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Optimizing diet quality is an important concept for college athletes.

BACKGROUND: Improving breastfeeding rates among African American (AA) families is an important public health goal. Breastfeeding self-efficacy, a known predictor of breastfeeding behavior, has seldom been assessed among AAs, in relation to breastfeeding intensity (% breastfeeding relative to total feeding) or as a protective factor in combating the historical breastfeeding challenges faced by people of color. We aimed to test the association between breastfeeding self-efficacy assessed during pregnancy and breastfeeding intensity assessed in the early postpartum period. METHODS: This was a secondary data analysis of a randomized controlled feasibility trial of breastfeeding support and postpartum weight management. AA women were recruited during pregnancy from a prenatal clinic in Detroit, MI. Data presented, in this study, were collected at enrollment (n = 50) and ∼6 weeks postpartum (n = 31). Linear regression models were used, adjusting for potential confounders. RESULTS: There were no differences in breastfeeding intensity by study arm; data are from all women with complete data on targeted variables. Age ranged from 18 to 43 years, 52% were Women, Infant's, and Children program enrollees, and 62% had ≥ some college. Breastfeeding self-efficacy during pregnancy was a significant predictor of breastfeeding intensity in the early postpartum period (β = 0.125, p

The Environmental influences on Child Health Outcomes (ECHO)-wide Cohort Study (EWC), a collaborative research design comprising 69 cohorts in 31 consortia, was funded by the National Institutes of Health (NIH) in 2016 to improve children’s health in the United States. The EWC harmonizes extant data and collects new data using a standardized protocol, the ECHO-wide Cohort data Collection Protocol (EWCP). EWCP visits occur at least once per life stage, but the frequency and timing of the visits vary across cohorts. As of March 4, 2022, the EWC cohorts contributed data from 60,553 children and consented 29,622 children for new EWCP data and biospecimen collection. The median (interquartile range) age of EWCP-enrolled children was 7.5 years (3.7-11.1). Surveys, interviews, standardized examinations, laboratory analyses, and medical record abstraction are used to obtain information in five main outcome areas: pre-, peri-, and post-natal outcomes; neurodevelopment; obesity; airways; and positive health. Exposures include place- (e.g., air pollution, neighborhood socioeconomic status), family- (e.g., parental mental health), and individual-level (e.g., diet, genomics) factors.

Purpose Perceived Social Support (PSS) can impact breastfeeding behaviors, and a lack of PSS potentially contributes to disparities in breastfeeding rates for African American women (AA). Objectives were to describe PSS at two timepoints and test associations between PSS and breastfeeding intensity for AA. Methods Data are from a feasibility trial of breastfeeding support among AA. The Hughes Breastfeeding Support Scale was used to measure PSS (Emotional, Informational, Tangible; total range = 30–120) in pregnancy (T1, n = 32) and early postpartum (T2, n = 31). Scale means were compared with t-tests. Associations between PSS at T1 and breastfeeding intensity (ie, quantitative measure of breastfeeding) were assessed with linear regression. Results Total PSS (mean ± SE) was high at both time points (T1 = 90.5 ± 4.8; T2 = 92.8 ± 3.1). At T2, older participants or those living with a partner had higher total PSS scores compared to those younger or living alone. Emotional PSS was significantly higher at T2 than T1 with no differences in tangible or informational PSS over time. Mixed-feeding, exclusive breastfeeding, and exclusive formula feeding was distributed at 39%, 32%, and 29%, respectively. Total PSS was not associated with breastfeeding intensity. Conclusion Women reported high levels of social support, and emotional PSS increased over time in this small sample of AA. PSS and sources of PSS are understudied, especially among AA, and future studies should explore quantitative methods to assess PSS. The results of such assessments can then be used to design breastfeeding support interventions.

Objectives Persistent disparities in breastfeeding rates among African American (AA) women compared to other population groups have motivated researchers to understand factors influencing breastfeeding choices using a variety of methods. Quantitative surveys are more commonly reported, however, qualitative work that amplifies voices of AA women is limited. Methods Participants were recruited from a randomized controlled feasibility trial focused on breastfeeding support for AA women in Detroit, MI. Thirteen women were enrolled in the qualitative portion of the study described here. Using the Socioecological model (SEM) as the theoretical foundation, semi-structured qualitative interviews were conducted to explore perceived facilitators and barriers to breastfeeding. Interviews were digitally recorded, transcribed, and analyzed using Theoretical thematic analysis. Results Women reported factors ranging from micro to macro SEM levels that discouraged or reinforced breastfeeding. Key challenges included breastfeeding-related discouragement issues, including factors that decreased confidence and led women to terminate breastfeeding (e.g., problems with latching, pumping, lack of comfort with breastfeeding in public, and work constraints). Facilitators included perceived mother and infant benefits, perseverance/commitment/self-motivation, pumping ability, and social support. Participant suggestions for expanding breastfeeding promotion and support included: (1) tangible, immediate, and proactive support; (2) positive non-judgmental support; (3) "milk supply" and "use of pump" education; and (4) self-motivation/willpower/perseverance. Conclusions for practice Despite the identification of common facilitators, findings reveal AA women face many obstacles to meeting breastfeeding recommendations. Collaborative discussions between women and healthcare providers focused on suggestions provided by AA women should be encouraged.

Background: Preterm delivery (PTD) and poor fetal growth are major contributors to neonatal mortality and morbidity that can extend from birth onward. Although overt maternal nutrient deficiencies ...

