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Biomedical subjects

Laurence Grummer-Strawn

Publications and source records attributed to Laurence Grummer-Strawn.

15 recordsLinked to original sources
PubMed2007

Changes in public attitudes toward breastfeeding in the United States, 1999-2003.

Data from the HealthStyles survey, an annual national mail survey to US adults, were examined to understand changes in public attitudes toward breastfeeding. The 1999 and 2003 HealthStyles surveys included four breastfeeding items related to public attitudes toward breastfeeding in public and toward differences between infant formula and breastmilk. The percentage of respondents in agreement with the statement, "Infant formula is as good as breastmilk," increased significantly from 14.3% in 1999 to 25.7% in 2003. The increase was particularly large among people of low socioeconomic status. The percentage increase in agreement that "feeding a baby formula instead of breastmilk increases the chances the baby will get sick" grew at a statistically significant level, but the total change was small (2.7 percentage points). No significant total changes were found for the other two survey items. The perception that infant formula is as good as breastmilk would be expected to soften a woman's commitment to breastfeeding should she be faced with obstacles to doing so. The findings underscore the need to educate the general public that breastfeeding is the best method of feeding and nurturing infants. Pediatricians and other health professionals should recommend human milk for all infants for whom breastfeeding is not specifically contraindicated.

Adolescent↗
PubMed2005

Regional variation in public opinion about breastfeeding in the United States.

Because social and cultural norms are associated with women's breastfeeding behaviors, it is important to understand public opinions toward breastfeeding in the United States. Using data from the Healthstyles survey, the authors examined regional variations in (1) public knowledge about health benefits of breastfeeding, (2) public attitudes toward breastfeeding in public, (3) public support for workplace breastfeeding policies, and (4) public perceptions about breastfeeding duration. Pacific, West South Central, West North Central, and Mountain respondents were the most knowledgeable about the health benefits of breastfeeding. Mountain, New England, and Pacific respondents exhibited the most positive attitudes about breastfeeding in public. Mountain and Pacific respondents showed the strongest support for workplace breastfeeding policies. Pacific, Mountain, and East North Central respondents displayed the most positive perceptions about breastfeeding duration. This study emphasizes the need to learn from the best regions and apply subsequent findings to those regions having less positive public opinions and low breastfeeding rates.

Adult↗
PubMed2005

Intention or experience? Predictors of continued breastfeeding.

Despite the known benefits of breastfeeding, many women do not breastfeed their infants or stop breastfeeding early. This study examines the effects of prenatal intention and initial breastfeeding experiences on breast-feeding initiation and duration among 1,665 U.S. women completing questionnaires on infant feeding practices. Outcomes included no initiation of breastfeeding at birth and termination at <10 weeks, 10 to <20 weeks, or 20 to <30 weeks. Predictor variables included intended breast feeding duration and early breast feeding experiences with analyses controlling for demographic characteristics, previous breastfeeding experience, and prenatal intentions to work after delivery. Prenatal intentions to never initiate or to stop breastfeeding early were significant risk factors for all breastfeeding outcomes. Initial breastfeeding experiences were significant risk factors for early termination. This study supports using the intention construct from the theory of reasoned action to predict initiation of behavior but suggests the need to include initial experience when predicting maintenance of behavior.

Adolescent↗
PubMed2004

Public beliefs about breastfeeding policies in various settings.

To understand the public beliefs about breastfeeding policies in various settings and to examine the associations of these beliefs with sociodemographic characteristics, we analyze the data from the 2001 Healthstyles survey, which is an annual national mail survey to US adults. We found that establishing workplace breastfeeding policies and lactation rooms in public places are the most acceptable breastfeeding policies surveyed, especially among African Americans and low-income populations. The overall population appears to approve of breastfeeding in public, but less-educated or older people (aged >/=45 years) are less likely to do so. In general, there is relatively less public support for breastfeeding education in high schools. The results indicate that many Americans, especially African Americans and those with low household income, believe that women who breastfeed need extra support both at work and in public places. A variety of policy strategies would be appropriate to create a favorable environment for breastfeeding.

