Association between acculturation and sociodemographic factors and cardiovascular disease among immigrants to the United States.

OBJECTIVE: This study investigated relationships among acculturation, sociodemographic, and health characteristics of adult U.S. immigrants and cardiovascular disease. DESIGN: Secondary data analysis using population data from 1,945 immigrant participants in the 2017 National Health Interview Survey (NHIS). MEASUREMENTS: Acculturation was measured using citizenship status, number of years in the U.S., and English language proficiency. Chi-square tests and multiple logistic regression modeling were utilized. RESULTS: Approximately 4.3% of the study sample had cardiovascular disease. Compared to immigrants without U.S. citizenship, significantly higher proportion of immigrants with U.S. citizenship had cardiovascular disease (6.2% vs. 1.7%, p < .001). In the multivariable-adjusted model, compared to non-citizen immigrants, odds of cardiovascular disease were higher in immigrants with U.S. citizenship (odds ratio 3.80, 95% confidence interval 1.91, 7.56). CONCLUSION: Acculturation factors, specifically U.S. citizenship, along with sociodemographic and health risk factors were associated with increased odds of cardiovascular disease among immigrants. This study builds upon previous findings demonstrating increased acculturation including U.S. citizenship in immigrant populations is associated with increased odds of cardiovascular disease. These findings inform public health specialists and clinicians of factors to consider for cardiovascular disease risk in immigrants as they adapt to their host country.

Correlates of women's knowledge of mother-to-child transmission of HIV and its prevention in Tanzania: a population-based study.

Studies that explored women's knowledge on mother-to-child transmission (MTCT) of HIV and its prevention (PMTCT) in the general population are currently lacking. This paper examined factors associated with having adequate knowledge of MTCT of HIV and PMTCT among a nationally representative sample of women in Tanzania. We conducted a cross-sectional analysis including 10,299 women from the 2011-2012 Tanzania HIV/AIDS and Malaria Indicator Survey. The outcome of interest was the presence of adequate knowledge on MTCT and PMTCT of HIV. We used multivariable logistic regression to identify factors associated with having adequate knowledge on MTCT and PMTCT of HIV. Results revealed that the overall prevalence of having adequate knowledge on MTCT and PMTCT of HIV was low (46%). We found a statistically significant difference in the proportions of having adequate knowledge between HIV-negative and HIV-positive women (45% vs. 56%; p < .0001), although knowledge of the transplacental route of transmission did not differ by HIV serostatus. Overall, having adequate knowledge on MTCT and PMTCT of HIV was positively associated with experiencing at least one pregnancy, having some education, having higher household wealth, residing in urban area, being exposed to HIV education, having tested for HIV, knowing a place to get HIV test, and having comprehensive knowledge on HIV and AIDS. Among HIV-seropositive women, experiencing at least one pregnancy and having comprehensive knowledge on HIV and AIDS were strongly associated with having adequate knowledge on MTCT and PMTCT of HIV (Adjusted odds ratio: aOR 2.78, 95% CI 1.21, 6.37 and aOR 1.71, 95% CI 1.15, 2.73, respectively). Further efforts are needed to enhance HIV/AIDS education among women of childbearing age and strengthen PMTCT services in Tanzania.

Development and Interrater Reliability of the Lactation Assessment Care Tool.

BACKGROUND: There have been no comprehensive predictive measurement instruments published that account for the dynamic interaction between maternal, infant, and functional factors related to breastfeeding difficulty. The Lactation Care Assessment Tool (LACT) was developed by the authors as a predictive measure of lactation acuity to identify families at risk for breastfeeding difficulty and facilitate access to the most effective level of care. RESEARCH AIM: To describe the development, content validation, and interrater reliability of the LACT. METHODS: This study was a cross-sectional, online survey. Upon reading a standardized case scenario reflective of common experiences among families with goals to breastfeed, participants (N = 82) anonymously completed the LACT, which consisted of 16 measures based upon research relevant to maternal, infant, and functional factors affecting breastfeeding success. Descriptive statistics were used to summarize and describe the characteristics of the study sample. Interrater reliability was evaluated using Krippendorff's alpha. RESULTS: An acceptable degree of interrater reliability (α = 0.70) among participants was detected for the 16 measures included in the instrument. CONCLUSION: This instrument supports Baby-Friendly Hospital Initiative Step 10 to facilitate more precise and timely continuity of care after discharge from the hospital by identifying families in need of referral to a level of care consistent with their lactation acuity. Future research is necessary to determine appropriate levels of care and support based on the instrument scores in diverse breastfeeding dyads during early lactation and through the duration of breastfeeding.

