Deborah Dee - Academia.edu (original) (raw)
Papers by Deborah Dee
The Journal of Nutrition, 2003
Breastfeeding rates among African-American women lag behind all other ethnic groups. National dat... more Breastfeeding rates among African-American women lag behind all other ethnic groups. National data show that only 45% of African-American women reported ever breastfeeding compared to 66 and 68% of Hispanic and white women, respectively. Of African-American women who do choose to breastfeed, duration is short, with many discontinuing in the first days after birth. This report applies a social ecological framework to breastfeeding to investigate macrolevel-microlevel linkages. We posit that macrolevel factors, such as the media, aggressive marketing of breastmilk substitutes, welfare reform, hospital policy and breastfeeding legislation, interact with microlevel factors to influence a woman's decision to breastfeed. These microlevel factors include features of the community, neighborhoods, workplaces that support or discourage breastfeeding, social and personal networks and cultural norms and individual beliefs about breastfeeding. The report discusses how power operates at each level to influence women's choices and also emphasizes the value of ethnographic data in breastfeeding studies. Through a case study of a sample of low income, African-American women living in Baltimore, MD, where breastfeeding role models are few, beliefs that discourage breastfeeding are many, and where everyday life is full of danger and fear, it is understandable that breastfeeding is not considered practical. The narrative data provide important information that can be used to enhance intervention efforts. To reach the Surgeon General's Healthy People 2010 breastfeeding goals requires a shift in cultural norms and structures at all levels that will support breastfeeding for all women. J. Nutr. 133: 305S-309S, 2003.
Pediatrics, 2007
Previous research has shown substantial racial/ethnic and socioeconomic disparities in US breastf... more Previous research has shown substantial racial/ethnic and socioeconomic disparities in US breastfeeding initiation and duration rates. However, the role of immigrant status in understanding such disparities has not been well studied. In this study we examined the extent to which breastfeeding initiation and duration varied by immigrant status overall and in conjunction with race/ethnicity and socioeconomic status after controlling for other relevant social and behavioral covariates. The cross-sectional data for 33121 children aged 0 to 5 years from the 2003 National Survey of Children's Health were used to calculate ever-breastfeeding rates and duration rates at 3, 6, and 12 months by social factors. Multivariate logistic regression was used to estimate relative odds of never breastfeeding and not breastfeeding at 6 and 12 months. More than 72% of mothers reported ever breastfeeding their infants, with the duration rate declining to 52%, 38%, and 16% at 3, 6, and 12 months, resp...
The Journal of nutrition, 2003
Breastfeeding rates among African-American women lag behind all other ethnic groups. National dat... more Breastfeeding rates among African-American women lag behind all other ethnic groups. National data show that only 45% of African-American women reported ever breastfeeding compared to 66 and 68% of Hispanic and white women, respectively. Of African-American women who do choose to breastfeed, duration is short, with many discontinuing in the first days after birth. This report applies a social ecological framework to breastfeeding to investigate macrolevel-microlevel linkages. We posit that macrolevel factors, such as the media, aggressive marketing of breastmilk substitutes, welfare reform, hospital policy and breastfeeding legislation, interact with microlevel factors to influence a woman's decision to breastfeed. These microlevel factors include features of the community, neighborhoods, workplaces that support or discourage breastfeeding, social and personal networks and cultural norms and individual beliefs about breastfeeding. The report discusses how power operates at each ...
PEDIATRICS, 2007
Previous research has shown substantial racial/ethnic and socioeconomic disparities in US breastf... more Previous research has shown substantial racial/ethnic and socioeconomic disparities in US breastfeeding initiation and duration rates. However, the role of immigrant status in understanding such disparities has not been well studied. In this study we examined the extent to which breastfeeding initiation and duration varied by immigrant status overall and in conjunction with race/ethnicity and socioeconomic status after controlling for other relevant social and behavioral covariates. The cross-sectional data for 33121 children aged 0 to 5 years from the 2003 National Survey of Children's Health were used to calculate ever-breastfeeding rates and duration rates at 3, 6, and 12 months by social factors. Multivariate logistic regression was used to estimate relative odds of never breastfeeding and not breastfeeding at 6 and 12 months. More than 72% of mothers reported ever breastfeeding their infants, with the duration rate declining to 52%, 38%, and 16% at 3, 6, and 12 months, respectively. Ever-breastfeeding rates varied greatly among the 12 ethnic-immigrant groups included in this analysis, from a low of 48% for native black children with native parents to a high of 88% among immigrant black and white children. Compared with immigrant Hispanic children with foreign-born parents (the least acculturated group), the odds of never breastfeeding were respectively 2.4, 2.9, 6.5, and 2.4 times higher for native children with native parents (the most acculturated group) of Hispanic, white, black, and other ethnicities. Socioeconomic patterns also varied by immigrant status, and differentials were greater in breastfeeding at 6 months. Immigrant women in each racial/ethnic group had higher breastfeeding initiation and longer duration rates than native women. Acculturation was associated with lower breastfeeding rates among both Hispanic and non-Hispanic women. Ethnic-immigrant and social groups with lower breastfeeding rates identified herein could be targeted for breastfeeding promotion programs.
