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Mogre V, Stevens FCJ, Aryee PA, Amalba A, Scherpbier AJJA. Why nutrition education is inadequate in the medical curriculum: a qualitative study of students' perspectives on barriers and strategies. BMC MEDICAL EDUCATION 2018; 18:26. [PMID: 29433505 PMCID: PMC5809975 DOI: 10.1186/s12909-018-1130-5] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2017] [Accepted: 01/24/2018] [Indexed: 05/22/2023]
Abstract
BACKGROUND The provision of nutrition care by doctors is important in promoting healthy dietary habits, and such interventions can lead to reductions in disease morbidity, mortality, and medical costs. However, medical students and doctors report inadequate nutrition education and preparedness during their training at school. Previous studies investigating the inadequacy of nutrition education have not sufficiently evaluated the perspectives of students. In this study, students' perspectives on doctors' role in nutrition care, perceived barriers, and strategies to improve nutrition educational experiences are explored. METHODS A total of 23 undergraduate clinical level medical students at the 5th to final year in the School of Medicine and Health Sciences of the University for Development Studies in Ghana were purposefully selected to participate in semi-structured individual interviews. Students expressed their opinions and experiences regarding the inadequacy of nutrition education in the curriculum. Each interview was audio-recorded and later transcribed verbatim. Using the constant comparison method, key themes were identified from the data and analysis was done simultaneously with data collection. RESULTS Students opined that doctors have an important role to play in providing nutrition care to their patients. However, they felt their nutrition education was inadequate due to lack of priority for nutrition education, lack of faculty to provide nutrition education, poor application of nutrition science to clinical practice and poor collaboration with nutrition professionals. Students opined that their nutrition educational experiences will be improved if the following strategies were implemented: adoption of innovative teaching and learning strategies, early and comprehensive incorporation of nutrition as a theme throughout the curriculum, increasing awareness on the importance of nutrition education, reviewing and revision of the curriculum to incorporate nutrition, and involving nutrition/dietician specialists in medical education. CONCLUSION Though students considered nutrition care as an important role for doctors they felt incapacitated by non-prioritisation of nutrition education, lack of faculty for teaching of nutrition education, poor application of nutrition science and poor collaboration with nutrition professionals. Incorporation of nutrition as a theme in medical education, improving collaboration, advocacy and creating enabling environments for nutrition education could address some of the barriers to nutrition education.
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Affiliation(s)
- Victor Mogre
- Department of Health Professions Education and Innovative Learning, School of Medicine and Health Sciences, University for Development Studies, P. O. Box TL, 1883 Tamale, Ghana
- School of Health Professions Education, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Fred C. J. Stevens
- School of Health Professions Education, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Paul A. Aryee
- Department of Nutritional Sciences, School of Allied Health Sciences, University for Development Studies, Tamale, Ghana
| | - Anthony Amalba
- Department of Health Professions Education and Innovative Learning, School of Medicine and Health Sciences, University for Development Studies, P. O. Box TL, 1883 Tamale, Ghana
| | - Albert J. J. A. Scherpbier
- School of Health Professions Education, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
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Dritsakou K, Liosis G, Valsami G, Polychronopoulos E, Souliotis K, Skouroliakou M. Mother's breast milk supplemented with donor milk reduces hospital and health service usage costs in low-birthweight infants. Midwifery 2016; 40:109-13. [PMID: 27428106 DOI: 10.1016/j.midw.2016.06.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2015] [Revised: 03/19/2016] [Accepted: 06/22/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE to compare hospital and health service usage costs of feeding low-birthweight (LBW) infants predominantly with their mother's milk, supplemented with donor milk, with donor milk and preterm formula. DESIGN prospective matching study. SETTING tertiary public perinatal centre, neonatal intensive care unit (NICU) and donor human milk bank. PARTICIPANTS 100LBW infants (Group I) fed predominantly with their mother's milk from the first hour of life, supplemented (mainly for the first week of life) with donor milk, were matched on a 1:1 basis with 100LBW infants (Group II) who were fed with donor milk for the first 3 weeks of life followed by preterm formula until hospital discharge. Individualised targeted fortification of human milk was implemented in both study groups. FINDINGS the costs of hospitalisation, doctor visits and prescription drugs for viral infections until 8 months of age were calculated for each infant. Infants fed predominantly with their mother's milk had significantly shorter hospital stays and lower hospitalisation costs. In Group I infants, the duration of enteral gavage feeding was shorter, resulting in significantly lower costs. Up to 8 months of age, Group I infants experienced fewer episodes of viral infections, and the cost of each doctor visit and drug prescription was lower for these infants. CONCLUSIONS feeding LBW infants predominantly with their mother's milk reduces hospital and health service usage costs. IMPLICATIONS FOR PRACTICE feeding LBW infants predominantly with their mother's milk, supplemented with donor milk, followed by exclusive breast feeding seems to result in potential savings in hospital and health service usage costs.
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Affiliation(s)
- Kalliopi Dritsakou
- Departments of Quality Control, Research and Continuing Education, Elena Venizelou Maternity Hospital, Athens, Greece.
| | - Georgios Liosis
- Human Milk Bank, Elena Venizelou Maternity Hospital, Athens, Greece
| | | | | | | | - Maria Skouroliakou
- Department of Science of Dietetics-Nutrition, Harokopeion University of Athens, Athens, Greece
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McIsaac KE, Lou W, Sellen D, Young TK. Exclusive breastfeeding among Canadian Inuit: results from the Nunavut Inuit Child Health Survey. J Hum Lact 2014; 30:229-41. [PMID: 24352650 DOI: 10.1177/0890334413515752] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Very little population-based research has been conducted around the exclusive breastfeeding practices of Inuit Canadians. OBJECTIVES This research aims to assess the distribution of exclusive breastfeeding among Inuit Canadians and to identify factors associated with exclusive breastfeeding as recommended. METHODS We use data from 188 infant-mother dyads who completed the Nunavut Inuit Child Health Survey, a cross-sectional, population-based survey of Inuit children aged 3 to 5 years. A series of multinomial logistic regression models were run to identify factors associated with 4 exclusive breastfeeding durations (≤ 1 month, > 1-< 5.5 months, 5.5-6.5 months, and > 6.5 months). RESULTS Of infants, 23% were exclusively breastfed as recommended (ie, between 5.5 and 6.5 months; 95% CI, 16.2-29.3). Many infants (61%) were exclusively breastfed for less than 5.5 months and 16% (95% CI, 10.9-22.0) were exclusively breastfed for more than 6.5 months. Families receiving income support were less likely to discontinue exclusive breastfeeding before 5.5 months (pOR1- < 5.5 months = 0.34; 95% CI, 0.13, 0.85) relative to those not receiving income support, in adjusted models. No other measured factors were significantly related to exclusive breastfeeding duration. CONCLUSIONS The majority of Inuit Canadian infants receive suboptimal exclusive breastfeeding. National, provincial, and community-specific interventions to protect, promote, and support exclusive breastfeeding should emphasize not only the benefits of exclusively breastfeeding to 6 months but also the importance of timely introduction of complementary foods into the infant's diet.
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Affiliation(s)
- Kathryn E McIsaac
- 1Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
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Fischer TP, Olson BH. A qualitative study to understand cultural factors affecting a mother's decision to breast or formula feed. J Hum Lact 2014; 30:209-16. [PMID: 24186645 DOI: 10.1177/0890334413508338] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND The presence of barriers is not sufficient to explain breastfeeding rate disparities. A relatively unexplored area in coping with breastfeeding barriers is culture. OBJECTIVE This research aims to better understand the role of culture in a woman's infant feeding decision by using race and socioeconomic status as indicators of culture. METHODS Focus groups and individual interviews were conducted with 42 pregnant women or mothers of infants younger than 12 months. Focus group composition was determined by self-identified African American or white race and self-reported eligibility for the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) or ineligibility (non-WIC). RESULTS Most participants acknowledged that breastfeeding was best, yet differences arose between groups in the perception of, and reaction to, breastfeeding barriers. WIC and non-WIC participants of both races indicated that some circumstances necessitated formula use. WIC participants felt that this was personally and socially acceptable due to need, whereas non-WIC participants felt that this was personally and socially unacceptable. When a barrier arose, WIC participants of both races felt that the infant feeding choice was not theirs and formula use might be inevitable. In contrast, non-WIC participants of both races expressed that they persevered to continue breastfeeding and did so by establishing small, achievable goals and seeking mentors. CONCLUSION Educational and public health efforts to reduce breastfeeding disparities may be enhanced if support is tailored to acknowledge cultural differences among women and address factors that make either breastfeeding or formula feeding acceptable, or even preferable, within their communities.
