Relationship between obesity and lower rates of breast feeding initiation in regional Victoria, Australia: an 8-year retrospective panel study

ObjectivesUsing routinely collected hospital data, this study explored secular trends over time in breast feeding initiation in a large Australian sample. The association between obesity and not breast feeding was investigated utilising a generalised estimating equations logistic regression that adjusted for sociodemographics, antenatal, intrapartum and postpartum conditions, mode of delivery and infant’s-related covariates.DesignPopulation-based retrospective panel.SettingA regional hospital that serves 26% of Victoria’s 6.5 million population in Australia.ParticipantsAll women experiencing live births between 2010 and 2017 were included. Women with missing body mass index (BMI) were excluded.ResultsA total of 7491 women contributed to 10 234 live births. At baseline, 57.2% of the women were overweight or obese, with obesity increasing over 8 years by 12.8%, p=0.001. Although, breast feeding increased over time, observed in all socioeconomic status (SES) and BMI categories, the lowest proportions were consistently found among the obese and morbidly obese (78.9% vs 87.1% in non-obese mothers, p<0.001). In the multivariable analysis, risk of not breast feeding was associated with higher BMI, teenage motherhood, smoking, belonging to the lowest SES class, gravidity >4 and undergoing an assisted vaginal or caesarean delivery. Compared with women with a normal weight, the obese and morbidly obese were 66% (OR 1.66, 95% CI 1.40 to 1.96, p<0.001) to 2.6 times (OR 2.61, 95% CI 2.07 to 3.29, p<0.001) less likely to breast feed, respectively. The detected dose–response effect between higher BMI and lower breast feeding was not explained by any of the study covariates.ConclusionThis study provides evidence of increasing breast feeding proportions in regional Victoria over the past decade. However, these proportions were lowest among the obese and morbidly obese and those coming from the most disadvantaged backgrounds suggesting the need for targeted interventions to support breast feeding among these groups. The psychosocial and physiological associations between obesity and breast feeding should further be investigated.

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Prevalence of breast-feeding and exclusive breast-feeding at 48 h after birth and up to the sixth month in Cyprus: the BrEaST start in life project

Public Health Nutrition ◽

10.1017/s1368980017003214 ◽

2017 ◽

Vol 21 (5) ◽

pp. 967-980 ◽

Cited By ~ 2

Author(s):

Mary Economou ◽

Ourania Kolokotroni ◽

Irene Paphiti-Demetriou ◽

Christiana Kouta ◽

Ekaterini Lambrinou ◽

...

Keyword(s):

Breast Feeding ◽

Family Income ◽

Mode Of Delivery ◽

Public Hospitals ◽

Policy Action ◽

Cross Sectional ◽

Exclusive Breast Feeding ◽

Life Project ◽

Breast Feed ◽

Higher Educational Attainment

AbstractObjectiveTo assess the prevalence and sociodemographic determinants of breast-feeding (BF) and exclusive breast-feeding (EBF) in Cyprus up to the sixth month.DesignCross-sectional and longitudinal descriptive study. BF and EBF were estimated based on mothers’ self-reported BF status in line with Step 7 of the WHO/UNICEF Baby-Friendly Hospital Initiative questionnaire and based on 24 h recall.SettingMaternity wards in all public hospitals and twenty-nine (of thirty-five) private maternity clinics nationwide.SubjectsConsecutive sample of 586 mothers recruited within 48 h from birth, followed up by telephone interview at the first, fourth and sixth month.ResultsAlthough 84·3 % of mothers initiated BF before discharge, prevalence of BF at the sixth month was 32·4 %, with the highest reduction observed between the first and fourth months. Prevalence of EBF at 48 h was 18·8 % and fell gradually to 5·0 % at the sixth month. Mothers with higher educational attainment or higher family income were more likely to breast-feed until the sixth month. In terms of EBF, an association was observed only with education, which persisted until the sixth month. Other than social gradient, mode of delivery was the strongest determinant of BF initiation, exclusivity and continuation. Mothers who gave birth vaginally were three to four times more likely to initiate BF (OR=3·1; 95 % CI 1·7, 5·4) and EBF (OR=4·3; 95 % CI 2·7, 6·8).ConclusionsThe low prevalence of BF and EBF in Cyprus, together with the fact that caesarean section rates are currently among the highest in Europe, suggest the need for further research to understand this multidimensional phenomenon and for interdisciplinary policy action to protect, promote and support BF.