Pediatric Research, 1997
The amplitude of respiratory sinus arrhythmia (RSA) reflects parasympathetic mediation of heart r... more The amplitude of respiratory sinus arrhythmia (RSA) reflects parasympathetic mediation of heart rate patterns and may be a useful index of functional CNS integrity related to the newborn's ability to coregulate autonomic and sensory-affective processes. This study ...
Journal of the American Dental Association, 2013
Breastfeeding is the reference against which alternative infant feeding models must be measured w... more Breastfeeding is the reference against which alternative infant feeding models must be measured with regard to growth, development and other health outcomes. Although not a systematic review, this report provides an update for dental professionals, including an overview of general and oral health-related benefits associated with breastfeeding. The authors examined the literature regarding general health protections that breastfeeding confers to infants and mothers and explored associations between breastfeeding, occlusion in the primary dentition and early childhood caries. To accomplish these goals, they reviewed systematic reviews when available and supplemented them with comparative studies and with statements and reports from major nongovernmental and governmental organizations. When compared with health outcomes among formula-fed children, the health advantages associated with breastfeeding include a lower risk of acute otitis media, gastroenteritis and diarrhea, severe lower respiratory infections, asthma, sudden infant death syndrome, obesity and other childhood diseases and conditions. Evidence also suggests that breastfed children may develop a more favorable occlusion in the primary dentition. The results of a systematic review in which researchers examined the relationship between breastfeeding and early childhood caries were inconclusive. The American Academy of Pediatric Dentistry, Chicago, suggests that parents gently clean infants' gums and teeth after breastfeeding. The American Academy of Pediatrics, Elk Grove Village, Ill., recommends that breastfeeding should be exclusive for about the first six months of life and should continue, with the introduction of appropriate complementary foods, to at least age 12 months or beyond, as desired by mother and child. Dentists and staff members can take steps to ensure they are familiar with the evidence and guidelines pertaining to breastfeeding and to oral health. They are encouraged to follow the surgeon general's recommendations to promote and support optimal breastfeeding and oral health practices among their patients.
American Journal of Public Health, 2008
The American Journal of Drug and Alcohol Abuse, 2001
There is an insufficient number of substance abuse treatment programs available to pregnant women... more There is an insufficient number of substance abuse treatment programs available to pregnant women; however, even when women do enroll in treatment, they often choose not to comply with particular components of their treatment. To better understand what factors are associated with a woman's likelihood of compliance with treatment, this study assesses 244 pregnant, substance-using women enrolled in a specialized substance abuse treatment program. Women who complied with treatment referrals are compared with those who did not comply with referrals on various factors including their sociodemographic characteristics, types of substance use before and during pregnancy, experiences of violence before and during pregnancy, and prior substance use treatment. Bivariate analysis found that outpatient treatment compliance was more likely among women who smoked cigarettes before pregnancy, women who had received previous substance abuse treatment, and women whose partner had received previous substance abuse treatment. Outpatient treatment compliance did not vary by sociodemographic characteristics, any other type of substance use, or the women's experiences of violence. Inpatient treatment compliance was more likely among women who received prior substance abuse treatment; however, no other characteristic was found to be associated with inpatient treatment compliance. Logistic regression analyses, which controlled for various factors, suggested that past experiences with substance abuse treatment by the woman or her partner were significantly associated with treatment referral compliance. These findings suggest that the previous treatment experiences of women and their partners are important factors in shaping a successful substance abuse treatment program for pregnant women.
