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Aderibigbe T, Kelleher SL, Henderson WA, Prescott S, Young EE, Lucas RF. COMT Variants are Associated With Breast and Nipple Pain. THE JOURNAL OF PAIN 2024; 25:104568. [PMID: 38763257 DOI: 10.1016/j.jpain.2024.104568] [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: 12/29/2023] [Revised: 04/09/2024] [Accepted: 05/08/2024] [Indexed: 05/21/2024]
Abstract
Estimates suggest that only 24.9% of infants born in 2019 were exclusively breastfed before 6 months of age, despite the known health benefits of exclusive breastfeeding. Breast and nipple pain is one of the primary determinants of exclusive breastfeeding. Environmental contributions to breastfeeding success have been reported extensively in the literature, but the contribution(s) of maternal genetics has yet to be discovered. The purpose of the study was to identify an association between pain and lactation-related gene variants with exclusive breastfeeding determinants. We selected 4 genes having single nucleotide polymorphisms (SNPs) with potential functional significance in breastfeeding and pain: prolactin receptor (PRLR), oxytocin receptor (OXTR), catechol-O-methyltransferase (COMT), and milk fat globule epidermal growth factor and factor V/VIII domain containing (MFGE8). We performed a cross-sectional secondary analysis of a longitudinal randomized controlled trial study, Promoting Self-Management of Breast and Nipple Pain with Biomarkers and Technology for Breastfeeding Women (NCT05262920). Breast and nipple pain, perceived insufficient milk, and breastfeeding self-efficacy were examined using total scale scores for the Brief Pain Inventory, Visual Analog Scale, H&H Lactation Scale, and the Breastfeeding Self-efficacy Scale-short form, respectively. Of the candidate genes examined, SNPs within COMT were significantly associated with breastfeeding-related outcomes. Specifically, COMT rs4633 and rs4680 minor allele carriers (T, A) reported higher breast and nipple pain intensity than women homozygous for the major allele (C, G). COMT is the most widely researched "pain gene" and has been linked to cold, postoperative, and postpartum pain. This study is the first to identify a contribution of COMT variants to breast and nipple pain and, as a result, to breastfeeding exclusivity. PERSPECTIVE: Two SNPs in the pain gene COMT are associated with breast and nipple pain. Clinically, a minor allele in COMT rs4633 and rs4680 may increase a woman's rating of moderate breast and nipple pain. TRIAL REGISTRATION: PROMPT was registered in ClinicalTrials.gov (protocol #NCT05262920).
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Affiliation(s)
| | - Shannon L Kelleher
- Department of Biomedical and Nutritional Sciences, University of Massachusetts, Lowell, Massachusetts
| | - Wendy A Henderson
- School of Nursing, University of Connecticut, Storrs, Connecticut; School of Medicine, University of Connecticut, Farmington, Connecticut
| | | | - Erin E Young
- Department of Anesthesiology, Pain and Perioperative Medicine, University of Kansas School of Medicine, KU Medical Center, Kansas City, Kansas
| | - Ruth F Lucas
- School of Nursing, University of Connecticut, Storrs, Connecticut; School of Medicine, University of Connecticut, Farmington, Connecticut.
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Oben AG, Blanchard CT, Robinson A, Girling I, Joly JM, Cribbs M, Tita A, Casey B, Sinkey R. Racial Disparities in Breastfeeding Rates in Patients with Heart Disease. J Racial Ethn Health Disparities 2024:10.1007/s40615-024-01933-1. [PMID: 38509443 DOI: 10.1007/s40615-024-01933-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 01/17/2024] [Accepted: 01/31/2024] [Indexed: 03/22/2024]
Abstract
OBJECTIVE To evaluate racial disparities in breastfeeding rates in patients with heart disease. STUDY DESIGN Retrospective cohort of pregnant patients with maternal cardiac disease managed by a Cardio-Obstetrics program. Patients self-identifying as Non-Hispanic Black (NHB) and Non-Hispanic White (NHW), who attended ≥ 1 prenatal visit at the Cardio-Obstetrics Program and delivered at the same hospital between March 2015 and June 2019 were included. The primary outcome was breastfeeding rate at discharge from the delivery-associated hospitalization. Secondary outcomes included breastfeeding intent on admission and breastfeeding rates at the postpartum visit among patients who initiated breastfeeding. RESULTS 138 pregnant patients with cardiac disease were included: 58 (42%) NHB and 80 (58%) NHW patients. Parity, marital status and insurance were statistically different between groups. NHB patients were more likely to have government insurance compared to NHW patients (77.6% vs. 40%; p < 0.001). There was a significant difference in the intent to breastfeed upon admission for the delivery-associated hospitalization (74.2% NHB vs. NHW 91.3%; p = 0.01), but not at hospital discharge (84.5% NHB vs. 93.8% NHW; p = 0.08). However, breastfeeding rates were significantly lower among NHB patients at the postpartum visit among the entire cohort (38.2% in NHB vs. 61.1% in NHW women; p = 0.036) and among those who initiated breastfeeding (35.3% NHB vs. 61.1% NHW, p = 0.018). CONCLUSIONS Despite similar breastfeeding rates at hospital discharge, NHB patients with maternal cardiac disease were less likely to intend to breastfeed at admission and/or continue breastfeeding by the postpartum visits. Qualitative studies understanding these differences are crucial to improve breastfeeding rates, especially for NHB patients with maternal cardiac disease.