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Kim MK, Shin JS, Patel RA, Min YS, Song HJ, Sohn UD, Kim DK, Nam JY, Kim DS. The Effects of Pigs' Feet Consumption on Lactation. Ecol Food Nutr 2013; 52:223-38. [DOI: 10.1080/03670244.2012.706157] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Sobel HL, Iellamo AD, Raya RR, Padilla AA, Sta Ana FS, Nyunt-U S. The economic burden of infant formula on families with young children in the Philippines. J Hum Lact 2012; 28:174-80. [PMID: 22526346 DOI: 10.1177/0890334412436719] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Infant formula usage places children at risk for illness and death. Studies in the United States demonstrated high economic burden, health care costs, and absenteeism of caregivers associated with formula usage. Despite high formula usage in developing countries, no economic studies were found. This study examines the financial burden of purchasing infant formula and increased health care expenditure in the Philippines, a developing country with a per capita income of $3930. The average exchange rate of the peso to the US dollar for 2003 was $1 to P52, according to Bangko Sentral ng Pilipinas (BSP). METHODS This is a secondary analysis of the 2003 Family Income and Expenditure Survey, a national cross-sectional multistage cluster survey of 42 094 households. RESULTS Almost half of Philippine families with a young child and one-third of families living on less than $2 per day purchase formula. Nationally, $260 million was spent on infant formula in 2003. Formula-buying families with young children had spent an aggregate of $143.9 million on medical care compared to $56.6 million by non-formula-buying families. After adjusting for income and nonmilk family expenditures, the average formula-purchasing Philippine family spent an additional $0.30 (95% CI: 0.24 - 0.36; r(2) = 0.08) on medical expenditure for every $1 spent on formula. CONCLUSIONS The economic burden from infant formula purchase and out-of-pocket medical expenditure exceeded $400 million in 2003. This cost was aside from other costs, such as absenteeism and the risk of childhood death and illness. These expenses caused an unnecessary burden on Filipino families and could instead have been invested in education and other social services.
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Affiliation(s)
- Howard L Sobel
- WHO Representative's Office in the Philippines, Manila, Philippines
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Tenfelde S, Finnegan L, Hill PD. Predictors of breastfeeding exclusivity in a WIC sample. J Obstet Gynecol Neonatal Nurs 2011; 40:179-89. [PMID: 21314715 DOI: 10.1111/j.1552-6909.2011.01224.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To examine predictors of breastfeeding exclusivity in low-income women who received services from a Chicago area clinic of the Special Supplemental Nutrition Program for Women, Infants and Children Program (WIC). DESIGN A secondary data analysis of existing clinical and administrative data. SETTING An urban community health center serving low-income families. PARTICIPANTS Two hundred and thirty-five (235) low-income women who initiated breastfeeding and received WIC services. METHODS Logistic regression models were fit to existing prenatal and postpartum data to determine predictors of breastfeeding exclusivity during the immediate postpartum period. RESULTS Only 23% of the sample breastfed exclusively. Women who received first-trimester prenatal care were more likely to exclusively breastfeed than women who entered prenatal care in later trimesters (OR = 2.02, p ≤ 0.05). Women who declared intentions prenatally to exclusively breastfeed were more likely to exclusively breastfeed than women who did not intend to breastfeed (OR = 3.85, p ≤ 0.001). Overweight/obese women were less likely to exclusively breastfeed than normal/underweight women (OR = 0.50, p ≤ 0.05). CONCLUSION Findings from this study can be used to develop tailored interventions to promote breastfeeding exclusivity among low-income WIC recipients.
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Affiliation(s)
- Sandi Tenfelde
- Marcella Niehoff School of Nursing, Loyola University, Maywood, IL, USA.
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Yanikkerem E, Tuncer R, Yilmaz K, Aslan M, Karadeniz G. Breast-feeding knowledge and practices among mothers in Manisa, Turkey. Midwifery 2009; 25:e19-32. [DOI: 10.1016/j.midw.2007.10.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2006] [Revised: 08/27/2007] [Accepted: 10/25/2007] [Indexed: 10/22/2022]
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Position of the American Dietetic Association: Promoting and Supporting Breastfeeding. ACTA ACUST UNITED AC 2009; 109:1926-42. [DOI: 10.1016/j.jada.2009.09.018] [Citation(s) in RCA: 92] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Meehan K, Harrison GG, Afifi AA, Nickel N, Jenks E, Ramirez A. The association between an electric pump loan program and the timing of requests for formula by working mothers in WIC. J Hum Lact 2008; 24:150-8. [PMID: 18436966 DOI: 10.1177/0890334408316081] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
An electric pump loan program designed to facilitate breastfeeding for low-income mothers returning to full-time work was evaluated. All mothers were WIC participants in the Los Angeles area. Electric pump loans were made until the infant's first birthday or until the mother requested formula from WIC. Information was provided to employers on supporting breastfeeding in the workplace. A subsample of mothers who received an electric pump on return to full-time work was compared with counterparts in a wait list control group. Mothers who received an electric pump as soon as requested did not request formula until 8.8 months on average, whereas those who did not receive an electric pump requested formula on average at 4.8 months (P < .0001). Mothers who received an electric pump when requested were 5.5 (95% CI 2.0-15.1) times as likely as mothers who did not receive an electric pump to not request formula at 6 months.
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Affiliation(s)
- Karen Meehan
- Public Health Foundation Enterprises WIC Program, Irwindale, California 91706, USA.
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Dollahite J, Kenkel D, Thompson CS. An economic evaluation of the expanded food and nutrition education program. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2008; 40:134-143. [PMID: 18457781 DOI: 10.1016/j.jneb.2007.08.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2007] [Revised: 08/19/2007] [Accepted: 08/21/2007] [Indexed: 05/26/2023]
Abstract
OBJECTIVE To evaluate the New York State Expanded Food and Nutrition Education Program using economic methodology. DESIGN Data were collected by nutrition educators in a pretest, posttest design with an epidemiological modeling approach to assess costs and estimate potential health benefits of the state program. SETTING Cooperative Extension, 35 counties. PARTICIPANTS 5730 low-income participants. INTERVENTION Series of 6 or more food and nutrition lessons. MAIN OUTCOME MEASURES Cost (program and participant); health benefits in quality adjusted life years (QALYs); and monetized benefits: society's willingness to pay for QALYs, and benefits of avoiding or delaying health care costs and loss of productivity. ANALYSIS Cost-effectiveness estimated from behavior change and QALY weights. Cost-benefit ratios estimated from costs and monetized benefits. Sensitivity analyses provided ranges where lack of agreement exists around parameters' values. RESULTS Cost was $892/graduate. Cost-effectiveness was 245 QALYs saved, at $20863/QALY (sensitivity 42-935 QALYs, $5467-$130311 per QALY). Societal willingness to pay benefit-to-cost ratio was $9.58:$1.00 (sensitivity $1.44-$41.92:$1:00); narrow governmental benefit-to-cost ratio was $0.82:$1.00 (sensitivity $0.08-$4.33:$1:00). CONCLUSIONS AND IMPLICATIONS Outcome data indicate that food and nutrition behavior changes resulting from the Program are likely to improve future health and reduce health care costs. Cost-effectiveness is estimated to be as great as for many current health interventions.
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Affiliation(s)
- Jamie Dollahite
- Division of Nutritional Sciences, Cornell University, Ithaca, New York 14853, USA.
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Hayes DK, Prince CB, Espinueva V, Fuddy LJ, Li R, Grummer-Strawn LM. Comparison of manual and electric breast pumps among WIC women returning to work or school in Hawaii. Breastfeed Med 2008; 3:3-10. [PMID: 18333763 DOI: 10.1089/bfm.2007.0022] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
INTRODUCTION The Women, Infants, and Children (WIC) branch of the Hawaii Department of Health encourages and assists mothers in breastfeeding. A study was done to determine whether an electric breast pump (vs. a manual pump) would increase breastfeeding duration in those returning to work or school full-time. MATERIALS AND METHODS During 2002-2003, a randomized trial was conducted among 280 women, with the duration of breastfeeding analyzed in 229 of these women. Descriptive analyses and a multivariate logistic regression analysis assessed factors associated with breastfeeding at 6 months. Unadjusted and adjusted survival analyses were performed to estimate the duration of breastfeeding. RESULTS In all, 76.8% of women using the manual breast pump and 72.3% of those using the electric breast pump breastfed for at least 6 months. This difference did not reach statistical significance. In the survival analysis adjusted for pump assignment, maternal age, race/ethnicity, marital status, and parity, women with at least some college education breastfed for a 38% shorter time than women with a high school or lower education. CONCLUSIONS Our findings suggest that the manual breast pump may work as well as the electric breast pump when breastfeeding is encouraged and supported among women returning to work or school full-time. Particular attention should be given to examining reasons why women with greater education breastfed for a shorter duration. Further research is needed to validate these results to better inform breastfeeding women returning to work or school.
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Affiliation(s)
- Donald K Hayes
- Family Health Services Division, Hawaii Department of Health, Honolulu, Hawaii 96816, USA.