Background Prior research has demonstrated bidirectional associations between gestational diabetes mellitus (GDM) and perinatal maternal depression. However, the association between GDM, prenatal depression, and postpartum depression (PPD) has not been examined in a prospective cohort longitudinally. Methods Participants in the current analysis included 5,822 women from the National Institutes of Health’s Environmental influences on Child Health Outcomes (ECHO) Research Program: N = 4,606 with Neither GDM nor Prenatal Maternal Depression (Reference Category); N = 416 with GDM only; N = 689 with Prenatal Maternal Depression only; and N = 111 with Comorbid GDM and Prenatal Maternal Depression. The PROMIS-D scale was used to measure prenatal and postnatal maternal depressive symptoms. Primary analyses consisted of linear regression models to estimate the independent and joint effects of GDM and prenatal maternal depression on maternal postpartum depressive symptoms. Results A higher proportion of women with GDM were classified as having prenatal depression (N = 111; 21%) compared to the proportion of women without GDM who were classified as having prenatal depression (N = 689; 13%), however this finding was not significant after adjustment for covariates. Women with Comorbid GDM and Prenatal Maternal Depression had significantly increased postpartum depressive symptoms measured by PROMIS-D T-scores compared to women with Neither GDM nor Prenatal Maternal Depression (mean difference 7.02, 95% CI 5.00, 9.05). Comorbid GDM and Prenatal Maternal Depression was associated with an increased likelihood of PPD (OR 7.38, 95% CI 4.05, 12.94). However, women with GDM only did not have increased postpartum PROMIS-D T-scores or increased rates of PPD. Conclusions Our findings underscore the importance of universal depression screening during pregnancy and in the first postpartum year. Due to the joint association of GDM and prenatal maternal depression on risk of PPD, future studies should examine potential mechanisms underlying this relation.

Depression is common during pregnancy, can elevate risk for excessive or inadequate gestational weight gain (GWG), and is associated with both underutilisation and overutilisation of prenatal care. Whether GWG is associated with adequacy of prenatal care among women with and without depression in the United States is unknown. This study evaluated whether adequacy of prenatal care differed by depression status and GWG.Data from the Pregnancy Risk Assessment Monitoring System from 1,379,870 women who were pregnant with a singleton and delivered at 37-42 weeks gestation during 2016 to 2018 were included. Depression was self-reported. The Kotelchuck index was used to evaluate adequacy of prenatal care. Maternal weight gain was compared to GWG guidelines.Approximately 13.1% of the sample experienced depression during pregnancy. Although those with depression had increased odds of both inadequate and above adequate levels of prenatal care, this association was no longer significant after accounting for demographics, medical comorbidities, and socioeconomic factors. Individuals with inadequate levels of prenatal care with a normal pre-pregnancy body mass index gained less weight during pregnancy.The association between depression and prenatal care utilisation seems driven by demographic, medical comorbidity, and socioeconomic variables. Weight outcomes were associated with inadequate prenatal care utilisation.

ImportanceThe prevalence of obesity among youths 2 to 19 years of age in the US from 2017 to 2018 was 19.3%; previous studies suggested that school lunch consumption was associated with increased obesity. The Healthy, Hunger-Free Kids Act of 2010 (HHFKA) strengthened nutritional standards of school-based meals.ObjectiveTo evaluate the association between the HHFKA and youth body mass index (BMI).Design, Setting, and ParticipantsThis cohort study was conducted using data from the Environmental Influences on Child Health Outcomes program, a nationwide consortium of child cohort studies, between January 2005 and March 2020. Cohorts in the US of youths aged 5 to 18 years with reported height and weight measurements were included.ExposuresFull implementation of the HHFKA.Main Outcomes and MeasuresThe main outcome was annual BMI z-score (BMIz) trends before (January 2005 to August 2016) and after (September 2016 to March 2020) implementation of the HHFKA, adjusted for self-reported race, ethnicity, maternal education, and cohort group. An interrupted time-series analysis design was used to fit generalized estimating equation regression models.ResultsA total of 14 121 school-aged youths (7237 [51.3%] male; mean [SD] age at first measurement, 8.8 [3.6] years) contributing 26 205 BMI measurements were included in the study. Overall, a significant decrease was observed in the annual BMIz in the period following implementation of the HHFKA compared with prior to implementation (−0.041; 95% CI, −0.066 to −0.016). In interaction models to evaluate subgroup associations, similar trends were observed among youths 12 to 18 years of age (−0.045; 95% CI, −0.071 to −0.018) and among youths living in households with a lower annual income (−0.038; 95% CI, −0.063 to −0.013).Conclusions and RelevanceIn this cohort study, HHFKA implementation was associated with a significant decrease in BMIz among school-aged youths in the US. The findings suggest that school meal programs represent a key opportunity for interventions to combat the childhood obesity epidemic given the high rates of program participation and the proportion of total calories consumed through school-based meals.

Pregnancy nutrition is important for maternal and child health and may affect the development of the infant gut microbiome. Our objective was to assess the feasibility of implementing a food-based intervention designed to increase fiber intake among pregnant women in a rural setting. Participants were enrolled (N = 27) mid-pregnancy from a prenatal care clinic in rural Michigan, randomized to intervention (N = 13) or usual care (N = 14), and followed to 6 weeks postpartum. The intervention was designed to be easily replicable and scalable by partnering with hospital foodservices and included non-perishable high fiber foods and recipes, as well as weekly delivery of salads, soup, and fresh fruit. Surveys, maternal blood, urine, and stool were collected at 24- and 36-weeks gestation and at 6 weeks postpartum. Infant stool was collected at 6 weeks. Participants were 100% White (7% Hispanic White, 7% Native American and White); 55% with education < 4-year college degree. Data on dietary intake and urinary trace elements are presented as evidence of feasibility of outcome measurement. Retention was high at 93%; 85% reported high satisfaction. The intervention described here can be replicated and used in larger, longer studies designed to assess the effects of pregnancy diet on the establishment of the infant gut microbiome and related health outcomes.

