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Ajetunmobi O, McIntosh E, Stockton D, Tappin D, Whyte B. Levelling up health in the early years: A cost-analysis of infant feeding and healthcare. PLoS One 2024; 19:e0300267. [PMID: 38776279 PMCID: PMC11111004 DOI: 10.1371/journal.pone.0300267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Accepted: 02/25/2024] [Indexed: 05/24/2024] Open
Abstract
BACKGROUND Although breastfeeding is recommended as the optimal form of nutrition in the first six months, it is not sustained as the predominant mode of feeding infants in Scotland. This study estimated the impact of infant feeding choices on primary and secondary healthcare service costs in a 13-year birth cohort. METHOD Using linked administrative datasets, in a retrospective cohort design of 502,948 singletons born in Scotland between 1997 and 2009, we estimated the cost of GP consultations and hospital admissions by area deprivation and mode of infant feeding up to 6-8 weeks for ten common childhood conditions from birth to 27 months. Additionally, we calculated the potential healthcare savings if all infants in the cohort had been exclusively breastfed at 6-8 weeks. Discounting of 1.5% was applied following current health economic conventions and 2009/10 used as the base year. RESULTS Over the study period, the estimated cost of hospital admissions in the cohort was £111 million and £2 million for the 2% subset of the cohort with primary care records. Within each quintile of deprivation, exclusively breastfed infants used fewer healthcare services and incurred lower costs compared to infants fed (any) formula milk. At least £10 million of healthcare costs may have been avoided if formula-fed infants had been exclusively breastfed within the first 6-8 weeks of birth. CONCLUSIONS This study using a representative birth cohort demonstrates how breastmilk can promote equitable child health by reducing childhood illness and healthcare utilisation in the early years.
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Affiliation(s)
- Omotomilola Ajetunmobi
- Public Health Scotland (Formerly Information Services Division, NHS National Services Scotland), Edinburgh, Scotland, United Kingdom
| | - Emma McIntosh
- Health Economics and Health Technology Assessment, School of Health and Wellbeing, University of Glasgow, Glasgow, Scotland, United Kingdom
| | - Diane Stockton
- Public Health Scotland (Formerly NHS Health Scotland), Edinburgh, Scotland, United Kingdom
| | - David Tappin
- Child Health, School of Medicine, Dentistry & Nursing, University of Glasgow, Glasgow, United Kingdom
| | - Bruce Whyte
- Glasgow Centre for Population Health, Glasgow, Scotland, United Kingdom
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2
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Boedker I, Ball HL, Richter M, South TL, Roberts SGB. Construction of the Views oN Infant Sleep (VNIS) Questionnaire. Early Hum Dev 2024; 191:105989. [PMID: 38513547 DOI: 10.1016/j.earlhumdev.2024.105989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 03/14/2024] [Accepted: 03/14/2024] [Indexed: 03/23/2024]
Abstract
Parents' beliefs about infant sleep behaviour vary over time and across cultures. No validated instrument exists to understand parents' pre- and postnatal views on infant sleep behaviours, which may influence their caregiving decisions. The Views oN Infant Sleep Questionnaire (VNIS) will be a tool to assess parents' beliefs in order to facilitate tailored perinatal care, increase the reliability of postnatal self-report measures, allow for cross-cultural comparisons, and provide a baseline for researchers to use in longitudinal studies. We recruited an online sample of 971 female participants who were resident in the United Kingdom, at least 28 weeks pregnant, and at least 18 years of age. The initial questionnaire consisted of 31 questions about infant independence, night-waking, infant feeding, touch, and safety, and items were rated on a 5-point Likert scale. The item pool was reduced to 12 using principal component analysis and a structure was found for the three components "Closeness", "Independence", and "Night-waking". Overall, these results suggest that the VNIS can provide a brief scale to measure different aspects of individuals' beliefs about infant sleep. In further research the VNIS needs to be validated with a confirmatory factor analysis in another sample, and to be tested as a cross-cultural instrument.
