Evaluating a bilingual video to improve infant feeding knowledge and behavior among immigrant Latina mothers.

Childhood obesity is recognized as a major health problem in the United States and is occurring at ever younger ages. While most prevention efforts are aimed at school-age children, this project focuses on the caregivers of children from 0 to 24 months of age. This study is an evaluation of an educational English/Spanish infant feeding video, distributed for home viewing at one New York City Special Supplemental Food Program for Women, Infants and Children (WIC) center (video group) but not at three others (comparison group). Baseline, 3 and 6 month infant feeding knowledge and behavior surveys were conducted. For this report, analyses are restricted to Latina immigrant mothers. The video and comparison group mothers were similar in age, education, and parity. The video group was more likely to speak Spanish at home, and had lower knowledge scores at baseline. At the 6 month follow-up, knowledge increased for both groups, but the video group showed a greater increase in knowledge between baseline and 6 months: in ordered logistic regression analyses the video group had a 1.7 times greater score increase at each outcome level. The video group also showed positive changes in behavior-later age at first solid feeding was observed in the video group. We found that an inexpensive, low-intensity video intervention can positively impact maternal knowledge and behavior related to infant feeding among immigrant Latinas. Attention should be given to intervening early with high-risk populations.

Disparities in cesarean delivery rates and associated adverse neonatal outcomes in New York City hospitals.

OBJECTIVE: To examine the primary cesarean delivery rates and associated neonatal outcomes by insurance status in public and private hospitals in New York City. METHODS: We accessed Vital statistics data on all births to women with Medicaid or private insurance from 1996 through 2003, compiling a total of 321,308 nulliparous women who delivered singleton neonates by either normal spontaneous vaginal delivery or primary cesarean delivery. Rates of primary cesarean delivery and adverse neonatal outcomes were examined by hospital type and insurance status while controlling for potential confounders. RESULTS: There were 51,682 and 269,626 women who delivered in public hospitals and private hospitals, respectively. The cesarean delivery rate of women with private insurance delivering in private hospitals was 30.4% compared with a cesarean rate of 21.2% in Medicaid patients delivering in public hospitals (adjusted odds ratio [OR] 1.57, 95% confidence interval [CI] 1.53-1.63). The percent of infants born to women with private insurance and Medicaid delivering in private hospitals with a 5-minute Apgar score less than 7 was 0.6% and 0.8% compared with 1.0% of infants delivering in the public hospital system (adjusted OR 0.59, 95% CI 0.51- 0.68 and adjusted OR 0.73, 95% CI 0.65- 0.82). The neonatal intensive care unit admission rate was also lower in neonates born in private hospitals at 6.7% and 8.5% compared with a 12.8% admission rate in public hospitals (adjusted OR 0.48, 95% CI 0.46-0.51 and adjusted OR 0.59, 95% CI 0.57- 0.62 after controlling for mode of delivery). CONCLUSION: Even when controlling for confounders, there was an association between primary cesarean delivery and insurance status regardless of hospital type. There was also a higher risk of adverse neonatal outcomes in the public hospitals regardless of mode of delivery. LEVEL OF EVIDENCE: III.

A further examination of the "epidemiologic paradox": birth outcomes among Latinas.

PURPOSE: Low rates of low birthweight (LBW) among foreign-born Latinas of low socioeconomic status have been called the "epidemiologic paradox." This study examined the extent to which the paradox can be explained by differential distribution of risk factors. PROCEDURES: The data source was the 1996-1997 New York City Birth File with 78,364 singleton births to Latinas. Ancestries included Colombians, Dominicans, Ecuadorians, Mexicans, Puerto Ricans and other Hispanics. First, a logistic regression was used to predict a LBW birth with ancestry and birthplace as the only independent variables. Demographic, medical and behavioral risks were added in subsequent regression models. FINDINGS: The LBW rate for the sample was 6.8%, with significant differences between birthplace subgroups and among ancestries. Puerto Ricans had the highest LBW rates, 9.1% for the mainland-born and 9.2% for the island-born. In separate regressions for six ancestry groups, birthplace was a significant predictor of LBW only among Mexicans and other Hispanics. CONCLUSION: In this population-based study of Latina women in New York City, the positive birth outcomes of foreign-born women are largely due to their more favorable distribution of behavioral risk factors. The "epidemiologic paradox" does not account for the LBW rates among Puerto Ricans in New York City, a high percentage of whom are mainland-born (73.4%). Compared to other Latinas, Puerto Rican women are likely to have experienced far more years of acculturation, which can result in negative health behaviors.

Prepregnancy weight and adverse perinatal outcomes in an ethnically diverse population.

OBJECTIVE: To examine the association between excessive prepregnancy weight and adverse outcomes, with a focus on women weighing over 200 lbs (91 kg) before pregnancy. METHODS: Data were from the 1998-1999 New York City births file for 213,208 singletons with information on prepregnancy weight. Five categories of prepregnancy weight were constructed and used to predict gestational diabetes, preeclampsia, cesarean delivery, very low birthweight, macrosomia, and treatment in the neonatal intensive care unit (NICU). Statistical adjustments were made for mother's age, race or ethnicity, marital status, education, parity, social risk (eg, smoking), initiation of prenatal care, health insurance, and infant's sex. RESULTS: Maternal prepregnancy weight was associated with several adverse outcomes. Women in the heaviest group (> 300 lbs or > 136 kg) had the highest adjusted odds ratios (OR) for gestational diabetes (OR 5.2), preeclampsia (OR 5.0), and cesarean delivery (OR 2.7) compared with women weighing 100-149 lbs (45-67 kg). Compared with the reference group, the heaviest women were more likely to have a macrosomic infant and an infant treated in the NICU (OR 4.2 and 1.9, respectively). Even among a subsample of women who did not have any diabetic or hypertensive diseases, excess weight significantly increased the likelihood of macrosomia and NICU treatment. Blacks were disproportionately represented in the two heaviest groups (49.8% of those weighing 200-299 lbs and 63.9% of those weighing over 300 lbs). CONCLUSION: In this population-based study of pregnant women, the adverse outcomes associated with excessive weight underline the urgency of weight loss interventions before pregnancy. The analysis also suggests that research is needed on rapidly growing racial or ethnic subgroups most at risk for obesity.