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Affiliation(s)
- Ayamo G Oben
- University of Alabama at Birmingham Marnix E. Heersink School of Medicine, Birmingham, AL, USA.
- Department of Obstetrics & Gynecology, University of Alabama at Birmingham, 1700 6th Ave South, Ste 10270, Birmingham, AL, 35233, USA.
| | - Christina T Blanchard
- University of Alabama at Birmingham Marnix E. Heersink School of Medicine, Birmingham, AL, USA
- Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Ashton Robinson
- University of Alabama at Birmingham Marnix E. Heersink School of Medicine, Birmingham, AL, USA
| | - Isabel Girling
- University of Alabama at Birmingham Marnix E. Heersink School of Medicine, Birmingham, AL, USA
| | - Joanna M Joly
- University of Alabama at Birmingham Marnix E. Heersink School of Medicine, Birmingham, AL, USA
- Department of Medicine, Division of Cardiovascular Disease, University of Alabama, Birmingham, AL, USA
| | - Marc Cribbs
- University of Alabama at Birmingham Marnix E. Heersink School of Medicine, Birmingham, AL, USA
- Department of Medicine, Division of Cardiovascular Disease, University of Alabama, Birmingham, AL, USA
| | - Alan Tita
- University of Alabama at Birmingham Marnix E. Heersink School of Medicine, Birmingham, AL, USA
- Department of Obstetrics & Gynecology, University of Alabama at Birmingham, 1700 6th Ave South, Ste 10270, Birmingham, AL, 35233, USA
- Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Brian Casey
- University of Alabama at Birmingham Marnix E. Heersink School of Medicine, Birmingham, AL, USA
- Department of Obstetrics & Gynecology, University of Alabama at Birmingham, 1700 6th Ave South, Ste 10270, Birmingham, AL, 35233, USA
- Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Rachel Sinkey
- University of Alabama at Birmingham Marnix E. Heersink School of Medicine, Birmingham, AL, USA
- Department of Obstetrics & Gynecology, University of Alabama at Birmingham, 1700 6th Ave South, Ste 10270, Birmingham, AL, 35233, USA
- Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, AL, USA
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LaPlant HW, Francis-Edoziuno C, Guan Z, Aderibigbe T, Chang X, Alhabodal AS, Delaney K, Scott D, Marshall-Crim M, Freytes I, Henderson WA, Walsh S, Lucas RF. Retention and the Intersection of Structural Inequities in a Breastfeeding Intervention Study. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.03.15.24304355. [PMID: 38559187 PMCID: PMC10980120 DOI: 10.1101/2024.03.15.24304355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
Introduction Women below the poverty threshold have lower representation and retention in breastfeeding studies. Methods A secondary analysis of a longitudinal randomized controlled self-management for breast and nipple pain during breastfeeding study. Participants completed online surveys at discharge, weeks 1, 2, 3, 6, 9, 12, 18, and 24, with face-to-face interviews at 6 and 24 weeks. Text messages were sent to participants when modules and surveys were due. Retention was assessed in R with descriptive statistics, Mann-Whitney, Pearson's chi-square, and Cox Proportional Hazard Regression. Results Two hundred and forty-four women (89 ≤$50,000 and 155 >$50,000) were recruited. Retention rates at 1 (93%), 2 (87%), 6 (82%), 9 (77%) and 24 (72%) weeks. For women of low income compared to those of high income there was a hazard ratio (HR) of 2.5 (p=0.0001) for retention. For non-Hispanic Black and Hispanic women compared to the combined non-Hispanic White and Other group, HRs for retention were 3.3 and 2.6 respectively (p=0.0001). Adjustment for age in the final hazard regression model of income, age, race and ethnicity decreased the HR for women of low income to 1.6 and HRs for non-Hispanic Black and Hispanic women to 2.1 and 1.9, respectively (p=.0001). However, none of the individual factors in the model achieved statistical significance. Discussion Retention in breastfeeding studies impacts breastfeeding duration, a key lifelong preventative health behavior. Despite accessible study design, retention of women desiring to breastfeed was adversely affected by the intersection of income, race and ethnicity, and age.