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Affiliation(s)
- Ingrid Boedker
- School of Psychology, Liverpool John Moores University, Liverpool, United Kingdom.
| | - Helen L Ball
- Department of Anthropology, Durham University, Durham, United Kingdom
| | - Michael Richter
- School of Psychology, Liverpool John Moores University, Liverpool, United Kingdom
| | - Tina L South
- School of Nursing and Allied Health, Liverpool John Moores University, Liverpool, United Kingdom
| | - Sam G B Roberts
- School of Psychology, Liverpool John Moores University, Liverpool, United Kingdom
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3
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Turner SE, Brockway M, Azad MB, Grant A, Tomfohr-Madsen L, Brown A. Breastfeeding in the pandemic: A qualitative analysis of breastfeeding experiences among mothers from Canada and the United Kingdom. Women Birth 2023:S1871-5192(23)00015-X. [PMID: 36669903 DOI: 10.1016/j.wombi.2023.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 01/12/2023] [Accepted: 01/12/2023] [Indexed: 01/20/2023]
Abstract
BACKGROUND Previous research shows that the COVID-19 pandemic resulted in both barriers and facilitators to breastfeeding. However, little research has looked specifically at first-time mothers' experiences of breastfeeding during the pandemic or compared experiences of mothers living in different countries. AIM This research explores mothers' breastfeeding experiences to describe how the COVID-19 pandemic has affected breastfeeding journeys in Canada and the United Kingdom. METHODS Ten semi-structured online interviews were undertaken with first-time mothers who breastfed their baby at least once during the COVID-19 pandemic and are living in Canada or the United Kingdom. Interview transcripts were coded inductively using thematic analysis. FINDINGS One overarching theme (all on mother) and four sub-themes were identified: 1) accessing and advocating for health care, 2) social support, 3) becoming a mother in isolation, and 4) breastfeeding baby. Similar themes were constructed for both countries. DISCUSSION Mothers reported that diminished health care and social support created challenges in their breastfeeding journey. Many mothers reported receiving virtual breastfeeding support, which was largely experienced as unhelpful. Some mothers reported fewer distractions from visitors and more one-on-one time with their infant, which helped them to establish breastfeeding and a strong mother-infant bond. CONCLUSION In both Canada and the United Kingdom, new mothers need consistent, reliable health care and social support when breastfeeding. This study supports the need to protect breastfeeding support in the midst of a global emergency and beyond to ensure positive breastfeeding experiences for both mother and baby.
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Affiliation(s)
- Sarah E Turner
- Children's Hospital Research Institute of Manitoba, 715 McDermot Ave, Winnipeg, Manitoba R3E 3P4, Canada; Manitoba Interdisciplinary Lactation Center (MILC), 715 McDermot Ave, Winnipeg, Manitoba R3E 3P4, Canada; Department of Community Health Sciences, University of Manitoba, 750 Bannatyne Avenue, Winnipeg, Manitoba R3E 0W3, Canada.
| | - Meredith Brockway
- Faculty of Nursing, University of Calgary, 2259 2800, Professional Faculties, University Way NW, Calgary, Alberta T2N 4V8, Canada
| | - Meghan B Azad
- Children's Hospital Research Institute of Manitoba, 715 McDermot Ave, Winnipeg, Manitoba R3E 3P4, Canada; Manitoba Interdisciplinary Lactation Center (MILC), 715 McDermot Ave, Winnipeg, Manitoba R3E 3P4, Canada; Department of Community Health Sciences, University of Manitoba, 750 Bannatyne Avenue, Winnipeg, Manitoba R3E 0W3, Canada; Department of Pediatrics and Child Health, University of Manitoba, 840 Sherbrook St, Winnipeg, Manitoba R3A 1S1, Canada
| | - Aimee Grant
- Centre for Lactation, Infant Feeding and Translation (LIFT), Swansea University, University Singleton Park Campus, Haldane Building, Sketty, Swansea SA2 8PP, United Kingdom; School of Health and Social Care, Swansea University, University Singleton Park Campus, Haldane Building, Sketty, Swansea SA2 8PP, United Kingdom
| | - Lianne Tomfohr-Madsen
- Department of Educational and Counselling Psychology, and Special Education, University of British Columbia, 2125 Main Mall, Vancouver, BC V6T 1Z4, Canada
| | - Amy Brown
- Centre for Lactation, Infant Feeding and Translation (LIFT), Swansea University, University Singleton Park Campus, Haldane Building, Sketty, Swansea SA2 8PP, United Kingdom; School of Health and Social Care, Swansea University, University Singleton Park Campus, Haldane Building, Sketty, Swansea SA2 8PP, United Kingdom
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4
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Grant A, Pell B, Copeland L, Brown A, Ellis R, Morris D, Williams D, Phillips R. Views and experience of breastfeeding in public: A qualitative systematic review. MATERNAL & CHILD NUTRITION 2022; 18:e13407. [PMID: 35914544 PMCID: PMC9480936 DOI: 10.1111/mcn.13407] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 06/23/2022] [Accepted: 06/24/2022] [Indexed: 12/02/2022]
Abstract
