Breastfeeding: How is it related to food insecurity and other factors among low-income mothers?

A cross-sectional study was conducted to (1) examine breastfeeding initiation and continuation rates, and; (2) investigate association between food insecurity and breastfeeding status, among low-income mothers. Mothers of infants two-months or younger were recruited from a local pediatric clinic serving primarily low-income families. Upon giving consent, mothers were interviewed in-person or over the phone in either English or Spanish. Of the total 92 mothers interviewed, 90% initiated breastfeeding, but only 24% were doing exclusive breastfeeding at 2 months of infant's age. After controlling for socio-demographics, it was found that food-insecure mothers were less likely to continue with breastfeeding (β = -1.51, p = .024). Future research is warranted to understand pathways through which food insecurity affects breastfeeding and how this disparity can be prevented to ensure a safe and secure start for infants worldwide.

Racial and Ethnic Differences in Infant Feeding Practices and Growth Trajectories Among Low-Income Households

Objectives

(1) To examine duration and intensity of breastfeeding, age of introduction to solids/other liquids, and complementary feeding choices among racial/ethnic minority infants living in low-income households. (2) To determine the association between feeding choices and model growth trajectory from early to late infancy in the study population.

Methods

Mother-infant dyads were recruited from a pediatric clinic mainly serving low-income and/or Medicaid-recipient families. Mothers were interviewed in English or Spanish to collect sociodemographic, food security status, and feeding practices when the infant was 2, 4, 6, 9, and 12 months of age (n = 249). From 6-months onwards, 24-hour feeding recalls were conducted to estimate daily nutrient intake. Infant height and weight were retrieved from the electronic medical record to estimate growth trajectories from early to late infancy.

Results

By race/ethnicity, the majority of the participants were African American (46%) or Hispanic (35%). The prevalence of low to very low food insecurity was 10%. Exclusive breastfeeding was not common among dyads at 2 (26%), 4 (17%), and 6 months (4%). Partial breastfeeding was significantly higher among Hispanic mothers (P < .05). For instance, at 4 months 72% of Hispanic mothers partially breastfed compared to 34% African American and 31% of non-Hispanic White mothers (p < .001). Early introduction to solids/other liquids was more common within African American dyads (p < .05). Preliminary growth trajectory modeling indicated some racial/ethnic differences, especially the weight of Hispanic infants was marginally higher compared to non-Hispanic white infants (p = .072) in late infancy.

Conclusions

Significant differences in infant feeding practices, including breastfeeding and introduction to solids/liquids, exist by race/ethnicity. Examination of these differences in feeding practices will be critical to understanding how they affect growth trajectory from early to late infancy.

Funding Sources

National Institute of Health NICHD.

Assessing Inconsistency in Home Food Supply and Association with Brain Activation for Palatable Foods Among Low-Income Women

Objectives

The objectives of this study were to investigate: 1) home food availability and dietary pattern in the beginning and end of the month, and; 2) brain activation for highly palatable and nutrient-dense food stimuli, among low-income women prone to food insecurity.

Methods

An in-depth exploratory study was conducted with low-income women receiving SNAP (n = 13) involving home food inventories, 24-h diet recalls and brain MRIs at two time points of ‘beginning’ and ‘end’ of month. Upon meeting the following main selection criteria: 1) 18 years or older; 2) no absolute and relative MRI contraindications, women provided their informed consent. Participants’ individual dates of monthly income and benefits receipt were used to define the ‘beginning of the month’ period as 1–7 days within receiving benefits and the ‘end of the month’ period starting 21–30 days following. Interviews and MRI scans were completed during these periods. Functional MRI scans were conducted to measure brain activation in response to both highly palatable and nutrient-dense food image stimuli. The study was approved by the UNC-Greensboro IRB. Frequencies, descriptives, and nonparametric statistical tests were used in analysis and results were considered statistically significant at P < 0.10.