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Castrucci BC, Hoover KL, Lim S, Maus KC. A Comparison of Breastfeeding Rates in an Urban Birth Cohort Among Women Delivering Infants at Hospitals That Employ and Do Not Employ Lactation Consultants. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2006; 12:578-85. [PMID: 17041307 DOI: 10.1097/00124784-200611000-00012] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To compare rates of breastfeeding at hospital discharge between facilities that employ and do not employ International Board Certified Lactation Consultants (IBCLCs). METHODS This study used a cross-sectional design. Data from 11,525 birth certificates of Philadelphia residents who delivered in 2003 were used. Breastfeeding was assessed using a question included on the Pennsylvania birth record, "Is the infant being breastfed at discharge?" The Philadelphia Department of Public Health's lactation consultants collected information on number of hours worked annually by IBCLCs by facility. RESULTS After adjusting for race/ethnicity, education, insurance status, age, marital status, route of delivery, birth weight, and gestational age, delivering in a hospital that employed an IBCLC was associated with a 2.28 (95% confidence interval [CI] =1.98,2.62) times increase in the odds of breastfeeding at hospital discharge. Among women receiving Medicaid, delivering at a hospital that employed IBCLCs was associated with a 4.13 (95% CI =3.22,4.80) times increase in the odds of breastfeeding at hospital discharge. CONCLUSIONS The findings presented here identify an association between delivering at a facility that employs IBCLCs and breastfeeding at hospital discharge. As the strength of this association is not negligible, particularly for women on Medicaid, these findings may be used to encourage widespread use of IBCLCs.
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Affiliation(s)
- Brian C Castrucci
- Family Health Research and Program Development Unit, Texas Department of State Health Services, Austin, USA.
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Cattaneo A, Ronfani L, Burmaz T, Quintero-Romero S, Macaluso A, Di Mario S. Infant feeding and cost of health care: a cohort study. Acta Paediatr 2006; 95:540-6. [PMID: 16825133 DOI: 10.1080/08035250500447936] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
AIM To compare the use and cost of health care in infants with different feeding patterns. METHODS Observational study on a cohort of 842 infants born in ten hospitals in northern Italy and followed up to age 12 months. Data on feeding gathered through telephone interviews with 24-hour recall. Data on use of health services reported by mothers and checked against records. Data on hospital cost derived from Disease Related Groups codes. Data on cost of other services obtained from maternal reports and available price lists. RESULTS At three months, 56% of infants were fully breastfed, 17% complementary fed and 27% not breastfed. Infants fully breastfed at three months had 4.90 episodes of illness requiring ambulatory care and 0.10 hospital admissions per infant/year compared with 6.02 and 0.17, respectively, in infants not or not fully breastfed. They had also a lower cost of health care: 34.69 euro versus 54.59 per infant/year for ambulatory care, and 133.53 euro versus 254.03 per infant/year for hospital care. Higher cost of health care was significantly associated with having a hospital admission and being a twin; cost of health care decreased with each additional gram of birth weight, each month of delayed return of the mother to work after the third month, and each extra month of breastfeeding. CONCLUSION Lack of breastfeeding and higher use and cost of health care are significantly associated.
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Affiliation(s)
- Adriano Cattaneo
- Unit for Health Services Research and International Health, Istituto per l'Infanzia IRCCS Burlo Garofolo, Trieste, Italy.
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Ryan AS, Zhou W. Lower breastfeeding rates persist among the Special Supplemental Nutrition Program for Women, Infants, and Children participants, 1978-2003. Pediatrics 2006; 117:1136-46. [PMID: 16585308 DOI: 10.1542/peds.2005-1555] [Citation(s) in RCA: 127] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE We set out to compare rates of breastfeeding between women who participated in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) with those of non-WIC mothers from 1978 to 2003. METHODS The Ross Laboratories Mothers Survey is a national survey designed to determine patterns of milk feeding during infancy. Mothers were asked to recall the type of milk fed to their infant in the hospital and during each month of age. Rates of breastfeeding in the hospital and at 6 months of age were evaluated. Logistic regression analyses identified significant predictors of breastfeeding in 2003. RESULTS From 1978 through 2003, rates for the initiation of breastfeeding among WIC participants lagged behind those of non-WIC mothers by an average of 23.6 +/- 4.4 percentage points. At 6 months of age, the gap between WIC participants and non-WIC mothers (mean: 16.3 +/- 3.1 percentage points) steadily increased from 1978 through 2003 and exceeded 20% by 1999. Demographic factors that were significant and positive predictors of breastfeeding initiation in 2003 included some college education, living in the western region of the United States, not participating in the WIC program, having an infant of normal birth weight, primipary, and not working outside the home. For mothers of infants 6 months of age, WIC status was the strongest determinant of breastfeeding: mothers who were not enrolled in the WIC program were more than twice as likely to breastfeed at 6 months of age than mothers who participated in the WIC program. CONCLUSIONS Breastfeeding rates among WIC participants have lagged behind those of non-WIC mothers for the last 25 years. The Healthy People 2010 goals for breastfeeding will not be reached without intervention. Food package and programmatic changes are needed to make the incentives for breastfeeding greater for WIC participants.
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Affiliation(s)
- Alan S Ryan
- Ross Products Division, Abbott Laboratories, Columbus, OH 43215, USA
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Ahluwalia IB, Morrow B, Hsia J. Why do women stop breastfeeding? Findings from the Pregnancy Risk Assessment and Monitoring System. Pediatrics 2005; 116:1408-12. [PMID: 16322165 DOI: 10.1542/peds.2005-0013] [Citation(s) in RCA: 214] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE We examined breastfeeding behaviors, periods of vulnerability for breastfeeding cessation, reasons for breastfeeding cessation, and the association between predelivery intentions and breastfeeding behaviors. STUDY DESIGN Using 2 years (2000 and 2001) of data from the Pregnancy Risk Assessment and Monitoring System we assessed the percentage of women who began breastfeeding, continued for < 1 week, continued for 1 to 4 weeks, and continued for > 4 weeks and their reasons for not initiating or stopping. Predelivery breastfeeding intentions of women and their relationship with subsequent breastfeeding behaviors were examined also. RESULTS We found that 32% of women did not initiate breastfeeding, 4% started but stopped within the first week, 13% stopped within the first month, and 51% continued for > 4 weeks. Younger women and those with limited socioeconomic resources were more likely to stop breastfeeding within the first month. Reasons for cessation included sore nipples, inadequate milk supply, infant having difficulties, and the perception that the infant was not satiated. Women who intended to breastfeed, thought they might breastfeed, or had ambivalent feelings about breastfeeding were more likely to initiate breastfeeding and to continue through the vulnerable periods of early infancy than were those who did not plan to breastfeed. CONCLUSIONS Our findings indicate a need to provide extensive breastfeeding support after delivery, particularly to women who may experience difficulties in breastfeeding.
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Affiliation(s)
- Indu B Ahluwalia
- Division of Adult and Community Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
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Peters E, Wehkamp KH, Felberbaum RE, Krüger D, Linder R. Breastfeeding duration is determined by only a few factors. Eur J Public Health 2005; 16:162-7. [PMID: 16207725 DOI: 10.1093/eurpub/cki199] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND According to a representative German study prepared between 1996 and 1998 (SuSe-Study) 90% of the mothers were willing to breastfeed, but only 33% (10%) of the babies were exclusively breastfed up to 4 (6) months of age. Bearing in mind that the period currently recommended for breastfeeding is 6 months, this discrepancy highlights the need for action to identify the causes. The present study investigates the behavioural pattern of mothers 4-5 months after delivery. METHODS The investigation was carried out as a cross-sectional study of mothers who intended to breastfeed their babies (n = 52). All mothers delivered in a hospital, with maximum medical care, and were interviewed later by telephone using a semi-standardised questionnaire. The differences between actual breastfeeding mothers (BF, n = 30) and non-breastfeeding mothers (not BF, n = 22) were identified. The factors influencing decision-making were determined. RESULTS Significant differences between the two groups tested (BF and not BF) were identified as the perception of the simplicity of breastfeeding, planned pregnancy, marital status, as well as participation at birth preparation classes. If only factors known prior to birth are applied, the decision to breastfeed can be correctly forecast as being 81%. CONCLUSION In order to allocate consulting resources more effectively, appropriate concepts need to be developed and promoted. If the present results could be verified by a study with a larger sample, the practical use for resource optimisation in breastfeeding consultations would be very beneficial.
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Affiliation(s)
- Elke Peters
- Faculty Life Sciences, University of Applied Sciences Hamburg, Hamburg, Germany.