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Infant and young child feeding patterns in Kuwait: results of a cross-sectional survey

Public Health Nutrition ◽

10.1017/s1368980017001094 ◽

2017 ◽

Vol 20 (12) ◽

pp. 2201-2207 ◽

Cited By ~ 2

Author(s):

Manuel Carballo ◽

Noureen Khatoon ◽

Elizabeth Catherine Maclean ◽

Nawal Al-Hamad ◽

Anwar Mohammad ◽

...

Keyword(s):

Breast Feeding ◽

Infant Nutrition ◽

Descriptive Analysis ◽

Mode Of Delivery ◽

Later Life ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Breast Feed ◽

Discharge From Hospital

AbstractObjectiveThe beneficial role of breast-feeding for maternal and child health is now well established. Its possible role in helping to prevent diabetes and obesity in children in later life means that more attention must be given to understanding how patterns of infant feeding are changing. The present study describes breast-feeding profiles and associated factors in Kuwait.Design/Setting/SubjectsInterviews with 1484 recent mothers were undertaken at immunisation clinics across Kuwait. Descriptive analysis and binary logistic regression of results were performed.ResultsRates of breast-feeding initiation in Kuwait were high (98·1 %) but by the time of discharge from hospital, only 36·5 % of mothers were fully breast-feeding, 37·0 % were partially breast-feeding and 26·5 % were already fully formula-feeding. Multiple social and health reasons were given for weaning the child, with 87·6 % of mothers who had stopped breast-feeding completely doing so within 3 months postpartum. Nationality (P<0·001), employment status 6 months prior to delivery (P<0·001), mode of delivery (P=0·01), sex of the child (P=0·026) and breast-feeding information given by nurses (P=0·026) were all found to be significantly associated with breast-feeding. Few women (5·6 %) got information on infant nutrition and feeding from nursing staff, but those who did were 2·54 times more likely to be still breast-feeding at discharge from hospital. Over 70 % of mothers had enjoyed breast-feeding and 74 % said they would be very likely to breast-feed again.ConclusionsIn Kuwait where the prevalence of both obesity and type 2 diabetes is growing rapidly, the public health role of breast-feeding must be recognised and acted upon more than it has in the past.

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Dynamics of Infant Feeding: Mothers, Professionals, and the Institutional Context in a Large Urban Hospital

PEDIATRICS ◽

10.1542/peds.77.3.357 ◽

1986 ◽

Vol 77 (3) ◽

pp. 357-365

Author(s):

Beverly Winikoff ◽

Virginia Hight Laukaran ◽

Deborah Myers ◽

Richard Stone

Keyword(s):

Breast Feeding ◽

Health Care Providers ◽

Chart Review ◽

Care Providers ◽

Urban Hospital ◽

Hospital Data ◽

Feeding Management ◽

Breast Feed ◽

Insufficient Milk ◽

Breast Fed

A multidimensional approach was taken to understand the constraints to breast-feeding in a large municipal hospital. Data were collected through direct observation, chart review, and questionnaires to patients and staff. Breast-feeding had not yet begun within 24 hours postpartum in 37% of women who wanted to breast-feed. Chart review revealed that at hospital discharge no woman was breast-feeding exclusively: only 16% of infants had ever been breast-fed and all of these also had been formula fed. The most common reason for the use of supplementary formula and early weaning was the mother's perception or anticipation of insufficient milk. The existing procedures communicated the message to patients that the health care providers expected women to bottle-feed. Some practices that prevented successful breast-feeding were prolonged and/or unnecessary separation of mother and infant, routine provision of infant formula, confusion about drug contraindications for breast-feeding, and inconsistent identification of breast-feeding infants. Staff knowledge about breast-feeding management was inadequate, and staff underestimated mothers' interest in breast-feeding. Recommendations to facilitate breast-feeding include a revision of routines and procedures as well as provision of staff education and expansion of patient education.