Adolescent↗
PubMed2004

Opinions and practices of clinicians associated with continuation of exclusive breastfeeding.

BACKGROUND: The American Academy of Pediatrics recommends exclusive breastfeeding for the first 6 months of life. Recent statistics indicate that initiation and maintenance of exclusive breastfeeding are low in the United States. Unfortunately, little information is available on how clinicians and health care organizations can best promote continuation of exclusive breastfeeding. OBJECTIVE: To identify clinicians' opinions and management practices that are associated with continuation of exclusive breastfeeding. METHODS: We conducted a prospective cohort study of low-risk mother-newborn pairs in a large, multispecialty group practice in which the mother was breastfeeding at 4 weeks. Mothers completed telephone interviews at 4 and 12 weeks postpartum, and their data were linked with their obstetric and pediatric clinicians' responses to a cross-sectional mailed survey conducted during the same time period. Obstetric and pediatric clinicians included medical doctors, nurse practitioners, and nurse midwives. Overall response rates were 63% for mothers and 82% for clinicians (54 obstetric and 67 pediatric clinicians). Bivariate and multivariate analyses were conducted to identify the characteristics of clinicians and mothers that predicted exclusive breastfeeding at 12 weeks. RESULTS: Of the 288 mothers who were breastfeeding at 4 weeks and had a complete 12-week interview, 152 (53%) were exclusively breastfeeding their infants at 12 weeks. Mothers who discontinued exclusive breastfeeding were more likely to have experienced problems with their infant latching on or sucking (odds ratio [OR]: 3.8; 95% confidence interval [CI]: 1.5-9.7) or report that a health care provider recommended formula supplementation (OR: 2.3; 95% CI: 1.1-5.0). Clinicians reported limited time during preventive visits to address breastfeeding problems as a very important barrier to promoting breastfeeding. Obstetric providers were least confident in resolving problems with mothers not producing enough breast milk. Pediatric providers were least confident in resolving problems with breast pain or tenderness or cracked or painful nipples. In the final multivariate model, mothers whose pediatric providers recommended formula supplementation if an infant was not gaining enough weight (OR: 3.2; 95% CI: 1.04, 9.7) or who considered their advice to mothers on breastfeeding duration to be not very important (OR: 2.2; 95% CI: 1.2-3.9) were more likely to have discontinued exclusive breastfeeding by 12 weeks postpartum. Black mothers were significantly more likely to discontinue exclusive breastfeeding by 12 weeks. CONCLUSIONS: Clinicians' practices regarding formula supplementation of healthy infants and their opinions about the importance of their breastfeeding advice are associated with the likelihood that mothers will continue exclusive breastfeeding. Policies to enhance clinicians' abilities to address breastfeeding problems within the constraints of busy practices could improve their ability to support exclusive breastfeeding.

Attitude of Health Personnel↗
PubMed2004

Mothers' and clinicians' perspectives on breastfeeding counseling during routine preventive visits.

