- Slone Epidemiology Center, Boston University, Boston, Massachusetts
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Ostfeld BM, Schwartz-Soicher O, Reichman NE, Teitler JO, Hegyi T. Prematurity and Sudden Unexpected Infant Deaths in the United States. Pediatrics 2017; 140:peds.2016-3334. [PMID: 28759397 DOI: 10.1542/peds.2016-3334] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/03/2017] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Prematurity, a strong risk factor for sudden unexpected infant death (SUID), was addressed in recommendations by the American Academy of Pediatrics in 2011 for safe sleep education in NICUs. We documented associations between gestational age (GA) and SUID subsequent to these guidelines. METHODS Using the 2012-2013 US linked infant birth and death certificate period files, we documented rates per live births of sudden infant death syndrome, ill-defined and unspecified causes, accidental suffocation and strangulation in bed, and overall SUID by GA in postneonatal, out-of-hospital, and autopsied cases; compared survivors and cases; and estimated logistic regression models of associations between GA and SUID. RESULTS SUID cases were more likely than survivors to be <37 weeks' GA (22.61% vs 10.79%; P < .0001). SUID rates were 2.68, 1.94, 1.46, 1.16, 0.73, and 0.51 per 1000 live births for 24 to 27, 28 to 31, 32 to 33, 34 to 36, 37 to 38, and 39 to 42 weeks' GA, respectively. Logistic regression models additionally indicated declines in the risk for SUID as GA increased. Prenatal smoking, inadequate prenatal care, and demographics associated with poverty were strongly associated with SUID. CONCLUSIONS Despite the 2011 American Academy of Pediatrics recommendations for increased safe sleep education in the NICUs, SUID rates were inversely associated with GA in 2012 to 2013, suggesting that risk of SUID associated with prematurity has multiple etiologies requiring continued investigation, including biological vulnerabilities and the efficacy of NICU education programs, and that strategies to reduce SUID should be multifaceted.
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Affiliation(s)
- Barbara M Ostfeld
- Department of Pediatrics, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey;
| | - Ofira Schwartz-Soicher
- Data and Statistical Services, Princeton University Library, Princeton University, Princeton, New Jersey
| | - Nancy E Reichman
- Department of Pediatrics, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey.,Institute of Health Evaluation, Management and Policy, University of Toronto, Toronto, Ontario, Canada; and
| | | | - Thomas Hegyi
- Department of Pediatrics, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey
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Fadel CW, Colson ER, Corwin MJ, Rybin D, Heeren TC, Wang C, Moon RY. Maternal Attitudes and Other Factors Associated with Infant Vaccination Status in the United States, 2011-2014. J Pediatr 2017; 185:136-142.e1. [PMID: 28410091 PMCID: PMC9528735 DOI: 10.1016/j.jpeds.2017.02.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Revised: 01/09/2017] [Accepted: 02/06/2017] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To assess the role of maternal attitudes and other factors associated with infant vaccination status. STUDY DESIGN Data on reported vaccination status were analyzed from a nationally representative prospective survey of mothers of 2- to 6-month-old infants. Weighted univariate and multiple logistic regression analyses were conducted. Latent profile analysis of mothers reporting nonimmunized infants identified distinct groups, RESULTS: Of 3268 mothers, 2820 (weighted 86.2%), 311 (9.1%), and 137 (4.7%), respectively, reported their infant had received all, some, or no recommended vaccinations for age. Younger infants and infants with younger mothers were more likely to have received no vaccinations. Mothers with neutral and negative attitudes toward vaccination were >3 (aOR 3.66, 95% CI 1.80-7.46) and 43 times (aOR 43.23, 95% CI 20.28-92.16), respectively, more likely than mothers with positive attitudes to report their infants had received no vaccinations. Two subgroups of mothers reporting that their infants had received no vaccinations were identified: group A (52.5%) had less than positive attitudes and less than positive subjective norms about vaccination (ie, perceived social pressure from others); group B (47.5%) had positive attitudes and positive subjective norms. Group A mothers were more likely to be white (76.1% vs 48.3%, P?=?.002), more educated (43.5% vs 35.4% college or higher, P?=?.02), and to exclusively breastfeed (74.9% vs. 27.3%, P?<?.001). CONCLUSIONS Although access barriers can result in nonvaccination, less than positive maternal attitude toward vaccination was the strongest predictor. Strategies to improve vaccination rates must focus on both improved access and better understanding of factors underlying maternal attitudes.
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Affiliation(s)
- Cicely W. Fadel
- Division of General Pediatrics and Community Health, Children’s National Health System, Washington, DC
| | - Eve R. Colson
- Department of Pediatrics, Yale University, New Haven, CT
| | | | - Denis Rybin
- Data Coordinating Center, Boston University School of Public Health, Boston, MA
| | - Timothy C. Heeren
- Department of Biostatistics, Boston University School of Public Health, Boston, MA
| | - Colin Wang
- Slone Epidemiology Center, Boston University, Boston, MA
| | - Rachel Y. Moon
- Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, VA
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Comparison of Text Messages Versus E-mail When Communicating and Querying With Mothers About Safe Infant Sleep. Acad Pediatr 2017; 17:871-878. [PMID: 28606858 PMCID: PMC5673525 DOI: 10.1016/j.acap.2017.06.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Revised: 05/23/2017] [Accepted: 06/03/2017] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To assess how mothers' choice of e-mail or text messages (SMS) to receive safe sleep communications is associated with educational video viewing and responses to care practice queries. METHODS Seven hundred ninety-two new mothers received safe sleep-related communications for 60 days after newborn hospital discharge as part of a trial of health education interventions on infant care practices. Mothers chose e-mail or SMS for study communications and were sent 22 short safe sleep videos and 41 queries regarding infant care practices. RESULTS Study communications via e-mail were elected by 55.7% of participants. The SMS group had a modestly higher overall view rate of videos (59.1% vs 54.4%; adjusted odds ratio [aOR], 1.39; 95% confidence interval [CI], 1.07-1.81) and a substantially higher response rate to queries (70.0% vs 45.2%; aOR, 3.48; 95% CI, 2.74-4.43). CONCLUSIONS Participants more commonly opted to receive infant care practice videos and queries via e-mail. SMS was associated with higher viewing and response rates, especially for query responses. These results highlight the importance of understanding how specific modalities of communication might vary in reach.
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