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A Downward Spiral? A Panel Study of Misinformation and Media Trust in Chile

The International Journal of Press/Politics ◽

10.1177/19401612211025238 ◽

2021 ◽

pp. 194016122110252

Author(s):

Sebastián Valenzuela ◽

Daniel Halpern ◽

Felipe Araneda

Keyword(s):

News Media ◽

Panel Study ◽

Future Research ◽

Panel Survey ◽

Downward Spiral ◽

The Media ◽

Media Trust ◽

People’S Attitudes ◽

Over Time

Despite widespread concern, research on the consequences of misinformation on people's attitudes is surprisingly scant. To fill in this gap, the current study examines the long-term relationship between misinformation and trust in the news media. Based on the reinforcing spirals model, we analyzed data from a three-wave panel survey collected in Chile between 2017 and 2019. We found a weak, over-time relationship between misinformation and media skepticism. Specifically, initial beliefs on factually dubious information were negatively correlated with subsequent levels of trust in the news media. Lower trust in the media, in turn, was related over time to higher levels of misinformation. However, we found no evidence of a reverse, parallel process where media trust shielded users against misinformation, further reinforcing trust in the news media. The lack of evidence of a downward spiral suggests that the corrosive effects of misinformation on attitudes toward the news media are less serious than originally suggested. We close with a discussion of directions for future research.

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Engineering students’ attitudinal beliefs by gender and student division: a methodological comparison of changes over time

International Journal of STEM Education ◽

10.1186/s40594-020-00269-6 ◽

2021 ◽

Vol 8 (1) ◽

Author(s):

Madison E. Andrews ◽

Anita D. Patrick ◽

Maura Borrego

Keyword(s):

Self Efficacy ◽

Engineering Students ◽

Focal Point ◽

Value Engineering ◽

Longitudinal Analyses ◽

Utility Value ◽

Cross Sectional ◽

Targeted Interventions ◽

Significant Difference ◽

Over Time

Abstract Background Students’ attitudinal beliefs related to how they see themselves in STEM have been a focal point of recent research, given their well-documented links to retention and persistence. These beliefs are most often assessed cross-sectionally, and as such, we lack a thorough understanding of how they may fluctuate over time. Using matched survey responses from undergraduate engineering students (n = 278), we evaluate if, and to what extent, students’ engineering attitudinal beliefs (attainment value, utility value, self-efficacy, interest, and identity) change over a 1-year period. Further, we examine whether there are differences based on gender and student division, and then compare results between cross-sectional and longitudinal analyses to illustrate weaknesses in our current understanding of these constructs. Results Our study revealed inconsistencies between cross-sectional and longitudinal analyses of the same dataset. Cross-sectional analyses indicated a significant difference by student division for engineering utility value and engineering interest, but no significant differences by gender for any variable. However, longitudinal analyses revealed statistically significant decreases in engineering utility value, engineering self-efficacy, and engineering interest for lower division students and significant decreases in engineering attainment value for upper division students over a one-year period. Further, longitudinal analyses revealed a gender gap in engineering self-efficacy for upper division students, where men reported higher means than women. Conclusions Our analyses make several contributions. First, we explore attitudinal differences by student division not previously documented. Second, by comparing across methodologies, we illustrate that different conclusions can be drawn from the same data. Since the literature around these variables is largely cross-sectional, our understanding of students’ engineering attitudes is limited. Our longitudinal analyses show variation in engineering attitudinal beliefs that are obscured when data is only examined cross-sectionally. These analyses revealed an overall downward trend within students for all beliefs that changed significantly—losses which may foreshadow attrition out of engineering. These findings provide an opportunity to introduce targeted interventions to build engineering utility value, engineering self-efficacy, and engineering interest for student groups whose means were lower than average.

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Maternal mortality in six low and lower-middle income countries from 2010 to 2018: risk factors and trends

Reproductive Health ◽

10.1186/s12978-020-00990-z ◽

2020 ◽

Vol 17 (S3) ◽

Author(s):

Melissa Bauserman ◽

Vanessa R. Thorsten ◽

Tracy L. Nolen ◽

Jackie Patterson ◽

Adrien Lokangaka ◽

...

Keyword(s):