Breastfeeding rates in many Global North countries are low. Qualitative research highlights that breastfeeding in public is a particular challenge, despite mothers often having the legal right to do so. To identify barriers and facilitators, we systematically searched the qualitative research from Organisation for Economic Co-operation and Development countries relating to breastfeeding in public spaces from 2007 to 2021. Data were analysed using the Thematic Synthesis technique. The review was registered with PROSPERO (registration number: CRD42017081504). Database searching identified 3570 unique records. In total, 74 papers, theses, or book chapters, relating to 71 studies, were included, accounting for over 17,000 mothers. Overall, data quality was high. Our analysis identified that five core factors influenced mothers' thought processes and their breastfeeding in public behaviour: legal system; structural (in)equality; knowledge; beliefs and the social environment. Macro-level factors relating to legislation and inequality urgently require redress if breastfeeding rates are to be increased. Widespread culture change is also required to enhance knowledge, change hostile beliefs and thus the social environment in which mother/infant dyads exist. In particular, the sexualisation of breasts, disgust narratives and lack of exposure among observers to baby-led infant feeding patterns resulted in beliefs which created a stigmatising environment. In this context, many mothers felt unable to breastfeed in public; those who breastfed outside the home were usually highly self-aware, attempting to reduce their exposure to conflict. Evidence-based theoretically informed interventions to remove barriers to breastfeeding in public are urgently required.
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Affiliation(s)
- Aimee Grant
- Centre for Trials ResearchCardiff UniversityCardiffUK
- Centre for Lactation, Infant Feeding and Translational ResearchSwansea UniversitySwanseaUK
| | - Bethan Pell
- Centre for Trials ResearchCardiff UniversityCardiffUK
- DECIPHerCardiff UniversityCardiffUK
| | - Lauren Copeland
- DECIPHerCardiff UniversityCardiffUK
- Division of Population MedicineCardiff UniversityCardiffUK
| | - Amy Brown
- Centre for Lactation, Infant Feeding and Translational ResearchSwansea UniversitySwanseaUK
| | - Rebecca Ellis
- Centre for Lactation, Infant Feeding and Translational ResearchSwansea UniversitySwanseaUK
| | - Delyth Morris
- Subject Librarian, Dental and MedicineCardiff UniversityCardiffUK
| | | | - Rhiannon Phillips
- Division of Population MedicineCardiff UniversityCardiffUK
- Cardiff School of Sport and Health SciencesCardiff Metropolitan UniversityCardiffUK
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Kwan J, Jia J, Yip KM, So HK, Leung SSF, Ip P, Wong WHS. A mixed-methods study on the association of six-month predominant breastfeeding with socioecological factors and COVID-19 among experienced breastfeeding women in Hong Kong. Int Breastfeed J 2022; 17:40. [PMID: 35597945 PMCID: PMC9123774 DOI: 10.1186/s13006-022-00484-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 05/10/2022] [Indexed: 02/01/2023] Open
Abstract
Background In the past decade, various breastfeeding policies were implemented in Hong Kong, including changes in perinatal guidelines in public hospitals, adoption of the Baby-Friendly Hospital Initiative (BFHI), provision of guidelines for the marketing of formula milk, penalisation of discrimination towards breastfeeding, and extension of the statutory maternity leave. Meanwhile, the COVID-19 pandemic brought new challenges and opportunities to breastfeeding practices. Infection control measures in public hospitals included the cancellation of antenatal classes, hospital tours, and postnatal classes; suspension of perinatal visiting periods; and compulsory separation of COVID-19 positive mothers from newborns. In addition, work-from-home policies were widely implemented. This study aimed to identify the associated factors of six-month predominant breastfeeding (PBF), and to evaluate the impact of COVID-19 on breastfeeding practice. Methods This study was conducted from 1 March 2021 to 7 April 2021 using a mixed-methods approach. An electronic questionnaire was distributed to members of breastfeeding or parenting groups who have had breastfeeding experience in the past 10 yrs. Logistic and linear regression analyses were conducted to identify factors associated with six-month PBF both in general and during the pandemic period. A qualitative content analysis was conducted using an inductive approach. Results The study included 793 participants. Giving birth in a public hospital (OR 2.21; 95% CI 1.46, 3.34) and breastfeeding support from family and friends (OR 1.28; 95% CI 1.05, 1.57) were significantly associated with six-month PBF, even during COVID-19. Factors associated with the self-rated impact of COVID-19 on breastfeeding include working from home, the perceived immunological benefits of breastfeeding, and the wish to avoid breastfeeding or expressing breast milk in public premises. Furthermore, breastfeeding practice in public hospitals was more likely to be affected by the busyness of staff, while private hospitals had worse rooming-in practices and staff who had inadequate breastfeeding knowledge. Conclusions Giving birth in a public hospital and having breastfeeding support from family and friends were associated with six-month PBF. Furthermore, COVID-19 in Hong Kong had an overall positive impact on six-month PBF. Further studies should investigate the impact of hospital practices and the COVID-19 pandemic on breastfeeding behaviours. Supplementary Information The online version contains supplementary material available at 10.1186/s13006-022-00484-7.