Association Between Influenza Vaccination During Pregnancy and Breastfeeding Duration.

Background: Prenatal vaccination and breastfeeding are both health promotional behaviors. The benefits of breastfeeding are widely investigated and well established, as well as the effectivity and the safety of the influenza vaccination. This study aimed to investigate the association between the prenatal health behavior of influenza vaccination and breastfeeding duration for at least 3 months in the United States. Methods: A secondary data analysis was conducted using 2016-2019 Pregnancy Risk Assessment and Monitoring System data consisting of 83,976 postpartum women. Results: Overall, 68.3% (n = 57,269) breastfed for at least 3 months and 56.6% (n = 48,834) received the influenza vaccine during pregnancy. Women who did not receive the influenza vaccine during pregnancy were significantly less likely to breastfeed compared with women who received the vaccine during pregnancy (64.5% versus 71.1%; p < 0.001). Significant covariates associated with ≥3-month breastfeeding duration included maternal sociodemographic factors, infant factors, maternal health factors, and prenatal health behaviors. In the multivariable logistic regression analyses, the odds of breastfeeding at least 3 months were significantly lower in women who did not receive the influenza vaccine during pregnancy compared with those who were vaccinated (odds ratio, 0.92; 95% confidence interval, 0.88-0.98; p = 0.005). Discussion: Findings from this large, nationally representative sample of U.S. mothers indicate an association between the health-promotional behaviors of prenatal influenza vaccination and breastfeeding duration postpartum. Recommendations and education by health care providers should include a focus on maternal health behaviors to support positive maternal-infant health outcomes including reduced risk of infection and extended breastfeeding duration.

The Relationship Between Place of Birth and Early Breastfeeding Initiation in Indonesia.

BACKGROUND: In many countries, hospital-based births are associated with the early initiation of breastfeeding, within the first hour postpartum, especially where the Baby Friendly Hospital Initiative guidelines have been adopted. While Indonesia has adopted the guidelines, there is a relatively low rate of early breastfeeding initiation in the country. RESEARCH AIM: To determine the relationship between place of birth and early breastfeeding initiation in Indonesia. METHOD: This study was a retrospective cross-sectional survey using national data from the 2017 Indonesia Demographic and Health Survey (N = 14,279). The association between place of birth and early breastfeeding initiation was examined using logistic regression models, adjusting for potential confounders. RESULTS: The overall prevalence of early breastfeeding initiation in Indonesia was 60.9% with a greater proportion of mothers giving birth in health facilities. In the multivariate model, there was a significant interaction between wealth index, insurance status, and place of birth on the timing of breastfeeding initiation. In the subgroup of mothers residing in middle wealth index households, women who gave birth in clinics and hospitals had lower odds of early breastfeeding initiation compared to those who gave birth at home (0.56; 0.34, 0.90; p = .018) and (0.58; 0.40, 0.85; p = .005), respectively. CONCLUSIONS: Place of birth was significantly associated with early breastfeeding initiation. There is a need to consider health disparities and to strengthen the implementation of the WHO guidelines, Baby Friendly Hospital Initiative, and International Code of Marketing of Breastmilk Substitutes, to increase early breastfeeding initiation in Indonesia.

Reexamination of ultra-thin nipple shield use, infant growth and maternal satisfaction.

AIMS AND OBJECTIVES: The primary objective of the multi-site, international study was to examine trends in weight gain for term infants breastfed with and without ultra-thin silicone nipple shields to determine the effect of nipple shield use on infant weight gain over two months. Additionally, the study examined maternal satisfaction with nipple shield use using a structured survey. BACKGROUND: The nipple shield may facilitate successful breastfeeding outcomes when indicated. There has been question regarding infant weight gain with nipple shield use. A published pilot study using within-subject design indicated no significant difference in infant test weights and maternal prolactin levels when breastfeeding with and without nipple shields. The current study builds and expands upon the pilot study. DESIGN: Prospective, multi-site, non-randomised, between-subject study. METHOD: Maternal-infant dyads (n = 54) who used a nipple shield for breastfeeding were studied. RESULTS: Results demonstrate no statistically significant difference in infant weight gain at two weeks, one month and two months between infants who breastfed with and infants who breastfed without a nipple shield. A majority (89.8%) of the women reported a positive experience with nipple shield use and 67.3% of the women reported that the nipple shield helped prevent breastfeeding termination. CONCLUSION: Infant weight gain was similar in maternal-infant dyads using nipple shields for two months compared to those not using the shields. Maternal positive report of nipple shield use lends to the clinical importance of nipple shield use when appropriately indicated. RELEVANCE TO CLINICAL PRACTICE: Nipple shield use may facilitate breastfeeding when clinically indicated in maternal-infant dyads without risk of decreased infant weight gain.

