Improving Self-Efficacy of Patients With a New Ostomy With Written Education Materials: A Quality Improvement Project.

PURPOSE: The purpose of this quality improvement project was to determine if supplementing the current education process for new ostomates with standardized, health literate written education materials which are initiated preoperatively improves patient self-efficacy for management of their new ostomy. DESIGN: A convenience sample of 25 patients undergoing new ostomy placement were selected to receive the written education materials. The project occurred in two outpatient clinics and an 874-bed hospital. METHODS: Preoperative education by wound, ostomy, continence (WOC) nurses in the outpatient clinic was supplemented by the new health literate written education materials, and this education continued during the postoperative period before hospital discharge. Stoma self-efficacy was measured at three timepoints: pre- and posteducation in the outpatient clinic and before discharge from the hospital following surgery. FINDINGS: Mean total self-efficacy scores significantly increased from 27.32 (SD = 12.15, confidence intereval [CI] = 22.30, 32.34) pre-education in the clinic to 39.56 (SD = 9.26, CI = 35.74, 43.38) posteducation in the clinic (P = .000), and further increased to 47.20 (SD = 7.38, CI = 44.14, 50.25) at discharge from the hospital postsurgery (P = .0004). CONCLUSIONS: Initiating education preoperatively and supplementing it with standardized, health literate written education materials improved patients' stoma self-efficacy. By improving self-efficacy, patients may be more effective in self-management of their ostomy and better prepared to care for themselves upon discharge from the hospital to prevent complications and improve outcomes.

The effect of North Carolina free clinics on hospitalizations for ambulatory care sensitive conditions among the uninsured.

BACKGROUND: Free clinics are volunteer based organizations that provide health care services to low-income individuals for free or minimal cost. Communities served by a free clinic can provide ambulatory care services for uninsured individuals, reducing reliance on costly hospital admissions for ambulatory care sensitive conditions. This study examines whether free clinics in North Carolina reduce hospitalizations for ambulatory care sensitive conditions for uninsured adults. METHODS: The study used North Carolina hospital discharge data from 2003 to 2007, restricted to uninsured adults residing in North Carolina (N = 270,325). Prevention Quality Indicators identified hospitalizations for ambulatory care sensitive conditions. The entry of new free clinics in some counties during this time period in conjunction with county-level and year fixed effects allows the logistic regression analysis to simulate a pre/post study design. RESULTS: Discharges for ambulatory care sensitive conditions constituted 12.6% of the sample. Despite the limited coverage provided by free clinics, which serve 5.5% of the uninsured in North Carolina, uninsured adults in counties served by a free clinic had an 8.0% reduced odds of a hospitalization being for an ambulatory care sensitive condition. When the model is limited to ambulatory care sensitive conditions related to chronic conditions, the odds of a hospitalization of an uninsured adult for an ambulatory care sensitive condition in counties served by a free clinic is reduced by 9.0%. CONCLUSION: Free clinics are effective providers of primary care services for uninsured individuals, particularly for those with chronic conditions. To enhance this impact by increasing free clinics' reach, state and local policy makers should support and encourage development of free clinics in high need areas.

Translation and pilot testing of a measure to assess hypertension self-care activities among Hispanics.

OBJECTIVE: Hispanics in the US have high rates of uncontrolled hypertension in comparison to non-Hispanic whites. This pilot study reports on the translation of a validated measure, the Hypertension Self-Care Activity Level Effects (H-SCALE), for use with Spanish speakers. The H-SCALE assesses Hispanics' adherence to lifestyle activities that contribute to primary and secondary risk reduction of high blood pressure. DESIGN: Cross-sectional data were collected from Hispanic primary care patients attending a free health clinic in Charlotte, NC. We performed basic psychometric tests and calculated descriptive statistics to assess adherence rates to recommended hypertension self-care behaviors. RESULTS: Participants were primarily female, under age 50 and had a high-school education or less; 48% were from Mexico. Internal consistency of all H-SCALE subscales was acceptable to good. Most participants were non-smokers (80%) and alcohol abstainers (85%). Participants had low adherence to weight management practices, physical activity and healthy eating habits. One-third of those with hypertension were adherent to medication regimens. CONCLUSION: The Spanish version of the H-SCALE is a reliable and useful tool for clinicians working with Hispanic adults. Based on these findings, all adult Hispanics need lifestyle behavior counseling for primary and secondary prevention of hypertension and other chronic diseases. The H-SCALE can provide valuable information to clinical and public health practitioners focused on chronic disease prevention and management.