MMWR. Morbidity and Mortality Weekly Report, 2016
The American Academy of Pediatrics recommends that infants be breastfed exclusively* for the firs... more The American Academy of Pediatrics recommends that infants be breastfed exclusively* for the first 6 months of life, and that mothers continue breastfeeding for at least 1 year (1). However, in 2011, only 19.3% of mothers aged ≤20 years in the United States exclusively breastfed their infants at 3 months, compared with 36.4% of women aged 20-29 years and 45.0% of women aged ≥30 years.(†) Hospitals play an essential role in providing care that helps mothers establish and continue breastfeeding. The U.S. Surgeon General and numerous health professional organizations recommend providing care aligned with the Baby-Friendly Hospital Initiative (BFHI), including adherence to the Ten Steps to Successful Breastfeeding (Ten Steps), as well as not providing gift packs containing infant formula (2,3). Implementing BFHI-aligned maternity care improves duration of any and exclusive breastfeeding among mothers (4,5); however, studies have not examined associations between BFHI-aligned maternity care and breastfeeding outcomes solely among adolescent mothers (for this report, adolescents refers to persons aged 12-19 years). Therefore, CDC analyzed 2009-2011 Pregnancy Risk Assessment Monitoring System (PRAMS) data and determined that among adolescent mothers who initiated breastfeeding, self-reported prevalence of experiencing any of the nine selected BFHI-aligned maternity care practices included in the PRAMS survey ranged from 29.2% to 95.4%. Among the five practices identified to be significantly associated with breastfeeding outcomes in this study, the more practices a mother experienced, the more likely she was to be breastfeeding (any amount or exclusively) at 4 weeks and 8 weeks postpartum. Given the substantial health advantages conferred to mothers and children through breastfeeding, and the particular vulnerability of adolescent mothers to lower breastfeeding rates, it is important for hospitals to provide evidence-based maternity practices related to breastfeeding as part of their routine care to all mothers, including adolescent mothers.
Journal of Clinical Gastroenterology, 2007
Preventive medicine, Jan 31, 2015
We assessed whether smoking cessation improved among pregnant smokers who attended Women, Infants... more We assessed whether smoking cessation improved among pregnant smokers who attended Women, Infants and Children (WIC) Supplemental Nutrition Program clinics trained to implement a brief smoking cessation counseling intervention, the 5As: ask, advise, assess, assist, arrange. In Ohio, staff in 38 WIC clinics were trained to deliver the 5As from 2006 through 2010. Using 2005-2011 Pregnancy Nutrition Surveillance System data, we performed conditional logistic regression, stratified on clinic, to estimate the relationship between women's exposure to the 5As and the odds of self-reported quitting during pregnancy. Reporting bias for quitting was assessed by examining whether differences in infants' birth weight by quit status differed by clinic training status. Of 71,526 pregnant smokers at WIC enrollment, 23% quit. Odds of quitting were higher among women who attended a clinic after versus before clinic staff was trained (adjusted odds ratio 1.16, 95% confidence interval: 1.04, 1...
Background: In April 2009, an outbreak of acute febrile respiratory illness (AFRI) caused by nove... more Background: In April 2009, an outbreak of acute febrile respiratory illness (AFRI) caused by novel swine-origin influenza A (H1N1) virus (S-OIV) occurred at a large public university. Spectrum of illness of S-OIV infection is largely unknown; thus, we compared its clinical characteristics with those of seasonal influenza A (SIA) infection that occurred earlier at the same university. Methods: AFRI was defined as documented or reported fever with cough, sore throat (ST), or nasal symptoms (congestion or rhinorrhea) in a student evaluated at the campus health clinic (HC) during April 5-May 8. A case of S-OIV was confirmed by real time RT-PCR in a student with AFRI tested during April 27-30. A case of SIA was a positive rapid influenza A test on nasopharyngeal swab from a student evaluated at HC during February 1-March 21. Medical charts were reviewed and descriptiveanalyses performed. Results: Of 497 AFRI patients identified from chart review, 127 (26%) sought care during April 27-30;...
Background: Beginning on April 27, 2009, the first novel influenza H1N1 outbreak in a university ... more Background: Beginning on April 27, 2009, the first novel influenza H1N1 outbreak in a university occurred in Delaware, with dramatic numbers of students presenting with respiratory illness. We characterized illnesses and determined the impact of this outbreak. Methods: Numbers of visits, respiratory illness and treatment were obtained from the health clinic administration. Also, an online survey was administered to all students, staff, and faculty, and included assessment of influenza like illness (ILI), defined as documented or subjective fever and cough or sore throat. Results: In the first six days, the university health clinic had 1430 visits and 1080 reported respiratory symptoms; a spillover emergency clinic had over 300 visits. More than 500 treatment courses of oseltamivir were distributed. Though only some students were tested, 24 cases of novel H1N1 influenza virus infection were confirmed. Of 23,149 students, 6048 (26%) responded to the survey; 66% were women and median a...