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Affiliation(s)
| | | | - Zhe Guan
- Department of Statistics, University of Connecticut
| | | | | | | | | | - Dana Scott
- Obstetrics and Gynecology Unit, Breast Health and Cancer Genetics, University of Connecticut Health Center
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Carter SK, Bansal S. Racializing Motherhood and Maternity Care in News Representations of Breastfeeding. JOURNAL OF HEALTH AND SOCIAL BEHAVIOR 2024:221465241235143. [PMID: 38444117 DOI: 10.1177/00221465241235143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/07/2024]
Abstract
Racial inequalities in breastfeeding have been a U.S. national concern, prompting health science research and public discourse. Social science research reveals structural causes, including racism in labor conditions, maternity care practices, and lactation support. Yet research shows that popular and health science discourses disproportionately focus on individual and community factors, blaming Black women and communities for unequal breastfeeding rates. This study examines how scientific reports are communicated to the public through a critical analysis of 104 U.S. news articles reporting research on racial disparities in breastfeeding. Findings show that articles acknowledge unequal treatment within maternity care but justify it by presenting Black patients as overburdening the maternity care systems they use due to low socioeconomic status, welfare dependency, poor family support, and poor health. Through these representations, articles co-construct racialized motherhood and maternity care systems in ways that hide manifestations of obstetric racism and combat social support for systemic change.
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Aderibigbe T, Walsh S, Henderson WA, Lucas RF. Psychometric testing of the breastfeeding self-efficacy scale to measure exclusive breastfeeding in African American women: a cross-sectional study. Front Public Health 2023; 11:1196510. [PMID: 37822543 PMCID: PMC10563511 DOI: 10.3389/fpubh.2023.1196510] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 09/12/2023] [Indexed: 10/13/2023] Open
Abstract
Background In United States, African American women are the least likely group to breastfeed exclusively compared with Hispanic and non-Hispanic white women. It is crucial to examine the perceived confidence of African American women towards practicing exclusive breastfeeding. Previous studies have examined breastfeeding self-efficacy and other factors influencing exclusive breastfeeding. However, there is no research on exclusive breastfeeding self-efficacy of this population. The purpose of this study was to examine the validity and reliability of the breastfeeding self-efficacy scale to measure exclusive breastfeeding, and the relationship between exclusive breastfeeding self-efficacy and general self-efficacy and demographic variables in African American women. Methods Descriptive cross-sectional design was used. A convenience sample of 53 pregnant African American women completed an online survey. Construct and criterion-related validity were assessed and reliability of the breastfeeding self-efficacy scale to measure exclusive breastfeeding (BSES-EBF) was examined using Cronbach's reliability. The general self-efficacy scale measured general self-efficacy. Descriptive statistics, bivariate correlation and non-parametric analyses were performed using statistical package for social sciences (v.28). Results The breastfeeding self-efficacy to measure exclusive breastfeeding scale had a Cronbach's alpha score of 0.907. One principal component was extracted from the BSES-EBF scale, with an Eigenvalue of 5.271 and which explained 58.57% of the variance in the instrument. The mean prenatal exclusive breastfeeding self-efficacy of participants was 35.15 (±7.41) from a range of 9 to 45. Exclusive breastfeeding was significantly associated with general self-efficacy (r = 0.503, p ≤ 0.001) and exclusive breastfeeding intention (p = 0.034). Conclusion Breastfeeding self-efficacy scale to measure exclusive breastfeeding is a valid and reliable tool to measure exclusive breastfeeding self-efficacy in African American women. African American women had high exclusive breastfeeding self-efficacy (internal motivation). Hence, there is a need to address breastfeeding barriers and provide access to culturally sensitive support (external motivation) to increase exclusive breastfeeding in African American women.
