Battering and breastfeeding in a WIC population.

The study reported in this paper was based on the hypothesis that women who are victims of domestic violence may be less likely to select breastfeeding than women who are not abused. Informed consent was obtained from 212 women at 2 Women, Infants and Children (WIC) Nutritional Supplemental Program clinics in the Midwestern United States. The Abuse Assessment Screen was administered by interview and women were also questioned about intended feeding choice and whether they had breastfed any previous children. No association was found between present or previous abuse and infant-feeding choice. Nevertheless, the findings of this study can be considered important, for two reasons: (1) this was an initial inquiry examining the relationship between having been abused and ability to choose the feeding method of a newborn; and (2) women in the sample who reported present or current abuse were able to breastfeed their infants in the same proportion as those who did not report abuse, which suggests that a woman's concern for her child overcomes her possible fears of control by the batterer.

Pregnancy intention and pregnancy happiness: are they different?

OBJECTIVES: This study examines the relationship among pregnancy intention and attitudes, inconsistent contraceptive use, and plans for potential pregnancy among 311 women who presented at local health departments to seek a pregnancy test and for whom a pregnancy would be unintended. METHODS: Women were surveyed prior to receiving pregnancy tests. Pregnancy intention was measured using traditional classifications of mistimed and unwanted pregnancies. Frequency distributions and chi-square tests were computed to examine and compare rates of happiness about the pregnancy among women with mistimed or unwanted pregnancy and to compare rates of inconsistent contraceptive use and plans for the pregnancy by intention and level of happiness. RESULTS: Although all of the women selected for our sample stated that their pregnancies would be unintended, almost half (46%) were inconsistent contraceptive users. Further, 48% reported that they would be somewhat or very happy about a pregnancy. The proportion of women who were uncertain about the future of a pregnancy and who considered adoption or abortion was highest among those for whom a potential pregnancy was mistimed and who were unhappy about the pregnancy. CONCLUSIONS: Differentiating between pregnancy intention and happiness has practice implications for family planning and prenatal providers. Additional research should further elaborate these distinctions.

Factors affecting contraceptive use in women seeking pregnancy tests: Missouri, 1997.

CONTEXT: If the national health objective of reducing unintended pregnancy is to be met, a better understanding is needed of barriers to women's acquisition and use of contraceptives. METHODS: A sample of 311 Missouri women who were seeking pregnancy tests in public health department clinics in 1997 and who said their potential pregnancy was unintended were asked about potential barriers to family planning. Factors affecting contraceptive use among these women were examined by frequency of use, insurance status, education and race. RESULTS: In general, the women mostly disagreed that particular factors were potential barriers to contraceptive use. For only one item--worry over the potential side effects of the hormonal injectable contraceptive--did a majority agree or strongly agree that it was a barrier to method use in the previous six months. Women who used a contraceptive infrequently were more likely than frequent users to identify 33 factors in nine areas as being potential barriers to contraceptive use. These ranged from factors involving access to services and condom-specific issues to cost-related concerns, social norms, pregnancy denial, embarrassment over discussing or obtaining birth control, worry about side effects and experience with forced sex, among others. Perceived barriers differed somewhat by insurance status in the areas of access, embarrassment, side effects and forced sex. For example, women with no insurance coverage reported a higher level of agreement that transportation problems had hindered their access to a clinic than did women with private insurance. Level of education affected agreement only in the area of side effects, with more-educated women expressing greater concern about side effects than less-educated women. The respondent's race affected agreement in six areas: access, social norms, pregnancy denial, embarrassment, forced sex and other miscellaneous concerns, such as condom use and relationship issues. CONCLUSION: Better education and improved access to and delivery of services might address several factors affecting contraceptive use that are associated with unintended pregnancy. Some barriers, however, such as those related to self-efficacy, self-esteem and fatalistic attitudes about pregnancy, would be much harder for family planning providers to resolve.