Evaluation of an educational intervention to promote breast pump use among women with infants in a special care nursery in Kenya.

OBJECTIVES: Development of an educational program for women of special care nursery (SCN) infants in Kenya about the use and cleaning of breast pumps through culturally appropriate teaching tools as well as conduction of an evaluation of change in knowledge, attitudes, beliefs, and practical ability in pump use following the educational intervention. DESIGN: An evaluation of an educational intervention. SAMPLE: 40 women with infants in the SCN unable to directly breastfeed. INTERVENTION: Educational intervention instructing electric or pedal breast pump use and cleaning with a pre- and posttest evaluation. RESULTS: Paired t test scores of the combined practically oriented questions were significantly increased from 1.8 to 4.6 (p<.001) from pre- to posttest scores. Likewise, the practical demonstration of learned pump use skills significantly improved from 0.08 preintervention to 4.8 postintervention ( p<.001). CONCLUSIONS: Results of the evaluation indicated the intervention significantly increased women's practical knowledge regarding use and cleaning of the breast pump and accessories. With knowledge of proper use of breast pumps, women will be more likely to successfully utilize pumps to provide adequate milk volumes for SCN infants. A culturally appropriate educational intervention in developing countries appears to be a feasible means of facilitating instruction of breast pump use.

Combined Influence of Gestational Diabetes and Gestational Weight Gain on Exclusive Breastfeeding.

Background: Over half of pregnant women in the United States do not meet the recommended gestational weight gain (GWG). In addition, the prevalence of gestational diabetes mellitus (GDM) is increasing. We examined the combined influence of GDM and GWG on breastfeeding practices on exclusive breastfeeding during the neonatal period and at 3 months postpartum. Materials and Methods: A cross-sectional study was performed on 173,603 women from the pregnancy risk assessment monitoring system, 2009-2015. Descriptive statistics and multivariable logistic regression modeling were performed. Results: The prevalence of GDM was 9.5%. Only 30.7% of women had weight gain within the Institute of Medicine (IOM) recommended guidelines. Approximately 21.7% and 10.3% of the participants exclusively breastfed their infants during the neonatal period and at 3 months postpartum, respectively. After adjusting for potential confounders, there was a significant multiplicative interaction between GWG and GDM on exclusive breastfeeding during the neonatal period and at 3 months postpartum. Among women with normal and excessive GWG, the odds of exclusively breastfeeding during the neonatal period were lower for women with GDM compared with women without GDM (odds ratio, 95% confidence interval: 0.74, 0.64-0.85 and 0.75, 0.66-0.85, respectively). Similarly, among women with normal and excessive GWG, the odds of exclusively breastfeeding at 3 months postpartum were lower for women with GDM compared to women without GDM (0.67, 0.55-0.81 and 0.71, 0.60-0.85, respectively). Conclusion: With the increasing prevalence of GDM and weight gain outside the IOM guidelines, it is critical to identify populations at risk and to promote exclusive breastfeeding practices.

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.

Association of Youth Characteristics and Recent Utilization of Dental Services in the United States.

Background: Oral health is important for overall health of youth, although dental service utilization is lower than national goals. The purpose of the study was to identify sociodemographic and health behavioral characteristics of youth in the United States who reported having at least one dental visit in the past 12 months. Methods: Secondary data analysis was conducted using the 2015 Youth Risk Behavior Survey (YRBS) to examine factors associated with dental care utilization using Andersen's theory-based Behavioral Model of Health Care Utilization. Results: Among 5,814 youth, nearly 78 percent reported visiting a dentist in the past 12 months. After adjusting for potential confounders, characteristics significantly associated with higher likelihood of dental care utilization were: predisposing factors of non-Hispanic white ethnicity and health behavior characteristics of not using tobacco, not using illegal substances, not drinking soda, and wearing a seat belt; enabling factor of speaking English well; and perceived health of not being overweight. Discussion: Use of the Healthcare Utilization Model identified significant factors classified as predisposing, enabling, and need-related factors associated with youth's utilization of dental care services. Findings from the theory-based population-based study informs healthcare providers of factors to consider when promoting dental care among youth.

