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PubMed2000

A new teaching model to prolong breastfeeding among Latinos.

Latino women in Salt Lake City, Utah, have some of the lowest breastfeeding rates in the state. In an attempt to prolong breastfeeding duration in this population, the authors designed a new class to be taught by certified WIC (Special Supplemental Nutrition Program for Women, Infants, and Children) personnel to pregnant Spanish-speaking participants. The class was designed after a literature review and onsite ethnographic research. The term la cuarentena del bebé was introduced to signify the recommended 40 days when mothers should exclusively breastfeed, avoiding bottles, pacifiers, and supplementation. As part of the teaching model, class participants prepare an infant-feeding plan. Preliminary interviews show that WIC participants and staff view the new approach as an improvement. A randomized controlled trial is under way to evaluate the effectiveness of the class.

Breast Feeding↗
PubMed2002

An innovative video succeeds in addressing barriers to breastfeeding among low-income women.

This study evaluates the effectiveness of an innovative breastfeeding promotion video intervention in addressing barriers to breastfeeding among low-income women in the state of Mississippi. The 15-minute video features a diverse group of women and their families. Survey data were collected from Special Supplemental Nutrition Program for Women, Infants and Children clients in the intervention group (n = 310) before and after watching the video, and from a comparison group (n = 204) that did not watch the video. The 2 groups were comparable at baseline. The intervention significantly improved women's perceptions with regard to the "embarrassment" and "time and social constraints" barriers to breastfeeding. In terms of the "lack of social support" barrier, the video positively affected participants' feelings that the baby's father encouraged breastfeeding but did not change their perceptions of support from female relatives and friends. The authors conclude that the video is an effective method of breastfeeding promotion among low-income women.

Adult↗
PubMed2004

Social capital, acculturation, and breastfeeding initiation among Puerto Rican women in the United States.

To examine reasons for not breastfeeding, and to identify factors associated with ever breastfeeding among Puerto Rican women, a retrospective study was done using a convenience sample of 161 low-income Latino women with children younger than 6 years. Women were recruited from the Hispanic Health Council (43.5%), the Supplemental Nutrition Program for Women, Infants, and Children (29.8%), and other places (26.7%). Participants were interviewed using a pretested questionnaire specific to the target community. Most (73%) of the respondents chose to be interviewed in Spanish. Chi-square analyses were used to examine the bivariate association between ever breastfeeding and the independent variables. Multivariate logistic regression was conducted to estimate the independent association between acculturation, social capital, and breastfeeding. Women with more social capital were more likely (odds ratio = 2.25, 95% confidence interval, 1.02-4.95) to have breastfed the index child, suggesting that social capital is an important predictor of breastfeeding initiation in this community.

Acculturation↗
PubMed2006

WIC's promotion of infant formula in the United States.

BACKGROUND: The United States' Special Supplemental Nutrition Program for Women, Infants and Children (WIC) distributes about half the infant formula used in the United States at no cost to the families. This is a matter of concern because it is known that feeding with infant formula results in worse health outcomes for infants than breastfeeding. DISCUSSION: The evidence that is available indicates that the WIC program has the effect of promoting the use of infant formula, thus placing infants at higher risk. Moreover, the program violates the widely accepted principles that have been set out in the International Code of Marketing of Breast-milk Substitutes and in the human right to adequate food. SUMMARY: There is no good reason for an agency of government to distribute large quantities of free infant formula. It is recommended that the large-scale distribution of free infant formula by the WIC program should be phased out.

Journal Article↗
PubMed2004

Low-protein diet during early life causes a reduction in the frequency of cells immunopositive for nestin and CD34 in both pancreatic ducts and islets in the rat.