Breastfeeding attitudes in a sample of Spanish-speaking Hispanic American women.

This descriptive, cross-sectional study examined attitudes toward breastfeeding in 57 Spanish-speaking Hispanic American women. Participants were asked to complete a Spanish version of the Breastfeeding Behavior Questionnaire (Cuestionario de Comportamiento Amamantar). The instrument is composed of 12 vignettes to which women agreed or disagreed using a Likert-type scale. Content validity was ascertained by a group of Spanish-speaking health professionals, and a Pearson correlation coefficient of .96 was calculated for test-retest reliability. Women were also interviewed for demographic data, reproductive history, and experience with breastfeeding. Mean scores on the instrument revealed generally positive attitudes toward breastfeeding. Although recent evidence suggests that breastfeeding initiation has been decreasing in Hispanic women, more than 90% of the women in this sample stated that their intention was to breastfeed and felt that they were supported in their decision by significant others.

Health care perceptions of mid-western urban-dwelling African-American women.

As a part of a comprehensive women's health needs assessment performed in Missouri, two focus groups were conducted with urban-dwelling African-American women. Ten African-American women 18 to 39 years of age comprised one group and 10 African-American women 40 to 74 years of age comprised the other group. Participants discussed major health concerns and issues related to service access. Although similar responses occurred between groups, major concerns such as reproductive issues in the younger women and chronic diseases in the older women, were clearly age-related. Participants commented on impediments to health care and adequacy of services. The Missouri Department of Health will use these findings in planning group-specific health interventions and services.

Beliefs concerning contraceptive acquisition and use among low-income women.

Despite the availability of a wide variety of safe and effective contraceptives, unintended pregnancy remains a problem of considerable social and public health concern. This qualitative, descriptive investigation was based on Ajzen's Theory of Planned Behavior. The study examined attitudinal and normative beliefs, as well as perceived control factors that may affect a woman's intention to acquire and use specific contraceptive methods. The study sample consisted of 42 low-income women of reproductive potential. In face-to-face, audiotaped interviews, open-ended questions were used to elicit salient beliefs that affected these women's decision making about contraceptive acquisition and use. Respondents named embarrassment as a factor influencing condom acquisition and use; concerns about potential risks and side effects were a major deterrent to use of hormonal contraceptives. Implications for practitioners and public policy are suggested.

PIP: Despite the availability of a wide range of safe and effective contraceptives, unintended pregnancy remains a considerable social and public health problem in the US. More than half of all pregnancies in the US are unintended, and of those, 1.6 million are aborted and 1.5 million are carried to term. A qualitative, descriptive study was conducted based upon Ajzen's Theory of Planned Behavior, examining the attitudinal and normative beliefs, as well as perceived control factors which may affect a woman's intention to acquire and use specific contraceptive methods. The study sample was comprised of 42 low-income, reproductive-age women of mean age 23.4 years. Study respondents cited embarrassment as a factor influencing condom acquisition and use, while concerns about potential risks and side effects were a major deterrent to the use of hormonal contraceptives. Implications for practitioners and public policy are considered.

Women's beliefs regarding persistent fatigue.

Investigation of women's perceptions of possible etiologies for, and solutions to, persistent fatigue was the purpose of this study. Although factors associated with fatigue have been explored in specific patient populations, little study has addressed the presence of fatigue among women generally thought to be well. A convenience sample of 76 community women participated in audiotaped interviews regarding their perceptions of personal fatigue. Transcribed interview data were content-analyzed for recurrent themes. Results suggest that long-term fatigue is ubiquitous in the lives of many women and that many perceive role burden and stress to be important contributing factors. Many women apply self-care measures to prevent and decrease fatigue, but others are unable to employ helpful strategies. Some respondents were able to identify specific ways in which family and important others could help them to decrease or prevent their fatigue. However, many expressed the belief that significant others were unconcerned and unwilling to assist them in any substantive way.

Congruence of decisions between patients and their potential surrogates about life-sustaining therapies.