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Affiliation(s)
- John Kwan
- Department of Paediatrics and Adolescent Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Jimsyn Jia
- Department of Paediatrics and Adolescent Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Ka-Man Yip
- Department of Paediatrics and Adolescent Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Hung-Kwan So
- Department of Paediatrics and Adolescent Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Sophie S F Leung
- Department of Paediatrics, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Patrick Ip
- Department of Paediatrics and Adolescent Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Wilfred H S Wong
- Department of Paediatrics and Adolescent Medicine, The University of Hong Kong, Hong Kong SAR, China.
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6
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Gallegos D, Parkinson J, Duane S, Domegan C, Jansen E, Russell-Bennett R. Understanding breastfeeding behaviours: a cross-sectional analysis of associated factors in Ireland, the United Kingdom and Australia. Int Breastfeed J 2020; 15:103. [PMID: 33267900 PMCID: PMC7709394 DOI: 10.1186/s13006-020-00344-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 11/23/2020] [Indexed: 12/29/2022] Open
Abstract
Background Breastfeeding is a complex behaviour relying on a combination of individual mother and infant characteristics, health systems, and family, community and professional support. Optimal breastfeeding in high-income countries is particularly low. Despite having similar sociocultural backgrounds, breastfeeding rates between Ireland, the United Kingdom (UK) and Australia vary, thus there is a need to understand whether this is due to individual, sociocultural or policy differences. This research identifies the between-country differences in infant feeding mode and examines if country differences in feeding mode persist once known individual, behavioural and structural factors are considered using socioecological and person-context models. Methods Participants were adult women with at least one infant less than 6 months of age, who completed an online survey (n = 2047) that was distributed by social media in June 2016. Within-country differences in infant feeding mode (‘any breastfeeding’ vs. ‘no breastfeeding’) were examined first before hierarchical multivariable logistic regression was used to determine if country differences in feeding mode persisted after adjusting for known factors associated with breastfeeding. Results In this sample, ‘any breastfeeding’ rates were 89, 71 and 72% in Australia, Ireland and the United Kingdom respectively. Within-country differences were evident in Australia, Ireland and the UK. Four factors showed no association with infant feeding mode in Australia while they did in the other countries (maternal age, income, skin-to-skin contact, support from friends and family). Two factors were unique to Australia: the odds of being in the ‘no breastfeeding’ group increased when the baby was delivered via caesarean and when not enough breastfeeding information was available after birth. One determinant was unique to Ireland: the odds of being in the ‘no breastfeeding’ group increased when respondents indicated they were not religious; in the UK this occurred when respondents were living in a town/village. After adjusting for sets of known factors of infant feeding mode based on socioecological and person-context models, country differences remained in hierarchical regressions: the odds of not breastfeeding were higher in both Ireland (AOR 3.3, 95%CI 1.8,6.1) and the United Kingdom (AOR 2.7, 95%CI 1.5, 4.7) compared to Australia. Conclusions This study indicates that different levels in the socioecological system are related to infant feeding behaviours. An adequate inter-systems level response would consider the interactions within and between behavioural and structural mechanisms which support breastfeeding behaviour. Optimising infant feeding practices will require an integrated web of interventions that go beyond the individual and focus on addressing factors that will influence families within their communities as they move between systems. Supplementary Information The online version contains supplementary material available at 10.1186/s13006-020-00344-2.