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Affiliation(s)
- Tumilara Aderibigbe
- School of Nursing, University of Connecticut, Storrs, CT, United States
- College of Nursing, University of Utah, Salt Lake City, UT, United States
| | - Stephen Walsh
- School of Nursing, University of Connecticut, Storrs, CT, United States
| | - Wendy A. Henderson
- School of Nursing, University of Connecticut, Storrs, CT, United States
- School of Medicine, University of Connecticut, Storrs, CT, United States
| | - Ruth F. Lucas
- School of Nursing, University of Connecticut, Storrs, CT, United States
- School of Medicine, University of Connecticut, Storrs, CT, United States
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Understanding Breastfeeding Barriers at an Urban Pediatric Practice. J Racial Ethn Health Disparities 2023; 10:581-592. [PMID: 35099765 DOI: 10.1007/s40615-022-01248-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 01/19/2022] [Accepted: 01/20/2022] [Indexed: 10/19/2022]
Abstract
Breastfeeding is the optimal nutrition for infants given the numerous health benefits that are conferred on mothers, infants, and society in a dose-dependent manner. However, low breastfeeding rates and racial breastfeeding inequities persist for the African American (AA) community due to historic structural racism. The issue is especially salient at the Rainbow Center for Women and Children, an urban health center in Cleveland, Ohio where approximately 90% of their mothers are AA, WIC-eligible, and publicly insured. Our study aims to elucidate factors contributing to breastfeeding practices and identify supports that could be added for women served at RCWC. The study was conducted within 2 cohorts both of exclusively AA women. Wave 1 of the study included AA mothers who exclusively breastfed, did mixed feeding, or exclusively formula fed. Wave 2 included expectant women at least considering breastfeeding. Breastfeeding attitudes of those who had exclusively breastfed or practiced mixed feeding were not significantly different than those of expectant participants planning to breastfeed; mean attitude scores, however, were in the "neutral" range. Participants endorsed many sources of support for their feeding choices, including the infant's father, their own parents, and family. However, the data show that even when women feel personally supported in their feeding choices by their partner and family, if additional breastfeeding help is needed, they will benefit from help accessing available resources. Thus, lactation support that helps women achieve their own breastfeeding goals is optimal; customized care ultimately can move the needle on racial inequities in breastfeeding for our society.
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Gyamfi A, Spatz DL, Jefferson UT, Lucas R, O'Neill B, Henderson WA. Breastfeeding Social Support Among African American Women in the United States: A Meta-Ethnography. Adv Neonatal Care 2023; 23:72-80. [PMID: 35939758 PMCID: PMC9891275 DOI: 10.1097/anc.0000000000001021] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND In the United States, there are racial disparities in 6 months of exclusive breastfeeding. Only, 25.8% of American infants were breastfed for the first 180 days of life, with African American infants least (19.8%) exclusively breastfed in 2018. PURPOSE The meta-ethnography explored the breastfeeding support for African American women in the United States. DATA SOURCES The online databases of American Psychological Association, PsycINFO, Cumulative Index to Nursing and Allied Health Literature, PubMed, and Scopus were searched with key words, and the search was not limited by the year of publication. STUDY SELECTION The inclusion criteria for the study selection entailed all qualitative studies conducted on breastfeeding support among self-identified African American women in the United States, written in English language, peer reviewed, or dissertation. The initial search produced 905 articles of which 8 met the eligibility criteria. DATA EXTRACTION Data extraction and analysis were guided by Noblit and Hare's (1988) meta-ethnography approach. The analysis process was completed by a team of researchers, inclusive of breastfeeding experts. RESULTS Five overarching themes emerged including trustworthy information; early postpartum support by key influencers; maternal culture; tangible resources, and Black mothers' empowerment. IMPLICATIONS FOR PRACTICE AND RESEARCH Social support is a major determinant for the initiation and continuation of breastfeeding among African American women in the United States. Future longitudinal studies are warranted to explore the social support of breastfeeding among African American women in the United States.
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Affiliation(s)
- Adwoa Gyamfi
- Correspondence: Adwoa Gyamfi, PhD, MPH, BSc, RN, University of Connecticut, School of Nursing, 231 Glenbrook Rd Unit 4026, Storrs, CT 06269 ()
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Dogan J, Hargons C, Stevens-Watkins D. "Don't Feel Like You Have to Do This All on Your Own": Exploring Perceived Partner Support of Breastfeeding Among Black Women in Kentucky. J Hum Lact 2023; 39:134-145. [PMID: 36511173 DOI: 10.1177/08903344221138101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Few researchers have explored partner breastfeeding support among Black women, who report low breastfeeding rates compared to women of other cultural groups. Ways to encourage partner support of Black women's breastfeeding can be understood from an Afrocentric perspective. RESEARCH AIM To explore perceptions of partner support among Black mothers to develop a culturally relevant framework of partner breastfeeding support. METHODS Secondary data analyses of qualitative data from a larger prospective, cross-sectional mixed methods study were utilized. Participants from Kentucky (N = 14), aged 23-71, who breastfed for at least 6 months, were recruited to participate in individual interviews. Professionally transcribed interviews were analyzed using Braun and Clarke's (2006) thematic analysis. RESULTS By integrating the Breastfeeding Coparenting Framework and Optimal Conceptual Theory, we identified four culturally affirming partner support themes that participants believed impacted their breastfeeding experiences: (a) doing research, (b) offering care, (c) verbalizing praise, and (d) achieving teamwork, and three culturally incongruent partner support barrier themes: (e) withdrawing commitment, (f) politicking bodies, and (g) stripping agency. CONCLUSION Participants who breastfed for at least 6 months largely attributed their breastfeeding success to the support received from their partners. Our findings offer a culturally relevant framework of partner breastfeeding support that can facilitate intervention efforts with participants and their partners to increase breastfeeding rates among this population.