Feeding a low-protein (LP) diet to pregnant and lactating rats impairs pancreatic islet mass and insulin release in the offspring, leading to glucose intolerance as adults. We hypothesized that an LP diet changes the number of pancreatic endocrine precursor cells or cells supporting endocrine cell neogenesis. Pregnant rats were given LP (8% protein) or a control (20% protein) diet from conception until postnatal d 21. Cells containing nestin, CD34, or c-Kit were quantified in pancreata of the offspring. Stellate cells immunoreactive for nestin were seen to be adjacent to ductal epithelium and were resident within the islets. These were proliferative and immunonegative for cytokeratin 20, fibronectin, tyrosine hydroxylase, pancreatic duodenal homeobox 1, Nk homeodomain transcription factor 6.1, or insulin, but expressed vimentin. Approximately 20% of islet nestin-positive cells also expressed the endothelial cell marker platelet endothelial cell adhesion molecule-1. Both ducts and islets also contained CD34- and c-Kit-positive cells with similar morphology to those expressing nestin. Offspring from rats fed the LP diet had significantly less nestin/CD34-positive cells and reduced expression of nestin mRNA. Within islets, there was an associated decrease in cell proliferation and in cells immunopositive for pancreatic duodenal homeobox 1. Nestin-positive cell number within islets correlated positively with the percent area of beta-cells. Supplementation of pregnant and lactating rats with taurine reversed the deficits in mean islet area and nestin-positive cells caused by the LP diet within the islets of the offspring. Nutritional programming of postnatal beta-cell mass may involve an altered abundance of cells expressing nestin and/or CD34, which may limit endocrine cell development.

Animals↗
PubMed2004

An evaluation of a breast-feeding education intervention among Spanish-speaking families.

This study assessed the impact of an educational breast-feeding intervention on the knowledge, attitudes and perceived ability to access breast-feeding resources among Spanish-speaking Latino families making breast-feeding decisions. Conducted in cooperation with the local office of The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), this university-based, multidisciplinary outreach and research project was held in a semirural part of Utah, where Latinos constitute the fastest and largest growing group of the population and have the lowest breast-feeding duration rates. The results suggested that teaching a lactation class in Spanish to Latino women significantly increased their willingness to breast-feed and empowered them by increasing their belief that they could breast-feed even if they work or attend school, that they would not have a problem with insufficient milk, and that they would not need to limit their diet to breast-feed. Additionally, the study indicated that Latino women are more likely to access health care services from agencies providing services in Spanish, regardless of their secondary fluency in English.

Adult↗
PubMed1991

Learning style preferences: a comparison of younger and older adult females.

This study explored the learning styles of older adult females (65 + years) as compared to younger adult females (35-55 years) in the areas of immediate environment, emotionality, sociological needs and physical needs. At recreation community centers, 80 subjects were selected on a non-random basis, with one-half falling in each age category. Each subject was individually questioned using the Productivity Environmental Preference Survey, which analyzes a personal preference for each of 20 elements and identifies how adults prefer to function, learn, concentrate and perform in their educational or occupational activities. An analysis by t test showed a significant difference between the two groups in the elements of light, learning alone--peer oriented, authority figures present, and evening--morning. When the elements were combined and treated by discriminant analysis, most of these findings were confirmed, showing a significant difference in five elements: light, motivation, responsibility, learning alone--peer oriented, evening--morning. These findings might be useful to nutrition educators when developing nutrition programs for the elderly.

Adult↗
PubMed2005

Kosher meal services in the community:need, availability, and limitations.

This project identified needs and barriers for Meals on Wheels and other nutrition programs serving kosher meals. Responses to a national survey indicated that some communities met their need for kosher meal services, others had difficulty keeping up with the demand and costs of providing these meals. The primary need for kosher meal services was in metropolitan areas where large communities of orthodox Jews observe kosher dietary laws. Knowledge about kosher dietary laws and lack of reasonably priced kosher meals were two main problems. Service providers need economical sources for kosher meals as well as financial support to offset the higher cost of these meals. Providers should work with local Jewish community organizations to determine what the actual need may be, whether it is simple dietary modifications or kosher meals.

Aged↗
PubMed2003

Pharmacist intervention enhances adherence to orlistat therapy.

