Factors That Modify the Association of Maternal Postpartum Smoking and Exclusive Breastfeeding Rates.

BACKGROUND AND OBJECTIVE: Maternal postpartum smoking increases the risk for poor infant health outcomes, while exclusive breastfeeding has been shown to support infant health. Limited population-based research has been published on the interaction between maternal smoking and exclusive breastfeeding. The objective of this study was to examine factors modifying the association between maternal postpartum smoking and exclusive breastfeeding among women in the United States. METHODS: Secondary data analysis was conducted using the 2009-2011 Pregnancy Risk Assessment Monitoring System. Stratified analyses were used to examine the associations between maternal postpartum smoking and exclusive breastfeeding by sociodemographic factors. RESULTS: The postpartum smoking rate was 17.1%. The relationship between postpartum smoking and exclusive breastfeeding at 12 weeks varied by maternal education level, race/ethnicity, Medicaid use, and pregestational or gestational diabetes. The magnitude of reduction in the odds of exclusive breastfeeding at 12 weeks postpartum among the women who smoked in the postpartum period ranges from odds ratio (95% confidence interval) 0.52 (0.37-0.74) for non-Hispanic blacks to 0.31 (0.22-0.43) for women who had <12 years of education. CONCLUSIONS: Women who smoked in the postpartum period, who also suffered from socioeconomic disadvantages, had a higher likelihood of not continuing exclusive breastfeeding. Identification of women at high risk for not exclusively breastfeeding is important for targeting populations in need of appropriate and timely support for prenatal and postpartum smoking cessation and breastfeeding promotion.

Factors associated with Ohio nurse practitioners' childhood obesity preventive practice patterns.

BACKGROUND AND PURPOSE: More nurse practitioners (NPs) infiltrate into primary care settings, and play a pivotal role in prevention of childhood obesity. However, minimal research has been published about their practice patterns. The current study uses a sample of Ohio NPs and describes NPs' childhood obesity prevention practice patterns, knowledge of the guidelines, their personal physical activity in relation to childhood obesity prevention practices, and identification of perceived barriers for practice. METHOD: Mail surveys were sent to a random selection of Ohio NPs. Quantitative and qualitative analyses methods were used to analyze the association between NPs' personal physical activity and their practice patterns and barriers to preventive practices related to childhood obesity. CONCLUSIONS: Ohio NPs who reported engaging in higher physical activity levels were more likely to report providing frequent assessment and counseling of healthy diet and physical activity. Frequency of weight tracking and referral to specialists were less frequent regardless of physical activity engagement by the NPs. Parental resistance was the most significant barrier to lifestyle counseling. IMPLICATIONS FOR PRACTICE: Findings from the current study may offer new insight into innovative approaches for treatment and prevention of childhood obesity. These may include simple quality improvement projects to advocacy for community and school programs.

Racial differences in the association between maternal prepregnancy obesity and children's behavior problems.

OBJECTIVE: Evidence for the adverse effects of prepregnancy obesity on offspring's neurodevelopmental outcomes has begun to emerge. The authors examined the association between prepregnancy obesity and children's behavioral problems and if the association would differ by race. METHODS: This observational study used a total of 3395 white (n = 2127) and African-American (n = 1268) children aged 96 to 119 months from the National Longitudinal Survey of Youth. Behavior Problem Index (BPI) total and subscale scores were used to measure children's behavioral problems. The association between maternal prepregnancy obesity and the BPI scores for each racial group was examined using multivariate linear and logistic regressions, controlling for prenatal, child, maternal, and family background factors. RESULTS: Maternal prepregnancy obesity was independently associated with an increase in the BPI total scores among the white sample only. Among the African-Americans, prepregnancy obesity was not associated with the BPI scores. Subsample analyses using externalizing and internalizing subscales also revealed similar trends. Among the white sample, children born to obese women were more socially disadvantaged than those born to nonobese women, whereas no such trend was observed in children of African-American obese and nonobese women. CONCLUSION: The impact of maternal prepregnancy obesity on children's behavioral problems differed by racial groups. Obesity-related metabolic dysregulations during the intrauterine period may not contribute to later children's behavioral problems. Social and psychological factors seem to play key roles in the association between prepregnancy obesity and childhood behavioral problems among whites.

The impact of the 2007 expert committee recommendations on childhood obesity preventive care in primary care settings in the United States.