Hispanics' Satisfaction with Free Clinic Providers: An Analysis of Patient-Centered Medical Home Characteristics.

Hispanic Americans are less likely to be insured and they experience cultural and linguistic barriers that may prevent them from obtaining necessary and preventive healthcare. Adoption of Patient Centered Medical Home (PCMH) concepts in healthcare settings utilized by Hispanics could improve Hispanic patients' satisfaction with their healthcare providers. This study examined the association between Spanish-speaking and non-Spanish-speaking patients' perceptions of PCMH characteristics and satisfaction with the provider. Data were collected using a self-administered survey from two unaffiliated free clinics. Logistic regression modeled the associations between patients' perceptions of PCMH and their satisfaction with their provider, and their desire to see the same provider in the future. The sample consisted of 367 adults; 44 % were Spanish-speaking. Spanish-speaking patients were younger, less educated, and had fewer chronic conditions than non-Spanish-speaking patients. In adjusted analyses for each population, better ratings of the provider's communication skills were associated with increased satisfaction with the provider (Spanish-speaking: OR = 8.33, 95 % CI = 2.19-31.76; non-Spanish-speaking: OR = 31.39, 95 % CI = 6.91-142.62), and willingness to see the provider again (Spanish-speaking: OR = 12.54, 95 % CI = 2.80-56.24; non-Spanish-speaking: OR = 8.77, 95 % CI = 2.40-31.96). Among Spanish-speakers, lower perceived discrimination was associated with 137 % increased odds and higher perceived staff helpfulness had 212 % increased odds of seeing the provider again. Relative to other PCMH components, interpersonal skills were the most important factors in patient satisfaction with free clinics. Increased training for clinicians on cultural competence and clinician-patient communication may lead to improved patient satisfaction for both Spanish and non-Spanish speakers seen at free clinics, particularly clinics in states without Medicaid expansion.

Initial evaluation of the Robert Wood Johnson Foundation Nurse Faculty Scholars program.

BACKGROUND: The Robert Wood Johnson Foundation Nurse Faculty Scholars (RWJF NFS) program was developed to enhance the career trajectory of young nursing faculty and to train the next generation of nurse scholars. Although there are publications that describe the RWJF NFS, no evaluative reports have been published. The purpose of this study was to evaluate the first three cohorts (n = 42 scholars) of the RWJF NFS program. METHODS: A descriptive research design was used. Data were derived from quarterly and annual reports, and a questionnaire (seven open-ended questions) was administered via Survey Monkey Inc. (Palo Alto, CA, USA). RESULTS: During their tenure, scholars had on average six to seven articles published, were teaching/mentoring at the graduate level (93%), and holding leadership positions at their academic institutions (100%). Eleven scholars (26%) achieved fellowship in the American Academy of Nursing, one of the highest nursing honors. The average ratings on a Likert scale of 1 (not at all supportive) to 10 (extremely supportive) of whether or not RWJF had helped scholars achieve their goals in teaching, service, research, and leadership were 7.7, 8.0, 9.4, and 9.5, respectively. The majority of scholars reported a positive, supportive relationship with their primary nursing and research mentors; although, several scholars noted challenges in connecting for meetings or telephone calls with their national nursing mentors. CONCLUSIONS: These initial results of the RWJF NFS program highlight the success of the program in meeting its overall goal-preparing the next generation of nursing academic scholars for leadership in the profession.

The Robert Wood Johnson Foundation Nurse Faculty Scholars Program: an opportunity for junior nurse faculty.

The Robert Wood Johnson Foundation Nurse Faculty Scholars program provides promising junior faculty extramural funding, expert mentoring, and the training needed to be successful in the academic role. The Nurse Faculty Scholars program, which admitted its first cohort in 2008, is designed to address the nursing faculty shortage by enhancing leadership, educational, and research skills in junior nursing faculty. This article provides an overview of the program, its purpose, and its eligibility requirements. The authors give strategies for selecting mentors, developing the written application, and preparing for an oral interview. Finally, the authors provide an analysis of funded institutions, research design and methods from current and recently funded projects, and rank and positions held by nursing mentors.

Healthy Food Policies Documented in University Food Service Contracts.