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Affiliation(s)
- Jardin Dogan
- Department of Educational, School, and Counseling Psychology, University of Kentucky, Lexington, KY, USA
| | - Candice Hargons
- Department of Educational, School, and Counseling Psychology, University of Kentucky, Lexington, KY, USA
| | - Danelle Stevens-Watkins
- Department of Educational, School, and Counseling Psychology, University of Kentucky, Lexington, KY, USA
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Villalobos AVK, Turner MM, Lapinski MK, Hull S, Long S, Wang J, Moore EWG. Predicting Breastfeeding Intentions: A Test and Extension of the Theory of Normative Social Behavior with African American Social Identity. HEALTH COMMUNICATION 2023; 38:101-113. [PMID: 34105433 DOI: 10.1080/10410236.2021.1936750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Breastfeeding is a health promoting social behavior but statistics suggest a persistent disparity of lower rates among African American mothers. The Theory of Normative Social Behavior (TNSB) explains when and how norms influence behaviors, but has produced inconsistent results with respect to proposed moderators group identity and injunctive norms (IN), limiting its predictive value in diverse cultural groups. Cultural norms are one of many influences on breastfeeding behaviors, yet little is known about their mechanisms of influence. The TNSB has not been tested in the breastfeeding context or within an exclusively African American cultural group. Given this knowledge gap, a survey of 528 African American mothers in the Washington, D.C. area was conducted to test the moderating effects of IN and subjective norms (SN) and social identity on the descriptive norms (DN) to intentions relationship as predicted by the TNSB. Structural equation modeling was used to show that when controlling for education and breastfeeding history, norms significantly predicted 26.4% of the variance in breastfeeding intentions. SN and DN interacted negatively to enhance breastfeeding intentions. Latent profile analysis using ethnic pride, collectivism, and religiosity scales detected four profiles of African American social identity. Social identity profile membership was a significant moderator on the DN to intentions pathway in the structural equation model. Profiles with the highest ethnic pride were significantly influenced by DN to intend to breastfeed. Implications from this study for public health intervention and communication messaging are discussed.
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Affiliation(s)
- Aubrey Van Kirk Villalobos
- Department of Prevention and Community Health, Milken Institute School of Public Health at the George Washington University
- School of Medicine and Health Sciences, The George Washington University Cancer Center
| | | | | | - Shawnika Hull
- Department of Prevention and Community Health, Milken Institute School of Public Health at the George Washington University
| | - Sahira Long
- Department of General and Community Pediatrics, Children's National Health System
- Department of Pediatrics, The George Washington University School of Medicine and Health Sciences
| | - Jichuan Wang
- Department of Pediatrics, The George Washington University School of Medicine and Health Sciences
- Department of Epidemiology and Biostatistics, Milken Institute School of Public Health at the George Washington University
- Children's National Health System, Children's National Research Institute
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Miller EB, Whipps MDM, Bogen DL, Morris PA, Mendelsohn AL, Shaw DS, Gross RS. Collateral benefits from a school-readiness intervention on breastfeeding: A cross-domain impact evaluation. MATERNAL & CHILD NUTRITION 2022; 19:e13446. [PMID: 36218286 PMCID: PMC9749611 DOI: 10.1111/mcn.13446] [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: 02/10/2022] [Revised: 09/19/2022] [Accepted: 09/22/2022] [Indexed: 11/05/2022]
Abstract
This study evaluated the collateral, or unanticipated, impacts of Smart Beginnings (SB), a two-site, tiered intervention designed to promote responsive parenting and school readiness, on breastfeeding intensity in a low-income sample. Impact analyses for the SB intervention were conducted using an intent-to-treat design leveraging a two-arm random assignment structure. Mothers assigned to the SB intervention group were more than three times more likely to give breastmilk as the only milk source at infant age 6 months than mothers assigned to the control group at one site, an effect not evident at the other study site. As development and growth are the two most salient domains of child health, understanding how interventions impact subsequent parenting practices across both domains is critical to address long-term economic and racial/ethnic disparities. Implications of the findings are discussed for improving the efficacy of interventions based on paediatric primary care.