BACKGROUND: Recent national statistics indicate that, despite increases in the proportion of mothers who initiate breastfeeding, the proportion that continue to breastfeed their infants through 6 months of age remains below the Healthy People 2010 goal of 50%. National professional organizations recommend that clinicians routinely counsel mothers about the benefits of breastfeeding. Little is known, however, about the counseling provided during these visits and how mothers and their clinicians perceive breastfeeding counseling. OBJECTIVES: We sought to describe mothers' and clinicians' perspectives on breastfeeding counseling during routine preventive visits and identify potential gaps in communication about breastfeeding and management practices. METHODS: We conducted a prospective cohort study of low-risk mother-newborn pairs and their clinicians in a large multispecialty group practice. The participating mothers completed telephone interviews at 4 and 12 weeks postpartum, and their data were linked with their obstetric and pediatric clinicians' responses to a cross-sectional mailed survey conducted during the same time period. Overall, response rates were 63% for mothers (n = 429) and 82% for clinicians (obstetric clinicians: n = 54; pediatric clinicians: n = 67). RESULTS: Of the 429 low-risk mother-newborn pairs in the study, 61% were white, 16% were black, 10% were Hispanic, and 8% were Asian, with a mean (SD) age of 32.7 (5.1) years. At 4 weeks postpartum, 319 mothers (74%) were either exclusively or mixed breastfeeding. According to the interviews, few mothers discussed breastfeeding duration with their obstetric clinicians during their prenatal visits (15%) or with their pediatric clinicians during their infants' 2-week preventive visit (24%). Among 164 mothers whose obstetric providers said they usually or always discuss breastfeeding duration during prenatal visits, only 26 (16%) of the mothers reported that the topic was discussed with them (22% agreement; kappa = -.004). Among those mothers whose pediatric clinicians said they usually or always discuss breastfeeding duration during the 2-week preventive visit, only 25% of the mothers reported that the topic was discussed (32% agreement; kappa =.05). Many of the mothers had either returned to work by 12 weeks (29%) or planned to return to work within the next few months (43%). Although nearly all the obstetric (91%) and pediatric (97%) clinicians reported that they usually or always discuss whether a mother plans to continue breastfeeding after returning to work, only approximately half (55%) of the mothers seen by the clinicians reported that the topic was discussed. Overall, few mothers reported discussing with their clinicians specific ways to continue breastfeeding after returning to work. CONCLUSION: Mothers' reports of breastfeeding advice given during routine preventive visits identified several areas in which unintentional communication gaps may occur, including specifics about breastfeeding duration and methods of breastfeeding after returning to work. Developing approaches to enhance communication with mothers during routine preventive visits could improve the support of breastfeeding.

Adult↗
PubMed2003

Maternal obesity and breast-feeding practices.

BACKGROUND: Maternal obesity has been associated with poor lactation in animal models, but the results of related research in humans are inconclusive. OBJECTIVE: We tested the hypothesis that women who are obese before pregnancy or who gain excessive weight during pregnancy are less likely to initiate and maintain breast-feeding than are their normal-weight counterparts. DESIGN: We analyzed 124 151 mother-infant pairs from the Pediatric Nutrition Surveillance System and the Pregnancy Nutrition Surveillance System. Body mass index (BMI) before pregnancy and gestational weight gain were categorized according to guidelines from the Institute of Medicine. Multiple logistic regression was used to identify the association between maternal obesity and breast-feeding initiation (n = 51 329), and multiple linear regression was used to examine the effect of maternal obesity on breast-feeding duration among women who initiated breast-feeding (n = 13 234). RESULTS: Regardless of gestational weight gain, obese women were less likely to initiate breast-feeding than were women with a normal BMI before pregnancy who also gained the recommended weight during pregnancy. Maternal BMI before pregnancy and gestational weight gain were each independently associated with duration of breast-feeding. Women who were obese before pregnancy breast-fed approximately 2 wk less than did their normal-weight counterparts, and women who either failed to reach or exceeded the recommended gestational weight gain breast-fed approximately 1 wk less than did those who gained the recommended gestational weight. CONCLUSIONS: Both obesity before pregnancy and inadequate weight gain during pregnancy have a negative effect on breast-feeding practice. Women who are obese before pregnancy or who gain inadequate weight during pregnancy need extra support for breast-feeding.

Adult↗
PubMed2003

Food insecurity is associated with increased risk of obesity in California women.

Food insecurity, the limited or uncertain availability of nutritionally adequate and safe foods, may be associated with disordered eating and a poor diet, potentially increasing risk for obesity and health problems. Patterns of food insecurity in California women are described and relationships between food insecurity and obesity (body mass index > or = 30 kg/m(2)) are evaluated using data from the 1998 and 1999 California Women's Health Survey. A total of 8169 women aged > or = 18 y were randomly selected and interviewed by telephone. Food insecurity was evaluated by use of four questions adapted from the U.S. Household Food Security Module. Logistic regression was used to examine the relationship between food insecurity and obesity, controlling for income, race/ethnicity, education, country of birth, general health status and walking. Food insecurity without hunger affected 13.9% of the population and food insecurity with hunger, 4.3%. Almost one fifth (18.8%) of the population was obese. Obesity was more prevalent in food insecure (31.0%) than in food secure women (16.2%). Food insecurity without hunger was associated with increased risk of obesity in whites [odds ratio (OR) = 1.36] and others (OR = 1.47). Food insecurity with hunger was associated with increased risk of obesity for Asians, Blacks and Hispanics (OR = 2.81) but not for non-Hispanic Whites (OR = 0.82). Food insecurity is associated with increased likelihood of obesity and risk is greatest in nonwhites.