In the United States, there is an opportunity to improve the nutritional health of university students through the campus food environment. This project used a content analysis approach to investigate whether healthy food standards and policies were incorporated into the contract agreements between North Carolina (NC) public universities and their food service management companies. Food service contracts were collected from 14 NC public universities using food service management companies on campus. Each contract was evaluated using the 35-item North Carolina Food Service Policy Guidelines Assessment to examine four elements of the campus food environment: Beverages, Packaged Snacks, Prepared Foods, and Other (e.g., strategic placement of healthier food). Five university food service contracts incorporated no North Carolina Food Service Policy Guidelines, three university contracts included one to five guidelines, and six university contracts included six to nine guidelines. Altogether, 13 of the 35 guidelines were incorporated into at least one university food service contract. This project presents a cost and time-effective assessment method for determining if evidence-based nutrition guidelines have been included in university food service contracts. This approach and findings may lead to contract revisions to improve the campus food environment and, subsequently, the nutritional health of college populations.

A trans-disciplinary approach to the evaluation of social determinants of health in a Hispanic population.

BACKGROUND: Individual and community health are adversely impacted by disparities in health outcomes among disadvantaged and vulnerable populations. Understanding the underlying causes for variations in health outcomes is an essential step towards developing effective interventions to ameliorate inequalities and subsequently improve overall community health. Working at the neighborhood scale, this study examines multiple social determinates that can cause health disparities including low neighborhood wealth, weak social networks, inadequate public infrastructure, the presence of hazardous materials in or near a neighborhood, and the lack of access to primary care services. The goal of this research is to develop innovative and replicable strategies to improve community health in disadvantaged communities such as newly arrived Hispanic immigrants. METHODS/DESIGN: This project is taking place within a primary care practice-based research network (PBRN) using key principles of community-based participatory research (CBPR). Associations between social determinants and rates of hospitalizations, emergency department (ED) use, and ED use for primary care treatable or preventable conditions are being examined. Geospatial models are in development using both hospital and community level data to identify local areas where interventions to improve disparities would have the greatest impact. The developed associations between social determinants and health outcomes as well as the geospatial models will be validated using community surveys and qualitative methods. A rapidly growing and underserved Hispanic immigrant population will be the target of an intervention informed by the research process to impact utilization of primary care services and designed, deployed, and evaluated using the geospatial tools and qualitative research findings. The purpose of this intervention will be to reduce health disparities by improving access to, and utilization of, primary care and preventative services. DISCUSSION: The results of this study will demonstrate the importance of several novel approaches to ameliorating health disparities, including the use of CBPR, the effectiveness of community-based interventions to influence health outcomes by leveraging social networks, and the importance of primary care access in ameliorating health disparities.

Diabetes symptoms, health literacy, and health care use in adult Latinos with diabetes risk factors.

PURPOSE: This study examined the extent of undetected and untreated type 2 diabetes in a sample of recent Latino immigrants, and looked at the relationships among diabetes symptoms, blood glucose level, diabetes knowledge, health literacy level, and health care use. METHODS: Using a descriptive and correlational design, 144 Latino adults were interviewed. RESULTS: Many participants had diabetes and reported symptoms, but they were not aware of the disease and were not receiving adequate health care. Lack of diabetes knowledge, low health literacy, and barriers to health care prevented appropriate symptom responses. CONCLUSIONS: Interventions that teach health literacy skills and diabetes symptom interpretation may improve health care use.

Text Message Intervention for Latino Adults to Improve Diabetes Outcomes.

Introduction: Determine the effectiveness of a diabetes text message intervention to improve diabetes outcomes in Latino adults at a free clinic in the southeastern United States. Methods: A pre-post, one-group design was used with a convenience sample (n = 24) of Latino adults with type 2 diabetes and A1C ≥ 7 who consented to participate. Over 8 weeks, participants were sent 23 educational and motivational text messages that were based on the American Association of Diabetes Educators (AADE) 7 self-care tasks and the American Diabetes Association (ADA) Standards of Medical Care in Diabetes Mellitus (DM). Diabetes knowledge, self-efficacy, self-care, and A1C were measured. Results: Diabetes knowledge, self-efficacy, self-care, and A1C improved after 8 weeks. Statistically significant results (p < .05) were seen in two of the four evaluation instruments administered (Spoken Knowledge in Low Literacy in Diabetes Scale [SKILLD], p = .001, Diabetes Self-Efficacy Scale [DSES], p = .000). A1C improvements were significant (0.86 or 10 mmol/mol) from the pre-intervention (M = 9.06 [76 mmol/mol], SD = 1.49) to the post-intervention (M = 8.20 [66 mmol/mol], SD = 1.27, t [23] = 3.02, p = .006). Conclusion: Personalized communication, education, and follow-up via text messages improved diabetes knowledge, self-efficacy, self-care, and A1C among pilot project participants. Text messages are a useful tool for diabetes management.