Background Parental mindfulness may be a novel intervention target for child obesity prevention. Objective To examine associations between maternal mindfulness and child body mass index z-score (BMIz). Methods In a secondary data analysis of pre-intervention data from a randomized controlled trial, we assessed survey and anthropometric data from English-speaking mother/child dyads enrolled in Head Start in south central Michigan (n=105). Surveys included demographic information, child dietary intake, family meal frequency, and the Philadelphia Mindfulness Questionnaire. Multivariable linear regression examined associations between maternal mindfulness and child BMIz, child intake of fruits and vegetables, and frequency of family meals. Results Children were M=53.7 (SD 7.5) months old, and mothers were M=31.6 (SD 8.3) years old. The sample of children was 39% white, 26% black, 14% Hispanic, and 35% of children were overweight or obese. Mean maternal BMI was 32.0 (SD 8.3). Greater mindfulness was associated with child BMIz (β=-0.02 (SE 0.01), p=.027) adjusting for child race/ethnicity, household food security, maternal education, maternal age, and maternal BMI. Mindfulness was not associated with child fruit intake, child vegetable intake or frequency of family meals. The results were consistent with alternative outcomes of BMI percentile (p=.016) and BMI at the trend level (p=.0595) at the trend level. Conclusions Greater maternal mindfulness was associated with lower child BMIz. Future work should consider mechanisms of association. Pediatric providers might consider supporting maternal mindfulness as one element of multicomponent strategies for child obesity prevention.

To determine the effect of a bundled intervention (home meal delivery and provision of cooking/serving resources) on preschoolers' body mass index z-score (BMIz), dietary quality, and family meal frequency.Participants (299 families; mean child age 4.4 years, 47% male, 55% White, 18% Black, 27% Hispanic or other race and ethnicity, and 25% were overweight or obese) were randomized to a control group or to provision of cooking/serving resources plus home meal delivery for 12 weeks (meals provided by Meals on Wheels [MOW cohort, n = 83] or a commercial service [COM cohort, n = 216]). Outcomes were child dietary quality, family meal frequency, and child BMIz.The intervention increased dinnertime intake of red and orange vegetables in the full sample (MOW cohort+COM cohort) (0.10 pre- to 0.15 cup equivalents (CE) post-in the intervention group vs 0.10 pre- to 0.09 post- in the control group; P = .01) and the COM cohort (0.11 pre- to 0.17 CE post- vs 0.11 pre- to 0.09 post-; P = .002), and typical daily dietary intake of fruit and fruit juice in the MOW cohort (1.50 CE pre- to 1.66 post- vs 1.48 pre- to 1.19 post-; P = .05). The intervention did not change meal frequency or BMIz.Short-term home meal delivery with provision of cooking/serving resources improved dietary quality among preschool-aged children but did not change meal frequency or BMIz. Expansion of Meals on Wheels programs to preschool-aged children may be a promising intervention to improve dietary quality. Family meals, when already frequent, are not further increased by reducing the burden of meal preparation.

Background: Previous research examined effects of human milk on the infant gut microbiota, but little attention has been given to the microbiota of lactating women. Research Aim: To determine associations between exclusive human milk feeding and gut microbiota characteristics in mothers and infants at 6-weeks postpartum. Methods: A sample of mother–infant dyads ( N = 24) provided fecal samples and questionnaire responses at 6-weeks postpartum as part of the Pregnancy, EAting & POstpartum Diapers study. Deoxyribonucleic acid was extracted from stool samples, followed by (V4) 16S ribosomal ribonucleic acid gene amplicon sequencing. Alpha and beta diversity, in addition to taxa differences, were compared by human milk exposure status, exclusive versus non-exclusive. A subset of dyads (those exclusively fed human milk; n = 14) was analyzed for shared bifidobacterial species using polymerase chain reaction. Results: Alpha diversity was significantly lower in exclusively human milk-fed infants. Maternal lactation status (exclusive vs. partial) and Shannon diversity were associated in univariate analysis but were no longer associated in multivariable regression including body mass index category in the model. Beta diversity (Sorensen dissimilarity) of fecal samples from women and infants was significantly associated with human milk feeding. Of six infants with Bifidobacterium longum subspecies longum in their fecal samples, all their mothers shared the same species. Conclusion: Maternal gut microbiotas differ by lactation status, a relationship potentially confounded by body mass index category. Further research is needed to identify whether lactation directly influences the maternal gut microbiota, which may be another mechanism by which lactation influences health.

We aimed to test main, additive, interactive effects, and feasibility of all possible combinations of six intervention components implemented for 8 weeks (Cooking/Serving Resources; Meal Delivery; Ingredient Delivery; Community Kitchen; Nutrition Education; Cooking Demonstrations). Primary outcomes were family meal frequency and preschoolers' dietary quality; secondary outcomes included family meal preparation type, meal preparation barriers, family functioning, and kitchen inventory adequacy. All possible intervention combinations were tested using a randomized factorial trial design in the first phase of a Multiphase Optimization Strategy (MOST). Feasibility was assessed via attendance, delivery logs, and satisfaction. Parent-reported data collection included: socio-demographics, frequency and type of family meals; preschooler dietary intake; perceived barriers to meal planning and preparation; assessment of family functioning; and a kitchen inventory of materials generally needed for meal preparation. Participants (n = 499) were recruited at two Head Start agencies in mid-Michigan with data collection and delivery of some intervention components in participants' homes. Promising intervention bundles were identified by evaluating pre-to post-intervention effect sizes. The combination of Cooking/Serving Resources and Meal Delivery increased family meal frequency (Cohen's d = 0.17), cooking dinner from scratch (d = 0.21), prioritization of family meals (d = 0.23), and kitchen inventory (d = 0.46) and decreased use/consumption of ready-made (d = -0.18) and fast foods (d = -0.23). Effects on diet quality were in the expected direction but effect sizes were negligible. Community Kitchen, Nutrition Education, and Cooking Demonstration showed poor feasibility due to low attendance while Ingredient Delivery was infeasible due to staffing challenges related to its labor intensity. Additionally, although not one of our pre-specified outcomes, Cooking/Serving Resources (RR = 0.74) and Meal Delivery (RR = 0.73) each decreased food insecurity. Cooking/Serving Resources combined with Meal Delivery showed promise as a strategy for increasing family meal frequency.