Maternal and Child Health Journal, 2015
Objectives In 2006, the state of Ohio initiated the implementation of a brief smoking cessation i... more Objectives In 2006, the state of Ohio initiated the implementation of a brief smoking cessation intervention (5As: Ask, Advise, Assess, Assist, and Arrange) in select public health clinics that serve low-income pregnant and post-partum women. Funds later became available to expand the program statewide by 2015. However, close to half of the clinics initially trained stopped implementation of the 5As. To help guide the proposed statewide expansion plan for implementation of the 5As, this study assessed barriers and facilitators related to 5As implementation among clinics that had ever received training.
Background: Previous studies have shown that breastfeeding is associated with significant reducti... more Background: Previous studies have shown that breastfeeding is associated with significant reductions in the risk of common infections among infants in developed countries; however, whether breastfeeding confers longer-term protection against infections is unknown. Methods: We linked data from the 2005-2006 Infant Feeding Practices Study-II and 2012 follow-up data collected when children were 6 years old. We used multivariate logistic regression, controlling for sociodemographics, to examine associations of any and exclusive breastfeeding duration and breastmilk intensity (categorized by tertiles of the percentage of milk feedings being breastmilk from age 0-6 months) with maternal reports of past-year infection (ear, sinus, throat, pneumonia/lung, urinary, cold/upper respiratory) among the 6-year-old children. Results: Among 1,292 respondents with complete data, the most common past-year infections at age 6 years were colds/upper respiratory (66%), ear (25%), and throat (24%) infect...
Background: Hospital breastfeeding support is critical to successful initiation of lactation and ... more Background: Hospital breastfeeding support is critical to successful initiation of lactation and long-term breastfeeding outcomes. Methods: From August 2007 through January 2008, CDC conducted a census of all U.S. birth facilities (hospitals and birth centers), assessing breastfeeding-related maternity care practices in terms of policies, personnel, staff training, prenatal education, postpartum care, and hospital discharge. Questionnaires were completed by the person in each facility most knowledgeable about infant feeding practices, typically a head maternity care nurse or the lactation coordinator. Results: Approximately 80% (2676) of facilities responded24% via internet, 76% by mail. Preliminary data from the first 1287 respondents indicates minimal staff breastfeeding training71% of facilities provided £8 hours of training to new nurses, 40% said that over half of nurses received none in the past year. Approximately 85% receive free infant formula, and 70% distribute marketing ...
Pediatrics, 2014
There is a dearth of information on the long-term maternal effects of breastfeeding. The objectiv... more There is a dearth of information on the long-term maternal effects of breastfeeding. The objective of this study was to examine adherence to breastfeeding recommendations of exclusive breastfeeding for ≥4 months and continuation of breastfeeding for ≥1 year and maternal weight retention 6 years after delivery. Using data from the Infant Feeding Practices Study II (IFPS II), we categorized women by the degree to which they met breastfeeding recommendations. Mothers' self-reported weight 6 years after delivery (IFPS Year 6 Follow-Up) was compared with self-reported prepregnancy weight from IFPS II. Using linear regression models, adjusting for covariates, we examined associations between breastfeeding recommendation adherence and weight retention. Of the 726 women in our study, 17.9% never breastfed. Among those who initiated breastfeeding, 29.0% breastfed exclusively for ≥4 months, and 20.3% breastfed exclusively for ≥4 months and continued breastfeeding for ≥12 months. Prepregna...
Pediatrics, 2014
Previous studies have shown that breastfeeding is associated with reductions in the risk of commo... more Previous studies have shown that breastfeeding is associated with reductions in the risk of common infections among infants; however, whether breastfeeding confers longer term protection is inconclusive. We linked data from the 2005-2007 IFPS II (Infant Feeding Practices Study II) and follow-up data collected when the children were 6 years old. Multivariable logistic regression was used, controlling for sociodemographic variables, to examine associations of initiation, duration, exclusivity of breastfeeding, timing of supplementing breastfeeding with formula, and breast milk intensity (proportion of milk feedings that were breast milk from age 0-6 months) with maternal reports of infection (cold/upper respiratory tract, ear, throat, sinus, pneumonia/lung, and urinary) and sick visits in the past year among 6-year-olds (N = 1281). The most common past-year infections were colds/upper respiratory tract (66%), ear (25%), and throat (24%) infections. No associations were found between b...