Smoking among female arrestees: prevalence of daily smoking and smoking cessation efforts.

Prior research on smoking in the criminal justice system has focused on men. This study examines smoking behavior among female arrestees in New York City (NYC). The sample includes 836 women interviewed as part of the Drug Use Forecasting (DUF) Program. Questionnaire items analyzed here include the use of licit and illicit substances, current pregnancy, childbearing history, demographics, age at smoking initiation, daily smoking, dependency on tobacco, and quit attempts. Bivariate techniques and logistic regression analyses were used. Fully 71% of all women and 64% of pregnant women were daily smokers. Recent cocaine or heroin users were the most likely to be daily smokers (84% and 92%). Among daily smokers, nearly a third had ever tried to cut down or quit. In the regressions, Latinas were more likely to have tried to quit; recent heroin users and women who had ever felt dependent on tobacco were the least likely to have tried. The authors strongly recommend that female inmates are prime candidates for smoking cessation counseling.

Maternal perceptions of infant hunger, satiety, and pressuring feeding styles in an urban Latina WIC population.

OBJECTIVE: Controlling feeding styles in which parents regulate feeding without responding to child cues have been associated with poor self-regulation of feeding and increased weight, but have not been well studied in infancy. We sought to assess maternal perception of infant feeding cues and pressuring feeding styles in an urban Latina Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) population. METHODS: Secondary analysis of a larger study of Latina mothers participating in New York City WIC programs. We examined maternal perception of infant feeding cues and pressuring feeding style. Using logistic regression, we assessed: 1) characteristics associated with perceptions of cues and pressuring to feed, including sociodemographics, breastfeeding, and maternal body mass index; and 2) whether perceptions of cues were associated with pressuring feeding style. RESULTS: We surveyed 368 mothers (84% response rate). Most mothers perceived that babies sense their own satiety. However, 72% believed that infant crying must indicate hunger. Fifty-three percent believed that mothers should always make babies finish the bottle ("pressure to feed"). Pressuring feeding style was associated with foreign maternal country of birth (adjusted odds ratio [AOR] 3.05; 95% confidence interval [CI], 1.66-5.60) and less than a high school education (AOR 1.81; 95% CI, 1.12-2.91). Two perceptions of feeding cues were related to pressuring feeding style: belief that infant crying must indicate hunger (AOR 2.59; 95% CI, 1.52-4.42) and infant hand sucking implies hunger (AOR 1.83; 95% CI, 1.10-3.03). CONCLUSIONS: Maternal characteristics influence perception of infant hunger and satiety. Interpretation of feeding cues is associated with pressuring feeding style. Improving responsiveness to infant cues should be a component of early childhood obesity prevention.

Maternal obesity and diabetes as risk factors for adverse pregnancy outcomes: differences among 4 racial/ethnic groups.

OBJECTIVES: We examined associations between obesity, diabetes, and 3 adverse pregnancy outcomes--primary cesarean delivery, preterm birth, and low birth-weight (LBW)--by racial/ethnic group. Our goal was to better understand how these associations differentially impact birth outcomes by group in order to develop more focused interventions. METHODS: Data were collected from the 1999, 2000, and 2001 New York City birth files for 329,988 singleton births containing information on prepregnancy weight and prenatal weight gain. Separate logistic regressions for 4 racial/ethnic groups predicted the adverse pregnancy outcomes associated with diabetes. Other variables in the regressions included obesity, excess weight gain, hypertension, preeclampsia, and substance use during pregnancy (e.g., smoking). RESULTS: Chronic and gestational diabetes were significant risks for a primary cesarean and for preterm birth in all women. Diabetes as a risk for LBW varied by group. For example, whereas chronic diabetes increased the risk for LBW among Asians, Hispanics, and Whites (adjusted odds ratios=2.28, 1.69, and 1.59), respectively, it was not a significant predictor of LBW among Blacks. CONCLUSIONS: In this large, population-based study, obesity and diabetes were independently associated with adverse pregnancy outcomes, highlighting the need for women to undergo lifestyle changes to help them control their weight during the childbearing years and beyond.

Why do WIC participants fail to pick up their checks? An urban study in the wake of welfare reform.

OBJECTIVES: This study explored whether work or immigration concerns affect women's participation in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). METHODS: The sample included women who had withdrawn from the WIC program and current WIC clients from 1 center in New York City. Logistic regression analyses were used to predict noncollection of checks; demographic characteristics, program participation, and problems with the WIC program were independent variables. RESULTS: Strong predictors of noncollection of checks were job conflicts, transportation or illness problems, and WIC receipt by the woman herself (rather than by her children). CONCLUSIONS: Employment conflicts were related to failure to pick up WIC checks; immigration concerns were not. As a means of enhancing WIC participation, flexibility is recommended in terms of center hours, locations, and staffing and program check distribution policies.