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Affiliation(s)
- Danielle Gallegos
- School of Exercise and Nutrition Sciences, Queensland University of Technology, Victoria Park Rd, Kelvin Grove, QLD, 4059, Australia. .,Woolworths Centre for Childhood Nutrition Research, Faculty of Health, Queensland University of Technology, Graham St, South Brisbane, QLD, 4101, Australia.
| | - Joy Parkinson
- Social Marketing @ Griffith, Griffith University, 170 Kessels Rd, Nathan, QLD, 4111, Australia
| | - Sinead Duane
- Applied Systems Thinking, Whitaker Institute, National University of Ireland, Galway, Ireland
| | - Christine Domegan
- Applied Systems Thinking, Whitaker Institute, National University of Ireland, Galway, Ireland
| | - Elena Jansen
- School of Exercise and Nutrition Sciences, Queensland University of Technology, Victoria Park Rd, Kelvin Grove, QLD, 4059, Australia.,Division of Child & Adolescent Psychiatry, Department of Psychiatry & Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Rebekah Russell-Bennett
- School of Advertising, Marketing and Public Relations, Queensland University of Technology, Gardens Point, Brisbane, 4000, Australia.,Centre for Behavioural Economics, Society and Technology, Queensland University of Technology, Gardens Point, Brisbane, 4000, Australia
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7
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Griffiths LJ, Johnson RD, Broadhurst K, Bedston S, Cusworth L, Alrouh B, Ford DV, John A. Maternal health, pregnancy and birth outcomes for women involved in care proceedings in Wales: a linked data study. BMC Pregnancy Childbirth 2020; 20:697. [PMID: 33198668 PMCID: PMC7667744 DOI: 10.1186/s12884-020-03370-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 10/28/2020] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Under the Children Act 1989, local authorities in Wales, UK, can issue care proceedings if they are concerned about the welfare of a child, which can lead to removal of a child from parents. For mothers at risk of child removal, timely intervention during pregnancy may avert the need for this and improve maternal/fetal health; however, little is known about this specific population during the antenatal period. The study examined maternity characteristics of mothers whose infants were subject to care proceedings, with the aim of informing preventative interventions targeted at high risk mothers. METHODS Anonymised administrative data from Cafcass Cymru, who provide child-focused advice and support for family court proceedings in Wales, were linked to population-based maternity and health records held within the Secure Anonymised Information Linkage Databank. Linked data were available for 1111 birth mothers of infants involved in care proceedings between 2015 and 2018. Findings were benchmarked with reference to an age-deprivation-matched comparison group (n = 23,414), not subject to care proceedings but accessing maternity services during this period. Demographic characteristics, maternal health, reproductive history, interaction with midwifery services, and pregnancy and birth outcomes were examined. Descriptive and statistical tests of independence were used. RESULTS Half of the women in the cohort (49.4%) resided in the most deprived areas. They were more likely to be younger at entry to motherhood (63.5% < 21 years-of-age compared to 42.7% in the comparison group), to have mental health (28.6% compared to 8.2%) and substance use issues (10.4% compared to 0.6%) and to smoke (62.7% compared to 24.8%) during pregnancy. The majority first engaged with maternity services within their first trimester of pregnancy (63.5% compared to 84.4%). Babies were more likely to be born preterm (14.2% compared to 6.7%) and, for full-term babies, to have low birthweights (8.0% compared to 2.8%). CONCLUSION This novel linkage study highlights multiple vulnerabilities experienced by pregnant mothers who have experienced care proceedings concerning an infant. Policy and practice colleagues require a clearer picture of women's needs if child protection and health services are to offer effective services which prevent the need for family court proceedings and infant removal.