The Journal of Nutrition, 2003
Breastfeeding rates among African-American women lag behind all other ethnic groups. National dat... more Breastfeeding rates among African-American women lag behind all other ethnic groups. National data show that only 45% of African-American women reported ever breastfeeding compared to 66 and 68% of Hispanic and white women, respectively. Of African-American women who do choose to breastfeed, duration is short, with many discontinuing in the first days after birth. This report applies a social ecological framework to breastfeeding to investigate macrolevel-microlevel linkages. We posit that macrolevel factors, such as the media, aggressive marketing of breastmilk substitutes, welfare reform, hospital policy and breastfeeding legislation, interact with microlevel factors to influence a woman's decision to breastfeed. These microlevel factors include features of the community, neighborhoods, workplaces that support or discourage breastfeeding, social and personal networks and cultural norms and individual beliefs about breastfeeding. The report discusses how power operates at each level to influence women's choices and also emphasizes the value of ethnographic data in breastfeeding studies. Through a case study of a sample of low income, African-American women living in Baltimore, MD, where breastfeeding role models are few, beliefs that discourage breastfeeding are many, and where everyday life is full of danger and fear, it is understandable that breastfeeding is not considered practical. The narrative data provide important information that can be used to enhance intervention efforts. To reach the Surgeon General's Healthy People 2010 breastfeeding goals requires a shift in cultural norms and structures at all levels that will support breastfeeding for all women. J. Nutr. 133: 305S-309S, 2003.
Pediatrics, 2007
Previous research has shown substantial racial/ethnic and socioeconomic disparities in US breastf... more Previous research has shown substantial racial/ethnic and socioeconomic disparities in US breastfeeding initiation and duration rates. However, the role of immigrant status in understanding such disparities has not been well studied. In this study we examined the extent to which breastfeeding initiation and duration varied by immigrant status overall and in conjunction with race/ethnicity and socioeconomic status after controlling for other relevant social and behavioral covariates. The cross-sectional data for 33121 children aged 0 to 5 years from the 2003 National Survey of Children's Health were used to calculate ever-breastfeeding rates and duration rates at 3, 6, and 12 months by social factors. Multivariate logistic regression was used to estimate relative odds of never breastfeeding and not breastfeeding at 6 and 12 months. More than 72% of mothers reported ever breastfeeding their infants, with the duration rate declining to 52%, 38%, and 16% at 3, 6, and 12 months, resp...
The Journal of nutrition, 2003
Breastfeeding rates among African-American women lag behind all other ethnic groups. National dat... more Breastfeeding rates among African-American women lag behind all other ethnic groups. National data show that only 45% of African-American women reported ever breastfeeding compared to 66 and 68% of Hispanic and white women, respectively. Of African-American women who do choose to breastfeed, duration is short, with many discontinuing in the first days after birth. This report applies a social ecological framework to breastfeeding to investigate macrolevel-microlevel linkages. We posit that macrolevel factors, such as the media, aggressive marketing of breastmilk substitutes, welfare reform, hospital policy and breastfeeding legislation, interact with microlevel factors to influence a woman's decision to breastfeed. These microlevel factors include features of the community, neighborhoods, workplaces that support or discourage breastfeeding, social and personal networks and cultural norms and individual beliefs about breastfeeding. The report discusses how power operates at each ...
PEDIATRICS, 2007
Previous research has shown substantial racial/ethnic and socioeconomic disparities in US breastf... more Previous research has shown substantial racial/ethnic and socioeconomic disparities in US breastfeeding initiation and duration rates. However, the role of immigrant status in understanding such disparities has not been well studied. In this study we examined the extent to which breastfeeding initiation and duration varied by immigrant status overall and in conjunction with race/ethnicity and socioeconomic status after controlling for other relevant social and behavioral covariates. The cross-sectional data for 33121 children aged 0 to 5 years from the 2003 National Survey of Children's Health were used to calculate ever-breastfeeding rates and duration rates at 3, 6, and 12 months by social factors. Multivariate logistic regression was used to estimate relative odds of never breastfeeding and not breastfeeding at 6 and 12 months. More than 72% of mothers reported ever breastfeeding their infants, with the duration rate declining to 52%, 38%, and 16% at 3, 6, and 12 months, respectively. Ever-breastfeeding rates varied greatly among the 12 ethnic-immigrant groups included in this analysis, from a low of 48% for native black children with native parents to a high of 88% among immigrant black and white children. Compared with immigrant Hispanic children with foreign-born parents (the least acculturated group), the odds of never breastfeeding were respectively 2.4, 2.9, 6.5, and 2.4 times higher for native children with native parents (the most acculturated group) of Hispanic, white, black, and other ethnicities. Socioeconomic patterns also varied by immigrant status, and differentials were greater in breastfeeding at 6 months. Immigrant women in each racial/ethnic group had higher breastfeeding initiation and longer duration rates than native women. Acculturation was associated with lower breastfeeding rates among both Hispanic and non-Hispanic women. Ethnic-immigrant and social groups with lower breastfeeding rates identified herein could be targeted for breastfeeding promotion programs.