Adolescent↗
PubMed2003

Evaluation of and recommendations for growth references for very low birth weight (< or =1500 grams) infants in the United States.

OBJECTIVE: To determine the best available growth reference for evaluating the growth status of very low birth weight (VLBW; < or =1500 g) infants in the United States. METHODS: We evaluated currently available growth references for VLBW infants in studies by Casey (Infant Health and Development Program [IHDP]), Brandt, Gairdner and Pearson, and Babson and Benda. We selected the 1 that best met a priori criteria and compared it with the new Centers for Disease Control and Prevention (CDC) growth charts. We evaluated the performance of both the selected VLBW reference and the CDC growth charts for use with VLBW infants by plotting data from 2 external data sets of VLBW infants (from Child Health and Development Studies [CHDS]) and linked the CDC's Pregnancy Nutrition Surveillance System/Pediatric Nutrition Surveillance System Data (PNSS/PedNSS) on both references. Age was adjusted for gestational age in all of the VLBW data set comparisons. RESULTS: The IHDP reference met the greatest number of our evaluation criteria. The IHDP charts are the most recent, are based on a relatively large sample of VLBW infants in the United States, and are adjusted for gestational age at birth (using the standard of birth at 40 weeks) to account for prematurity. The IHDP VLBW infants, based on corrected postnatal age, compared with the non-VLBW infants included in the new CDC growth charts showed more rapid growth in length-for-age from birth (40 weeks) to 24 months, were nearly equivalent in weight-for-age at birth (40 weeks), yet demonstrated less rapid growth in weight-for-age from 40 weeks to 24 months. The performance evaluation of the IHDP and CDC growth reference based on the 2 external VLBW data sets (CHDS and PNSS/PedNSS) showed that the IHDP charts more closely matched the external data sets in relative position on the graphs and growth patterns for length-for-age, but the CDC growth charts more closely matched the external data sets in the growth pattern for weight-for-length. In weight-for-age, because of the lack of stability in the pattern, we could not determine which reference the external data growth pattern more closely matched. CONCLUSIONS: Our evaluation of growth references for VLBW infants yielded no clear, simple recommendation. The inconsistencies in the discrepancies across anthropometric indices between the 2 external combined VLBW data sets (CHDS and PNSS/PedNSS) and the IHDP reference and the CDC growth charts make it difficult to recommend 1 reference. Therefore, we recommend using either the IHDP reference or the CDC growth charts to evaluate the growth of VLBW infants. The choice of which to use depends on its purpose. The IHDP reference is the best available reference for comparisons of the growth of a VLBW infant with those of other VLBW infants. The CDC growth charts allow comparison of the growth of a VLBW infant with that of non-VLBW infants.

Birth Weight↗
PubMed2003

Prevalence of breastfeeding in the United States: the 2001 National Immunization Survey.

OBJECTIVE: To address key gaps in the annual monitoring of breastfeeding prevalence in the United States, 3 breastfeeding questions concerning the initiation, duration, and exclusivity of breastfeeding were added to the rotating modules of the National Immunization Survey (NIS) beginning in the third quarter of 2001. The present study examines the current prevalence of breastfeeding in the United States using NIS data from this initial quarter. METHODS: The NIS is a random-digit-dialing survey of households with children aged 19 to 35 months, followed by a mail survey of the eligible children's vaccination providers to validate the child's vaccination information. In the third quarter of 2001, a randomly selected subset of households interviewed in the NIS (N = 896) were asked questions about breastfeeding. RESULTS: Almost two thirds (65.1%) of children had ever been breastfed. At 6 and 12 months, 27.0% and 12.3%, respectively, were receiving some breast milk. Non-Hispanic blacks had the lowest rates of breastfeeding initiation and continuation. Exclusive breastfeeding rates were low in the United States with only 7.9% at 6 months. CONCLUSIONS: Although breastfeeding initiation is near the national goal of 75%, breastfeeding continuation lags behind the national goals of 50% and 25% at 6 and 12 months, respectively. Strenuous public health efforts are needed to improve breastfeeding practices among blacks.