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James DCS, Dobson B. Position of the American Dietetic Association: Promoting and supporting breastfeeding. ACTA ACUST UNITED AC 2005; 105:810-8. [PMID: 15883562 DOI: 10.1016/j.jada.2005.03.015] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
It is the position of the American Dietetic Association (ADA) that exclusive breastfeeding provides optimal nutrition and health protection for the first 6 months of life, and breastfeeding with complementary foods for at least 12 months is the ideal feeding pattern for infants. Breastfeeding is also a public health strategy for improving infant and child health survival, improving maternal morbidity, controlling health care costs, and conserving natural resources. ADA emphasizes the essential role of dietetics professionals in promoting and supporting breastfeeding by providing up-to-date, practical information to pregnant and postpartum women, involving family and friends in breastfeeding education and counseling, removing institutional barriers to breastfeeding, collaborating with community organizations and others who promote and support breastfeeding, and advocating for policies that position breastfeeding as the norm for infant feeding. ADA also emphasizes its own role by providing up-to-date information to the public, encouraging empirical research, providing continuing education opportunities, providing cultural sensitivity and cultural competence training to dietetics professionals, and encouraging universities to review and update undergraduate and graduate training programs.
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20
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Kang NM, Song Y, Hyun TH, Kim KN. Evaluation of the breastfeeding intervention program in a Korean community health center. Int J Nurs Stud 2005; 42:409-13. [PMID: 15847903 DOI: 10.1016/j.ijnurstu.2004.08.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2004] [Revised: 08/04/2004] [Accepted: 08/29/2004] [Indexed: 11/18/2022]
Abstract
A new model for the breastfeeding intervention program was implemented in a Korean community health center and the effectiveness of the program was evaluated. Thirty health care personnel from 29 smaller community health centers and 23 breastfeeding helpers were trained in four workshops. They then gave information on breastfeeding to pregnant and lactating women, living in each community in groups or individually. The breastfeeding rate after intervention has significantly increased at 1 week and 9 months of age. These results indicate that the community-based breastfeeding intervention program by training both the health care professionals and peer helpers is effective in promoting breastfeeding.
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Affiliation(s)
- Nam-Mi Kang
- Department of Nursing Science, Konkuk University, Chungju, Republic of Korea.
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21
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Grjibovski AM, Yngve A, Bygren LO, Sjöström M. Socio-demographic determinants of initiation and duration of breastfeeding in northwest Russia. Acta Paediatr 2005; 94:588-94. [PMID: 16188748 DOI: 10.1111/j.1651-2227.2005.tb01944.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM This study examines socio-demographic determinants of initiation and duration of breastfeeding in a community-based cohort in northwest Russia. METHODS All infants born to women who were registered at the antenatal clinics in Severodvinsk in 1999 comprised the cohort (n=1399) and were followed up at 1 y. Data on maternal and infant characteristics as well as the duration of breastfeeding were obtained from medical records. Proportional hazard analysis was applied to quantify the effect of the selected factors on the risk of breastfeeding discontinuation adjusted for potential confounders. RESULTS Only 1.3% of infants were never breastfed. Breastfeeding rates were 75.0% and 47.2% at 3 and 6 mo, respectively. Maternal age and early initiation of prenatal care were positively associated with breastfeeding initiation rates. Increased risks of breastfeeding discontinuation were found in teenage mothers (OR=1.45, 95% CI: 1.06-1.99), in mothers with basic education (OR=1.68, 95% CI: 1.06-2.66) and in unmarried mothers (OR=1.19, 95% CI: 1.03-1.38). Women with no previous deliveries were more likely to breastfeed longer (OR=0.74, 95% CI: 0.62-0.90). CONCLUSIONS Compared with previous studies in Russia, almost universal initiation and considerably higher rates of breastfeeding at specific time points were found. Social variations in initiation and duration of breastfeeding should raise concern of inequalities in breastfeeding practices in transitional Russia.
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Affiliation(s)
- Andrej M Grjibovski
- Unit for Preventive Nutrition, Department of Biosciences at Novum, Karolinska Institutet, Huddinge, Sweden
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22
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Khoury AJ, Moazzem SW, Jarjoura CM, Carothers C, Hinton A. Breast-feeding initiation in low-income women: Role of attitudes, support, and perceived control. Womens Health Issues 2005; 15:64-72. [PMID: 15767196 DOI: 10.1016/j.whi.2004.09.003] [Citation(s) in RCA: 96] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2003] [Revised: 07/09/2004] [Accepted: 09/15/2004] [Indexed: 11/15/2022]
Abstract
Despite the documented health and emotional benefits of breast-feeding to women and children, breast-feeding rates are low among subgroups of women. In this study, we examine factors associated with breast-feeding initiation in low-income women, including Theory of Planned Behavior measures of attitude, support, and perceived control, as well as sociodemographic characteristics. A mail survey, with telephone follow-up, of 733 postpartum Medicaid beneficiaries in Mississippi was conducted in 2000. The breast-feeding initiation rate in this population was 38%. Women who were older, white, non-Hispanic, college-educated, married, not certified for the Supplemental Nutrition Program for Women, Infants, and Children, and not working full-time were more likely to breast-feed than formula-feed at hospital discharge. Attitudes regarding benefits and barriers to breast-feeding, as well as health care system and social support, were associated with breast-feeding initiation at the multivariate level. Adding the health care system support variables to the regression model, and specifically support from lactation specialists and hospital nurses, explained the association between breast-feeding initiation and women's perceived control over the time and social constraints barriers to breast-feeding. The findings support the need for health care system interventions, family interventions, and public health education campaigns to promote breast-feeding in low-income women.
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Affiliation(s)
- Amal J Khoury
- Department of Health Services Research, Management, and Policy, University of Florida, Gainesville, Florida, USA.
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Chertok IR, Shoham-Vardi I, Hallak M. Four-month breastfeeding duration in postcesarean women of different cultures in the Israeli Negev. J Perinat Neonatal Nurs 2004; 18:145-60. [PMID: 15214252 DOI: 10.1097/00005237-200404000-00009] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The objective of the study was to increase breastfeeding initiation and duration rates among postcesarean women by implementing a culturally appropriate breastfeeding intervention. This study was a prospective population-based, controlled evaluation of a breastfeeding intervention consisting of 570 Jewish and Muslim postcesarean women who had delivered healthy, term infants at an Israeli hospital. Women in the control group (n = 264) received standard hospital care and women in the intervention group (n = 306) received early, culturally sensitive, postcesarean breastfeeding guidance. Surveys regarding breastfeeding duration practices were conducted at 10 and 16 weeks postpartum. Overall and exclusive 4-month breastfeeding duration rates were significantly higher for the intervention group as compared to the control group for the Jewish women at 10 and 16 weeks postpartum. Since few Muslim women ceased breastfeeding, only exclusive breastfeeding rates were evaluated. At 10 and 16 weeks, significantly more Muslim women in the intervention group were exclusively breastfeeding as compared to the control group, although rates dramatically declined by 16 weeks. Despite the challenges to breastfeeding posed by cesarean delivery, early and appropriate breastfeeding guidance facilitated successful outcomes for both Jewish and Muslim women.
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Affiliation(s)
- Ilana R Chertok
- School of Nursing, University of Washington, BOX 357266, Seattle, WA 98195, USA.
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24
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Forster D, McLachlan H, Lumley J, Beanland C, Waldenström U, Harris H, Earl D, Dyson K. ABFAB. Attachment to the breast and family attitudes to breastfeeding. The effect of breastfeeding education in the middle of pregnancy on the initiation and duration of breastfeeding: a randomised controlled trial [ISRCTN21556494]. BMC Pregnancy Childbirth 2003; 3:5. [PMID: 12946279 PMCID: PMC201032 DOI: 10.1186/1471-2393-3-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2003] [Accepted: 08/29/2003] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND: It has proven difficult to reach World Health Organization (WHO) recommendations that infants be exclusively breastfed from birth to six months of age 12, yet there is limited knowledge about interventions that are effective in increasing breastfeeding initiation and duration. Particularly lacking is evidence about how to maintain breastfeeding rates in countries which already have a high initiation of breastfeeding. This study aims to determine whether mid-pregnancy breastfeeding education, with a focus on either attitudes to breastfeeding or on technical aspects of breastfeeding, has an effect on rates of breastfeeding initiation and duration. Secondary aims of the study are to: explore what factors might affect the duration of breastfeeding and evaluate the interventions from the participant and childbirth facilitator perspectives. METHODS/DESIGN: A randomised controlled trial (RCT) design will be used. Women having their first baby, and planning to give birth as public patients at the Royal Women's Hospital (RWH), Melbourne, will be approached at 18-20 weeks of pregnancy and invited to participate in the study. Participants will be randomly allocated to a control group or one of two group interventions: a previously designed and trialled tool to teach practical aspects of breastfeeding or an exploration of family attitudes to breastfeeding. The latter was developed and piloted by the investigators in conjunction with the group facilitators, prior to trial commencement. The interventions are planned to take place at 20-25 weeks. Data will be collected by questionnaire at recruitment, at interview in hospital after the birth and by telephone interview six months later. Medical/obstetric outcomes will be obtained from the medical record. The sample size (972) was calculated to identify an increase in breastfeeding initiation from 75 to 85% and an increase from 40 to 50% in breastfeeding at six months.