Pediatric Research, 1997
The amplitude of respiratory sinus arrhythmia (RSA) reflects parasympathetic mediation of heart r... more The amplitude of respiratory sinus arrhythmia (RSA) reflects parasympathetic mediation of heart rate patterns and may be a useful index of functional CNS integrity related to the newborn's ability to coregulate autonomic and sensory-affective processes. This study ...
Journal of the American Dental Association, 2013
Breastfeeding is the reference against which alternative infant feeding models must be measured w... more Breastfeeding is the reference against which alternative infant feeding models must be measured with regard to growth, development and other health outcomes. Although not a systematic review, this report provides an update for dental professionals, including an overview of general and oral health-related benefits associated with breastfeeding. The authors examined the literature regarding general health protections that breastfeeding confers to infants and mothers and explored associations between breastfeeding, occlusion in the primary dentition and early childhood caries. To accomplish these goals, they reviewed systematic reviews when available and supplemented them with comparative studies and with statements and reports from major nongovernmental and governmental organizations. When compared with health outcomes among formula-fed children, the health advantages associated with breastfeeding include a lower risk of acute otitis media, gastroenteritis and diarrhea, severe lower respiratory infections, asthma, sudden infant death syndrome, obesity and other childhood diseases and conditions. Evidence also suggests that breastfed children may develop a more favorable occlusion in the primary dentition. The results of a systematic review in which researchers examined the relationship between breastfeeding and early childhood caries were inconclusive. The American Academy of Pediatric Dentistry, Chicago, suggests that parents gently clean infants' gums and teeth after breastfeeding. The American Academy of Pediatrics, Elk Grove Village, Ill., recommends that breastfeeding should be exclusive for about the first six months of life and should continue, with the introduction of appropriate complementary foods, to at least age 12 months or beyond, as desired by mother and child. Dentists and staff members can take steps to ensure they are familiar with the evidence and guidelines pertaining to breastfeeding and to oral health. They are encouraged to follow the surgeon general's recommendations to promote and support optimal breastfeeding and oral health practices among their patients.
American Journal of Public Health, 2008
The American Journal of Drug and Alcohol Abuse, 2001
There is an insufficient number of substance abuse treatment programs available to pregnant women... more There is an insufficient number of substance abuse treatment programs available to pregnant women; however, even when women do enroll in treatment, they often choose not to comply with particular components of their treatment. To better understand what factors are associated with a woman's likelihood of compliance with treatment, this study assesses 244 pregnant, substance-using women enrolled in a specialized substance abuse treatment program. Women who complied with treatment referrals are compared with those who did not comply with referrals on various factors including their sociodemographic characteristics, types of substance use before and during pregnancy, experiences of violence before and during pregnancy, and prior substance use treatment. Bivariate analysis found that outpatient treatment compliance was more likely among women who smoked cigarettes before pregnancy, women who had received previous substance abuse treatment, and women whose partner had received previous substance abuse treatment. Outpatient treatment compliance did not vary by sociodemographic characteristics, any other type of substance use, or the women's experiences of violence. Inpatient treatment compliance was more likely among women who received prior substance abuse treatment; however, no other characteristic was found to be associated with inpatient treatment compliance. Logistic regression analyses, which controlled for various factors, suggested that past experiences with substance abuse treatment by the woman or her partner were significantly associated with treatment referral compliance. These findings suggest that the previous treatment experiences of women and their partners are important factors in shaping a successful substance abuse treatment program for pregnant women.