Neonatal Abstinence Syndrome in West Virginia Substate Regions, 2007-2013.

PURPOSE: The opioid epidemic is a public health threat with consequences affecting newborns. Neonatal Abstinence Syndrome (NAS) is a constellation of withdrawal symptoms resulting primarily from in utero opioid exposure. The purpose of this study was to examine NAS and drug-specific trends in West Virginia (WV), where rurality-related issues are largely present. METHODS: The 2007-2013 WV Health Care Authority, Uniform Billing Data were analyzed for 119,605 newborn admissions with 1,974 NAS diagnoses. NAS (ICD9-CM 779.5) and exposure diagnostic codes for opioids, hallucinogens, and cocaine were utilized as incidence rate (IR) per 1,000 live births. FINDINGS: Between 2007 and 2013, NAS IR significantly increased from 7.74 to 31.56 per 1,000 live births per year (Z: -19.10, P < .0001). During this time period, opioid exposure increased (Z: -9.56, P < .0001), while cocaine exposure decreased (Z: 3.62, P = .0003). In 2013, the southeastern region of the state had the highest NAS IR of 48.76 per 1,000 live births. NAS infants were more likely to experience other clinical conditions, longer hospital stay, and be insured by Medicaid. CONCLUSIONS: Statewide NAS IR increased 4-fold over the study period, with rates over 3 times the national annual averages. This alarming trend is deleterious for the health of WV mother-child dyads and it strains the state's health care system. Therefore, WV has a unique need for prenatal public health drug treatment and prevention resources, specifically targeting the southeastern region. Further examination of maternal drug-specific trends and general underutilization of neonatal exposure ICD-9-CM codes is indicated.

Breastfeeding Self-efficacy of Women With and Without Gestational Diabetes.

PURPOSE: The purpose of the study was to examine the breastfeeding self-efficacy of women with and without gestational diabetes mellitus (GDM). Breastfeeding rates among women with GDM are often lower than rates of women without GDM, possibly related to early breastfeeding challenges that may negatively affect breastfeeding self-efficacy. STUDY DESIGN AND METHODS: The breastfeeding self-efficacy scale short form (BSES-SF) survey was used to compare breastfeeding self-efficacy of 32 women with GDM and 35 women without GDM who gave birth to singleton, term (≥37 weeks gestation) baby in an Israeli hospital. Linear regression analysis was used to determine factors associated with BSES-SF scores in the first week postpartum. RESULTS: In the final regression model, significant factors associated with higher BSES-SF scores were no perceived delayed lactogenesis II (beta = -0.24, p = 0.050) and earlier initiation of breastfeeding (beta = -0.31, p = 0.011). CLINICAL IMPLICATIONS: Factors significantly associated with BSES-SF scores can be addressed through encouragement and support of breastfeeding by healthcare providers. Lactation support in the early postpartum period should focus on facilitation of early and frequent breastfeeding and/or milk expression to decrease risk of delayed breastfeeding initiation and to minimize risk of perceived delayed lactogenesis II. Early lactation support is especially important among women at increased risk for delayed breastfeeding initiation or perceived delayed lactogenesis II such as women with GDM in pregnancy.

Association between oral contraceptive use and markers of iron deficiency in a cross-sectional study of Tanzanian women.

OBJECTIVE: To analyze the associations between oral contraceptive (OC) use and markers of iron deficiency, objectively measured using hemoglobin and soluble transferrin receptor. METHODS: A secondary data analysis was performed of a population-based cross-sectional study using data from the 2010 Tanzania Demographic and Health Survey. Weighted percentages were calculated. Multivariable logistic regression was used to examine the associations between OC use and iron deficiency, anemia, and iron deficiency anemia. RESULTS: Of the 4336 participants, only 7.3% reported a history of OC use. The prevalence rates of iron deficiency, anemia, and iron deficiency anemia were 30.3%, 40.9%, and 15.1%, respectively. Use of OCs was negatively associated with anemia and iron deficiency anemia, independent of potential confounders. Compared with OC nonusers, the multivariable-adjusted odds ratio among OC users was 0.44 (95% confidence interval 0.32-0.59; P<0.001) for anemia and 0.43 (95% confidence interval 0.27-0.68; P<0.001) for iron deficiency anemia. A longer duration of OC use was negatively associated with iron deficiency (P=0.003 for trend), anemia (P<0.001 for trend), and iron deficiency anemia (P<0.001 for trend). CONCLUSION: The significant association between OC use and iron status has important implications for educating healthcare providers and women about additional nutritional benefits of the use of OCs.