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Affiliation(s)
- Elizabeth B. Miller
- Department of Population HealthNYU Grossman School of MedicineNew YorkNew YorkUSA
| | | | - Debra L. Bogen
- Department of PediatricsUniversity of PittsburghPittsburghPennsylvaniaUSA
| | - Pamela A. Morris
- Department of Applied PsychologyNew York UniversityNew YorkNew YorkUSA
| | - Alan L. Mendelsohn
- Department of PediatricsNYU Grossman School of MedicineNew YorkNew YorkUSA
| | - Daniel S. Shaw
- Department of PsychologyUniversity of Pittsburgh, PittsburghPennsylvaniaUSA
| | - Rachel S. Gross
- Department of PediatricsNYU Grossman School of MedicineNew YorkNew YorkUSA
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Innovations in Breastfeeding Support. Clin Obstet Gynecol 2022; 65:648-662. [PMID: 35894738 DOI: 10.1097/grf.0000000000000736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Despite the numerous benefits that breastfeeding confers to those who breastfeed and their infants, the United States' exclusive breastfeeding rates and any breastfeeding rates at 12 months remain low and inequitable. This public health crisis has been prioritized in the US Healthy People 2030 goals. Current evidence-based practices to support lactation have afforded limited progress, thus, achieving national breastfeeding goals requires innovative ideas in thinking, technology, and care. This article highlights potential innovative strategies in the field of lactation to improve outcomes and work toward achieving health equity, while underscoring the critical role that perinatal caregivers play in lactation support.
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Abstract
BACKGROUND Low job control may predict shorter breastfeeding (BF) among working mothers and may contribute to racial disparities in BF. METHODS We used demographic, employment, and health data for n = 631 observations from the Panel Study of Income Dynamics. Job control scores came from a job-exposure matrix.Using path analysis, we assessed whether job control predicted BF and mediated Black-White BF differences. We controlled for education, working hours, marital status, and low birthweight. RESULTS Lower job control predicted decreased odds of BF for at least 6 months (odds ratio, 0.61; 95% confidence interval, 0.31-0.90; reference, no BF). Low job control explained 31% of the Black-White difference for both shorter-term and longer-term BF. CONCLUSIONS Low job contributes to shorter BF and to BF disparities by race. Intervening to enhance job control could improve BF.
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Affiliation(s)
- Margaret D Whitley
- From the Population Studies Center, Institute for Social Research, University of Michigan, Ann Arbor, Michigan (Dr Whitley); Program in Public Health, University of California, Irvine, Irvine, California (Dr Ro); and Center for Work and Health Research, Irvine, California (Mr Choi)
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Aderibigbe O, Lucas R. Exclusive breastfeeding in African American women: A concept analysis. J Adv Nurs 2022; 79:1699-1713. [PMID: 35621344 DOI: 10.1111/jan.15301] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 03/25/2022] [Accepted: 05/07/2022] [Indexed: 11/29/2022]
Abstract
AIM To report an analysis of the concept of exclusive breastfeeding (EBF) in African American women. BACKGROUND EBF is the gold standard for infant nutrition from birth until 6 months. The rate of EBF in United States is low-26%, with African American women having the lowest rates. The low rates of EBF in this population are strongly attributed to bias, racism and generational trauma. Therefore, clarifying the concept of EBF with respect to these factors is important for promoting EBF rates of this population. DESIGN Concept analysis. DATA SOURCES Search was conducted in four databases (CINAHL, PubMed, PsycINFO and Scopus) for articles published between 2001 and 2021. A total of 30 articles (20 quantitative, seven qualitative and three mixed methods) clarified the concept. Relevant literature emanated from diverse disciplines examining historical and present maternal and infant health. METHODS Concept analysis using Rodger's evolutionary method. RESULTS An operational definition of the concept of EBF in African American women was developed from the identified antecedents (modifiable and non-modifiable), defining attributes and consequences of the concept. Access to breastfeeding resources, maternal (prenatal intention to breastfeed, smoking status, attitude towards breastfeeding), infant (skin-to-skin care, successful latching and weight) and contextual factors (socioeconomic, occupational and cultural) predict EBF. The primary attributes of EBF were physiological, physical, psychological and relational. Consequences of EBF were positive health outcomes for, and increased bonding between, mother and infant. CONCLUSION This concept analysis is the first identifying modifiable and non-modifiable antecedents of EBF. The analysis provides an operational definition for EBF in African American women which is useful to promote understanding of breastfeeding. This new concept examines the historic societal trauma associated with wet nursing and reframes breastfeeding as a positive maternal and infant health behaviour.