BACKGROUND: Pharmacists, especially those in community practice, should increase their level of intervention in dealing with the nationwide epidemic of obesity since they interact with large numbers of the public on a regular basis. We hypothesized that patients who receive medication for weight loss may have an improved therapeutic outcome if they received additional support from their community pharmacist. OBJECTIVE: To evaluate the impact of pharmacist support on patient persistence with orlistat. METHODS: Pharmacists were trained in basic obesity management skills. Patients who were prescribed orlistat and attending an outpatient nutrition program were invited to participate in the study. All patients agreed to receive pharmaceutical care. Those who lived where the service was available were assigned to the intervention (I) group and those who did not were assigned to the control (C) group. All patients received usual care provided by the outpatient clinic. RESULTS: Thirty patients, 15 in the I group and 15 in the C group, were recruited. Both groups were predominantly women (87%) with a mean +/- SD age of 43.8 +/- 9.7 years. Patients in the I group had significantly greater persistence with orlistat therapy as assessed by duration of therapy (p = 0.006) and number of patients completing the 26-week study (7 I, 2 C; p = 0.046). There was no significant difference in percent of weight loss between groups (p > 0.05). CONCLUSIONS: In this pilot study, patients receiving pharmaceutical care took orlistat longer than the controls and had improved outcome with orlistat therapy.

Adult↗
PubMed2003

Alcohol use in pregnant low-income women.

OBJECTIVE: The present study had two aims: (1) to examine the prevalence rates of prenatal alcohol consumption in a group of women participating in the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) in Southern California, with special emphasis on Hispanic women, and (2) to identify variables associated with postconception drinking in low-income minority women. METHOD: The study employed a cross-sectional survey that assessed alcohol use rates, demographic variables, and alcohol risk status. Participants were 826 pregnant women enrolled in the Public Health Foundation Enterprises (PHFE) WIC Program in Los Angeles and Orange counties, California. Pregnant women who enrolled self-administered a specially designed alcohol screener. RESULTS: Findings were that 24% of sample women were consuming alcohol post conception. Of that percentage, approximately two thirds drank prior to pregnancy recognition, and one third continued to drink after pregnancy was confirmed. Approximately 30% of white non-Hispanic, black non-Hispanic and English-speaking Hispanic women were found to drink post conception compared with 15.8% of Spanish-speaking Hispanic women. This finding supported recent research that suggests more acculturated Hispanic women tend to incorporate the drinking patterns of the larger U.S. population to a greater extent than less acculturated Hispanic women. Although a number of demographic variables differentiated women who were abstinent from those who were postconception drinkers, the best predictor of postconception alcohol consumption was the woman's high-risk drinking score as measured by the TWEAK (sensitivity = 70.1%, specificity = 88.5%). CONCLUSIONS: Results suggest the importance of screening low-income minority pregnant women in a community setting so that interventions can be initiated to prevent fetal alcohol syndrome and related conditions.

Adult↗
PubMed2006

Health care provider advice and risk factors associated with alcohol consumption following pregnancy recognition.

OBJECTIVE: This study examined the extent to which pregnant women participating in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) were counseled by their health care providers to stop drinking alcohol during pregnancy. A second purpose was to identify characteristics associated with alcohol consumption postrecognition of pregnancy. METHOD: The sample consisted of 279 women who continued to drink after learning they were pregnant. Measures of provider advice on alcohol consumption, demographic characteristics, caffeine intake, smoking, other drug use, alcohol risk (using the TWEAK scale), and depressive symptoms on the Center for Epidemiological Studies Depression Scale (CES-D) were collected. RESULTS: Sixty-two percent of women had significantly high TWEAK scores, and 60% scored within the clinical range for depression (CESD > or =16). Sixty percent of sample women had been advised by their care providers not to drink alcohol during pregnancy. Women who were most likely to receive advice were black non-Hispanic and Hispanic, were Spanish speaking, were less educated, were on public assistance, and had a higher number of alcohol-related risk behaviors. Advanced age, public assistance, caffeine use, smoking, and elevated TWEAK and CESD scores predicted elevations in alcohol consumption rates. CONCLUSIONS: Although advice to stop drinking during pregnancy was provided to 60% of this sample, women continued to drink following pregnancy recognition, with alcohol consumption rates highly associated with sociodemographic and psychological factors, namely maternal depression. Because elevations in alcohol consumption during pregnancy are associated with poorer developmental outcomes for children, further efforts are needed to better address social and mental health factors that influence consumption.