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Affiliation(s)
- Della Forster
- Centre for the Study of Mothers' and Children's Health, La Trobe University, 251 Faraday St, Carlton, 3053, Australia
| | - Helen McLachlan
- Clinical School of Midwifery and Neonatal Nursing Studies, School of Nursing, La Trobe University, 251 Faraday St, Carlton, 3053, Australia
| | - Judith Lumley
- Centre for the Study of Mothers' and Children's Health, La Trobe University, 251 Faraday St, Carlton, 3053, Australia
| | - Christine Beanland
- School of Nursing, Deakin University, 221 Burwood Hwy, Burwood 3125, Australia
| | | | - Heather Harris
- The Royal Women's Hospital, 132 Grattan St, Carlton, 3053, Australia
| | - Diane Earl
- The Royal Women's Hospital, 132 Grattan St, Carlton, 3053, Australia
| | - Kaye Dyson
- The Royal Women's Hospital, 132 Grattan St, Carlton, 3053, Australia
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Haider SJ, Jacknowitz A, Schoeni RF. Welfare work requirements and child well-being: evidence from the effects on breast-feeding. Demography 2003; 40:479-97. [PMID: 12962059 DOI: 10.1353/dem.2003.0023] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
A central theme of welfare reform is that recipients are required to engage in work activities. In many states, these work requirements apply to mothers whose children are a few months old, which may increase the costs and decrease the prevalence of breast-feeding. Given the substantial benefits of breast-feeding, any reduction represents an important negative consequence of these requirements. Our results suggest that in the absence of welfare reform, the national breast-feeding rate six months after birth would have been 5.5% higher in 2000. Such negative consequences of these policies must be weighed against potential benefits as states refine their welfare programs.
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Affiliation(s)
- Steven J Haider
- Department of Economics, Michigan State University, 101 Marshall Hall, East Lansing, MI 48824, USA.
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26
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Oyeku SO. A closer look at racial/ethnic disparities in breastfeeding. Commentary on "Breastfeeding advice given to African American and white women by physicians and WIC counselors". Public Health Rep 2003. [PMID: 12815088 DOI: 10.1016/s0033-3549(04)50265-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Affiliation(s)
- Suzette O Oyeku
- Harvard Pediatric Health Services Research Fellowship Program, Children's Hospital Boston, Boston, MA 02115, USA.
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Ahluwalia IB, Morrow B, Hsia J, Grummer-Strawn LM. Who is breast-feeding? Recent trends from the pregnancy risk assessment and monitoring system. J Pediatr 2003; 142:486-91. [PMID: 12756378 DOI: 10.1067/mpd.2003.199] [Citation(s) in RCA: 60] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To examine breast-feeding initiation and continuation among women with recent live births in 10 states. STUDY DESIGN By using Pregnancy Risk Assessment and Monitoring System surveillance data (n = 96,204), we assessed breast-feeding initiation and continuation for > or =10 weeks among women with recent deliveries from 1993 to 1998. We used 1993 as the base for comparing results by using univariate and multivariate analyses. RESULTS Ten states showed a significant increase of 18% in initiation of breast-feeding from 1993 to 1998, from 57.0% (95% confidence interval [CI], 55.6-58.4) to 67.5% (95% CI, 66.1-68.9). Initiation increased among vulnerable groups such as low-income and black women, participants in the Special Supplemental Nutrition Program for Women, Infants, and Children program, and mothers of infants admitted to the neonatal intensive care unit. The percentage of women predominantly breast-feeding at > or =10 weeks among women who initiated remained stable: 58.5% (95% CI, 56.5-60.5) in 1993 and 57.9% (95% CI, 56.0-59.8) in 1998. More women in vulnerable groups initiated breast-feeding, but those from higher socioeconomic groups continued breast-feeding. CONCLUSIONS Breast-feeding initiation significantly increased, and several states exceeded the year 2010 objective. Breast-feeding continuation among women who initiated remained stable; however, gaps remained, indicating a continued need to implement breast-feeding promotion programs.
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Affiliation(s)
- Indu B Ahluwalia
- Division of Adult and Community Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia 30341, USA.
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28
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Mitra AK, Khoury AJ, Carothers C, Foretich C. Evaluation of a comprehensive loving support program among state Women, Infants, and Children (WIC) program breast-feeding coordinators. South Med J 2003; 96:168-71. [PMID: 12630643 DOI: 10.1097/01.smj.0000053675.41623.15] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Mississippi was selected as a pilot state in the national breastfeeding promotion campaign titled Loving Support Makes Breastfeeding Work (LSMBW). To reinforce the national LSMBW project, the Mississippi Women, Infants and Children (WIC) Breastfeeding Promotion Project Team developed a comprehensive program that included patient and family education, staff training, public awareness activities, health professional outreach, and partnerships with the community. The program also implemented a breastfeeding-friendly clinic environment project and a videotape project. This study was conducted to evaluate the impact of Mississippi's LSMBW activities among WIC breastfeeding coordinators in the United States. METHOD The cross-sectional study was performed with the use of a mailed, self-administered questionnaire. RESULTS Representatives of 50 state WIC agencies returned the survey. Of these 50 agencies, 36 (72%) had effectively used education materials created by the state of Mississippi. Breastfeeding coordinators reported that among the campaign activities, staff training, community outreach, and peer counseling were most beneficial. They also identified the videotape project developed by Mississippi as useful in addressing barriers to breastfeeding and in training support groups, staff, and health care professionals. CONCLUSION This study showed that Mississippi's outreach activities and motivational videotape had a positive impact on coordinators' promotion of breastfeeding.
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Affiliation(s)
- Amal K Mitra
- Center for Community Health, University of Southern Mississippi, Hattiesburg, MS 39406-5122, USA.
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29
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Smith JP, Thompson JF, Ellwood DA. Hospital system costs of artificial infant feeding: estimates for the Australian Capital Territory. Aust N Z J Public Health 2002; 26:543-51. [PMID: 12530799 DOI: 10.1111/j.1467-842x.2002.tb00364.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To estimate the attributable ACT hospital system costs of treating selected infant and childhood illnesses having known associations with early weaning from human milk. METHOD We identified relative risks of infant and childhood morbidity associated with exposure to artificial feeding in the early months of life vs. breastfeeding from cohort studies cited by the American Academy of Pediatrics in 1997 as establishing the protective effect of breastfeeding. Data for ACT breastfeeding prevalence is assessed from a 1997 prospective population-based cohort study of 1,295 women. ACT Hospital Morbidity Data and DRG treatment costs were used to estimate the attributable fraction of costs of hospitalisation for gastrointestinal illness, respiratory illness and otitis media, eczema, and necrotising enterocolitis. RESULTS Although initiation rates were high (92%), less than one in 10 ACT infants are exclusively breastfed for the recommended six months, mainly due to supplementation or weaning on to formula within the first three months and the early introduction of solids by breastfeeding mothers. This study suggests the attributable hospitalisation costs of early weaning in the ACT are about $1-2 million a year for the five illnesses. CONCLUSIONS AND IMPLICATIONS Early weaning from breastmilk is associated with significant hospital costs for treatment of gastrointestinal illness, respiratory illness and otitis media, eczema, and necrotising enterocolitis. These costs are minimum estimates of the cost of early weaning as they exclude numerous other chronic or common illnesses and out-of-hospital health care costs. Higher rates of exclusive breastfeeding would reduce these costs. Interventions to protect and support breastfeeding are likely to be cost-effective for the public health system.
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Affiliation(s)
- Julie P Smith
- National Centre for Epidemiology and Population Health and Research School of Social Sciences, Australian National University, Australian Capital Territory.
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30
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Graham ID, Harrison MB, Brouwers M, Davies BL, Dunn S. Facilitating the use of evidence in practice: evaluating and adapting clinical practice guidelines for local use by health care organizations. J Obstet Gynecol Neonatal Nurs 2002; 31:599-611. [PMID: 12353740 DOI: 10.1111/j.1552-6909.2002.tb00086.x] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
This article describes a framework for evaluating and adapting existing practice guidelines for local use by health care organizations and groups. The framework presents the major issues related to guideline adaptation and breaks them down into manageable steps. Many steps of the framework are illustrated using the process used by the Registered Nurses Association of Ontario to develop best practice guidelines for breastfeeding.
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Affiliation(s)
- Ian D Graham
- Ottawa Health Research Institute, Ottawa Hospital, Ontario, Canada.