Decisions concerning life-sustaining treatments and the congruence in decision-making between patients and potential surrogates were examined. The ability of a patient-chosen surrogate to make decisions reflecting the wishes of that patient was estimated. Thirty patient-surrogate pairs independently responded to vignettes of five treatments. Patients and surrogates made similar decisions on all treatments except cancer chemotherapy, for which surrogates were significantly more likely to choose treatment when patients would have them refuse. The findings can assist patients and clinicians in choosing a surrogate whose decision-making corresponds with patient choices.

Case-management of AIDS clients as a predictor of total inpatient hospital days.

AIDS has shifted from an acute short-term terminal illness to a progressive, chronic disorder. Evaluation of AIDS case-management is imperative due to both the increasing numbers of cases and the lengthened survival of those with the disease. In 1988 the Missouri Department of Health (MDOH) initiated the first statewide system of AIDS case-management in the United States. This study was done to determine if deceased AIDS clients who received MDOH case-management services had fewer inpatient hospital days than clients who did not receive these services, during the last six months of life. Death certificates and Medicaid records were merged for 100 case-managed and 99 control, non-case-managed AIDS clients. No significant difference between groups was found in number of inpatient hospital days. Further, neither age, ethnicity, gender, cause of death, nor specific AIDS risk factors were associated with total number of inpatient hospital days. The client-centered philosophy of the program may have encouraged case managers to utilize all available service, including hospitalization, without considering cost-containment issues. Future evaluation efforts will investigate both cost-containment and quality-of-life indicators, such as satisfaction with care, of case-managed AIDS clients.

Sexual harassment of female registered nurses in hospitals.

Sexual harassment of nurses seriously affects nursing performance and productivity. In this survey, sexual harassment by male patients and coworkers was reported by greater than 70% of the female staff nurses surveyed. The most common manifestations of harassment were sexual remarks; however, behaviors involving touch were frequent. Nurses noted that they often confronted patients when these behaviors occurred, but were less likely to confront male co-workers. Findings suggest that nursing managers and executives must discover and eliminate sexual harassment in hospital work settings and create work cultures that discourage manifestation of sexually harassing behaviors.

Perceptions of breastfeeding and infant feeding choice in a group of low-income mid-Missouri women.

This cross-sectional descriptive study investigated attitudes regarding breastfeeding in 69 low-income women presenting for prenatal care at a teaching facility in a small midwest United States community. Women were interviewed for demographic data, reproductive history, and experience with infant feeding. The sample was predominantly white and rural. Almost half stated an intent to breastfeed. Breastfeeding by the maternal grandmother and endorsement by a male partner were associated positively with intent to breastfeed. Subjects were asked to estimate ease, convenience, and freedom associated with breastfeeding. Intenders viewed breastfeeding as significantly easier (p < .01), more convenient (p < .0001), and more conducive to freedom (p < .0001) than women who did not intend to breastfeed. Subjects also completed an investigator-designed tool, the Breastfeeding Behavior Questionnaire. Results indicated relatively neutral attitudes regarding breastfeeding.

Lactation education practice and procedure: information and support offered to economically disadvantaged women.

Seventy-five agencies providing services to a large percentage of economically disadvantaged pregnant women returned mailed survey questionnaires. These surveys described the timing and nature of lactation education available to clients of the respondent agencies. Lactation education was most frequently introduced at 16-week gestation. Fifty-seven (76%) of the respondents stated that lactation education was offered to all clients at least once during pregnancy, and 23 (31%) stated that all prenatal clients were expected to attend breastfeeding classes, regardless of stated feeding choice. Respondents generally agreed that breastfeeding should be encouraged if a woman is undecided about feeding issues, but they were less definite concerning active encouragement of breastfeeding to women who had made another feeding choice. These findings may facilitate the effort to increase initiation of breastfeeding by examining education practices and provider attitudes that may foster or hinder breastfeeding adoption in this client population.

