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To examine the relationship between food and housing insecurity and the continuation of breastfeeding, interviews were conducted with 203 birthing parents in English or Spanish. The study was conducted between August 2019 and March 2021 in the southeastern U.S. The breastfeeding rate among participants was 52%. Multivariate analysis indicated that birthing parents experiencing housing insecurity were less likely to be breastfeeding at 4 months of infant's age (p =.019). Future research is warranted to understand how housing insecurity might contribute to the discontinuation of breastfeeding through stress, poor rent affordability and the lack of clean and safe environments. [ABSTRACT FROM AUTHOR]

Objective: To describe breastfeeding rates from early to late infancy and to examine associations between breastfeeding duration and infant growth, including rapid weight gain (RWG, > 0·67 SD increase in weight-for-age Z -score), among infants from low-income, racially and ethnically diverse backgrounds. Design: A short, prospective cohort study was conducted assessing breastfeeding status at infant ages 2, 4, 6, 9 and 12 months. Infant length and weight measurements were retrieved from electronic health records to calculate weight-for-length Z -scores and the rate of weight gain. Setting: Pediatric clinic in the Southeastern USA. Participants: Mother-infant dyads (n = 256). Results: Most participants were African American (48 %) or Latina (34 %). Eighty-one per cent were participating in the Special Supplemental Nutrition Program for Women, Infants and Children. Infants were breastfed for a median duration of 4·75 months, with partial more common than exclusive breastfeeding. At 12 months, 28 % of the participants were breastfeeding. Infants breastfed beyond 6 months had significantly lower growth trajectories than infants breastfed for 0–2 months (β = 0·045, se = 0·013, P = 0·001) or 3–6 months (β = 0·054, se = 0·016, P = 0·001). Thirty-six per cent of the infants experienced RWG. RWG was more common among infants who were breastfed for 2 months or less than 6+ month breastfed group (relative risk = 1·68, CI95 (1·03, 2·74), P = 0·03). Conclusions: Breastfeeding beyond 6 months is associated with the prevention of accelerated growth among infants from low-income, racially and ethnically diverse backgrounds, suggesting progress toward health equity. [ABSTRACT FROM AUTHOR]

We examined differences in mean daily calorie intake and rapid weight gain risk among 6- to 12-month-old infants by milk feeding status: breastmilk only, breastmilk and formula (combined), or formula only. Another objective was to determine what frequency and amount of formula fed were associated with overfeeding among infants. Mother–infant dyads (n = 240) were recruited from a pediatric clinic mainly serving Medicaid recipients. At 6, 9, and 12 months of infants' age, 24 h feeding recalls were conducted using the multiple-pass method. Infant weight measurements were accessed from clinic records to estimate rapid weight gain between 6 and 12 months. Among the participants, 82% received WIC. More than half of the participants were either African American or Latino by race/ethnicity. Calorie intake among formula-only fed infants was higher than in the other two milk feeding groups. One-fourth of the infants were experiencing rapid weight gain, and the risk was 3-fold higher among formula-only fed infants. Exceeding daily calorie requirements or overfeeding was associated with both formula amount and the frequency of feeding (p < 0.01). Specific guidelines and education on formula feeding practices are critical to prevent accelerated growth among infants. Gaining further understanding on parenting style and formula feeding practices is also warranted. [ABSTRACT FROM AUTHOR]

Objective: To examine the association between food insecurity, dietary intake, and body mass index among Somali refugee women living in the United States. Methods: Cross-sectional study utilizing the snowball sampling method. Results: Most (67%) participants experienced some level of food insecurity, which was common among recent arrivals and those who spoke only Somali at home (P less than 0.05). Intake of meat and eggs was higher, whereas intake of fruits and vegetables was lower, among food insecure than secure participants. Food insecurity was positively related to overweight and obesity (odds ratio: 2.66; confidence interval: 1.25-5.69; P less than 0.01). Conclusions and Implications: Somali refugees experienced high levels of food insecurity upon resettlement. Poor dietary habits and the high overweight/obesity rate among insecure families call for future research in understanding what role family structure, cultural norms, and food preference play in predicting food security and dietary habits among Somali and overall African refugees in the United States. (Contains 3 tables and 1 figure.)