Persistent disparities in breastfeeding rates among African American (AA) women compared to other population groups have motivated researchers to understand factors influencing breastfeeding choices using a variety of methods. Quantitative surveys are more commonly reported, however, qualitative work that amplifies voices of AA women is limited.Participants were recruited from a randomized controlled feasibility trial focused on breastfeeding support for AA women in Detroit, MI. Thirteen women were enrolled in the qualitative portion of the study described here. Using the Socioecological model (SEM) as the theoretical foundation, semi-structured qualitative interviews were conducted to explore perceived facilitators and barriers to breastfeeding. Interviews were digitally recorded, transcribed, and analyzed using Theoretical thematic analysis.Women reported factors ranging from micro to macro SEM levels that discouraged or reinforced breastfeeding. Key challenges included breastfeeding-related discouragement issues, including factors that decreased confidence and led women to terminate breastfeeding (e.g., problems with latching, pumping, lack of comfort with breastfeeding in public, and work constraints). Facilitators included perceived mother and infant benefits, perseverance/commitment/self-motivation, pumping ability, and social support. Participant suggestions for expanding breastfeeding promotion and support included: (1) tangible, immediate, and proactive support; (2) positive non-judgmental support; (3) "milk supply" and "use of pump" education; and (4) self-motivation/willpower/perseverance.Despite the identification of common facilitators, findings reveal AA women face many obstacles to meeting breastfeeding recommendations. Collaborative discussions between women and healthcare providers focused on suggestions provided by AA women should be encouraged.

Purpose: The objective of this study was to characterize the study designs, recruitment strategies, and other study characteristics among cohorts that initiated during pregnancy as part of the Environmental influences on Child Health Outcomes (ECHO) program.Methods: ECHO research programs (cohorts) were reviewed. Only those who had or were currently recruiting during pregnancy were surveyed in 2018 about research recruitment strategies (participant incentives, study burden, community collaboration, and cultural adaptations). Data are presented with cohort characteristics (location, inclusion and exclusion criteria, sociodemographics, medical information, behavioral factors, and biospecimens).Results: Forty-seven of the 84 ECHO pediatric cohorts recruited during pregnancy. Findings demonstrate various recruitment strategies, domains of data collection, and biospecimen collection are all characteristics of successful cohorts.Clinical Implications: These data that include over 50,000 children from families across the country, many in underserved areas, will be used for research with the potential to lead to profound policy changes. Prenatal conditions prenatal conditions such as maternal age, obesity, depression, and drug use can be examined using study data, including biological markers, from pregnancy through childbirth and into childhood and will inform national policies on the role of early life exposures and underlying mechanisms of disease progression.

Background Maternal pre-pregnancy obesity and human milk feeding have been associated with altered infant gut microbiota. Research aim Determine the relationships between maternal pre-pregnancy BMI, human milk exposure, and their influence on the infant microbiota simultaneously. Methods This was a cross-sectional study of infants at 6 months of age ( N = 36), a time when many infants are fed a mixed diet of human milk and other foods. Fecal samples and participant information were collected from a subset of dyads enrolled in two related prospective cohorts (ARCHGUT and BABYGUT) in Michigan. Sequencing the V4 region of the 16S gene was used to analyze fecal bacterial samples collected from 6-month-old infants. Participants were grouped into four categories designated by their extent of human milk exposure (100%, 80%, 50%–80%, ≤ 20% human milk in the infant diet) and by maternal pre-pregnancy BMI category (normal, overweight, obese). Results Fewer participants with pre-pregnancy obesity were breastfeeding at 6 months postpartum compared to non-obese participants (35.7% and 81.8%, respectively). In univariate analyses, maternal pre-pregnancy BMI and human milk exposure were both significantly associated with alpha and beta diversity of the infant microbiota. However, in multivariate analyses, human milk exposure accounted for 20% of the variation in alpha diversity, but pre-pregnancy BMI was not significantly associated with any form of microbiota diversity. Conclusions The proportion of the infant diet that was human milk at 6 months was the major determinant of alpha and beta diversity of the infant. Maternal obesity contributes to the gut microbiota by its association with the extent of human milk feeding.

Background The United States physician shortages affect rural health care access, including maternity care. Project aims were to identify and characterize prenatal and delivery care in Michigan's rural counties and to explore access to trial of labor after cesarean (TOLAC) services for women in rural Michigan. Methods Descriptive, cross-sectional design used 2015 Medicaid claims data and public health plan information to identify maternity care services provided within Michigan's rural counties. Publicly available health plan information was used to identify rural maternity hospitals and prenatal care practitioners; findings were verified by Internet searches and telephone interviews. Medicaid claims data were used to determine services provided. High-risk geographic areas were defined as those where women needed to travel >30 miles for maternity-related care. Expected TOLAC rate was determined based on published national birth data; rural hospitals were stratified based on whether they met the expected TOLAC rate, delivered 20%-60% of expected rate, or billed ≤1 TOLAC birth to Medicaid in 2015. Results In Michigan's 57 rural counties, only 29 hospitals provide maternity care. Geographic high-risk areas were identified in the Upper Peninsula and northeast Lower Peninsula of Michigan. Only two rural hospitals billed for the expected rate of TOLAC births; six delivered at a lower rate, and the remaining 21 hospitals provided no TOLAC services, resulting in large areas of the state where women were not offered this option locally. Conclusions Maternity care services are limited for many rural Michigan women. Findings can be used to target specific strategies to improve access to care for these women. Similar analyses, exploring patterns of maternity care delivery in other rural regions worldwide, may uncover similar or additional inequities.