MMWR. Morbidity and Mortality Weekly Report, 2016
The American Academy of Pediatrics recommends that infants be breastfed exclusively* for the firs... more The American Academy of Pediatrics recommends that infants be breastfed exclusively* for the first 6 months of life, and that mothers continue breastfeeding for at least 1 year (1). However, in 2011, only 19.3% of mothers aged ≤20 years in the United States exclusively breastfed their infants at 3 months, compared with 36.4% of women aged 20-29 years and 45.0% of women aged ≥30 years.(†) Hospitals play an essential role in providing care that helps mothers establish and continue breastfeeding. The U.S. Surgeon General and numerous health professional organizations recommend providing care aligned with the Baby-Friendly Hospital Initiative (BFHI), including adherence to the Ten Steps to Successful Breastfeeding (Ten Steps), as well as not providing gift packs containing infant formula (2,3). Implementing BFHI-aligned maternity care improves duration of any and exclusive breastfeeding among mothers (4,5); however, studies have not examined associations between BFHI-aligned maternity care and breastfeeding outcomes solely among adolescent mothers (for this report, adolescents refers to persons aged 12-19 years). Therefore, CDC analyzed 2009-2011 Pregnancy Risk Assessment Monitoring System (PRAMS) data and determined that among adolescent mothers who initiated breastfeeding, self-reported prevalence of experiencing any of the nine selected BFHI-aligned maternity care practices included in the PRAMS survey ranged from 29.2% to 95.4%. Among the five practices identified to be significantly associated with breastfeeding outcomes in this study, the more practices a mother experienced, the more likely she was to be breastfeeding (any amount or exclusively) at 4 weeks and 8 weeks postpartum. Given the substantial health advantages conferred to mothers and children through breastfeeding, and the particular vulnerability of adolescent mothers to lower breastfeeding rates, it is important for hospitals to provide evidence-based maternity practices related to breastfeeding as part of their routine care to all mothers, including adolescent mothers.
Journal of Clinical Gastroenterology, 2007
Preventive medicine, Jan 31, 2015
We assessed whether smoking cessation improved among pregnant smokers who attended Women, Infants... more We assessed whether smoking cessation improved among pregnant smokers who attended Women, Infants and Children (WIC) Supplemental Nutrition Program clinics trained to implement a brief smoking cessation counseling intervention, the 5As: ask, advise, assess, assist, arrange. In Ohio, staff in 38 WIC clinics were trained to deliver the 5As from 2006 through 2010. Using 2005-2011 Pregnancy Nutrition Surveillance System data, we performed conditional logistic regression, stratified on clinic, to estimate the relationship between women's exposure to the 5As and the odds of self-reported quitting during pregnancy. Reporting bias for quitting was assessed by examining whether differences in infants' birth weight by quit status differed by clinic training status. Of 71,526 pregnant smokers at WIC enrollment, 23% quit. Odds of quitting were higher among women who attended a clinic after versus before clinic staff was trained (adjusted odds ratio 1.16, 95% confidence interval: 1.04, 1...
Background: In April 2009, an outbreak of acute febrile respiratory illness (AFRI) caused by nove... more Background: In April 2009, an outbreak of acute febrile respiratory illness (AFRI) caused by novel swine-origin influenza A (H1N1) virus (S-OIV) occurred at a large public university. Spectrum of illness of S-OIV infection is largely unknown; thus, we compared its clinical characteristics with those of seasonal influenza A (SIA) infection that occurred earlier at the same university. Methods: AFRI was defined as documented or reported fever with cough, sore throat (ST), or nasal symptoms (congestion or rhinorrhea) in a student evaluated at the campus health clinic (HC) during April 5-May 8. A case of S-OIV was confirmed by real time RT-PCR in a student with AFRI tested during April 27-30. A case of SIA was a positive rapid influenza A test on nasopharyngeal swab from a student evaluated at HC during February 1-March 21. Medical charts were reviewed and descriptiveanalyses performed. Results: Of 497 AFRI patients identified from chart review, 127 (26%) sought care during April 27-30;...
Background: Beginning on April 27, 2009, the first novel influenza H1N1 outbreak in a university ... more Background: Beginning on April 27, 2009, the first novel influenza H1N1 outbreak in a university occurred in Delaware, with dramatic numbers of students presenting with respiratory illness. We characterized illnesses and determined the impact of this outbreak. Methods: Numbers of visits, respiratory illness and treatment were obtained from the health clinic administration. Also, an online survey was administered to all students, staff, and faculty, and included assessment of influenza like illness (ILI), defined as documented or subjective fever and cough or sore throat. Results: In the first six days, the university health clinic had 1430 visits and 1080 reported respiratory symptoms; a spillover emergency clinic had over 300 visits. More than 500 treatment courses of oseltamivir were distributed. Though only some students were tested, 24 cases of novel H1N1 influenza virus infection were confirmed. Of 23,149 students, 6048 (26%) responded to the survey; 66% were women and median a...