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Affiliation(s)
- L J Griffiths
- Population Data Science, Swansea University Medical School, Swansea, SA2 8PP, UK.
| | - R D Johnson
- Population Data Science, Swansea University Medical School, Swansea, SA2 8PP, UK
| | - K Broadhurst
- Centre for Child & Family Justice Research, Lancaster University, Lancaster, LA1 4YW, UK
| | - S Bedston
- Centre for Child & Family Justice Research, Lancaster University, Lancaster, LA1 4YW, UK
| | - L Cusworth
- Centre for Child & Family Justice Research, Lancaster University, Lancaster, LA1 4YW, UK
| | - B Alrouh
- Centre for Child & Family Justice Research, Lancaster University, Lancaster, LA1 4YW, UK
| | - D V Ford
- Population Data Science, Swansea University Medical School, Swansea, SA2 8PP, UK
| | - A John
- Population Data Science, Swansea University Medical School, Swansea, SA2 8PP, UK
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8
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Brown LJ, Myers S, Page AE, Emmott EH. Subjective Environmental Experiences and Women's Breastfeeding Journeys: A Survival Analysis Using an Online Survey of UK Mothers. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17217903. [PMID: 33126713 PMCID: PMC7662350 DOI: 10.3390/ijerph17217903] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 10/26/2020] [Accepted: 10/26/2020] [Indexed: 01/02/2023]
Abstract
Local physical and social environmental factors are important drivers of human health and behaviour. Environmental perception has been linked with both reproduction and parenting, but links between subjective environmental experiences and breastfeeding remain unclear. Using retrospective data from an online survey of UK mothers of children aged 0-24 months, Cox-Aalen survival models test whether negative subjective environmental experiences negatively correlated with any and exclusive breastfeeding (max n = 473). Matching predictions, hazards of stopping any breastfeeding were increased, albeit non-significantly, across the five environmental measures (HR: 1.05-1.26) Hazards for stopping exclusive breastfeeding were however (non-significantly) reduced (HR: 0.65-0.87). Score processes found no significant time-varying effects. However, estimated cumulative coefficient graphs showed that the first few weeks postpartum were most susceptible to environmental influences and that contrary to our predictions, mothers with worse subjective environmental experiences were less likely to stop breastfeeding at this time. In addition, the hazard of stopping exclusive breastfeeding declined over time for mothers who thought that littering was a problem. The predicted increased hazards of stopping breastfeeding were only evident in the later stages of any breastfeeding and only for mothers who reported littering as a problem or that people tended not to know each other. Perceived harsher physical and social environmental conditions are assumed to deter women from breastfeeding, but this may not always be the case. Women's hazards of stopping breastfeeding change over time and there may be particular timepoints in their breastfeeding journeys where subjective environmental experiences play a role.
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Affiliation(s)
- Laura J. Brown
- Department of International Development, London School of Economics & Political Science, London WC2A 2AE, UK
- Institute for Global Health, University College London, London NW3 2PF, UK
- Correspondence:
| | - Sarah Myers
- UCL Anthropology, University College London, London WC1H 0BW, UK; (S.M.); (E.H.E.)
- BirthRites Independent Max Planck Research Group, Max Planck Institute for Evolutionary Anthropology, 04103 Leipzig, Germany
| | - Abigail E. Page
- Department of Population Health, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK;
| | - Emily H. Emmott
- UCL Anthropology, University College London, London WC1H 0BW, UK; (S.M.); (E.H.E.)
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9
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Kummer L, Duke N, Davis L, Borowsky I. Association of Social and Community Factors with U.S. Breastfeeding Outcomes. Breastfeed Med 2020; 15:646-654. [PMID: 32856942 DOI: 10.1089/bfm.2020.0083] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Objective: To explore, in a large, nationally representative U.S. sample of children, potential independent associations between social and community factors and breastfeeding outcomes, using the Social Ecological Model as a theoretical framework. Materials and Methods: A secondary data analysis of the 2011-2012 National Survey of Children's Health was conducted (N = 29,829). Multivariate logistic regression was performed to estimate associations between predictor variables (parental emotional support, neighborhood social support, neighborhood safety, neighborhood amenities, and medical home) and breastfeeding outcomes (breastfeeding initiation [BFI] and exclusive breastfeeding for 6 months [EBF6m]). For predictor variables reaching statistical significance in the adjusted models, we performed subgroup analyses by race-ethnicity. Results: After adjusting for individual- and family-level sociodemographic and maternal-child health factors, living in a neighborhood with 4 amenities was associated with 1.54 (95% confidence interval [CI] 1.06-2.23) times the odds of BFI, compared to children living in neighborhoods with no amenities. There was a negative association (adjusted odds ratio [aOR] 0.83; 95% CI 0.70-0.99) between neighborhood social support and BFI, although living in a supportive neighborhood was associated with 1.37 (95% CI 1.11-1.69) times the odds of EBF6m. There was a negative association (aOR 0.71; 95% CI 0.54-0.93) between perceived neighborhood safety and EBF6m. The observed associations differed by race-ethnicity. Conclusion: Community-level structural and social support factors influence breastfeeding outcomes, independent of previously described individual level sociodemographic factors, and the observed associations differ by race-ethnicity. These findings have implications for the development of "breastfeeding-friendly" communities and public policies.