Alcohol Drinking↗
PubMed1998

Racial/ethnic differences in the decision to breastfeed among adolescent mothers.

OBJECTIVE: To identify racial/ethnic differences in prevalence and the factors that influence decisions to breastfeed among adolescent mothers. METHODS: A total of 696 Mexican-American, African-American, and Caucasian adolescent mothers </=18 years of age were interviewed on the postpartum ward of university hospital within 48 hours of delivery. Self-reported factors associated with the decision to breastfeed were assessed. RESULTS: The decision to breastfeed was reported by 55% of Mexican-American, 45% of Caucasian, and 15% of African-American adolescent mothers. With the exception of perceived benefits of breastfeeding and exposure to educational materials, most factors associated with breastfeeding differed by race/ethnicity. Among Mexican-Americans, important factors included having relied on feeding advice (adjusted odds ratio [AOR] = 7.6); the feeding preference of a partner (AOR = 7.0) or mother (AOR = 6. 6); and feeding decisions made in early pregnancy (AOR = 4.7). Among African-Americans, important factors included living with a partner (AOR = 10.6); having a mother who breastfed (AOR = 5.9); the feeding preference of a partner (AOR = 5.6) or health care provider (AOR = 4. 7); and low family support (AOR = 3.4). Among Caucasians, health care providers' feeding preference (AOR = 6.1); having two or more breastfeeding role models (AOR = 4.1); not being enrolled in Women, Infants, and Children's Supplemental Nutrition Program (AOR = 3.0); having relied on infant-feeding advice (AOR = 3.0); and prenatal alcohol use (AOR = 2.6) were associated with the decision to breastfeed. CONCLUSIONS: Prevalence and influences to breastfeed differ by patient race/ethnicity. We speculate that targeting the adolescent mother and members of her support system, educating them before and during pregnancy, and stressing benefits of this method while eliminating misinformation, especially among African-Americans, may be important intervention strategies to promote breastfeeding.

Adolescent↗
PubMed2000

Screening for iron deficiency anemia by dietary history in a high-risk population.