Maternal and Child Health Journal, 2015
Objectives In 2006, the state of Ohio initiated the implementation of a brief smoking cessation i... more Objectives In 2006, the state of Ohio initiated the implementation of a brief smoking cessation intervention (5As: Ask, Advise, Assess, Assist, and Arrange) in select public health clinics that serve low-income pregnant and post-partum women. Funds later became available to expand the program statewide by 2015. However, close to half of the clinics initially trained stopped implementation of the 5As. To help guide the proposed statewide expansion plan for implementation of the 5As, this study assessed barriers and facilitators related to 5As implementation among clinics that had ever received training.
Background: Previous studies have shown that breastfeeding is associated with significant reducti... more Background: Previous studies have shown that breastfeeding is associated with significant reductions in the risk of common infections among infants in developed countries; however, whether breastfeeding confers longer-term protection against infections is unknown. Methods: We linked data from the 2005-2006 Infant Feeding Practices Study-II and 2012 follow-up data collected when children were 6 years old. We used multivariate logistic regression, controlling for sociodemographics, to examine associations of any and exclusive breastfeeding duration and breastmilk intensity (categorized by tertiles of the percentage of milk feedings being breastmilk from age 0-6 months) with maternal reports of past-year infection (ear, sinus, throat, pneumonia/lung, urinary, cold/upper respiratory) among the 6-year-old children. Results: Among 1,292 respondents with complete data, the most common past-year infections at age 6 years were colds/upper respiratory (66%), ear (25%), and throat (24%) infect...
Background: Hospital breastfeeding support is critical to successful initiation of lactation and ... more Background: Hospital breastfeeding support is critical to successful initiation of lactation and long-term breastfeeding outcomes. Methods: From August 2007 through January 2008, CDC conducted a census of all U.S. birth facilities (hospitals and birth centers), assessing breastfeeding-related maternity care practices in terms of policies, personnel, staff training, prenatal education, postpartum care, and hospital discharge. Questionnaires were completed by the person in each facility most knowledgeable about infant feeding practices, typically a head maternity care nurse or the lactation coordinator. Results: Approximately 80% (2676) of facilities responded24% via internet, 76% by mail. Preliminary data from the first 1287 respondents indicates minimal staff breastfeeding training71% of facilities provided £8 hours of training to new nurses, 40% said that over half of nurses received none in the past year. Approximately 85% receive free infant formula, and 70% distribute marketing ...
Pediatrics, 2014
There is a dearth of information on the long-term maternal effects of breastfeeding. The objectiv... more There is a dearth of information on the long-term maternal effects of breastfeeding. The objective of this study was to examine adherence to breastfeeding recommendations of exclusive breastfeeding for ≥4 months and continuation of breastfeeding for ≥1 year and maternal weight retention 6 years after delivery. Using data from the Infant Feeding Practices Study II (IFPS II), we categorized women by the degree to which they met breastfeeding recommendations. Mothers' self-reported weight 6 years after delivery (IFPS Year 6 Follow-Up) was compared with self-reported prepregnancy weight from IFPS II. Using linear regression models, adjusting for covariates, we examined associations between breastfeeding recommendation adherence and weight retention. Of the 726 women in our study, 17.9% never breastfed. Among those who initiated breastfeeding, 29.0% breastfed exclusively for ≥4 months, and 20.3% breastfed exclusively for ≥4 months and continued breastfeeding for ≥12 months. Prepregna...
Pediatrics, 2014
Previous studies have shown that breastfeeding is associated with reductions in the risk of commo... more Previous studies have shown that breastfeeding is associated with reductions in the risk of common infections among infants; however, whether breastfeeding confers longer term protection is inconclusive. We linked data from the 2005-2007 IFPS II (Infant Feeding Practices Study II) and follow-up data collected when the children were 6 years old. Multivariable logistic regression was used, controlling for sociodemographic variables, to examine associations of initiation, duration, exclusivity of breastfeeding, timing of supplementing breastfeeding with formula, and breast milk intensity (proportion of milk feedings that were breast milk from age 0-6 months) with maternal reports of infection (cold/upper respiratory tract, ear, throat, sinus, pneumonia/lung, and urinary) and sick visits in the past year among 6-year-olds (N = 1281). The most common past-year infections were colds/upper respiratory tract (66%), ear (25%), and throat (24%) infections. No associations were found between b...