Risk Factors ◽

Maternal Mortality ◽

Maternal Deaths ◽

Middle Income ◽

Maternal Risk ◽

Live Births ◽

Middle Income Countries ◽

Risk Of Death ◽

Increased Risk ◽

Over Time

Abstract Background Maternal mortality is a public health problem that disproportionately affects low and lower-middle income countries (LMICs). Appropriate data sources are lacking to effectively track maternal mortality and monitor changes in this health indicator over time. Methods We analyzed data from women enrolled in the NICHD Global Network for Women’s and Children’s Health Research Maternal Newborn Health Registry (MNHR) from 2010 through 2018. Women delivering within research sites in the Democratic Republic of Congo, Guatemala, India (Nagpur and Belagavi), Kenya, Pakistan, and Zambia are included. We evaluated maternal and delivery characteristics using log-binomial models and multivariable models to obtain relative risk estimates for mortality. We used running averages to track maternal mortality ratio (MMR, maternal deaths per 100,000 live births) over time. Results We evaluated 571,321 pregnancies and 842 maternal deaths. We observed an MMR of 157 / 100,000 live births (95% CI 147, 167) across all sites, with a range of MMRs from 97 (76, 118) in the Guatemala site to 327 (293, 361) in the Pakistan site. When adjusted for maternal risk factors, risks of maternal mortality were higher with maternal age > 35 (RR 1.43 (1.06, 1.92)), no maternal education (RR 3.40 (2.08, 5.55)), lower education (RR 2.46 (1.54, 3.94)), nulliparity (RR 1.24 (1.01, 1.52)) and parity > 2 (RR 1.48 (1.15, 1.89)). Increased risk of maternal mortality was also associated with occurrence of obstructed labor (RR 1.58 (1.14, 2.19)), severe antepartum hemorrhage (RR 2.59 (1.83, 3.66)) and hypertensive disorders (RR 6.87 (5.05, 9.34)). Before and after adjusting for other characteristics, physician attendance at delivery, delivery in hospital and Caesarean delivery were associated with increased risk. We observed variable changes over time in the MMR within sites. Conclusions The MNHR is a useful tool for tracking MMRs in these LMICs. We identified maternal and delivery characteristics associated with increased risk of death, some might be confounded by indication. Despite declines in MMR in some sites, all sites had an MMR higher than the Sustainable Development Goals target of below 70 per 100,000 live births by 2030. Trial registration The MNHR is registered at NCT01073475.

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Measuring Poverty in Britain as a Multi-dimensional Concept, 1991 to 2003

Journal of Social Policy ◽

10.1017/s0047279408002237 ◽

2008 ◽

Vol 37 (4) ◽

pp. 597-620 ◽

Cited By ~ 39

Author(s):

MARK TOMLINSON ◽

ROBERT WALKER ◽

GLENN WILLIAMS

Keyword(s):

Structural Equation Modelling ◽

Structural Equation ◽

Panel Study ◽

Financial Stress ◽

Material Deprivation ◽

New Approach ◽

Equation Modelling ◽

Dimensional Measure ◽

Trends Over Time ◽

Over Time

AbstractWhile poverty is widely accepted to be an inherently multi-dimensional concept, it has proved very difficult to develop measures that both capture this multi-dimensionality and facilitate comparison of trends over time. Structural equation modelling appears to offer a solution to this conundrum and is used to exploit the British Household Panel Study to create a multi-dimensional measure of poverty. The analysis reveals that the decline in poverty in Britain between 1991 and 2003 was driven by falls in material deprivation, but more especially by reduced financial stress, particularly during the early 1990s. The limitations and potential of the new approach are critically discussed.

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Attitudes of Expectant Fathers Regarding Breast-Feeding

PEDIATRICS ◽

10.1542/peds.90.2.224 ◽

1992 ◽

Vol 90 (2) ◽

pp. 224-227

Author(s):

Gary L. Freed ◽

J. Kennard Fraley ◽

Richard J. Schanler

Keyword(s):

Breast Feeding ◽

Formula Feeding ◽

Education Programs ◽

Feeding Method ◽

Familial Support ◽

Feeding Group ◽

Breast Feed ◽

Nursing Mothers ◽

Expectant Fathers ◽

Study Population

Fathers participate in choosing the feeding method for their newborns. However they traditionally have not been included in most breast-feeding education programs. To examine expectant fathers' attitudes and knowledge regarding breast-feeding, we surveyed 268 men during the first session of their Childbirth education classes at five private hospitals in Houston, Texas. The study population was 81% white, 8% black, and 6% hispanic. Ninety-seven percent (n = 259) of the total were married. Fifty-eight percent (n = 156) reported that their spouses planned to breast-feed exclusively; several signficant differences existed between these men and those who reported plans for exclusive formula feeding. The breast-feeding group was more likely to believe breast-feeding is better for the baby (96% vs 62%; P < .0001), helps with infant bonding (92% vs 53%; P < .0001), and protects the infant from disease (79% vs 47% P < .001). The breast-feeding group was also more likely to want their partner to breast-feed (90% vs 13%; P < .0001) and to have respect for breast-feeding women (57% vs 16%; P < .0001). Conversely, those in the formula feeding group were more likely to think breast-feeding is bad for breasts (52% vs 22%; P < .01), makes breasts ugly (44% vs 23%; P < .05), and interferes with sex (72% vs 24%; P < .0001). The majority of both groups indicated breast-feeding was not acceptable in public (breast-feeding = 71%, formula feeding = 78%, P < .05). These data demonstrate misperceptions and a lack of education regarding breast-feeding in the formula feeding group and a lack of public acceptance in both groups. We conclude that fathers must be included in breast-feeding education programs. Confrontation of myths and misperceptions prenatally may help to overcome obstacles to the initiation of breast-feeding and to provide greater familial support for nursing mothers.