BACKGROUND: Iron deficiency anemia (IDA) in young children is important to identify because of its adverse effects on behavior and development. Because of costs and inconvenience associated with blood test screening and the decline in prevalence of IDA, the Institute of Medicine and the Centers for Disease Control and Prevention recommend that blood test screening for IDA be targeted to children first identified by dietary and health history. OBJECTIVE: To evaluate a parent-completed dietary and health history as the first stage of 2-stage screening for IDA. DESIGN AND METHODS: A cross-sectional study was conducted in inner-city clinics in children 9 to 30 months old having routine anemia screening as part of a scheduled visit. Parents completed a questionnaire and children had venous blood sampling for complete blood count and ferritin. Anemia was defined as Hb <11.0 g/dL. Iron deficiency (ID) was defined as ferritin <10 microg/L or mean corpuscular volume <70 fL and red cell distribution width >14.5%. Children were categorized into 1 of 4 groups: iron-sufficient, not anemic (ISNA); iron-sufficient, anemic (ISA); iron-deficient, not anemic (IDNA); and iron-deficient anemic (IDA). The questionnaire consisted of 15 dietary items in domains of infant diet, intake of solid food, intake of beverages, and participation in the Special Supplemental Nutrition Program for Women, Infants, and Children together with 14 historical items in domains of birth history, recent illness, chronic medical conditions, history of anemia, and maternal history. Analysis was performed on individual items, domains, and combinations of selected items. RESULTS: In the 282 study subjects, the prevalence of anemia (35%), IDNA (7%), and IDA (8%) did not vary significantly by age. Among individual historical and dietary questions, maternal history of anemia and drinking >2 glasses of juice per day identified the highest proportion of children with IDA: 50% sensitivity (95% confidence interval [CI]: 16,81) and 77% sensitivity (95% CI: 54,89), respectively. However, specificities for these questions were 60% (95% CI: 55,65) and 22% (95% CI: 17,27), respectively. Domains of questions with the highest sensitivity for IDA were beverage intake (91%; 95% CI: 68,99) and intake of solid food (91%; 95% CI: 68,99). However, specificities of the domains were only 14% (95% CI: 10,18) and 29% (95% CI: 24,35), respectively. The dietary items used by Boutry and Needlman were 95% (95% CI: 77, 99) sensitive but only 15% (95% CI: 11,19) specific for IDA. The recommendations of the Centers for Disease Control and Prevention for health and dietary screening were 73% (95% CI: 56,92) sensitive and 29% (95% CI: 24,35) specific for IDA. The individual questions, domains of questions, and interdomain groups of questions had similar sensitivity and specificity for anemia and ID (IDA + IDNA). CONCLUSION: In this high-risk population, neither individual nor combinations of parental answers to dietary and health questions were able to predict IDA, anemia, or ID well enough to serve as a first-stage screening test.

Anemia, Iron-Deficiency↗
PubMed2000

Maternal perceptions of overweight preschool children.

CONTEXT: Childhood obesity is a major public health problem, and prevention efforts should begin early in life and involve parents. OBJECTIVE: To determine what factors are associated with mothers' failure to perceive when their preschool children are overweight. DESIGN: Cross-sectional survey. SETTINGS: Offices of private pediatricians and clinics of the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). PARTICIPANTS: Six hundred twenty-two mothers with children 23 to 60 months of age. MAIN OUTCOME MEASURES: Maternal demographic variables, maternal self-reported height and weight, and children's measured height and weight. Mothers were asked whether they considered themselves or their children overweight. RESULTS: Forty-five percent of mothers had low education (high school degree or less) and 55% had high education (some college or more). Obesity (body mass index: >/=30 kg/m(2)) was more common in the low education group of mothers (30% vs 17%), and their children tended to be more overweight (weight-for-height percentile: >/=90th; 19% vs 14%). Ninety-five percent of obese mothers believed that they were overweight, with no difference between education groups. However, 79% of mothers failed to perceive their overweight child as overweight. Among the 99 mothers with overweight children, low maternal education was associated with a failure to perceive their children as overweight after adjusting for low family income (</=185% of poverty), maternal obesity, age, and smoking plus the child's age, race, and gender (adjusted odds ratio: 6.2; 95% confidence interval: 1.7-22.5). CONCLUSIONS: Obesity was more common in mothers with less education as well as in their children. Nearly all of the obese mothers regarded themselves as overweight. However, the majority of mothers did not view their overweight children as overweight, and this misperception was more common in mothers with less education. Childhood obesity prevention efforts are unlikely to be successful without a better understanding of how mothers perceive the problem of overweight in their preschool children.

Adult↗
PubMed2001

Why don't low-income mothers worry about their preschoolers being overweight?