Relative and Cumulative Effects of Hypertension Self-Care Behaviors on Blood Pressure.

New recommendations for hypertension (HTN) diagnosis and treatment highlight the role of self-care activities in managing blood pressure (BP). This cross-sectional study investigated the predictive validity of the Hypertension Self-Care Activity Level Effects (H-SCALE) measure and examined the relative and cumulative effects of HTN self-care adherence on BP. We pooled baseline data from three studies (N = 79), resulting in a gender and racially balanced sample. Partial correlations determined the relative effects of individual self-care behaviors on BP. We modeled the relationship between adherence to self-care behaviors and BP control using logistic regression. Physical activity had the greatest correlation with systolic BP. Adherence to each additional self-care behavior increased the odds of systolic BP control by 88% (95% confidence interval (CI) = [1.20, 2.96]) and diastolic BP control by 74% (95% CI = [1.10, 2.75]). Results provide further evidence that the H-SCALE is a valid assessment tool and should be adopted by clinicians to aid in improving BP management.

Postpartum Depression Screening and Referrals in Special Supplemental Nutrition Program for Women, Infants, and Children Clinics.

OBJECTIVES: To examine the relationships among participants' demographic, social, and health characteristics and positive screening scores for symptoms of postpartum depression (PPD); to examine the feasibility of referring to a case management program women with symptoms of PPD who are accessing Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) services; and to identify barriers to screening and treatment programs for women with symptoms of PPD. DESIGN: Descriptive, cross-sectional study followed by a process evaluation. SETTING: Two WIC clinics in a large southeastern U.S. city. PARTICIPANTS: One group (n = 302) included women with infants younger than 12 months who were screened for symptoms of PPD. The second group (n = 31) included case managers (n = 7), nutritionists (n = 12), advisory board members (n = 7), and student volunteers (n = 5) who participated in focus groups. METHODS: We conducted an initial screening of women for symptoms of PPD using the two-item Patient Health Questionnaire (PHQ-2). Participants with scores of 2 or greater (n = 73) were asked to complete the nine-item PHQ (PHQ-9) and the Edinburgh Postnatal Depression Scale. Participants were referred for case management services if they scored 10 or greater on the PHQ-9 or Edinburgh Postnatal Depression Scale (n = 29) and agreed to the referral (n = 19). We transcribed and analyzed the qualitative data recorded during focus groups. RESULTS: Participants with no health insurance and limited support in caring for their infants were more likely to report symptoms of PPD. Overall, 302 women were screened for PPD, indicating the feasibility of PPD screening in WIC clinics. Of the 19 participants referred to case management, 47% (n = 9) accessed care. The results of focus groups illuminated barriers to screening and treatment programs for women at the individual, local, and macrosystem levels. CONCLUSION: Our findings show the feasibility of PPD screening in WIC clinics. However, some participants did not receive mental health services after referral because of various barriers, which highlights the need to integrate mental health providers into WIC clinics.

ECHO: A Pilot Health Literacy Intervention to Improve Hypertension Self-Care.