OBJECTIVES: In this study we examined the impact of the Expert Committee Recommendations (ECRs) on childhood obesity preventive care during well-child visits in the United States. METHODS: Data from the 2006-2009 National Ambulatory Medical Care Survey and National Hospital Ambulatory Care Survey-outpatient department were used to examine frequencies of diet/nutrition and exercise counseling during well-child visits by children aged 2 to 18 years. Differences in rates of the counseling before and after the ECRs were made were compared. RESULTS: Only 37% and 22% of all patients in 2006-2007 and 33% and 18% of all patients in 2008-2009 were provided with diet/nutrition and exercise counseling, respectively. The frequencies of counseling for patients with a diagnosis of obesity showed no change. Socioeconomically disadvantaged children received counseling less frequently after the ECRs were made. CONCLUSION: Overall, rates of obesity preventive care were low in all years, with no evidence of improvement after the ECRs were made. Systematic approaches are needed to improve delivery of obesity preventive care irrespective of the socioeconomic backgrounds of children.

The impact of prepregnancy obesity on children's cognitive test scores.

To examine the association between maternal prepregnancy obesity and cognitive test scores of children at early primary school age. A descriptive observational design was used. Study subjects consist of 3,412 US children aged 60-83 months from the National Longitudinal Survey of Youth 1979 Mother and Child Survey. Cognitive test scores using the Peabody Individual Achievement Test reading recognition and mathematics tests were used as the outcomes of interest. Association with maternal prepregnancy obesity was examined using the ordinary least square regression controlling for intrauterine, family background, maternal and child factors. Children of obese women had 3 points (0.23 SD units) lower peabody individual achievement test (PIAT) reading recognition score (p = 0.007), and 2 points (0.16 SD units) lower PIAT mathematics scores (p < 0.0001), holding all other factors constant. As expected, cognitive test score was associated with stimulating home environment (reading: ß = 0.15, p < 0.0001, and math: ß = 0.15, p < 0.0001), household income (reading: ß = 0.03, p = 0.02 and math: ß = 0.04, p = 0.004), maternal education (reading: ß = 0.42, p = 0.0005, and math: ß = 0.32, p = 0.008), and maternal cognitive skills (reading: ß = 0.11, p < 0.0001, and math: ß = 0.09, p < 0.0001). There was a significant association between maternal prepregnancy obesity and child cognitive test scores that could not be explained by other intrauterine, family background, maternal, and child factors. Children who live in disadvantaged postnatal environments may be most affected by the effects of maternal prepregnancy obesity. Replications of the current study using different cohorts are warranted to confirm the association between maternal prepregnancy obesity and child cognitive test scores.

Integrating risks for type 2 diabetes across childhood: a life course perspective.

Type 2 diabetes (T2DM) emerged among children, due in large measure to a strong physiological link between increased weight states and T2DM. In this article, cumulative risk factors for T2DM across childhood and its underlying mechanisms are reviewed. The points of intervention for T2DM should occur throughout childhood. The use of Halfon and Hochstein's framework enables practitioners and researchers in the nursing field to better understand a child's individual risk for T2DM. Only with this long view will prevention and interventions be successful in stemming the tide of the "twin epidemic" threatening children worldwide.

Impact of the implementation of an alcohol withdrawal guideline on patients with burn injuries.

PURPOSE: The purpose of this study was to determine the impact of implementation of evidence-based alcohol withdrawal syndrome (AWS) guideline using the Clinical Institute Withdrawal Assessment of Alcohol Scale--Revised scale on care and outcomes of burn patients with comorbid alcohol use and on physician and nurse documentation of alcohol screening, education, and referral. DESIGN: A retrospective medical record review of burn patients (n = 428) was completed. Data were collected on admissions 1 year before implementation of the alcohol withdrawal guideline and 1 year after implementation. Data collection included alcohol use, use of benzodiazepines, sitter use, restraint use, total body surface area, inhalation injury, previous alcohol withdrawal, length of stay, and physician and nurse documentation. SETTING: A Midwestern academic medical center with an American Burn Association and the American College of Surgeons verified burn center. METHODS: A multidisciplinary team developed evidence-based practice guidelines for the treatment of AWS. Treatment of AWS was evaluated before and after implementation of the new guidelines. RESULTS: Burn severity and inhalation injury were associated with patients at risk for alcohol abuse. There was no difference in the experience of alcohol withdrawal after guideline implementation. Documentation in the medical record of alcohol use, abuse, or previous withdrawal improved after implementation of the guideline. CONCLUSION: Screening and treatment of alcohol abuse in the burn patient are still less than ideal. IMPLICATIONS: Greater efforts should be directed at managing alcohol withdrawal. An advance practice nurse can make an important contribution.

Registered nurses' judgments of the classification and risk level of patient care errors.

As frontline clinicians, nurses play a critical role in mitigating patient harm, recovery from health care errors, and overall improvement of patient safety. This cross-sectional study asked nurse respondents to make judgments about the classification and severity of errors in 4 clinical vignettes. Our results showed that agreement about error classification and associated risk among registered nurses is less than optimal. Further research is needed to advance our understanding of how nurses working in complex patient care situations can improve their ability to recognize subtle cues to facilitate early recognition of potential errors.