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Ruowei Li

Publications and source records attributed to Ruowei Li.

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

The validity and reliability of maternal recall of breastfeeding practice.

In large epidemiologic studies, information on breastfeeding practice is often collected from maternal recall through interviews, but there is concern about the accuracy of the data, especially when mothers are asked to recall their practices from many years earlier. This review examines the validity and reliability of maternal recall of breastfeeding history using 11 studies published between 1966 and 2003 in English with a sample of 10 or more. Validity is the degree to which recall compares with a validation standard or reference, and reliability refers to the degree to which the breastfeeding practices obtained by recall are repeatable over time. The existing studies suggest that maternal recall is a valid and reliable estimate of breastfeeding initiation and duration, especially when the duration of breastfeeding is recalled after a short period (< or = 3 years). Validity and reliability of maternal recall for the age at introduction of food and fluids other than breast milk are less satisfactory. Further and more extensive studies on maternal recall of breastfeeding history and ways to improve such recall are warranted.

Adult↗
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↗
PubMed2004

Breastfeeding rates in the United States by characteristics of the child, mother, or family: the 2002 National Immunization Survey.

OBJECTIVE: In the third quarter of 2001, the National Immunization Survey (NIS) began collecting data on the initiation and duration of breastfeeding and whether it was the exclusive method of infant feeding. Using the data from the 2002 NIS, this study estimates breastfeeding rates in the United States by characteristics of the child, mother, or family. METHODS: The NIS uses random-digit dialing to survey households nationwide with children 19 to 35 months old about vaccinations and then validates the information through a mail survey of the health care providers who gave the vaccinations. In 2002, approximately 3500 households from the NIS were randomized to 1 of the 3 rotating topical modules that covered breastfeeding. RESULTS: More than two thirds (71.4%) of the children had ever been breastfed. At 3 months, 42.5% of infants were exclusively breastfed, and 51.5% were breastfed to some extent. At 6 months, these rates dropped to 13.3% and 35.1%, respectively. At 1 year, 16.1% of infants were receiving some breast milk. Non-Hispanic black children had the lowest breastfeeding rates. Breastfeeding rates also varied by participation in day care or the Women, Infants, and Children program, socioeconomic status, and geographic area of residence. CONCLUSIONS: Although the rate of breastfeeding initiation in the United States is near the national goal of 75%, at 6 and 12 months postpartum the rates of breastfeeding duration are still considerably below the national goals of 50% and 25%, respectively. In addition, rates of exclusive breastfeeding are low. Strenuous public health efforts are needed to improve breastfeeding behaviors, particularly among non-Hispanic black women and socioeconomically disadvantaged groups.

Black or African American↗
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

Nutritional rickets among children in the United States: review of cases reported between 1986 and 2003.

Reports of hypovitaminosis D among adults in the United States have drawn attention to the vitamin D status of children. National data on hypovitaminosis D among children are not yet available. Reports from 2000 and 2001 of rickets among children living in North Carolina, Texas, Georgia, and the mid-Atlantic region, however, confirmed the presence of vitamin D deficiency among some US children and prompted new clinical guidelines to prevent its occurrence. We reviewed reports of nutritional rickets among US children <18 y of age that were published between 1986 and 2003. We identified 166 cases of rickets in 22 published studies. Patients were 4-54 mo of age, although in 17 studies the maximal age was <30 mo. Approximately 83% of children with rickets were described as African American or black, and 96% were breast-fed. Among children who were breast-fed, only 5% of records indicated vitamin D supplementation during breast-feeding. The American Academy of Pediatrics (AAP) recently recommended a minimal intake of 200 IU/d vitamin D for all infants, beginning in the first 2 mo of life. AAP recommends a vitamin D supplement for breast-fed infants who do not consume at least 500 mL of a vitamin D-fortified beverage. Given our finding of a disproportionate number of rickets cases among young, breast-fed, black children, we recommend that education regarding AAP guidelines emphasize the higher risk of rickets among these children. Education should also emphasize the importance of weaning children to a diet adequate in both vitamin D and calcium.

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

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

Effects of chronic iodine excess in a cohort of long-term American workers in West Africa.

A cross-sectional survey of 102 Peace Corps volunteers in Niger, West Africa, in 1998 had previously demonstrated a high rate of thyroid dysfunction and goiter attributable to excess iodine from their water filters. The Peace Corps volunteers were followed-up a mean of 30 wk after they ceased using iodine-based water filtration systems. Goiter was present in 44% of subjects during excess iodine ingestion and in 30% after removal of excess iodine. Mean serum iodine decreased from 293 micro g/liter during excess iodine ingestion to 84 micro g/liter after cessation of excess iodine. Mean total serum T(4) values increased from 100.4 to 113.3 nmol/liter (7.8 to 8.8 micro g/dl). Mean serum free T(4) increased from 32.2 to 34.7 pmol/liter (2.5 to 2.7 ng/dl). Mean serum TSH decreased from 4.9 to 1.8 mU/liter. Mean serum thyroid peroxidase antibody levels decreased from 33,000 to 22,000 IU/liter (33 to 22 IU/ml). We found that during prolonged excess iodine exposure there were marked increases in serum total iodine concentrations, and the prevalence of goiter, elevated serum TSH values, and elevated serum thyroid peroxidase antibody values increased. The prevalence of all abnormalities decreased after removal of excess iodine from the drinking water system.

Adult↗