Objective: To examine the association of microbial contamination of the meal preparer's hands with microbial status of food and kitchen/utensil surfaces during home preparation of a "Chicken and Salad" meal. Design and Setting: Observational home food safety assessment. Before starting meal preparation, participants' hands were tested to estimate total bacterial and coliform counts and the presence of "Campylobacter", "Salmonella, Listeria", and "Staphylococcus aureus" ("S. aureus"). Microbiological testing was conducted on samples from kitchen/utensil surfaces, and on food ingredients obtained before and during meal preparation. Participants: Sixty Puerto Rican women residing in inner-city Hartford, CT. Main Outcome Measures: Total bacterial and coliform counts, and presence of "S. aureus" in target samples. Analysis: Bivariate tests and multiple logistic regression. Results: Participants considering food safety as "very important" were less likely to test positive for "S. aureus" on hands (P less than 0.05). "S. aureus" on post-handling chicken, counter/cutting board, and salad was positively associated with "S. aureus" on participants' hands (P less than 0.05). Coliform count on the counter/cutting board and sink was significantly higher at baseline when participants' hands tested positive for coliform before starting meal preparation. Conclusions and Implications: Meal preparer's hands can be a vehicle of pathogen transmission during meal preparation. (Contains 3 tables and 1 figure.)

A cross-sectional study was conducted to (1) examine breastfeeding initiation and continuation rates, and; (2) investigate association between food insecurity and breastfeeding status, among low-income mothers. Mothers of infants two-months or younger were recruited from a local pediatric clinic serving primarily low-income families. Upon giving consent, mothers were interviewed in-person or over the phone in either English or Spanish. Of the total 92 mothers interviewed, 90% initiated breastfeeding, but only 24% were doing exclusive breastfeeding at 2 months of infant's age. After controlling for socio-demographics, it was found that food-insecure mothers were less likely to continue with breastfeeding (β = −1.51, p =.024). Future research is warranted to understand pathways through which food insecurity affects breastfeeding and how this disparity can be prevented to ensure a safe and secure start for infants worldwide. [ABSTRACT FROM AUTHOR]

Women act as gatekeepers in securing water for their households. Using this qualitative methodology, 35 participants were interviewed with the objectives to determine roles and responsibilities of different family members in fetching and managing water and examine differences in perceptions related to water access/use between men and women in households from rural areas of the Menoua Division, West Cameroon. We found that the household structure was key component in each family member's degree of involvement in water fetching and management. A significant gender gap was found among adults with fewer men than women experiencing coping strategies-related to water scarcity. Hence, women participation in designing water and food security initiatives is warranted. [ABSTRACT FROM AUTHOR]

Objective: To assess the coverage and consumer satisfaction with the Fight BAC! campaign and to evaluate the influence of the campaign on food safety knowledge, attitudes, and behaviors among a predominantly Latino population living in inner-city Hartford, Connecticut. Design: A cross-sectional pre- and postsurvey was administered to 500 Latino consumers in either English or Spanish. It included 30 food safety-related questions and information on the socioeconomic and demographic characteristics of participants. Setting and Participants: Respondents were selected from Latino households, with at least one child 12 years old or under, located in 5 predominantly Latino neighborhoods in inner-city Hartford. Intervention: Fight BAC! media campaign. Results: Seventy-three percent of respondents were exposed to at least one campaign media item and were highly satisfied with it. Recognition of the Fight BAC! logo increased from 10% to 42% between surveys (P < .001). Individuals exposed to the campaign were more likely to have a food safety knowledge score of at least 2 of a possible 4 compared with unexposed counterparts (odds ratio = 3.54; 95% CI 1.74-7.18; P < .001). They were also more likely to report defrosting meats in the refrigerator (14% vs 7%; P = .01).There was a dose-response association between the degree of campaign exposure and awareness of the term 'cross-contamination.' Conclusion and Implications: Social marketing campaigns that take advantage of multiple culturally relevant media channels are likely to improve food safety awareness and bring about changes in food safety knowledge and attitudes among Latino consumers. KEY WORDS: Fight BAC!, food safety, Hispanic, Latino, Puerto Rican, low-income consumers