Perspectives of common breastfeeding situations: a known group comparison.

Infant feeding choice is influenced by social and cultural factors, as reflected in sociodemographic correlates of breastfeeding, which show consistently low breastfeeding rates among women from low-income populations. This study examines attitudes and beliefs that are thought to affect feeding choice and breastfeeding behavior among diverse social and cultural groups. A breastfeeding behavior questionnaire asking women to respond to a variety of breastfeeding situations presented as narratives was administered to members of a La Leche League group and to a group of WIC participants. Results support the idea that different social groups of women display divergent attitudes toward and perceptions of breastfeeding. Although small sample size prohibits generalization of results, the findings reinforce the necessity of designing breastfeeding education programs within specific cultural contexts.

Condoms as primary prevention in sexually active women.

PIP: The origin of the word condom is the subject of some debate, but the use of a linen sheath as a preventive measure for venereal disease was noted in the writings of Fallopius in 1564. In recent years condom sales have increased, and in a sample of San Francisco male homosexuals consistent condom use was reported to have increased from 26% to 79% between 1984 and 1987. Condom sales in drugstores increased by over 20% from 1986 to 1987, with women being responsible for an estimated 40-50% of US purchases. Studies suggest a failure rate of 2-15/100 couples using condoms. Failure rates for 1st-year users average about 12%, but consistent and correct condom use theoretically results in approximately a 2% failure rate. Mean breakage rates ranging from 0% to 13% have been reported. Both epidemiological and laboratory studies have demonstrated that latex condoms are effective mechanical barriers to important viral transmissions including HIV, herpes simplex virus (HSV), hepatitis B virus (HBV), and cytomegalovirus (CMV), as well as bacteria such as Chlamydia trachomatis and Neisseria gonorrhea. Condoms are safe to use, particularly in view of the fact that AIDS is now 1 of the 5 leading causes of death for women ages 15-44. An important contraindication, however, is the presence of latex allergy, potentially leading to contact urticaria or manifestations of anaphylaxis. The female condom shows promise for placing personal protection increasingly under the control of women. Condom promotion in the US with education at both public and individual levels could emulate developed and developing countries that have promoted condom use with marketing and mass-media techniques, as well conspicuous and aggressive distribution methods. Nursing is involved in program efforts aimed at enhancing condom use and nurses can be effective in encouraging clients to use condoms to protect themselves.^ieng

Prenatal education in a high-risk population: the effect on birth outcomes.

This case-control investigation examined the relationship between absence of specific educational content during prenatal care and risk of adverse birth outcomes. A total of 1484 women from three regions with high rates of low birthweight and infant mortality participated in structured postpartum interviews. Analyses were performed for both the full sample and three regional subsamples. For the full sample an adjusted risk ratio of 2.87 (95% CI = 1.75, 4.71) was noted between risk of preterm low birthweight and lack of advice to call the health provider if preterm labor were suspected. For one subsample an adjusted risk ratio of 2.50 (95% CI = 1.11, 5.60) was noted between the risk of preterm low birthweight and lack of education on the signs and symptoms of preterm labor. This study reinforces a body of literature that stresses the importance of appropriate prenatal care in preventing preterm low birthweight. It further suggests that adequacy measures of prenatal care should reflect quality and content as well as timing and number of prenatal visits.

Enterobiasis.

Enterobiasis or pinworm infestation is an ubiquitous infection often seen in primary care settings. Incidence and prevalence are difficult to identify as it is believed that many cases go undiagnosed. Diagnosis, most commonly made in the school-aged child after complaints of nocturnal pruritus ani, can be made either by a cellulose tape test or by parental or self-report. A number of effective antihelminthics are available for treatment. It is thought that all close family members should be treated when a confirmed case exists and that retreatment should be given after a two-week interval to ensure eradication of the parasite. The nurse practitioner can be instrumental in providing treatment, education, support and reassurance to families with pinworms.