ObjectiveIn resource-constrained facilities or during resuscitation, immediate paediatric weight estimation remains a fundamental challenge. We aimed to develop and validate weight estimation models based on ulna length and forearm width and circumference measured by simple and portable tools; and to compare them against previous methods (advanced paediatric life support (APLS), Theron and Traub–Johnson formulas).DesignCross-sectional analysis of anthropometric measurements. Four ulna- and forearm-based weight estimation models were developed in the training set (n 1016). Assessment of bias, precision and accuracy was examined in the validation set (n 457).SettingNational Children’s Study-Formative Research in Anthropometry (2011–2012).SubjectsMulti-racial/ethnic infants and children aged n 1473).ResultsDeveloped Models 1–4 had high predictive precision (R2=0·91–0·97). Mean percentage errors between predicted and measured weight were significantly smaller across the developed models (0·1–0·7 %) v. the APLS, Theron and Traub–Johnson formulas (−1·7, 9·2 and −4·9 %, respectively). Root-mean-squared percentage error was overall smaller among Models 1–4 v. the three existing methods (range=7·5–8·7 v. 9·8–13·3 %). Further, Models 1–4 were within 10 and 20 % of actual weight in 72–87 and 95–99 % of the weight estimations, respectively, which outperformed any of the three existing methods.ConclusionsUlna length, forearm width and forearm circumference by simple and portable tools could serve as valid and reliable surrogate measures of weight among infants and children aged

This study evaluated feasibility, acceptability, and preliminary efficacy of a 12-week Guys/Girls Opt for Activities for Life (GOAL) intervention on 10- to 13-year-old adolescents’ body mass index (BMI), percent body fat, physical activity (PA), diet quality, and psychosocial perceptions related to PA and healthy eating. Parent–adolescent dyads from two schools were enrolled. Schools were assigned to either GOAL (38 dyads) or control (43 dyads) condition. The intervention included an after-school club for adolescents 2 days/week, parent–adolescent dyad meeting, and parent Facebook group. Intervention adolescents had greater autonomous motivation for PA and self-efficacy for healthy eating than control adolescents (both p < .05). Although between-group differences were not significant, close-to-moderate effect sizes resulted for accelerometer-measured moderate-to-vigorous PA and diet quality measured via 24-hr dietary recall ( d = .46 and .44, respectively). A trivial effect size occurred for percent body fat ( d = −.10). No differences emerged for BMI. Efficacy testing with a larger sample may be warranted.

The purpose of this pilot quasi-experimental study was to examine the feasibility and preliminary efficacy of using Facebook in a 10-week lifestyle intervention with Head Start caregiver–preschooler dyads to improve healthy behaviors and reduce body mass index. Sixty-nine dyads participated with 39 in the intervention group. Average preschooler attendance rate for the Head Start center-based program was 77%, and caregiver participation rate was 87%. About 94% of the caregivers were satisfied with the program, and 97% would recommend the program to others and/or participate again. The intervention decreased preschoolers’ body mass index z score (Cohen’s d = –.30) and screen time ( d = –.21), and increased their fruit and vegetable intake ( d = .40) and moderate-to-vigorous physical activity ( d = .42). The intervention increased caregivers’ fruit and vegetable intake ( d = .40). The intervention is feasible, and preliminary efficacy is encouraging, but further investigation using a rigorous study design is warranted.

Background: The beneficial effect of breastfeeding on individual components of the metabolic syndrome in children and adolescents has been reported, but it is unknown if there is an association between being breastfed and metabolic syndrome as a whole. Research aim: This systematic review was performed to assess quality and strength of evidence for the association between being breastfed and the development of metabolic syndrome in children and adolescents. Methods: Articles were obtained from searches using PubMed and Embase databases, as well as from secondary searches through reference lists. Study quality was assessed using a three-level quality rating system. Results: Of 11 studies reviewed, 7 found a protective association between breastfeeding and metabolic syndrome and 4 found no association. There was no clear dose–response relationship between duration of breastfeeding and metabolic syndrome risk and insufficient evidence to demonstrate an added effect of being exclusively breastfed. The overall quality of the articles was moderate. In general, lower quality articles found no significant association, whereas higher quality articles found a significant association. Conclusion: Our review demonstrated a limited amount of high-quality research on the relationship between being breastfed and development of metabolic syndrome in children and adolescents. The evidence presented in this review suggests that being breastfed may be protective against metabolic syndrome, but further research with improvements in study design, such as improved measurement of breastfeeding and the use of prospectively collected data, will improve our understanding of this relationship.