Water is a physiological need, key for survival. In limited water access situations, health, well-being, and productivity of households are negatively affected. Water insecurity refers to when access to adequate amount of clean water does not occur all the times for household members to lead a healthy and active life. A cross sectional study was conducted with 121 women from three rural communities in the West-Cameroon, to assess water insecurity experience and its correlation with related indicators. Specifically, this study aimed to: examine drinking water access by time spent on collection and distance to the water source, determine the prevalence of household water insecurity, and examine the relationship between water insecurity and diarrhea as well as drinking water access-related indicators. The main sources of drinking water included boreholes (69%), wells (13%), and rivers (12%). Each household spent an average total amount of 3 hours on water fetching. The mean duration of the drinking water stored was 4 days, after which the process was repeated. The majority of households (94.2%) were water insecure (total WATINE-17 score ≥1). About 61% reported drinking less water than they felt they should and 32% of them, said they had to drink dirty water. Water insecurity mean score was higher in households who reported diarrhea among their 0-5 years old children than their counterparts (p = 0.008). This study highlights the problem that good access to improved water source still represents in low-resource households of rural areas, with the subsequent complex interactions on women and children's health. Future research on water management and storage is warranted to understand the sources of cross-contamination and to identify the potential points of intervention to ensure safe drinking water for rural households. Policies should be designed in order to incorporate systematic household water insecurity measurement in monitoring advancement towards 2030 SDG. [ABSTRACT FROM AUTHOR]

Undernutrition among children is a significant issue in rural areas in Cameroon, with diarrhea being one of the major contributing risk factors. To gain a better understanding of the risk factors of diarrhea, the main objective of this epidemiological study was to examine associations between water access and sanitation service with diarrhea, diet diversity, and anemia among infants and toddlers in rural households in Cameroon. The study involved household- and individual-level data of 2,129 rural-dwelling infants and toddlers from the Demographic and Health Survey database. About one-third of infants and toddlers were experiencing diarrhea, with higher odds among those who lived in households with limited water service (p = 0.028). The odds of having diarrhea were 50% higher among infants and toddlers when households did not have sanitation facilities (p=0.007). The lack of improved water and sanitation was also associated with a low intake of various food groups among older infants and toddlers. The prevalence of anemia was high, but no significant differences were seen by water and sanitation services. The achievement of SDG #6 will help address undernutrition and achieve other SDGs, including improving health and wellbeing. [ABSTRACT FROM AUTHOR]

Background: Water represents the core of food-energy nexus and is vital for human survival. In developing countries, contaminated water and lack of basic water services undermine efforts to improve nutritional status and related health issues. In the rural areas of Central Africa, a majority of the population lacks access to improved water sources and has to devote considerable efforts to obtain water. Objectives: Using the following definition of water insecurity, i.e. it exists when access to adequate amount of safe and clean water does not occur all the times for the entirety of household members to lead a healthy and active life, the study aimed to develop and test a household-level experiential water insecurity scale for rural households in Central Africa. Methods: The research was conducted in three phases: 1) the formative data collection; 2) the scale development; and, 3) the scale testing. In the third Phase, the scale was tested with 250 women who were water managing person of their households. Statistical analysis included items reduction, reliability, as well as criterion and construct validity assessment. The testing led to a final scale of 17 statements (WATINE-17), covering three domains of water insecurity: 1) psychosocial distress; 2) quantity; 3) quality of water. Results: The scale showed an excellent reliability (Cronbach's alpha = 0.92) and was significantly associated with lower frequency of water intake among women (p = 0.007, concurrent validity). In assessing WATINE-17's predictive validity, it was found that water insecurity was positively related to food insecurity (p < 0.001) and the level of water insecurity was the highest among severely food insecure households [F (3, 246) = 22.469, p < 0.001]. Conclusion: The WATINE-17 is able to capture key elements of water insecurity and can be used to monitor and evaluate SDG# 6 and water-related programs, such as WASH, in Central Africa. [ABSTRACT FROM AUTHOR]