Background: Medication adherence and diet and weight control are essential contributors to blood pressure management. Low health literacy is also associated with poor health behaviors and outcomes among adults with hypertension. Objective: This study aims to pilot test the acceptability and feasibility of a brief health literacy intervention focused on hypertension self-care and to assess changes in self-care activities. Methods: We recruited patients with hypertension who were treated at a low-cost clinic. A 2-hour evidence-based class was delivered in Spanish and English, and a telephone follow-up survey was conducted 1 month later. Intervention content included health literacy activities, nutrition education, and medication use. Participants engaged in reading, writing, a group activity, and critical discussion. Health literacy was measured using the Newest Vital Sign and the Test of Functional Health Literacy in Adults. Key Results: The intervention was delivered to 52 English- (52%) and Spanish-speaking adults (48%) with a mean age of 52.3 years (SD 7.9). More than one-half had Stage 1 or 2 hypertension (54%), and 56% had inadequate health literacy. At 1-month follow-up, participants showed improvement on all self-care measures with significant mean differences (p < .05) on diet adherence and weight management activities. These improvements were largely among Hispanics and those with low health literacy. Conclusions: Results suggest that teaching targeted self-care skills in a brief health literacy intervention can be effective in improving self-care activities relating to diet and weight management among vulnerable populations. [HLRP: Health Literacy Research and Practice. 2019;3(4):e259-e267.]. Plain Language Summary: This study explored the effects of a 2-hour health education class on self-care behaviors. At the follow-up, participants reported better self-care behaviors. Effects were more pronounced among those with low health literacy, suggesting brief exposure to health education may improve high blood pressure in this population.

Self-prescription practices in recent Latino immigrants.

OBJECTIVE: Self-prescription involves the purchase and use of restricted medications without medical advice. Although common in Central and South American countries, little is known about this practice among Latino immigrants in the United States. The purpose of this study, therefore, was to explore how Latino immigrants obtain and use prescription medications without accessing the formal health care system. DESIGN: This exploratory descriptive study used focus groups to gain an understanding of the use of prescription medications without medical care. SAMPLE: Three focus group discussions were held with 19 adult Latino immigrants who were new residents in the United States, and did not have health insurance; most were undocumented. RESULTS: Analysis of the data revealed 4 major themes: (a) health care barriers, (b) cultural norms, (c) self-care, and (d) self-prescription. CONCLUSIONS: The data indicate that this population experiences significant barriers to accessing health care, forcing them to seek treatment alternatives including the purchase and use of drugs manufactured in Mexico. There are many public health and safety concerns related to self-prescription practices. Nurses need to be aware of the barriers to health care that lead to these potentially dangerous medication practices, and to recognize and understand self-prescription.

Effects of tangible social support and depression on diabetes self-efficacy.

Although social support has been found to promote health and decrease depression in individuals with diabetes, little research has examined the kinds and sources of support. This descriptive correlational study examined the effects of diabetes-related tangible social support and depression on diabetes self-efficacy in Hispanic older adults. Participants were predominantly Puerto Rican, and many were depressed. Primary support needs included transportation and communication; family was the primary source of support. Variables associated with diabetes self-efficacy included tangible support and education. Understanding the relationship between diabetes tangible support, depression, and diabetes self-efficacy will help nurses adapt their care.

Using CBPR to Decrease Health Disparities in a Suburban Latino Neighborhood.

INTRODUCTION: This project tested the feasibility of using a community-based participatory research (CBPR) approach to deliver health and social resources in two high-risk, suburban neighborhoods. METHOD: An established research network was used to engage stakeholders to design and deliver a neighborhood-based intervention targeting a Latino immigrant population. The intervention provided screenings for hypertension, diabetes, and depression; primary care provider visits; and information about navigating health care delivery systems and related community-based resources. Participants ( N = 216) were consented for participation and their subsequent use of health and social services were measured at baseline and 1 year post intervention. RESULTS: At baseline, 5.1% of participants had health insurance, 16.7% had a primary care provider, and 38.4% had a chronic illness. SF-12 scores showed a majority of participants with low perceived health status (56%) and high risk for clinical depression (33%). Self-reported use of primary care services increased from 33.8% at baseline to 48% 1 year after the intervention, and 62% reported use of social services. CONCLUSION: Neighborhood-based interventions informed by a CBPR approach are effective in both identifying community members who lack access to health care-related services and connecting them into needed primary care and social services.

Associations between perceived value of exclusive breastfeeding among pregnant women in the United States and exclusive breastfeeding to three and six months postpartum: a prospective study.