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31
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Finch C, Daniel EL. Breastfeeding education program with incentives increases exclusive breastfeeding among urban WIC participants. JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION 2002; 102:981-4. [PMID: 12146564 DOI: 10.1016/s0002-8223(02)90224-5] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Cristin Finch
- Jordan Health Center, Jordan Health Link WIC, Rochester, NY, USA
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32
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Morrow AL, Guerrero ML. From bioactive substances to research on breast-feeding promotion. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2002; 501:447-55. [PMID: 11787715 DOI: 10.1007/978-1-4615-1371-1_56] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
UNLABELLED Despite known health benefits, exclusive breast-feeding for at least 4 months is uncommon in many countries. In Mexico, most mothers initiate breast-feeding but few breast-feed exclusively. OBJECTIVE The objective was to examine the effectiveness of home visits by lay peer counselors to increase exclusive breast-feeding among mothers in a periurban area of Mexico. METHODS An ethnographic assessment conducted in 1994 that identified key maternal beliefs, practices, and needs was used to guide educational strategies. Lay counselors were recruited from the same community and trained by La Leche League. From March 1995 through September 1996, pregnant women were identified by community census and invited to participate. Women were enrolled into a randomized, controlled study of 3 groups: no intervention (control), 3 visits, and 6 visits during pregnancy and early postpartum. Data collection was performed by a social worker apart from the counselors. Exclusive breast-feeding was defined by WHO criteria. RESULTS The study enrolled 130 women; 52 were in the 3-visit group, 44 in the 6-visit group, and 34 in the control group. Study groups did not differ in the maternal characteristics or initiation of breast-feeding (96%). At 3 months postpartum, exclusive breast-feeding was practiced by only 12% of controls vs. 52% in the 3-visit group and 67% in the 6-visit group (P < 0.001, log rank test). In the first 3 months, significantly (P = 0.037) fewer intervention than control infants had an episode of diarrhea (11% vs. 26%, respectively). Intervention effectiveness was independent of maternal factors or birth hospital. CONCLUSIONS This unique experimental study demonstrated a dramatic increase in exclusive breast-feeding and a significant reduction in infant illness in an urban community through well-designed maternal support including early intervention and repeated contact.
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Affiliation(s)
- A L Morrow
- Center for Pediatric Research, Eastern Virginia Medical School, Children's Hospital of The King's Daughters, Norfolk 23510, USA
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33
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Pugh LC, Milligan RA, Frick KD, Spatz D, Bronner Y. Breastfeeding duration, costs, and benefits of a support program for low-income breastfeeding women. Birth 2002; 29:95-100. [PMID: 12000411 DOI: 10.1046/j.1523-536x.2002.00169.x] [Citation(s) in RCA: 100] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Breastfeeding can ameliorate some of the complex health issues faced by low-income families. Women who breastfeed and their infants have lower health care costs compared with those who formula feed. Increasing the duration of breastfeeding is recognized as a national priority, particularly for low-income women. This community-based randomized clinical trial involving low-income mothers compared usual care with an intervention comprising hospital and home visits, and telephone support by a community health nurse/peer counselor team for 6 months after delivery. METHODS Forty-one women were recruited after delivery of a full-term singleton infant and randomly assigned to intervention or usual care groups. RESULTS Women receiving the community health intervention breastfed longer than the women receiving usual care. The infants in the intervention group had fewer sick visits and reported use of fewer medications than infants in the usual care group. The intervention cost ($301/mother) was partially offset by cost savings on formula and health care. CONCLUSIONS Community health nurse and peer counselor support can increase breastfeeding duration in low-income women, and has the potential to reduce total costs including the cost of support.
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Affiliation(s)
- Linda C Pugh
- Johns Hopkins University, School of Nursing, Baltimore, Maryland 21205, USA
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34
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Walker M. Expanding breastfeeding promotion and support in the Special Supplemental Nutrition Program for Women, Infants and Children (WIC). J Hum Lact 2002; 18:115-24. [PMID: 12033072 DOI: 10.1177/089033440201800202] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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35
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Burney J, Haughton B. EFNEP: a nutrition education program that demonstrates cost-benefit. JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION 2002; 102:39-45. [PMID: 11794500 DOI: 10.1016/s0002-8223(02)90014-3] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Data on the economic value of nutrition education programs, such as the Expanded Food and Nutrition Education Program (EFNEP), can help decision makers choose among alternative programs based on costs and benefits. A cost-benefit analysis of EFNEP was conducted to determine if participants' savings in food expenditures exceeded program implementation costs. DESIGN/SUBJECTS Costs were collected over 6 months using expenditure reports and other records. Benefits were determined using prospective data from 371 women enrolled in EFNEP who completed a 24-hour food recall and behavior survey, and recorded the amount of money spent monthly on food at program entry and exit. Two treatment groups received nutrition education and one group did not receive education. One treatment group estimated food expenditures from recall and the other collected register receipts or recorded expenditures. Control group subjects reported expenditures from recall. Net present value (NPV) was calculated using mean EFNEP cost per participant subtracted from the mean change in family food expenditures per participant over a 5-year period at three discount rates. STATISTICAL ANALYSES Analysis was designed to compare food expenditures among the two experimental groups and control group and food and nutrient intakes and survey scores between the combined experimental group and control group. RESULTS The average EFNEP program cost perparticipant was $388, and graduating participants reported that family food expenditures decreased on average by $10 to $20 per month or $124 to $234 over a year. When benefits were projected to last 5 years, the NPV was $147 to $696 depending on the method of food expenditure estimation and the discount rate. At the same time individuals reduced food expenditures, they increased intakes of iron, vitamin C, vitamin B-6, and fiber. They added less salt when cooking and read nutrition labels more often. They also reported not running out of food at the end of the month as often. APPLICATIONS/CONCLUSIONS Findings from this research showed that EFNEP is cost-beneficial. The magnitude of the savings in food expenditures is sensitive to the method of food expenditure reporting and assumptions about how long participants will retain the behaviors they learn.
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Affiliation(s)
- Janie Burney
- Tennessee Agricultural Extension Service, The University of Tennessee, Knoxville, USA.
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36
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Bonuck K, Arno PS, Memmott MM, Freeman K, Gold M, McKee D. Breast-feeding promotion interventions: good public health and economic sense. J Perinatol 2002; 22:78-81. [PMID: 11840248 DOI: 10.1038/sj.jp.7210620] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The health benefits of breast-feeding are well documented, as are the positive effects of breast-feeding promotion interventions. There is a clear dose-response relationship between breast-feeding and infant health in the first year of life, and beyond. Further, nearly all breast-feeding promotion interventions improve--at least minimally--breast-feeding initiation and duration rates. However, the extent to which the costs of such interventions might be offset by the potential health care cost savings during the infant's first year of life has not been examined. From a health policy perspective, such an economic analysis is indicated.
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Affiliation(s)
- Karen Bonuck
- Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York, USA
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Abstract
Sociodemographic and economic changes in Spain have played a role in the choice of infant feeding as more and more women enter the workforce. Nevertheless, the prevalence of breast-fed-only infants at 6 weeks remains fairly high, at 65.5% in 1999, although there is a sharp decline by 3 and 6 months postpartum. Achieving adequate nutritional status for lactation principally begins during pregnancy, as this constitutes the biological stage for accumulating nutrient stores. The benefits of breast-feeding for the mother and infant are presented, along with nutrition and dietary guidelines for the nursing woman. Apart from dietary considerations, special attention should be paid to encouraging a positive attitude and environment for breast-feeding success.
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Affiliation(s)
- P Cervera
- Centre d'Ensenyament Superior de Nutrició i Dietètica (CESNID), University of Barcelona, Santa Coloma de Gramenet, Spain.
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38
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Position of the American Dietetic Association: breaking the barriers to breastfeeding. JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION 2001; 101:1213-20. [PMID: 11678497 DOI: 10.1016/s0002-8223(01)00298-x] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
It is the position of the American Dietetic Association (ADA) that broad-based efforts are needed to break the barriers to breastfeeding initiation and duration. Exclusive breastfeeding for 6 months and breastfeeding with complementary foods for at least 12 months is the ideal feeding pattern for infants. Increases in initiation and duration are needed to realize the health, nutritional, immunological, psychological, economical, and environmental benefits of breastfeeding. Breastfeeding initiation rates have increased, but cultural barriers to breastfeeding, especially against breastfeeding for 6 months and longer, still exist. Gaps in rates of breastfeeding based on age, race, and socioeconomic status remain. Children benefit from the biologically unique properties of human milk including protection from illness with resulting economic benefits. Mother's benefits include reduced rates of premenopausal breast and ovarian cancers. Appropriate lactation management is a critical component of successful breastfeeding for healthy women. Lactation support and management is even more important in women and children with special needs caused by physical or developmental disability, disease, or limited resources. Dietetics professionals have a responsibility to support breastfeeding through appropriate education and training, advocacy, and legislative action; through collaboration with other professional groups; and through research to eliminate the barriers to breastfeeding.