Few data are available concerning the socio-demographic characteristics and fruit and vegetable (F&V) purchasing behaviors of visitors attending the farmers' markets sponsored by the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) Farmers' Market Food and Nutrition Program (FMNP). The objectives of this cross-sectional study were to compare socio-demographics, food purchasing behaviors, and motivators for visiting a new WIC-based farmers' market among convenience samples of WIC FMNP participants (n = 124, 30%) and non-participants (n = 291, 70%) using a customer survey (n = 415). Frequency counts and percentages were obtained while independent t-tests and Chi-square were carried out to compare WIC FMNP participants to non-WIC participants (p ≤ 0.05). The age range of most (62%) of the visitors was 25–54 and the majority were female (91%). The primary motivators for market attendance included variety of F&V (76%), quality of F&V (55%), and to purchase food grown locally (59%). The majority of the total sample agreed (88%) that shopping at the WIC-based farmers' market increased their F&V consumption. WIC FMNP participants were further motivated by low prices (44%) and the ability to easily spend FMNP coupons (75%). Additionally, the study finds that location and convenience play a critical role in increasing FMNP coupon redemption rates. [ABSTRACT FROM AUTHOR]

Abstract Background: Montagnard refugees, an indigenous multilingual tribal people from Vietnam, experience lifestyle changes and post-resettlement challenges in the United States that contribute to chronic health conditions. Foundational research and health data are lacking. Objectives: We describe the Montagnard Hypertension Study, a community-based participatory research (CBPR) project documenting chronic disease risk. Methods: We developed a Montagnard dictionary of hypertension-specific terminology and conducted two focus group discussions (FGD), 131 biological assessments (blood pressure, height, weight, waist circumference, scalp hair and saliva sample collection), and 127 behavioral surveys. We implemented two health fairs that offered services to the community. Lessons Learned: This is the first study to examine chronic disease using a CBPR framework for Montagnard health. We highlight lessons learned specific to constituents and their capacities, historical and current conflicts, and the iterative processes in CBPR design. Conclusions: CBPR is a practically achievable approach to studying chronic disease risk within indigenous, tribal communities, with implications for future research with Asian American subgroups and other minority populations. [ABSTRACT FROM AUTHOR]

Objective: To (i) determine differences in the availability of variety of fruits and vegetables (F&V) at home by food security status; and (ii) examine the inter-associations between food security status, availability of variety of F&V at home and frequency of F&V intake, among low-income pregnant women. Design/Setting Participants were interviewed to collect food security status, home availability of variety of F&V and frequency of F&V intake. Bivariate analyses, multivariate regression and exploratory mediation analyses were conducted using IBM SPSS Statistics version 23.0 and the PROCESS macro.Subjects: Low-income pregnant women (n 198) were interviewed if they were ≥18 years of age, in the second trimester of pregnancy, and spoke English or Spanish.Results: Low/very low food security was found among 43 % of participants. Compared with fully food-secure participants, very low food-secure participants reported a lower variety of fruits (P=0·028) and vegetables (P=0·058) available at home. Mediation analyses indicated that through home availability of variety of fresh F&V, food security status was associated with the daily intake of F&V (indirect effect (95 % CI): fresh fruits, -0·039 (-0·074, -0·013); fresh vegetables, -0·048 (-0·083, -0·023)). As food security worsened, the available variety of fresh F&V decreased, which was associated with lower intake.Conclusions: The study highlights the interlink between food security, home food environment and diet quality, and the importance of nutrition education intervention to promote a healthy home food environment and improved pregnancy outcomes among low-income women. [ABSTRACT FROM AUTHOR]

Low-income women were interviewed and their post-natal records were retrieved (n= 160) to assess prevalence of excess gestational weight gain and its socio-demographic predictors. More than half of the women (64%) gained excess weight during pregnancy, with an average of 10 lbs in excess of Institute of Medicine guidelines. Logistic regression indicated that women that started pregnancy at an obese body mass index; who were African American or having an unplanned pregnancy were at significant risk of gaining excess weight in pregnancy. Intervention to prevent excess weight gain during pregnancy is critical in addressing obesity epidemic in the United States and worldwide. [ABSTRACT FROM AUTHOR]