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Affiliation(s)
| | - Ruth Lucas
- University of Connecticut School of Nursing, Storrs, Connecticut, USA
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Schmitt L, Spatz DL. Breastfeeding While Incarcerated: Evidence-Based Recommendations for Integrating Policy and Practice. JOURNAL OF CORRECTIONAL HEALTH CARE 2022; 28:129-137. [PMID: 35213245 DOI: 10.1089/jchc.19.12.0094] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Breastfeeding and pumping to express human milk are restricted practices for incarcerated women, and their infants are at high risk for not receiving human milk. Clinical practice guidelines are not applied to perinatal women who are incarcerated, and the rates of breastfeeding and the potential to do so in correctional facilities are extrapolated from small studies. The purpose of this analysis is to summarize current national trends in breastfeeding and lactation policy and the extent to which lactation in correctional facilities is addressed, identify ongoing lactation support programs and strategies in correctional facilities as potential areas for further study, and offer a context-specific, adaptable, and evidence-based approach to breastfeeding and lactation support using the Spatz 10-step model. This analysis calls for strategic updates to research and policy and offers recommendations in collaboration with existing programs to increase access to breastfeeding and lactation services for incarcerated women.
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Affiliation(s)
- Liliana Schmitt
- University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA
| | - Diane L Spatz
- University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA.,The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
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15
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Kirksey K. A social history of racial disparities in breastfeeding in the United States. Soc Sci Med 2021; 289:114365. [PMID: 34592542 DOI: 10.1016/j.socscimed.2021.114365] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 08/22/2021] [Accepted: 09/01/2021] [Indexed: 11/15/2022]
Abstract
Over the past five decades in the United States, White women have breastfed at higher rates than Black women. While a small but growing body of social historical research has examined racial disparities in breastfeeding over time, empirical research, particularly quantitative research, has focused on single historical snapshots, unintentionally treating the persistent racial disparities in breastfeeding as a static phenomenon, rather than one with distinct social mechanisms at different points in time. Further, few studies on racial disparities in health deconstruct difference both within and across racial groups. But what if we thought about persistent racial disparities instead as discrete trends with distinct social mechanisms at different points in time? In a binary logistic regression of breastfeeding initiation rates from 1973 to 2015 using the National Survey of Family Growth (NSFG), I found that the persistent racial disparities were actually comprised of three distinct types of changing racial disparities: (1) increases in racial disparities that derive from improvements for Whites not captured by Blacks (1973-1982); (2) decreases in racial disparities that stem from improvements for Whites captured even more strongly by Blacks (1995-2006); and, (3) leveling off of racial disparities (2006-2015). Placing results of this quantitative analysis within the context of public policy and social movement history, I identify three distinct mechanisms that drive the different trends in racial disparities in breastfeeding. This paper contributes to the literature on motherhood, race, and health a more nuanced understanding of the social historical mechanisms that pattern breastfeeding, and more broadly, racial disparities in health.
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Affiliation(s)
- Kristen Kirksey
- Department of Sociology, University of Connecticut, 344 Mansfield Road, Unit 1068, Storrs, CT, 06269, USA.
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17
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Whitley MD, Ro A, Palma A. Work, race and breastfeeding outcomes for mothers in the United States. PLoS One 2021; 16:e0251125. [PMID: 33951094 PMCID: PMC8099119 DOI: 10.1371/journal.pone.0251125] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 04/20/2021] [Indexed: 12/29/2022] Open
Abstract
Background In the United States, mothers’ employment status and occupation are related to breastfeeding. However, it is unclear whether not working leads to longer breastfeeding duration even when compared to professional/managerial jobs, which tend to accommodate breastfeeding better than service/manual labor jobs. Furthermore, occupation and breastfeeding are racially patterned, and it is possible that race could moderate the relationships between mother’s work and breastfeeding. Methods Using data from the Panel Study of Income Dynamics, we modeled breastfeeding duration based on mother’s employment/occupation (not working, professional/managerial work, or service/labor work) during the first 6 months postpartum, as well as mother’s race (White, Black or other) and other potential confounders. We used zero-inflated negative binomial regression models and tested an interaction between employment/occupation type and race. Predictive margins were used to compare breastfeeding duration among subgroups. Results Mothers working in service/labor occupations had the shortest breastfeeding duration of the three employment/occupation groups, and there was no significant difference in duration between not working and professional/managerial occupation. White mothers had longer breastfeeding duration than Black mothers on average. When we included an interaction between employment/occupation and race, we found that among White mothers, non-working mothers breastfed the longest, while mothers in service/labor work breastfed for the shortest duration, but among Black mothers, mothers in professional/managerial work breastfed for longer than mothers in the other two work categories. Discussion Race moderated the relationship between employment status/occupation type and breastfeeding such that, for White mothers, not working was the most advantageous circumstance for breastfeeding, in line with traditional work-family conflict theory. In contrast, for Black mothers, professional/managerial work was the most advantageous circumstance. These findings support the idea of the Market-Family Matrix, which allows that different work scenarios may be more or less advantageous for parenting behaviors like breastfeeding, depending on mothers’ circumstances.