Results

Comparison of home food indicated there was a significant decrease in variety of food in the end of the month period with specific reduction in fresh fruits, fresh vegetables and meat groups. Food insecurity was prevalent (69%) among participants, where one-third of the participants reported running out of food at the end of the month. In dietary pattern, mean percentage of total energy intake by carbohydrates and added sugars increased in the end of the month. For instance, 42% of total energy intake came from carbohydrates in the beginning of the month vs. 48% in the end of month. Analysis of brain MRI scan data is currently underway to investigate overall and monthly differences in sensitivity to food between beginning and end of the month.

Conclusions

Inconsistency in food availability is occurring in low-income households related to monthly food resources. It is possible that food insecurity affects food habits through a bio-behavioral pathway of increasing sensitivity and liking for highly palatable food to negate inconsistency in household food availability.

Funding Sources

UNCG internal funding.

Assessment of the relationship between water insecurity, hygiene practices, and incidence of diarrhea among children from rural households of the Menoua Division, West Cameroon

The objectives of a cross-sectional, semi-quantitative study were to: i) assess the prevalence of water insecurity and its association with water access-related behaviors such as time, distance, and sources of water; ii) identify major themes of concern raised in reference to anxiety, water quality/quantity, and perceived health risk domains of water insecurity, and; iii) examine the relationship between water insecurity, hygiene practices, and diarrheal incidence among children in rural areas of the Menoua Division in the Western Region of Cameroon In-person interviews were conducted with 18 years or older women living with at least one child between 2 and 5 years old (n=134). Participants spent on average 17±12 minutes walking to a drinking water source. Prevalence of water insecurity was 58%, and it was associated with a lower hygiene score among caretakers, i.e., hygiene score of water secure: 9.2±1.2 vs. insecure:8.2±2.2, F_{(1, 132)}=8.096, P<0.01). Overall, the incidence of diarrhea among children was 18%, and it was significantly higher among water insecure households (79%) compared with secure households (21%, P=0.02). In conclusion, access to improved sources of water is an issue in rural areas. Addressing water insecurity is critical in promoting optimal health and development of children due to its association with poor hygiene practices among caretakers.

Predictors and outcomes of excess gestational weight gain among low-income pregnant women

Low-income women were interviewed and their post-natal records were retrieved (n = 160) to assess prevalence of excess gestational weight gain and its socio-demographic predictors. More than half of the women (64%) gained excess weight during pregnancy, with an average of 10 lbs in excess of Institute of Medicine guidelines. Logistic regression indicated that women that started pregnancy at an obese body mass index; who were African American or having an unplanned pregnancy were at significant risk of gaining excess weight in pregnancy. Intervention to prevent excess weight gain during pregnancy is critical in addressing obesity epidemic in the United States and worldwide.

Evaluating the Implementation of a Farmers' Market Targeting WIC FMNP Participants

The present study planned and implemented a new farmers' market (FM) at a WIC (Special Supplemental Nutrition Program for Women, Infants, and Children) clinic in North Carolina, of which WIC FM Nutrition Program (FMNP) participants were the main priority population. The purpose of this FM was to provide convenience and improve access to locally grown fresh fruits and vegetables in the community and to increase the FMNP coupon redemption rate. The main objective of this study was to describe the overall process and key strategies involved in implementing a FM at a WIC clinic. A community-based participatory research design using different formative methods documented the process and key inputs in FM implementation. Local farmers, program administrators, and community advocates were involved in documenting the implementation process. Multiple formative methods included direct observation and semistructured interviews with staff and farmers (n = 13). A community partnership was key in implementing the FM. The market operated weekly over the course of 24 weeks, involved 12 WIC-approved farmers, and featured over 50 types of fresh fruits and vegetables. The FMNP coupon redemption rate at the county level increased from 51.3% to 62.9%. The results demonstrate that a FM can be successfully located near a WIC clinic with positive effects of increasing availability to fresh fruits and vegetables for a low-income population and revenue for local farmers.