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Breast-Feeding, Birth Interval, and Infant Health

PEDIATRICS ◽

10.1542/peds.74.4.695 ◽

1984 ◽

Vol 74 (4) ◽

pp. 695-701

Author(s):

John E. Anderson ◽

James S. Marks ◽

Tai-Keun Park

Keyword(s):

Breast Feeding ◽

Indirect Effects ◽

Infant Health ◽

Fertility Rates ◽

Recent Issue ◽

Birth Intervals ◽

Contraceptive Effect ◽

Breast Feed ◽

Lower Fertility ◽

Demographic Surveys

In this section we consider the indirect effects of breast-feeding on infant health through its effect on birth intervals. First, we examine the evidence that breast-feeding is associated with longer intervals between births. Then we discuss studies that have attempted to show that short birth intervals are related to poorer infant health. EFFECT OF BREAST-FEEDING ON INTERVALS BETWEEN BIRTHS Breast-feeding is associated with a delay in the return of ovulation after a birth, with longer intervals between births, and with lower fertility rates occurring in populations where this practice is prolonged. In a recent issue of Population Reports,13 numerous studies that evaluate the contraceptive effect of breast-feeding were reviewed. Studies that link breast-feeding and fertility include clinical reports based on small numbers of women, larger prospective studies, and single-round demographic surveys which may be representative of national populations. Clinical Studies Because ovulation is difficult to measure, studies linking breast-feeding with ovulation have been limited to small numbers of clinic-based subjects.4,14,17 These studies have shown that women who breast-feed—and those who breast-feed for longer periods—tend to ovulate later following a birth than other women. This effect is believed to be related to the hormone prolactin, which is released through the stimulus caused by the infant's sucking. Prolactin promotes the production of breast milk and is believed to be related to the inhibition of ovulation. Levels of prolactin and the anovulatory effect are related to the frequency and intensity of nursing. Thus, women who breast-feed partially on infrequently, while giving supplementary food, are more likely to ovulate than those who breast-feed fully.

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Trends in Breast-Feeding

PEDIATRICS ◽

10.1542/peds.74.4.591 ◽

1984 ◽

Vol 74 (4) ◽

pp. 591-602

Author(s):

Gerry E. Hendershot

Keyword(s):

Infant Feeding ◽

Breast Feeding ◽

Market Research ◽

The United States ◽

Upward Trend ◽

Disadvantaged Women ◽

Breast Feed ◽

Statistical Studies ◽

Low Levels ◽

Short Section

Starting from very high levels in the 1940s, breast-feeding declined steadily to low levels in the early 1970s, and then began an upward trend which has apparently continued until the present (Fig. 1). In the 1940s, breast-feeding was more common among disadvantaged women. The subsequent decline was also more rapid among the disadvantaged, however, so that by the early 1970s, disadvantaged women were considerably less likely than others to breast-feed. Because the increase since the early 1970s has not been so pronounced among the disadvantaged, they continue to have relatively low levels of breast-feeding. The causes of these trends and differentials are not well understood. These are the principal conclusions drawn from a review of statistical studies of trends and differentials in breast-feeding in the United States. The studies included national health surveys conducted by the federal government, market research surveys conducted by infant formula manufacturers, and infant feeding surveys conducted by medical researchers. The studies differed markedly in their methods—a fact that affects their validity, reliability, and comparability. The first section of this paper discusses these data sources and their limitations. The next two sections discuss the downward trend in breast-feeding from the 1940s to the early 1970s, and the upward trend since. Each of these sections examines demographic differences in these trends. A short section that addresses possible causes of the trends and differentials follows those two sections. SOURCES AND LIMITATIONS OF THE DATA The principal sources of data on trends and differentials in breast-feeding are national fertility surveys, market research surveys, and special purpose infant-feeding surveys.

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