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Affiliation(s)
- Margaret D. Whitley
- Program in Public Health, University of California, Irvine, Irvine, CA, United States of America
- * E-mail:
| | - Annie Ro
- Program in Public Health, University of California, Irvine, Irvine, CA, United States of America
| | - Anton Palma
- Institute for Clinical and Translational Science, University of California, Irvine, Irvine, CA, United States of America
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18
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Mieso BR, Burrow H, Lam SK. Beyond Statistics: Uncovering the Roots of Racial Disparities in Breastfeeding. Pediatrics 2021; 147:peds.2020-037887. [PMID: 33833073 DOI: 10.1542/peds.2020-037887] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/09/2021] [Indexed: 11/24/2022] Open
Affiliation(s)
- Bethel R Mieso
- School of Medicine, Case Western Reserve University, Cleveland, Ohio; and
| | - Hunter Burrow
- School of Medicine, Case Western Reserve University, Cleveland, Ohio; and
| | - Suet Kam Lam
- School of Medicine, Case Western Reserve University, Cleveland, Ohio; and .,Department of Pediatric Hospital Medicine, Cleveland Clinic, Cleveland, Ohio
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Woods Barr AL, Miller E, Smith JL, Cummings SM, Schafer EJ. #EveryGenerationMatters: Intergenerational Perceptions of Infant Feeding Information and Communication Among African American Women. Breastfeed Med 2021; 16:131-139. [PMID: 33591228 DOI: 10.1089/bfm.2020.0308] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Objective: African American (AA) women look to their mother and maternal grandmother for parenting information and support; this intergenerational communication may reinforce or hinder breastfeeding practices. Rooted in Black Feminist Thought, this study's objective was to use an asset-based approach to explore infant feeding information shared across at least two generations of AA female family members. Materials and Methods: Fifteen family triads/dyads (N = 35 women), residing in Southeastern United States, participated in semistructured interviews in 2019. Qualitative data were analyzed using thematic analysis. Results: Infant feeding information shared across generations was characterized into six themes: Guidance, Practical assistance, Reservations, Affirmations, Observational learning, and Perceived undermining. Typically, conversations occurred in one of four reproductive life stages (preconception, prenatal, birth, and post-birth) of the youngest adult generation and may have been influenced by each family's feeding history ("One generation breastfed," "Two generations breastfed," and "Three generations breastfed"). Notably, with each additional generation of breastfeeding experience, perceived undermining and reservation reporting decreased. In addition, families reclaimed and reconnected with ancestral breastfeeding practices. Conclusions: Findings suggest that every generation matters to breastfeeding behaviors in AA families. Therefore, nuanced, family-centered approaches should build on assets within AA families to support them in meeting their feeding goals. Practitioners should recognize the importance of oral tradition as a mode of transmitting infant feeding information among AAs and understand the influence of family feeding history in intergenerational infant feeding communication. When working with AAs, practitioners must be flexible, respectful, supportive, and actively learning about an individual's beliefs and culture, creating space to reframe, without judgment or paternalism.
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Affiliation(s)
- Alexis L Woods Barr
- Carolina Global Breastfeeding Institute, Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Elizabeth Miller
- Department of Anthropology, University of South Florida, Tampa, Florida, USA
| | - Jacquana L Smith
- Carolina Global Breastfeeding Institute, Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Shanita M Cummings
- Division of Quality and Patient Safety, United Regional Hospital, Wichita Falls, Texas, USA
| | - Ellen J Schafer
- Department of Community and Environmental Health, College of Health Sciences, Boise State University, Boise, Idaho, USA
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