Exploring Challenges and Opportunities for Breastfeeding in Hawai'i During the COVID-19 Pandemic.

Increasing exclusive breastfeeding rates is an established public health strategy to reduce chronic disease and protect infants from illness. The role of breastfeeding in addressing health disparities takes on new significance as the COVID-19 pandemic has disproportionately impacted some communities in Hawai'i, and those with chronic conditions face increased risk of hospitalization and death. However, there are myriad policy, systemic, and environmental barriers that make it difficult for parents to breastfeed, some of which have been exacerbated by the COVID-19 pandemic. This editorial discusses the importance of breastfeeding in reducing chronic disease, reviews the status of breastfeeding in Hawai'i, explores the challenges parents face in breastfeeding their infants, especially in the time of COVID-19, and presents opportunities for improved access to lactation care to reduce health disparities.

Reinventing health promotion for healthy default beverage laws in the face of COVID-19.

Shortly after a healthy default beverage (HDB) law took effect in Hawai'i, requiring restaurants that serve children's meals to offer healthy beverages with the meals, the COVID-19 pandemic struck. Efforts to contain the virus resulted in changes to restaurants' operations and disrupted HDB implementation efforts. Economic repercussions from containment efforts have exacerbated food insecurity, limited access to healthy foods, and created obstacles to chronic disease management. Promoting healthy default options is critical at a time when engaging in healthy behaviors is difficult, but important, to both prevent and manage chronic disease and decrease COVID-19 risk. This commentary discusses COVID-19's impact on restaurant operations and healthy eating, and the resulting challenges and opportunities for this promising health promotion intervention.

Maternal Race Trends in Early Infant Feeding Patterns in Hawai'i Using Newborn Metabolic Screening-Birth Certificate Linked Data 2008-2015.

Breastfeeding provides optimal nutrition for infants, including short- and longterm health benefits for baby and mother. Maternity care practices supporting breastfeeding after delivery increase the likelihood of exclusive breastfeeding. This study explores trends in early infant feeding practices by maternal race and other characteristics in Hawai'i. Data from a linked 2008-2015 Hawai'i Newborn Metabolic Screening and Birth Certificate file for 128 399 singleton term infants were analyzed. Early infant feeding occurring 24-48 hours after delivery and before discharge was categorized: Early formula feeding; early mixed feeding; and early exclusive breastfeeding. Differences were assessed over time by maternal race and other socio-demographic characteristics. Further assessment of maternal race included a generalized logit model adjusting for maternal age, marital status, county of residence, type of birth attendant, and birth year. Statewide, early exclusive breastfeeding increased from 58.8% in 2008 to 79.1% in 2015 (relative increase=+35%); early mixed feeding declined from 31.1% to 16.0% (relative decrease=-49%) and early formula feeding declined from 10.1% to 4.9% (relative decrease=-51%). Most maternal race subgroups experienced increases in early exclusive breastfeeding and decreases in mixed and formula. Japanese mothers were 2.15 (95%CI=1.90-2.42) and Korean mothers were 1.73 (95%CI=1.37-2.18) times more likely to practice early exclusive breastfeeding compared with white mothers. Several subgroups were less likely to practice early exclusive breastfeeding compared with white mothers. Substantial increases in early exclusive breastfeeding in Hawai'i occurred across all subgroups. Development of culturally appropriate hospital practices, particularly in those with persistently lower estimates, could help improve early exclusive breastfeeding.

Key Program Findings and Insights From the Baby-Friendly Hawaii Project.

BACKGROUND: Breastfeeding is the optimal method for infant feeding. In the United States, 81.1% of mothers initiate breastfeeding; however, only 44.4% and 22.3% of mothers are exclusively breastfeeding at 3 and 6 months, respectively. Research aim: The Centers for Disease Control and Prevention provides guidance and funding to state health departments to support strategies to improve breastfeeding policies and practices in the hospital, community, and worksite settings. In 2010, the Hawaii State Department of Health received support from the Centers for Disease Control and Prevention to launch the Baby-Friendly Hawaii Project (BFHP) to increase the number of Hawaii hospitals that provide maternity care consistent with the Ten Steps to Successful Breastfeeding and increase the rate of women who remain exclusively breastfeeding throughout their hospital stay. METHODS: For this article, we examined the BFHP's final evaluation report and Hawaii breastfeeding and maternity care data to identify the role of the BFHP in facilitating improvements in maternity care practices and breastfeeding rates. RESULTS: Since 2010, 52 hospital site visits, 58 trainings, and ongoing technical assistance were administered, and more than 750 staff and health professionals from BFHP hospitals were trained. Hawaii's overall quality composite Maternity Practices in Infant Nutrition and Care score increased from 65 (out of 100) in 2009 to 76 in 2011 and 80 in 2013, and Newborn Screening Data showed an increase in statewide exclusive breastfeeding from 59.7% in 2009 to 77.0% in 2014. CONCLUSION: Implementation and findings from the BFHP can inform future planning at the state and federal levels on maternity care practices that can improve breastfeeding.

A comprehensive multi-level approach for passing safe routes to school and complete streets policies in Hawaii.

BACKGROUND: Policy changes were needed to reshape the built environment for active transportation. METHODS: Using the social ecological model as a framework, the Healthy Hawaii Initiative worked with a contractor to develop a series of meetings, planning sessions, and workshops. Activities spanned 22 months between 2007 and 2009, and involved multiple stakeholders, including educational outreach for legislators and collaborative planning sessions with advocates. RESULTS: Ultimately, with the help of the contractor to initiate the process, Complete Streets and Safe Routes to School (SRTS) legislation were introduced January 2009. Advocacy groups monitored bill progress, testified at hearings, and assisted in rewording the bills. The SRTS statute required the Department of Transportation (DOT) to administer the federal SRTS funds and the complete streets law tasked the state and county DOTs to adopt complete streets policies and review existing highway design standards and guidelines. Both bills were signed into law June 2009. CONCLUSIONS: Focusing efforts at multiple levels of the social ecological model involving champions and key stakeholders led to the successful passage of legislation supporting active transportation. Tracking policy implementation and evaluation over time will help determine actual impact on active transportation behaviors across Hawaii.