Pediatric global health education: correlation of website information and curriculum.

OBJECTIVE: Web sites describing residency programs are initial sources of information for applicants. The correlation of global health content on pediatric residency program Web sites with reported curricula is unknown. To determine the accuracy of global health education, information on program Web sites was compared with queried program content responses. STUDY DESIGN: The Fellowship and Residency Electronic Interactive Database was used to assess pediatric residency programs' Web sites for global health education, applying American Academy of Pediatrics consensus guidelines. The authors developed a questionnaire using these consensus guidelines and contacted each program to assess Web site findings, and χ(2) tests were used to compare data from these 2 sources. RESULTS: Of 194 programs, 177 had operational Web sites, of which 98 participated in the questionnaire (55%). Ninety-three of 177 programs (53%) reported global health education on Web sites, whereas 80 of 98 programs (82%) reported global health education through direct questioning (P < .001). Results include provision of resident salaries during global health elective (Web site 5% vs questionnaire 98%, P < .001), mandatory training before global health elective (8% vs 20%, P = .02), presence of global health elective curriculum (24% vs 75%, P < .001), postexperience debriefing (16% vs 29%, P = .05), and bidirectional resident exchange (2% vs 13%, P = .01). CONCLUSIONS: Results indicate continued expansion of pediatric global health education, but significant differences exist between information on Web sites and data obtained through direct questioning. Accurate representation of global health opportunities would allow for more informed decision-making among prospective applicants. Findings also suggest substantial variability in global health curricula that needs to be addressed through improved planning and cooperation among training programs.

Combination feeding of breast milk and formula: evidence for shorter breast-feeding duration from the National Health and Nutrition Examination Survey.

OBJECTIVE: To examine combination breast milk and formula-feeding (CBFF), defined as daily breast-feeding and formula-feeding begun in the first week of life and to examine associations between CBFF and overall breast-feeding duration. STUDY DESIGN: We used the National Health and Nutrition Examination Survey, 1999-2006, to determine the prevalence of CBFF in both univariable and multivariable analyses. We examined breast-feeding duration using Kaplan-Meier and Cox proportional hazards analyses. RESULTS: Among 6788 children ages 0-71 months, 8% were CBFF and 55% were exclusively breast-fed during the first week of life. Factors independently associated with CBFF were Hispanic ethnicity (adjusted OR, 3.81) and black race (adjusted OR, 2.59). CBFF was associated with decreased overall breast-feeding duration in the full cohort (P < .001) but not in the Hispanic or black subgroups. CBFF and formula-feeding, when compared with 4 months of exclusive breast-feeding, were associated with an increased risk for overweight/obesity between ages 2 and 6 years. CONCLUSIONS: In a nationally representative sample, CBFF is associated with shorter overall breast-feeding duration in white but not Hispanic or black mother-baby dyads. A significant number of US infants, though breast-fed, do not receive the health benefits of exclusive breast-feeding.

A barrier to exclusive breastfeeding for WIC enrollees: limited use of exclusive breastfeeding food package for mothers.

BACKGROUND: In the first 2 weeks of life, most breastfeeding mother-infant dyads in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) receive infant formula from WIC, instead of a larger food package designed for exclusively breastfeeding mothers. This study was designed to explore reasons for high rates of formula supplementation of breastfeeding newborns enrolled in WIC and the limited use of the WIC expanded food package. METHODS: We conducted in-depth interviews with 29 mothers who either partially or exclusively breastfed for at least 2 months. Interviews were transcribed verbatim, analyzed, coded, and organized into 10 themes. RESULTS: Participants view the WIC program in a contradictory manner. They see it as highly supportive of breastfeeding, but also as a promoter of infant formula. The expanded food package for mothers is not valued, but free supplemental formula is highly valued. Misinformation about breastfeeding pervades the healthcare system, and exclusive breastfeeding is not promoted as an important health goal. Lack of access to breast pumps, the unacceptability of pumping in the workplace, and difficulties with nursing in public all contribute to formula supplementation. CONCLUSIONS: The healthcare system, the WIC program, and demands of daily life all contribute to low rates of exclusive breastfeeding in the WIC program. The available expanded food package for mothers who are exclusively breastfeeding is both disliked and underutilized, while free supplemental formula is rarely discouraged.