Black or African American↗
PubMed2002

Racial and ethnic disparities in breastfeeding among United States infants: Third National Health and Nutrition Examination Survey, 1988-1994.

BACKGROUND: The studies suggesting that blacks are less likely to initiate and maintain breastfeeding than whites in the United States are limited either by the representativeness of the sample or by the ambiguousness of attribution of racial and ethnic disparities to generally poor socioeconomic status among blacks. The purpose of this study was to examine racial and ethnic disparities in breastfeeding rates among U.S. infants using national representative data. METHODS: We analyzed breastfeeding data reported by parents of children ages 12 to 71 months at the time of interview from the Third National Health and Nutrition Examination Survey (1988-1994). Breastfeeding data were stratified by both race and ethnicity, and by a series of sociodemographic and health-related characteristics. RESULTS: The proportion of children ever breastfed was 60 percent among non-Hispanic whites, 26 percent among non-Hispanic blacks, and 54 percent among Mexican Americans. By 6 months postpartum, the proportion still breastfed decreased to 27, 9, and 23 percent, correspondently. Blacks also had a significantly lower rate of exclusive breastfeeding at 4 months than whites (14%). In addition, the differentials in breastfeeding rates between high and low socioeconomic classes were most substantial among blacks. CONCLUSIONS: Blacks had consistent lower breastfeeding rates than whites regardless of their sociodemographic status. The large differentials between high and low socioeconomic classes among blacks suggest that socioeconomic status has a bigger impact on breastfeeding practices among blacks. Therefore, blacks, particularly those who are poor or less educated, need to be targeted for promotion, protection, and support of breastfeeding.

Adult↗
PubMed2002

Public perceptions on breastfeeding constraints.

To describe public perceptions on breastfeeding constraints, the authors studied the responses of 2369 US adults who participated in the Healthstyles 2000 national mail survey (response rate = 75%). Among them, 2351 answered at least 1 of the 12 breastfeeding items. Public perceptions were positive for 8 of the 12 items. Among the other 4, however, almost half of US adults (45%) agreed that a breastfeeding mother has to give up too many lifestyle habits, 31% thought that babies ought to be fed cereal or baby food by age 3 months, 31% said that 1-year-olds should not be breastfed, and 27% considered breastfeeding in public embarrassing. The results revealed more negative perceptions among non-whites, people under 30 or above 65 years, and those who had low income and less education. To promote and support breastfeeding in society as a whole, these messages need to be considered in planning and implementing breastfeeding interventions.

Adult↗
PubMed2002

Adherence to antimicrobial inhalational anthrax prophylaxis among postal workers, Washington, D.C., 2001.

In October 2001, two envelopes containing Bacillus anthracis spores were processed at the Washington, D.C., Processing and Distribution Center of the U.S. Postal Service; inhalational anthrax developed in four workers at this facility. More than 2,000 workers were advised to complete 60 days of postexposure prophylaxis to prevent inhalational anthrax. Interventions to promote adherence were carried out to support workers, and qualitative information was collected to evaluate our interventions. A quantitative survey was administered to a convenience sample of workers to assess factors influencing adherence. No anthrax infections developed in any workers involved in the interventions or interviews. Of 245 workers, 98 (40%) reported full adherence to prophylaxis, and 45 (18%) had completely discontinued it. Anxiety and experiencing adverse effects to prophylaxis, as well as being <45 years old were risk factors for discontinuing prophylaxis. Interventions, especially frequent visits by public health staff, proved effective in supporting adherence.

Adolescent↗