Purpose – The community health workers (CHWs) model, which refers to individuals from the same community, sharing the same culture and origin, was used to conduct lifestyle, food and health assessments in the refugee and immigrant communities in the study area. In order to understand the process and effectiveness of CHW model, the purpose of this paper is to identify key characteristics of CHWs; and, describe the major roles CHWs play in reaching and carrying out health-based research among under-served refugee populations. Design/methodology/approach – The results of this paper reflect a grounded theory approach that specifically analyzed core categories or themes of the CHW model that were observed and recorded from the process of a larger study examining health and diet habits of refugees. In this study, women from the study community were recruited to be trained as CHWs. Recruitment criteria for potential CHWs included women from the same origin of the study community, live in the study area for several years and have familiarity with the community, and possess basic English reading and writing skills. Findings – The results showed that CHWs were most effective when they possessed specific key characteristics. These characteristics included being invested in the community and research project, being objective and non-judgmental and able to understand guidelines of research ethics. The CHW helped to carry out the study by acting as a gatekeeper by building trust among community members and, by acting as a cultural broker by explaining the study questions using culturally appropriate probes. Research limitations/implications – The CHWs described in this study represent the key characteristics of effectiveness they possess in reaching refugee and immigrant groups in the USA. The limitation reflects the need for further examination of the characteristics that make for effective CHWs in a US-based refugee resettlement context concerning health-based research and outreach reaching a general low-income, racial/ethnic minority groups in the USA. Practical implications – The CHW model is key in conducting culturally appropriate research with an under-served and difficult to reach population. Originality/value – There is limited published research on the use of the CHW in health-based research in the USA resettlement context and this research study is one step toward closing the gap in our examination of the CHW model. [ABSTRACT FROM AUTHOR]

This study was conducted with the Montagnard refugee women (n = 42) to understand their pre-resettlement living conditions and estimate pre- and post-resettlement differences in their intake of major food groups. In-depth interviews were conducted with the participants in their homes by multilingual Montagnard women fluent in English and their tribal languages. Most of the participants did not receive education and 39% reported household incomes of $500 or less per month. Participants had a very limited or no experience in weekly food shopping and budgeting before moving to the United States. In comparison of food habits, intake of different types of meat increased upon resettlement (P < .05). Pre-resettlement food shortage experience and receiving ≥ $500 in SNAP increased the odds of high meat intake. Due to a significant shift in food choices and environment, refugees are at a higher risk of experiencing poor health after moving to the United States. [ABSTRACT FROM PUBLISHER]

Food insecurity threatens health. To understand how food store location contributes to food insecurity in Lewiston, Maine, we visited all city food stores, determined availability and cost of healthy food in each, and mapped the stores against residence locations of at-risk groups (households with a single-parent, without a car, or with income. [ABSTRACT FROM AUTHOR]

The primary objectives of the study were to estimate the prevalence of child hunger and its relationship to dietary intake and body mass index (BMI) among Somali refugee children. This article also examined the sociodemographic risk factors of child hunger in Somali households. Somali refugee mothers and children twelve years old or younger (n = 195) were recruited to participate in a cross-sectional survey. During the survey, children's height and weight were measured to calculate BMI while their mothers were interviewed to collect information on sociodemographics, food insecurity, and children's dietary habits. Results indicated that 23 percent of households experienced child hunger. Overall, underweight or BMI < 5th percentile was significantly higher in children who experienced hunger. In terms of dietary intake, compared to food secure or mild to moderate food insecure households, intake of green leafy vegetables was significantly lower (OR: .32; CI: .15-.68; p = .003) while intake of eggs was higher (OR: 23.65; CI: 9.57-58.45; p < .000) among children experiencing hunger. Logistic regression showed that acculturation indicators such as poor English proficiency (OR: 17.76; CI: 1.50-20.14; p = .022) and shorter length of stay in the United States (OR: 3.27; CI: 1.26-8.47; p = .015) increased the likelihood of child hunger. [ABSTRACT FROM AUTHOR]