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Fatturi AL, Wambier LM, Chibinski AC, Assunção LRDS, Brancher JA, Reis A, Souza JF. A systematic review and meta-analysis of systemic exposure associated with molar incisor hypomineralization. Community Dent Oral Epidemiol 2019; 47:407-415. [PMID: 31111554 DOI: 10.1111/cdoe.12467] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 04/15/2019] [Accepted: 04/19/2019] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To evaluate systemic exposures associated with molar incisor hypomineralization (MIH). METHODS This systematic review was performed using published observational studies that evaluated the systemic exposures associated with MIH. The sources of articles searched were PubMed, Scopus, Web of Science, LILACS, BBO, Cochrane Library and Grey literature. The risk of bias was analysed according to the Newcastle-Ottawa Scale for quality assessment. The meta-analysis was performed considering the exposures during the prenatal, perinatal and postnatal periods using the CMA software. RESULTS A total of 4207 articles were identified. Twenty-nine studies were eligible for inclusion and 27 were included in the meta-analysis. The studies presented low and moderate risks of bias, except for one that was classified as having a high risk of bias. Maternal illness during pregnancy (OR 1.40; 95% CI 1.18-1.65, P < 0.0001) and psychological stress (OR = 2.65; 95% CI 1.52-4.63; P = 0.001) was observed to be significantly associated with higher odds of MIH. During the perinatal period, caesarean delivery (OR = 1.32, 95% CI 1.11-1.57, P = 0.001) and delivery complications (OR = 2.06; 95% CI 1.47-2.88, P < 0.0001) were also associated with MIH. In the postnatal period, only respiratory diseases (OR = 1.98; 95% CI 1.45-2.70, P < 0.0001) and fever (OR = 1.50; 95% CI 1.22-1.84; P < 0.0001) were associated with higher prevalence of MIH. The evidence was graded as very low quality. CONCLUSIONS Maternal illness, psychological stress, caesarean delivery, delivery complications, respiratory diseases and fever during the first years of a child's life were significantly associated with a higher odds of MIH. However, this should be interpreted with caution, once the primary studies were observational, with serious limitations according to the risk of bias, imprecision, and inconsistency. Further, well-designed cohort studies are still required.
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Affiliation(s)
- Aluhe Lopes Fatturi
- Department of Stomatology, Universidade Federal do Paraná, Curitiba, Brazil.,Dentistry Department, Universidade Federal do Paraná, Curitiba, Brazil
| | | | - Ana Claudia Chibinski
- Department of Dentistry, Universidade Estadual de Ponta Grossa, Ponta Grossa, Brazil
| | | | | | - Alessandra Reis
- Department of Dentistry, Universidade Estadual de Ponta Grossa, Ponta Grossa, Brazil
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Novrinda H, Han DH, Jung-Choi K, Ryu JI. Neo-Marxian social class inequalities in oral health among the South Korean population. Community Dent Oral Epidemiol 2018; 47:162-170. [PMID: 30548668 DOI: 10.1111/cdoe.12439] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 11/12/2018] [Accepted: 11/13/2018] [Indexed: 12/27/2022]
Abstract
AIM The aims of this study were to examine inequalities in periodontitis and tooth loss among South Korean adults using the Wright's Neo-Marxian social class (NMSC) indicator and to assess the impact of material, psychosocial, health behavioural and workplace environmental factors in the association of social class with oral health. METHODS This study used the data from the 4th Korea National Health and Nutrition Examination Survey with 6710 participants aged 19-54 years old. Participants were classified into 12 social class positions based on the Wright's social class map. Healthy gum and absence of tooth loss were the health outcomes. Mediating factors were material (M), psychosocial (PS), health behavioural (HB) and workplace environmental (WPE) factors. A series of logistic regressions were performed to analyse the data. Odds ratio (OR) and 95% confidence interval (CI) were used to report the results. RESULTS For the absence of periodontal pockets status, expert supervisors were the healthiest periodontal group among the social classes (OR = 2.15 95% CI 1.59-2.90) in the age and gender adjusted model. For the absence of tooth loss, skilled workers had the highest OR for absence of tooth loss (OR = 1.64 95% CI 1.31-2.05) in the age- and gender-adjusted model. For absence of periodontal pockets, the explanatory power of the M factor was the highest in all social class positions except for nonskilled supervisors followed by the HB factor. Additionally, the absence of tooth loss had a fairly similar pattern. The explanatory power of the M factor was the highest in all social class positions except for the petty bourgeoisie (highest: HB) and nonskilled supervisors (highest: WPE) followed by the HB and WPE factors. CONCLUSION There were nongradient oral health inequalities among the South Korean population according to the NMSC. Oral health promotion programmes that focus on changing the socioeconomic environment and health behaviours should be implemented.