Background Infant feeding practices are thought to shape food acceptance and preferences. However, few studies have evaluated whether these affect child diet later in life. Objective The study objective was to examine the association between infant feeding practices and dietary patterns (DPs) in school-aged children. Design A secondary analysis of data from a diverse prospective birth cohort with 10 years of follow-up (WHEALS [Wayne County Health Environment Allergy and Asthma Longitudinal Study]) was conducted. Participants/setting Children from the WHEALS (Detroit, MI, born 2003 through 2007) who completed a food screener at age 10 years were included (471 of 1,258 original participants). Main outcome measures The main outcome was DPs at age 10 years, identified using the Block Kids Food Screener. Statistical analysis performed Latent class analysis was applied for DP identification. Breastfeeding and age at solid food introduction were associated with DPs using a 3-step approach for latent class modeling based on multinomial logistic regression models. Results The following childhood DPs were identified: processed/energy-dense food (35%), variety plus high intake (41%), and healthy (24%). After weighting for loss to follow-up and covariate adjustment, compared with formula-fed children at 1 month, breastfed children had 0.41 times lower odds of the processed/energy-dense food DP vs the healthy DP (95% CI 0.14 to 1.25) and 0.53 times lower odds of the variety plus high intake DP (95% CI 0.17 to 1.61), neither of which were statistically significant. Results were similar, but more imprecise, for breastfeeding at 6 months. In addition, the association between age at solid food introduction and DP was nonsignificant, with each 1-month increase in age at solid food introduction associated with 0.81 times lower odds of the processed/energy-dense food DP relative to the healthy DP (95% CI 0.64 to 1.02). Conclusions A significant association between early life feeding practices and dietary patterns at school age was not detected. Large studies with follow-up beyond early childhood that can also adjust for the multitude of potential confounders associated with breastfeeding are needed.

BACKGROUND: US iodine intake, estimated from the median urinary iodine concentration of population representative data, has declined by half since the 1970s which is problematic because maternal iodine intake is critical for fetal neurodevelopment. Relying on median urinary concentrations to assess iodine intake of populations is standard practice but does not describe the number of individuals with insufficient intake. Prevalence estimates of inadequate and excessive intake are better for informing public health applications but require multiple urine samples per person; such estimates have been generated in pediatric populations but not yet among pregnant women. OBJECTIVE: Our aims were: 1) to assess median urinary iodine concentrations across pregnancy for comparison to national data; and 2) to estimate the prevalence of inadequate and excessive iodine intake among pregnant women in mid-Michigan. STUDY DESIGN: Data were collected in 2008–2015 as part of a prospective pregnancy cohort where women were enrolled at their first prenatal clinic visit. Few exclusion criteria (

Background Though in-person contacts in the home have demonstrated efficacy in improving breastfeeding outcomes in peer counseling programs, home contacts are resource-intensive. Objective To compare the feasibility and effectiveness of an Integrated Model of peer counseling breastfeeding support characterized by select home visits augmented with individual WIC clinic visits and group education, in contrast to the Standard Model which includes a standard number of in-person home contacts. Methods Six counties (n = 226 participants) and nine counties (n = 472 participants) were assigned to the Standard Model and the Integrated Model, respectively. Differences in demographic characteristics and breastfeeding outcomes were tested using Chi square tests and Cox proportional hazards regression models. Results Participants in counties where the Integrated Model was implemented had fewer home contacts (p = 0.03) and were more likely to have a hospital (p = 0.03) or group education (p

Objective While obesity prevention efforts emphasize the importance of healthy family meals, few studies have addressed instrumental barriers to family meals as an obesity prevention strategy. Therefore, our study objectives are to: Phase 1 - test the additive effects of six intervention components reflecting differing levels of supports for family mealtimes; identify components associated with family meals and dietary outcomes in a Screening Phase and Phase 2 - evaluate the identified components as an intervention in a randomized controlled trial in a Confirming Phase. Description Phase 1 (n = 499 children from Head Start/parents) analyses indicated that the provision of healthy meals and cookware/dinnerware sets was most robustly associated with mealtime frequency and dietary quality. In Phase 2, participants in the treatment condition receive two prepared meals delivered weekly by Meals on Wheels for 12 weeks and a comprehensive set of cookware/dinnerware. We have enrolled 58 pilot parent-child dyads (Mage parents = 31.12 years, SD = 7.97; Mage children = 4.21 years, SD = 0.52) who reflect a racially diverse, low-income sample. 75% of parents/27% of children are overweight/obese and 57% of families were food insecure at enrollment. Recruitment for an additional 250 children/parents is underway. Evaluation Given the small pilot, we utilized descriptive analyses of pre-post changes in mean scores, with Cohen's d compared to the control condition noted. The pilot intervention showed pre-post increases in the frequency of eating meals together (d = 0.13), increases in efficacy in mealtime planning (d = 0.27) and decreases in time barriers regarding meal preparation (d = -0.36). Children's body mass index z-score decreased in the treatment and control groups. Conclusion and Implications Preliminary pilot results suggest the provision of healthy, prepared meals may be related to greater frequency of family meals eaten together and improvements in perceived barriers to planning and preparing meals. At the conclusion of Phase 2, study results are expected to inform policy (e.g. where limited resources may be best allocated) and interventions (e.g. supports most effective in promoting family meals).

Background: Peer counseling (PC) breastfeeding support programs have proven effective in increasing breastfeeding duration in low-income women. Objectives: This study aimed to describe program participants and breastfeeding duration in a PC program according to (1) timing of enrollment (prenatal vs postnatal) and (2) breastfeeding status at program exit (discontinued breastfeeding, exited program while breastfeeding, and completed 1 year program) to improve understanding of how these groups differ and how services might be optimized when resources are limited. Methods: This study is a secondary analysis of data from low-income women enrolled in a PC breastfeeding support program. Participant characteristics and breastfeeding duration were described using chi-square tests, analyses of variance, and logistic regression. Results: Postnatal enrollees had longer breastfeeding duration than prenatal enrollees ( F < .001) and were more likely to be older, to be married, to be more educated, and to have prior breastfeeding experience (each variable P < .01). Women who withdrew from the program while breastfeeding were more demographically similar to those who discontinued breastfeeding prior to 1 year than to those who continued in the program breastfeeding for 1 year, although they breastfed for significantly longer at exit (mean ± SD = 27.8 ± 14.8 weeks) compared to women who discontinued breastfeeding while in the program (15.7 ± 13.3 weeks) ( P < .001). Conclusion: It may be advantageous for peer counselors to direct fewer resources to later postnatal enrollees and more to prenatal or early postnatal enrollees. It may also be advantageous to focus on supporting women at high risk of discontinuation rather than on retaining women who choose to withdraw from the program while breastfeeding.