The study was conducted to compare and identify the magnitude of differences between self-reported and observed food safety behaviors among women preparing a chicken and salad dish at home. The observed food safety practices also were compared according to sociodemographic variables and prior food safety education. Sixty Puerto Rican women who were the main meal preparers for their households were recruited in Hartford, Conn. Three household visits were made to (i) deliver food ingredients to prepare the chicken and salad meal, (ii) conduct household observation, and (iii) conduct a self-reported survey. The difference between self-reported and observed behaviors varied across food handling and sanitation behaviors. There was a high level of inaccuracy for socially desirable behaviors such as hand washing; the vast majority of participants reported practicing these behaviors but they were not observed doing so. Cutting board washing also was considerably over-reported, questioning the validity of these self-reported data for regression analyses. There was a significant association (P < 0.05) between proper thawing method and prior food safety education, use of cutting board and higher income, and washing tomatoes and having a positive attitude towards food safety. Results revealed that overreporting errors must be considered when analyzing and/or interpreting data derived from self-reported food safety consumer surveys and that food safety education and positive food safety attitudes are associated with recommended food safety behaviors. [ABSTRACT FROM AUTHOR]

A study was conducted to estimate physical activity and fruits and vegetable behaviors, perceptions, and attitude among Maine high school students (n = 765). Over half (57%) reported participating in physical activity for >40 minutes per day. Only 6% reported eating five or more servings of fruits and vegetables per day. However, nearly half of the students (49%) reported eating enough fruits and vegetables "Always/Most of the time." A significant positive relationship was found between environmental indicators and daily intake of fruits and vegetables. Results highlight the need to promote fruits and vegetables consumption among high school students. [ABSTRACT FROM AUTHOR]

Purpose: One of the major federal food assistance programs, the Special Supplemental Program for Women, Infants, and Children (WIC), serves approximately 1.5 million low-income pregnant women per year; however, limited information is available on their dietary habits. This is critical because low-income women are at higher risk of gaining excess weight during pregnancy. Thus, the study objectives were to (1) determine the overall diet quality of WIC pregnant women and (2) examine diet quality and eating behaviors by race/ethnicity and other sociodemographics.Design: This was a cross-sectional study.Setting: One of the 3 WIC offices in a north-central county in North Carolina, USA.Sample: Pregnant women (n = 198) in the second trimester.Measures: Interviews included sociodemographics, food security, diet, and eating behaviors. Diet quality was assessed by the Healthy Eating Index (HEI) 2010 scores.Analysis: Descriptives, bivariate analysis, and multivariate analysis.Results: Average participant age was 26 years, and the mean HEI-2010 score was 56 of maximum score of 100. Specifically, African American women consumed significantly lower servings of whole grains (β = -1.71; 95% CI: -3.10 to -0.32; P < .05) and dairy (β = -1.42; 95% CI: -2.51 to -0.33; P < .05) compared with non-Hispanic white women. Hispanic women scored higher in daily intake of fruits (β = 0.98; 95% CI: 0.17-1.79; P < .05) and for consuming empty calories in moderation (β = 1.57; 95% CI: 0.06-3.09; P < .05). Frequency of intake of fast foods/outside meals was higher among African American women (57%, P = .025).Conclusion: Efforts are warranted to promote optimal nutrition among WIC pregnant women. Specifically, African American women are highly vulnerable to poor dietary habits during pregnancy. Further investigation of barriers/facilitators for healthy eating is necessary to address nutrition disparities among WIC pregnant women. [ABSTRACT FROM AUTHOR]