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Philipp BL, Merewood A, Miller LW, Chawla N, Murphy-Smith MM, Gomes JS, Cimo S, Cook JT. Baby-friendly hospital initiative improves breastfeeding initiation rates in a US hospital setting. Pediatrics 2001; 108:677-81. [PMID: 11533335 DOI: 10.1542/peds.108.3.677] [Citation(s) in RCA: 193] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Breastfeeding initiation rates were compared at Boston Medical Center before (1995), during (1998), and after (1999) Baby-Friendly policies were in place. Boston Medical Center, an inner-city teaching hospital that provides care primarily to poor, minority, and immigrant families, achieved Baby-Friendly status in 1999. METHODS Two hundred complete medical records, randomly selected by a computer, were reviewed from each of 3 years: 1995, 1998, and 1999. Infants were excluded for medical records missing feeding data, human immunodeficiency virus-positive parent, neonatal intensive care unit admission, maternal substance abuse, adoption, incarceration, or hepatitis C-positive mother. All infant feedings during the hospital postpartum stay were tallied, and each infant was categorized into 1 of 4 groups: exclusive breast milk, mostly breast milk, mostly formula, and exclusive formula. RESULTS Maternal and infant demographics for all 3 years were comparable. The breastfeeding initiation rate increased from 58% (1995) to 77.5% (1998) to 86.5% (1999). Infants exclusively breastfed increased from 5.5% (1995) to 28.5% (1998) to 33.5% (1999). Initiation rates increased among US-born black mothers in this population from 34% (1995) to 64% (1998) to 74% (1999). CONCLUSIONS Full implementation of the Ten Steps to Successful Breastfeeding leading to Baby-Friendly designation is an effective strategy to increase breastfeeding initiation rates in the US hospital setting.
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Affiliation(s)
- B L Philipp
- Department of Pediatrics, Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts 02118, USA.
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Yngve A, Sjöström M. Breastfeeding in countries of the European Union and EFTA: current and proposed recommendations, rationale, prevalence, duration and trends. Public Health Nutr 2001; 4:631-45. [PMID: 11683556 DOI: 10.1079/phn2001147] [Citation(s) in RCA: 100] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
UNLABELLED Recommendations suggest exclusive breast feeding for at least the first 4 to 6 months after birth. Paradoxically, an overwhelming proportion of breast feeding (BF) data in Europe refers to all BF, i.e. not only exclusive but also partial BF (including formula, juices, water, sweetened water etc). This makes it difficult to estimate to what extent the recommendations are met. There is currently strong evidence for recommending exclusive breast feeding for at least 6 months. Exclusive BF has progressively gained scientific support. Prevention of infections, allergies and chronic diseases and a favourable cognitive development are highlighted in the recent scientific literature. Further long-term studies on the effects of BF on prevention of chronic disease in the adult are needed. Great differences exist in BF prevalence and duration both within and between European countries. Trends point towards higher prevalence and duration, with some exceptions. Young mothers breast feed less than older mothers; single and/or less educated mothers breast feed less than married mothers with more education. However, inefficient and unreliable monitoring systems prevail, and the data are scarce, not only on exclusive BF but also on demographic, socio-economic, psychosocial and medical determinants of BF patterns. National BF coordinators have not been appointed in many countries, and only every second country has promotion of BF incorporated into their national plan of action for nutrition. CONCLUSIONS Efficient surveillance systems, comparable across Europe and using common definitions and methodology, need to be developed. These should include determinants of breast feeding. A European consensus conference should urgently be organised, in which strategies for successful promotion of exclusive BF should be particularly considered. There is now strong evidence for a recommendation to breast feed exclusively for about 6 months, which is more than the duration recommended previously.
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Affiliation(s)
- A Yngve
- Department of Biosciences, Karolinska Institutet, Stockholm County Council, Stockholm.
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Abstract
Although breastfeeding is well accepted as the optimal method of infant feeding, the US failed to reach the goals set for the year 2000. Support from employers, health insurers, health providers, and society are required to reach the goals set forth in Healthy People 2010-75% of mothers initiate breastfeeding, 50% of infants still receive breast milk at 6 months, and 25% of infants are still breastfed at 1 year of age. In today's era of cost accountability and economic competition, these groups likely will desire information regarding the financial effects of breastfeeding and breastfeeding promotion from their perspectives. Although much research still is needed in this area, evidence suggests that a significant return on investment is likely with breastfeeding promotion. Also, the finances of health care must be viewed within the concept of value. In health care, value can be thought of as the cost required to achieve a specified outcome. In lay terms, this can be thought of as "how much bang we get for our buck." Breastfeeding clearly improves the health of infants and mothers and seems to result in cost savings for parents, insurers, employers, and society, which means that the medical and economic value of breastfeeding is high. To reap the health and economic benefits associated with breastfeeding, society must support breastfeeding promotion, which most likely will necessitate a coordinated US breastfeeding program. The US government is in a unique position to accomplish this goal as it views the associated costs from the joint perspectives of employer, health insurer, medical provider, and society. Through support of such a program, the US government likely will benefit significantly by improving the health of children and its financial bottom line.
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Affiliation(s)
- T M Ball
- Department of Pediatrics and Steele Memorial Research Center, University of Arizona, Tucson, Arizona, USA.
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Ahluwalia IB, Tessaro I, Grummer-Strawn LM, MacGowan C, Benton-Davis S. Georgia's breastfeeding promotion program for low-income women. Pediatrics 2000; 105:E85. [PMID: 10835098 DOI: 10.1542/peds.105.6.e85] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Beginning in 1990, Georgia's Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) initiated 5 new strategies to promote breastfeeding among its pregnant and postpartum clients. These strategies were implemented in 1991, each to be provided as an addition to its standard program of counseling on breastfeeding and distributing appropriate literature: 1) enhanced breastfeeding education, 2) breast pump loans, 3) hospital-based programs, 4) peer counseling, and 5) community coalitions. The enhanced breastfeeding education strategy provides access to a hotline as well as periodic training of staff, and the breast pump loan provides free breast pumps to mothers who want to use them. The hospital-based strategy provides bedside support and counseling to women who have just given birth and includes staff training, as well as a hotline number for women to call after they leave the hospital. The peer-counseling strategy focuses on identifying former WIC participants who have successfully breastfed their infants; these women are recruited to provide support and encouragement to current WIC participants. Finally, the community coalitions approach is designed to identify existing community attitudes about breastfeeding, establish plans to address gaps in breastfeeding services, to develop resource guides on breastfeeding for the community, and to advocate at the community level to support breastfeeding women. The objective of our research was to evaluate the impact of breastfeeding promotion strategies on breastfeeding initiation among WIC participants in Georgia. METHODS Using data from the Pregnancy Nutrition Surveillance System (PNSS) for 1992-1996, we examined breastfeeding initiation rate during this period and compared rates among 6 different intervention strategies. Also, we used data from the Pregnancy Risk Assessment Monitoring System (PRAMS) to assess breastfeeding initiation and duration among WIC enrollees. We conducted 13 focus groups to understand the experiences of program participants. Ten focus groups were conducted with women who were breastfeeding their infants, 3 each with women from the community coalitions, hospital-based programs, and standard education programs, and 1 with women from the breast pump loan program. Three focus groups were conducted with women who were feeding their infants formula. RESULTS PNSS data show that breastfeeding initiation increased in the Georgia WIC program from 31.6% in 1992 to 39.5% in 1996. PRAMS data confirmed the increase in breastfeeding initiation from 33.6% (standard error [SE]: 2.2) in 1993 to 42.1% (SE: 2.4) in 1996 among WIC participants. Both datasets (PRAMS and PNSS) showed breastfeeding initiation to be well below the year 2000 goal of 75%. Overall, PRAMS data show a high breastfeeding initiation among non-WIC participants (range: 64.7% [SE: 2.2]) for 1994 to 70.1% (SE: 2.2) in 1996. The percent change between 1993 and 1996 was 8% for non-WIC participants, and it was 25% for the WIC participants among those responding to the PRAMS questionnaire. Data from PRAMS indicated no statistical change in the percentage of WIC enrollees who breastfed their infants for 8 weeks or more; this estimate was 18.3% (95% confidence interval (CI): 14.9-21.8) in 1993 and 19.4% (95% CI: 15.7-23.2) in 1996, well below the Healthy People 2000 objective of 50% at 6 months. According to PNSS data, the largest increases in breastfeeding initiation for 1992 to 1996 were among younger women (</=19 and 20-24 years old), those with no college (less than high school and high school only), unmarried, and black women (see Table 1). The smallest increases during this period were among older women (30+), those with more than a high school education, and women who were white, Hispanic, or from other ethnic or racial groups. The PRAMS data (1993-1996) generally display similar results, but the pattern by marital status demonstrated larger increases for married women than for unmarried women.
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Affiliation(s)
- I B Ahluwalia
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA 30341-3724, USA.