Background: Peer counseling programs have demonstrated efficacy in improving breastfeeding rates in the low-income population, but there is little research concerning why women enrolled in these programs ultimately discontinue breastfeeding. Objective: This study aimed to describe the self-reported reasons for discontinuing breastfeeding among women who are receiving peer counseling support by participant characteristics and timing of discontinuation. Methods: This study is a secondary analysis of data collected from 7942 participants who discontinued breastfeeding while enrolled in a peer counseling breastfeeding support program from 2005 to 2011. Reasons for discontinuing breastfeeding were assessed in relation to participant characteristics and weaning age using chi-square analyses and Kruskall-Wallis analyses of variance. Results: The most common reasons reported for discontinuing breastfeeding were mother’s preference (39%) and low milk supply (21%), although reasons differed by age of infant weaning ( P < .001). Among participants who discontinued the earliest, the most commonly cited reasons were breastfeeding challenges [median duration (interquartile range), 4.7 (2.0, 13.4) weeks], followed by low milk supply [8.9 (4.6, 19.1) weeks] and mother’s preference [12.9 (5.0, 25.7) weeks]. Women who were younger, were less educated, were non-Hispanic black, were unmarried, and had no prior breastfeeding experience were the most likely to discontinue breastfeeding due to mother’s preference. Conclusion: Peer counselors are in a unique position to offer breastfeeding education and encouragement and may be able to use evidence presented here to anticipate specified concerns either prenatally or postpartum, to prevent early breastfeeding discontinuation.

OBJECTIVES: Healthy pregnancy diet is important for infant development, but maternal dietary effects on establishment of the infant gut microbiome are not well understood. Our goal was to test the feasibility of conducting a randomized controlled trial (RCT) to implement a diet intervention and collect survey data and biospecimens from pregnant women and their infants. METHODS: Employing a 2-arm RCT, we recruited women (n = 27) in mid-pregnancy from a prenatal care clinic, randomized participants to the intervention (n = 13) or to usual care (n = 14), and followed to 6 wks postpartum. Data collection included surveys, maternal blood, urine, and stool at three time points (T1 = 25 and T2 = 36 wks gestation [pre- and 4 wks post-intervention initiation, respectively]; T3 = 6 wks postpartum), and infant stool at 6 wks. The intervention was initiated at 32 wks gestation and continued until birth of the baby. In wk 1, participants received non-perishable high fiber foods (whole wheat cereal, oatmeal, dried fruit, canned beans) as well as olive oil, vinegar, recipes for salad dressing and side dishes, and general nutrition information. Partnering with a hospital catering service, the intervention included weekly food delivery of 3 large prepared salads, 2 quarts of soup including either legumes or whole grains (e.g., beans, barley), and 5 pieces of fresh fruit (e.g., apples, oranges). RESULTS: Our sample is considered entirely rural and maternal characteristics reflected the local population: 100% White, 17% Hispanic or Native American; 89% at least some college; 26% Medicaid; 33% ever smoked. Mean maternal age was 29.6 y (range 20–40 y), mean pre-pregnancy BMI was 26.9 kg/m(2) (range 18.5-41.6). Data collection adherence was high with few missing data points: T1 = 100% for survey, blood, urine, stool; T2 = 93% for stool, 96% for blood and urine; T3 = 93% for survey, blood, urine, and stool). Overall satisfaction was high with 85% reporting satisfied or very satisfied and important qualitative insights were gained from participants. CONCLUSIONS: This pilot trial produced valuable information to effectively refine the intervention so that it can be tested in a larger, longer study using a factorial design to test the effects of pregnancy diet and/or postpartum diet of breastfeeding moms on the establishment of the infant microbiome. FUNDING SOURCES: MSU internal funds (AgBioResearch and faculty start-up).

Background To obtain a probability sample of pregnancies, the National Children's Study conducted door-to-door recruitment in randomly selected neighbourhoods in randomly selected counties in 2009–10. In 2011, an experiment was conducted in 10 US counties, in which the two-stage geographic sample was maintained, but participants were recruited in prenatal care provider offices. We describe our experience recruiting pregnant women this way in Wayne County, Michigan, a county where geographically eligible women attended 147 prenatal care settings, and comprised just 2% of total county pregnancies. Methods After screening for address eligibility in prenatal care offices, we used a three-part recruitment process: (1) providers obtained permission for us to contact eligible patients, (2) clinical research staff described the study to women in clinical settings, and (3) survey research staff visited the home to consent and interview eligible women. Results We screened 34 065 addresses in 67 provider settings to find 215 eligible women. Providers obtained permission for research contact from 81.4% of eligible women, of whom 92.5% agreed to a home visit. All home-visited women consented, giving a net enrolment of 75%. From birth certificates, we estimate that 30% of eligible county pregnancies were enrolled, reaching 40–50% in the final recruitment months. Conclusions We recruited a high fraction of pregnancies identified in a broad cross-section of provider offices. Nonetheless, because of time and resource constraints, we could enrol only a fraction of geographically eligible pregnancies. Our experience suggests that the probability sampling of pregnancies for research could be more efficiently achieved through sampling of providers rather than households.