BACKGROUND: Successful breastfeeding often starts with prenatally established intention. Yet, few mothers with the intention to exclusively breastfeed achieve their intended breastfeeding duration goal. This study examined the degree to which having a strong value of exclusive breastfeeding is associated with exclusive breastfeeding duration for at least 3 and 6 months postpartum among women who reported prenatal intention to exclusively breastfeed. METHODS: Data were from the Infant Feeding Practices Study II, a longitudinal US national survey that followed maternal-infant dyads from pregnancy to 1 year postpartum. Bivariate and multivariate regression examined the degree to which strong maternal value of exclusive breastfeeding predicted exclusive breastfeeding duration. RESULTS: Of the 1799 women who prenatally intended to exclusively breastfeed within the first few weeks postpartum, 34 and 9 % exclusively breastfed for at least 3 months and 6 months, respectively. Thirty-six percent of women reported strongly valuing exclusive breastfeeding out of which 46 % exclusively breastfeed to three months. In adjusted results, women who reported that they strongly value exclusive breastfeeding had more than twice the odds of exclusive breastfeeding for at least 3 months (Adjusted Odds Ratio [AOR] 2.29; 95 % confidence interval [CI] 1.84, 2.85) and for 6 months (AOR 2.49; 95 % CI 1.76, 3.53) compared to those who did not strongly value exclusive breastfeeding. CONCLUSION: Valuing the benefits of exclusive breastfeeding during pregnancy is a strong independent predictor of actual exclusive breastfeeding duration. A minority of pregnant women strongly value exclusive breastfeeding and are able to exclusively breastfeed to 3 months even among women with established prenatal intention to exclusively breastfeed. Prenatal maternal education and environmental lactation support that extends into the postnatal period can promote longer duration of exclusive breastfeeding.

Accuracy of the Yamax CW-701 Pedometer for measuring steps in controlled and free-living conditions.

OBJECTIVE: The Yamax Digi-Walker CW-701 (Yamax CW-701) is a low-cost pedometer that includes a 7-day memory, a 2-week cumulative memory, and automatically resets to zero at midnight. To date, the accuracy of the Yamax CW-701 has not been determined. The purpose of this study was to assess the accuracy of steps recorded by the Yamax CW-701 pedometer compared with actual steps and two other devices. METHODS: The study was conducted in a campus-based lab and in free-living settings with 22 students, faculty, and staff at a mid-sized university in the Southeastern US. While wearing a Yamax CW-701, Yamax Digi-Walker SW-200, and an ActiGraph GTX3 accelerometer, participants engaged in activities at variable speeds and conditions. To assess accuracy of each device, steps recorded were compared with actual step counts. Statistical tests included paired sample t-tests, percent accuracy, intraclass correlation coefficient, and Bland-Altman plots. RESULTS: The Yamax CW-701 demonstrated reliability and concurrent validity during walking at a fast pace and walking on a track, and in free-living conditions. Decreased accuracy was noted walking at a slow pace. CONCLUSIONS: These findings are consistent with prior research. With most pedometers and accelerometers, adequate force and intensity must be present for a step to register. The Yamax CW-701 is accurate in recording steps taken while walking at a fast pace and in free-living settings.

Perceived Infant Feeding Preferences of Significant Family Members and Mothers' Intentions to Exclusively Breastfeed.

BACKGROUND: Breastfeeding intention is a significant predictor of initiation and duration. The decision to breastfeed may be influenced by the opinions of family and friends. OBJECTIVE: This study aimed to examine the relationship between maternal perception of the infant feeding preferences of the baby's father and the maternal grandmother and the woman's intention to breastfeed. METHODS: This study analyzed data from the Infant Feeding Practices Survey II (2005-2007). RESULTS: The sample included 4690 women, of whom approximately 82% were white, 67% were married, 68% were multiparous, and 66% had some college education or beyond. In adjusted analyses, the odds of intending to exclusively breastfeed in the first few weeks postpartum were higher among mothers who perceived that the baby's father or the maternal grandmother preferred exclusive breastfeeding (vs preferred other feeding) (fathers: odds ratio [OR] = 7.44; 95% confidence interval [CI], 6.20-8.92; maternal grandmothers: OR = 2.45; 95% CI, 2.01-2.99). Mothers in each of the racial/ethnic groups examined were more likely to intend to exclusively breastfeed in the first few weeks postpartum if they perceived that the expectant father preferred exclusive breastfeeding (vs preferred other feeding methods) (white: OR = 7.67; 95% CI, 6.25-9.41; black: OR = 11.76; 95% CI, 4.85-28.51; Hispanic: OR = 7.01; 95% CI, 3.44-14.28; other: OR = 7.51; 95% CI, 3.39-16.67). CONCLUSION: These results suggest that significant family members should be counseled on the benefits of breastfeeding and the risks of formula feeding along with pregnant mothers.