In an exploratory study, a convenience sample of 148 pregnant women was recruited from a WIC clinic in the southeast region of the U.S. to: 1) Examine and compare daily nutrient and food group intakes of WIC pregnant women to national guidelines, and; 2) Determine racial/ethnic differences in nutrient and food group intakes among WIC pregnant women. Women were selected for the study if they were: ≥ 18 y, in 2nd trimester of pregnancy, and if they spoke English or Spanish as a first language. Upon recruitment, participants were interviewed to collect information on their socio-demographics, including race/ethnicity. Additionally, 24-h diet recalls were conducted to collect information on average nutrient and food groups intakes of participants during pregnancy. Of the total participants, more than half self-identified as African American (59%), while the remaining reported being Hispanic (20%) and non-Hispanic White (22%). For nutrient intakes, women consumed folate, iron, and potassium below recommended amounts. In contrast, sodium was consumed above the recommendations for pregnancy. For food groups, intake of fruits and whole grains was limited. In comparison by race/ethnicity, specifically it was found that African American women were consuming higher amounts of carbohydrates, but lower amounts of potassium, vitamin A, and fiber in reference to non-minority group of non-Hispanic Whites. While, Hispanic women were consuming lower amounts of added sugar and animal protein than non-Hispanic Whites. Findings highlight the importance of prenatal nutrition education programs and interventions to improve dietary habits of low-income, racial/ethnic minority women. Inter-racial and ethnic differences exist in dietary intake patterns among low-income pregnant women, with African American women being at an increased risk for poor dietary habits and inability to meet nutrient requirements for pregnancy. [ABSTRACT FROM AUTHOR]

Objective: To describe breastfeeding rates from early to late infancy and to examine associations between breastfeeding duration and infant growth, including rapid weight gain (RWG, > 0·67 SD increase in weight-for-age Z -score), among infants from low-income, racially and ethnically diverse backgrounds., Design: A short, prospective cohort study was conducted assessing breastfeeding status at infant ages 2, 4, 6, 9 and 12 months. Infant length and weight measurements were retrieved from electronic health records to calculate weight-for-length Z -scores and the rate of weight gain., Setting: Pediatric clinic in the Southeastern USA., Participants: Mother-infant dyads ( n = 256)., Results: Most participants were African American (48 %) or Latina (34 %). Eighty-one per cent were participating in the Special Supplemental Nutrition Program for Women, Infants and Children. Infants were breastfed for a median duration of 4·75 months, with partial more common than exclusive breastfeeding. At 12 months, 28 % of the participants were breastfeeding. Infants breastfed beyond 6 months had significantly lower growth trajectories than infants breastfed for 0-2 months ( β = 0·045, se = 0·013, P = 0·001) or 3-6 months ( β = 0·054, se = 0·016, P = 0·001). Thirty-six per cent of the infants experienced RWG. RWG was more common among infants who were breastfed for 2 months or less than 6+ month breastfed group (relative risk = 1·68, CI 95 (1·03, 2·74), P = 0·03)., Conclusions: Breastfeeding beyond 6 months is associated with the prevention of accelerated growth among infants from low-income, racially and ethnically diverse backgrounds, suggesting progress toward health equity.

The objectives of a cross-sectional, semi-quantitative study were to: i) assess the prevalence of water insecurity and its association with water access-related behaviors such as time, distance, and sources of water; ii) identify major themes of concern raised in reference to anxiety, water quality/quantity, and perceived health risk domains of water insecurity, and; iii) examine the relationship between water insecurity, hygiene practices, and diarrheal incidence among children in rural areas of the Menoua Division in the Western Region of Cameroon In-person interviews were conducted with 18 years or older women living with at least one child between 2 and 5 years old (n=134). Participants spent on average 17±12 minutes walking to a drinking water source. Prevalence of water insecurity was 58%, and it was associated with a lower hygiene score among caretakers, i.e. , hygiene score of water secure: 9.2±1.2 vs . insecure:8.2±2.2, F (1, 132) =8.096, P<0.01). Overall, the incidence of diarrhea among children was 18%, and it was significantly higher among water insecure households (79%) compared with secure households (21%, P=0.02). In conclusion, access to improved sources of water is an issue in rural areas. Addressing water insecurity is critical in promoting optimal health and development of children due to its association with poor hygiene practices among caretakers., Competing Interests: Conflict of interests: the authors declare no conflict of interests