CONTEXT: Mothers are in an important position to prevent obesity in their children by shaping early diet and activity patterns. However, many mothers of overweight preschool children are not worried about their child's weight. OBJECTIVE: To explore mothers' perceptions about how they determine when a child is overweight, why children become overweight, and what barriers exist to preventing or managing childhood obesity. DESIGN: Three focus groups with 6 participants in each. Participant comments were transcribed and analyzed. Themes were coded independently by the 6 authors who then agreed on common themes. SETTING: A clinic of the Special Supplemental Nutrition Program for Women, Infants, and Children in Cincinnati, Ohio. PARTICIPANTS: Eighteen low-income mothers (13 black, 5 white) of preschool children (mean age of 44 months) who were at-risk for later obesity. All but 1 mother had a body mass index (BMI) >/=25 kg/m(2), and 12 mothers had a BMI >/=30 kg/m(2). All but 1 child had a BMI >/=85th percentile for age and sex, and 7 had a BMI >/=95th percentile. Results. Mothers did not define overweight or obese in their children according to how height and weight measurements were plotted on the standard growth charts used by health professionals. Instead, mothers were more likely to consider being teased about weight or developing limitations in physical activity as indicators of their child being overweight. Children were not believed to be overweight if they were active and had a healthy diet and/or a good appetite. Mothers described overweight children as thick or solid. Mothers believed that an inherited tendency to be overweight was likely to be expressed in the child regardless of environmental factors. In trying to shape their children's eating, mothers believed that their control over the child's diet was challenged by other family members. If a child was hungry, despite having just eaten, it was emotionally difficult for mothers to deny additional food. CONCLUSIONS: Health professionals should not assume that defining overweight according to the growth charts has meaning for all mothers. Despite differing perceptions between mothers and health professionals about the definition of overweight, both groups agree that children should be physically active and have healthy diets. Health professionals may be more effective in preventing childhood obesity by focusing on these goals that they share with mothers, rather than on labeling children as overweight.

Adult↗
PubMed2001

Prevalence and predictors of immunization among inner-city infants: a birth cohort study.

CONTEXT: Although the proportion of US children who are appropriately immunized increased dramatically in the past decade, rates remain suboptimal among low-income, inner-city youth. Timely initiation of immunization is an important predictor of immunization status later in childhood; however, prospective studies identifying predictors of initiation are lacking. OBJECTIVES: The objectives of this study were to: 1) describe immunization patterns in a cohort of infants born to predominantly low-income, inner-city mothers; 2) identify determinants, as measured at birth, of immunization status at 3 and 7 months of age; and 3) identify determinants of continuation of immunization among those who initiate immunization by 3 months of age. DESIGN: Prospective, birth cohort study. METHODS: Maternal/infant dyads were systematically selected from 3 District of Columbia hospitals between August 1995 and September 1996. Three hundred sixty-nine mothers were interviewed shortly after delivery, at 3 to 7 months postpartum, and at 7 to 12 months postpartum. Medical records were reviewed at all reported sites of care for 324 (88%) infants. Vaccinations assessed included diphtheria, tetanus, and pertussis; polio; and Haemophilus influenzae type B. Multivariate logistic regression analyses were used to determine factors associated with immunization status of infants at 3 and 7 months of age. RESULTS: At 3 months of age, 75% of infants were up-to-date (UTD) versus only 41% at 7 months. In adjusted analyses, baseline factors associated with being UTD at 3 months included enrollment in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) during pregnancy, intention to breastfeed, and presence of the infant's grandmother in the household. Infants were less likely to be UTD if their mothers perceived higher barriers to immunization. Baseline factors associated with being UTD at 7 months included lower birth order and maternal employment. Among the subset of infants who were UTD at 3 months, only 53% remained UTD at 7 months. Factors measured at the first follow-up interview that were associated with continuation of immunization at 7 months included maternal employment and lower perceived barriers. CONCLUSIONS: Immunization rates during the first 7 months of life were low in this inner-city population. Factors associated with immunization status that are potentially amenable to change included perceived barriers to immunization and enrollment in WIC during pregnancy.

Adult↗
PubMed2002

Television viewing and television in bedroom associated with overweight risk among low-income preschool children.