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Affiliation(s)
- Herry Novrinda
- Department of Preventive and Social Dentistry, Seoul National University School of Dentistry, Seoul, Korea.,Department of Dental Public Health and Preventive Dentistry, Universitas Indonesia, Jakarta, Indonesia
| | - Dong-Hun Han
- Department of Preventive and Social Dentistry, Seoul National University School of Dentistry, Seoul, Korea.,Dental Research Institute, Seoul National University, Seoul, Korea
| | - Kyunghee Jung-Choi
- Department of Preventive Medicine, Ewha Womans University School of Medicine, Seoul, Korea
| | - Jae-In Ryu
- Department of Preventive and Social Dentistry, Kyung Hee University, Seoul, Korea
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12
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Peregrino AB, Watt RG, Heilmann A, Jivraj S. Breastfeeding practices in the United Kingdom: Is the neighbourhood context important? MATERNAL AND CHILD NUTRITION 2018; 14:e12626. [PMID: 29888866 DOI: 10.1111/mcn.12626] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 03/23/2018] [Accepted: 04/20/2018] [Indexed: 01/27/2023]
Abstract
Breastfeeding is an important public health issue worldwide. Breastfeeding rates in the United Kingdom, particularly for exclusive breastfeeding, are low compared with other OECD countries, despite its wide-ranging health benefits for both mother and child. There is evidence that deprivation in the structural and social organisation of neighbourhoods is associated with adverse child outcomes. This study aimed to explore whether breastfeeding initiation, exclusive breastfeeding for at least 3 months, and any type of breastfeeding for at least 6 months were associated with neighbourhood context measured by neighbourhood deprivation and maternal neighbourhood perceptions in a nationally representative U.K. SAMPLE A cross-sectional analysis was conducted using data from the Millennium Cohort Study. Logistic regression was carried out on a sample of 17,308 respondents, adjusting for individual- and familial-level socio-demographic characteristics. Neighbourhood deprivation was independently and inversely associated with breastfeeding initiation. Compared with the least deprived areas, the likelihood of initiating breastfeeding was 40% lower in the most deprived neighbourhoods (OR: 0.60, 95% CI [0.50, 0.72]). The relationship between both exclusive and any type of breastfeeding at 3 and 6 months respectively with neighbourhood deprivation after adjustment for potential confounders was not entirely linear. Breastfeeding initiation (OR: 0.78, 95% CI [0.71, 0.85]), exclusivity for 3 months (OR: 0.84, 95% CI [0.75, 0.95]), and any breastfeeding for 6 months (OR: 0.82, 95% CI [0.73, 0.93]) were each reduced by about 20% among mothers who perceived their neighbourhoods lacking safe play areas for children. Policies to improve breastfeeding rates should consider area-based approaches and the broader determinants of social inequalities.
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Affiliation(s)
- Andressa B Peregrino
- Research Department of Epidemiology and Public Health, University College London, Torrington Place, London, UK
| | - Richard G Watt
- Research Department of Epidemiology and Public Health, University College London, Torrington Place, London, UK
| | - Anja Heilmann
- Research Department of Epidemiology and Public Health, University College London, Torrington Place, London, UK
| | - Stephen Jivraj
- Research Department of Epidemiology and Public Health, University College London, Torrington Place, London, UK
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