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Affiliation(s)
- C R Tuttle
- Department of Nutrition and Food Science, 3304 Marie Mount Hall, University of Maryland, College Park, MD 20742, USA
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Mozingo JN, Davis MW, Droppleman PG, Merideth A. "It wasn't working. " Women's experiences with short-term breastfeeding. MCN Am J Matern Child Nurs 2000; 25:120-6. [PMID: 10810844 DOI: 10.1097/00005721-200005000-00004] [Citation(s) in RCA: 99] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To investigate the lived experiences of women who initiate breastfeeding but stop within the first 2 weeks after birth. DESIGN Phenomenology. METHODS Interviews were recorded on audio tape, transcribed verbatim, and analyzed for themes by an interdisciplinary group of researchers. RESULTS Women described a clash or incongruity between highly idealized expectations and early breastfeeding problems. This led to incremental disillusionment and cessation of breastfeeding attempts. Women spoke poignantly about a sense of failure, guilt, or shame and had lingering self-doubts about not continuing with breastfeeding. CLINICAL IMPLICATIONS Women need more accurate information about the process of initiating breastfeeding. Nurses should avoid teaching breastfeeding practices that can confuse infants and sabotage mothers and should work toward providing sensitive care that respects personal boundaries of mothers. Additionally, provisions need to be made for continued support and consultation after the mother's discharge from the hospital or birthing center. Finally, nurses and other health professionals should understand that women who stop breastfeeding at an early date may feel guilty about doing so, and may need assistance in resolving feelings about having made that choice.
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Affiliation(s)
- J N Mozingo
- University of Tennessee, Knoxville, College of Nursing 37996-4180, USA.
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Horswill LJ, Yap C. Consumption of foods from the WIC food packages of Chinese prenatal patients on the US west coast. JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION 1999; 99:1549-53. [PMID: 10608949 DOI: 10.1016/s0002-8223(99)00379-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To assess consumption of foods from food packages provided by the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) among 80 Chinese prenatal WIC recipients living in Oakland or San Francisco, Calif. DESIGN During a single interview, a food frequency questionnaire was used to assess WIC food consumption by the prenatal patients for the period before and after receipt of WIC vouchers. SETTING The study was conducted at Asian Health Services, Oakland, and the Chinatown Public Health Center of the San Francisco Department of Public Health in California. SUBJECTS Eighty low-income Chinese prenatal women with limited education and limited ability to speak English, aged 21 to 43 years, with gestational stages of 15 to 38 weeks. STATISTICAL ANALYSES PERFORMED Descriptive statistics (frequency and percent distribution) were used to report the findings of the study. RESULTS Subjects reported that before receiving WIC vouchers, milk, eggs, and juice were the only foods in their WIC food package that had been consumed frequently (> 5 times/week) in their daily diet. Other WIC foods, including cheese, peanut butter, dried beans, and hot and cold cereals, were consumed infrequently (0 to 1 time/month). Subjects reported that with the availability of WIC vouchers, milk, eggs, and juice remained frequently consumed with 81% to 100% of monthly supply as the most prevalent reported consumption rate. Dried beans and hot and cold cereals were also consumed frequently. Cheese remained poorly consumed (0% to 20% of the monthly supply). As many as 74 of 80 subjects stated that they had shared foods from their own WIC package, except milk, with their families. The use of any WIC foods provided to other children in the family was not assessed in this study. APPLICATIONS Data from this study indicate that most WIC foods were well used by Chinese prenatal patients. The most notable exception was cheese, which was poorly consumed. The ready consumption of milk by pregnant Chinese WIC recipients in this study suggests that milk may be readily consumed by these women, even though it is atypical of the Asian diet. The WIC food package for Chinese prenatal patients may be improved by omitting cheese and substituting more milk and/or foods such as tofu and dark green leafy vegetables.
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Affiliation(s)
- L J Horswill
- Department of Nutrition, Finch University of Health Sciences, Chicago Medical School, North Chicago, Ill., USA
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Schanler RJ, O'Connor KG, Lawrence RA. Pediatricians' practices and attitudes regarding breastfeeding promotion. Pediatrics 1999; 103:E35. [PMID: 10049991 DOI: 10.1542/peds.103.3.e35] [Citation(s) in RCA: 121] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Public awareness of the benefits of breastfeeding is expected to increase during and after the national, federally funded Best Start Breastfeeding Promotion Campaign. It is anticipated that this will result in more breastfeeding-based interactions between families and pediatricians. The American Academy of Pediatrics conducted a survey of its members to identify their educational needs regarding breastfeeding to assist in the design of appropriate information programs. METHOD An eight-page, self-administered questionnaire was sent to 1602 active Fellows of the American Academy of Pediatrics. RESULTS The response rate was 71%. Breastfeeding, as the exclusive feeding practice for the first month after birth, was recommended by only 65% of responding pediatricians; only 37% recommended breastfeeding for 1 year. A majority of pediatricians agreed with or had a neutral opinion about the statement that breastfeeding and formula-feeding are equally acceptable methods for feeding infants. Reasons given for not recommending breastfeeding included medical conditions with known treatments that did not preclude breastfeeding. The majority of pediatricians (72%) were unfamiliar with the contents of the Baby-Friendly Hospital Initiative. The majority of pediatricians had not attended a presentation on breastfeeding management in the previous 3 years; most said they wanted more education on breastfeeding management. CONCLUSION Pediatricians have significant educational needs in the area of breastfeeding management.
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Affiliation(s)
- R J Schanler
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas 77030-2600, USA
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Abstract
The objective of the study was to ascertain the nature of health professional contacts related to breastfeeding for 341 women. Subjects were prospectively queried by phone or home visit over a 20-week period regarding the number and nature of contacts with health care professionals related to breastfeeding. Lactation consultants gave significantly more positive encouragement (98%) (p = .01) than either nurses (75%) or physicians (68%) did. However, of the 233 health provider contacts that included breastfeeding advice, only 21% involved lactation consultants. Primiparae were likely to decrease their level of breastfeeding if a health professional encouraged supplemental foods (39%) or weaning (86%) during the prior week. Multiparae who were experienced at breastfeeding (3+ weeks breastfeeding the previous infant) decreased their breastfeeding slowly across the weeks with the current infant, and their level of breastfeeding in general appeared independent of health care provider advice. Multiparae who lacked previous sustained breastfeeding experience (0-3 weeks) had the most rapid decrease (65%) in their breastfeeding rates even with health care provider encouragement to continue. Thus, they too appeared to act independently of health care provider advice.
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Naglak M, Mitchell DC, Kris-Etherton P, Harkness W, Pearson TA. What to consider when conducting a cost-effectiveness analysis in a clinical setting. JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION 1998; 98:1149-54. [PMID: 9787721 DOI: 10.1016/s0002-8223(98)00266-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
More data are needed providing strong evidence that nutrition services are cost-effective. Economic evaluations, such as cost-effectiveness analyses, are excellent practice-based research projects. We conducted a cost-effectiveness analysis in a clinical setting to compare the cost-effectiveness of lipid-lowering medications plus diet therapy (medication + diet) with diet therapy alone (diet alone) for treating patients with hypercholesterolemia. Twenty-five adults with hypercholesterolemia (13 receiving medication + diet, 12 receiving diet alone) either participated in an 8-week, home-based, step 1 intervention or were counseled about diet and lifestyle by their care provider. Diet, cost, and laboratory data were collected at baseline, at 9 months, and at 19 months after participation in the intervention (follow-up). Cost per unit change in outcome was evaluated for each group. The diet-alone group made only small changes in dietary intake, changes that were smaller in magnitude than those made by the medication + diet group. Nevertheless, at 9 months, costs per unit change in total serum cholesterol level and low-density lipoprotein cholesterol (LDL-C) level were approximately $24 and $83 less, respectively, for the diet-alone group. At follow-up, however, the cost per unit change in LDL-C level was approximately $17 less for the medication + diet group, which can be explained by the medication + diet group's greater decrease in LDL-C level. The following elements should be considered when conducting a cost-effectiveness analysis of medical nutrition therapy: effectiveness of the nutrition intervention, adequate sample size, confounding variables, compliance with diet and drug therapy, direct and indirect costs of care, and follow-up evaluation.
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Affiliation(s)
- M Naglak
- Department of Health, West Chester University, Pa., USA
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Abstract
This policy statement on breastfeeding replaces the previous policy statement of the American Academy of Pediatrics, reflecting the considerable advances that have occurred in recent years in the scientific knowledge of the benefits of breastfeeding, in the mechanisms underlying these benefits, and in the practice of breastfeeding. This document summarizes the benefits of breastfeeding to the infant, the mother, and the nation, and sets forth principles to guide the pediatrician and other health care providers in the initiation and maintenance of breastfeeding. The policy statement also delineates the various ways in which pediatricians can promote, protect, and support breastfeeding, not only in their individual practices but also in the hospital, medical school, community, and nation.
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