CONTEXT: Television (TV) viewing is associated with obesity among school-aged children, adolescents, and adults, but this relationship has not been evaluated in preschool-aged children. OBJECTIVE: To describe the TV/video viewing habits of a multiethnic, low-income preschool population of children and to determine whether TV/video viewing is related to their adiposity. DESIGN: Cross-sectional survey of parents/guardians with measurements of children's height and weight. SETTING AND PARTICIPANTS: Two thousand seven hundred sixty-one adults with children, 1 through <5 years, from 49 New York State agencies of the Supplemental Nutrition Program for Women, Infants, and Children. OUTCOME MEASURES: Cross-sectional relationships between the amount of time the child spends viewing TV/video and the presence of a TV set in the child's bedroom, with the prevalence of overweight children (body mass index [BMI] >85th percentile) after adjustment for potential confounders. RESULTS: Mean TV/video viewing times were higher among black children and Hispanic children than white children and increased with the child's age. In multiple logistic regression, the odds ratio of children having a BMI >85th percentile was 1.06 (95% confidence interval [CI]: 1.004-1.11) for each additional hour per day of TV/video viewed, independent of child age, child sex, parental educational attainment, and race/ethnicity. Almost 40% of children had a TV set in their bedroom; they were more likely to be overweight and spent more time (4.6 hours per week) watching TV/video than children without a TV in their bedroom. In multiple logistic regression, the odds ratio of having a BMI >85th percentile was 1.31 (95% CI: 1.01-1.69) among those with a TV in their bedroom versus those without a TV, after statistical adjustment for child age, child sex, child TV/video viewing hours per week, maternal BMI, maternal education, and race/ethnicity. CONCLUSIONS: This study extends the association between TV viewing and risk of being overweight to younger, preschool-aged children. A TV in the child's bedroom is an even stronger marker of increased risk of being overweight. Because most children watch TV by age 2, educational efforts about limiting child TV/video viewing and keeping the TV out of the child's bedroom need to begin before then.

Body Height↗
PubMed2002

Breastfeeding continues to increase into the new millennium.

OBJECTIVE: To update reported rates of breastfeeding and exclusive breastfeeding through 2001 and to compare rates in 2001 to those from 1996. METHODS: The Ross Laboratories Mothers Survey (RLMS) is a large, national survey designed to determine patterns of milk feeding during infancy. Questionnaires were mailed each month to a representative sample of mothers when their infant was 1 month of age, 2 months of age, 3 months or age, and so forth. In 1996, approximately 744 000 questionnaires were mailed, and in 2001, 1.4 million questionnaires were mailed. Mothers were asked to recall the type of milk fed to their infant in the hospital, and during each month of age. Two categories of breastfeeding were considered: breastfeeding (human milk or a combination of human milk and formula or cow's milk) and exclusive breastfeeding (only human milk). Rates of breastfeeding and exclusive breastfeeding in the hospital and at 6 months of age were evaluated. RESULTS: In 2001, the prevalence of the initiation of breastfeeding and breastfeeding to 6 months of age in the United States reached their highest levels recorded to date, 69.5% and 32.5%, respectively. Comparing rates in 2001 and 1996, increases in the initiation of breastfeeding and continued breastfeeding to 6 months of age were observed across all sociodemographic groups but were greater among groups that have been historically less likely to breastfeed: women who were black, younger (<20 years of age), no more than high school-educated, primiparous, employed at the time they received the survey, and who participated in the Supplemental Nutrition Program for Women, Infants, and Children (WIC). Breastfeeding in the hospital and at 6 months of age was most common in the Mountain and Pacific states and among women who were white or Hispanic, older, college-educated, and were not enrolled in WIC. Mothers most likely to practice exclusive breastfeeding in the hospital (46.2%) and at 6 months of age (17.2%) had a similar sociodemographic profile as mothers who breastfed their infants. CONCLUSIONS: If increases in breastfeeding continue at the current rate (approximately 2% per year), in-hospital breastfeeding in the United States should meet or exceed the Healthy People 2010 goal of 75% for the early postpartum period. However, the Healthy People 2010 goal for continued breastfeeding to 5 to 6 months of age (50%) may not be reached in every subgroup. To ensure that these goals are achieved, educational and promotional strategies for breastfeeding must be continued to support mothers who are young, less educated, and participating in WIC.

Adult↗