Problem Autism spectrum disorder (ASD) is one of the most commonly diagnosed neurodevelopmental disorders in the United States. While ASD can be significantly influenced by genetics, prenatal exposure to maternal infections has also been implicated in conferring risk. Despite this, the effects of several important maternal pathogens, such as cytomegalovirus (CMV) and herpes simplex virus 2 (HSV2), remain unknown. Method of study We tested whether maternal CMV and/or HSV2 sero-positivity was associated with ASD symptoms in children. ELISA was used to assay for CMV IgG and HSV2 IgG in serum from the mothers of 82 children whose ASD symptoms were assessed at 3-6 years of age using the Social Responsiveness Scale version 2 (SRS-2). Results Associations between maternal viral serostatus and SRS-2 scores were estimated using linear regression with covariate adjustments. The children of mothers sero-positive for CMV, but not for HSV2, had SRS-2 scores 3.6-4.2 points higher, depending on the adjustment model, than sero-negative women, a significant finding, robust to several statistical adjustments. Conclusion Our results suggest that maternal CMV infections may influence ASD symptoms. These findings are being further evaluated in ongoing prospective studies with larger population samples.

Background: The insulin-like growth factor (IGF) system is associated with the adult diet and chronic disease. Childhood diet may influence chronic disease through its effect on the IGF system; however, there is limited information describing the dietary predictors of the IGF system in adolescents. Objective: We examined associations between dietary food intake [fat, protein (animal and vegetable), carbohydrate, lactose, dietary fiber, calcium, zinc, and sodium] and serum IGF-I, IGF binding protein 1 (IGFBP-1), IGF binding protein 3 (IGFBP-3), and the IGF-I:IGFBP-3 molar ratio in adolescent females. Design: One hundred fifty-nine adolescent females in the Dietary Intervention Study in Children (age range: 14–18 y; 0.2–6.3 y postmenarche) were included. The dietary intake was assessed via three 24-h dietary recalls. IGF-related biomarkers were determined by using radioimmunoassays. Associations between dietary intakes and biomarkers were assessed with Pearson's correlations and multivariable linear regression. Dietary intakes and biomarkers were logarithmically transformed; thus, β coefficients represented percentages. Results: In analyses adjusted for energy, age, and time since menarche, significant correlations (P < 0.05) were as follows: IGF-I with total protein, lactose, calcium, and sodium; IGFBP-3 with total fat (inverse), lactose, fiber, and calcium; IGF-I/IGFBP-3 with lactose and calcium; and IGFBP-1 with vegetable protein. In multivariable analyses, significant predictors of IGF-I were energy (β = 0.14, P < 0.05) and calcium (β = 0.14, P < 0.01), the significant predictor of IGFBP-3 was calcium (β = 0.07, P < 0.05), and significant predictors of IGFBP-1 were vegetable protein (β = 0.49, P < 0.05) and body mass index–for-age percentile (β = −0.01, P < 0.001). Conclusion: This study provides evidence that dietary intake affects IGF-related biomarkers—particularly elevated calcium with IGF-I and IGFBP-3 and elevated vegetable protein with IGFBP-1—and, to our knowledge, is novel in reporting these associations in adolescent females. The Dietary Intervention Study in Children was registered at clinicaltrials.gov as {"type":"clinical-trial","attrs":{"text":"NCT00000459","term_id":"NCT00000459"}}NCT00000459.

Objective This study was undertaken to test the hypothesis that specific meal and snack patterns are associated with selected nutrient intakes in US adults. Design Using the 24-hour dietary recall from the Third National Health and Nutrition Examination Survey, meal and snack patterns were described in relation to nutrient intakes. Subjects The study included US adults aged 20 years or older (n=15,978). Statistical Analyses Performed All statistical analyses accounted for the survey design and sample weights. Linear regression analyses controlled for confounding factors, including energy intakes. Wald F tests were used for determination of significance between means of nutrient intakes by daily eating frequency or meal pattern groups. Results Daily eating frequency was positively related to carbohydrate, folic acid, vitamin C, calcium, magnesium, iron, potassium, and fiber intakes and inversely related to protein, total fat, cholesterol, and sodium intakes. Meal patterns were further categorized into the five most commonly reported meal and snack combinations by population percentages including breakfast (B), lunch (L), dinner (D), and ≥2 snacks (S) (31.6%); B, L, D and 1 S (15.4%); B, D and ≥2 S (13.1%); B, L, D (8.3%); and L, D and ≥2 S (7.6%). Groups reporting B, L, D and 1 S and B, L, D and ≥2 S had the highest intakes of all micronutrients examined except cholesterol, vitamin B-6, and sodium. Breakfast skippers (L, D and ≥2 S) had the lowest intakes of all micronutrients examined except sodium. Conclusions Findings from this cross-sectional survey suggest that meal and snack patterns may be markers for nutrient intakes and therefore diet quality. Complete nutrient intakes should be considered in investigations of meal patterns and health outcomes.

This study tested the hypothesis that the dietary behaviors of Korean Americans (KAs) can be grouped into dietary patterns and subsequently examined relations between major dietary patterns and sociodemographic characteristics.A cross-sectional study was conducted with KAs residing in Michigan using a mail survey. Of 1,860 questionnaires mailed to KAs in Michigan, 637 (34%) responded and 497 first-generation KAs (263 men, 234 women, aged 30-87 y) were included in the final analyses. A factor analysis was used to identify dietary patterns from a 93-item food frequency questionnaire developed for KAs (KFFQ).Major dietary patterns of KAs were labeled "vegetable/fruit," and "traditional Korean" in both men and women and "acculturated American" in men and "traditional American" in women. The "traditional Korean" dietary pattern was negatively associated with length of residence in the U.S. for both men and women (p0.01). The other major dietary patterns were not associated with other sociodemographic variables examined in men; however, the "vegetable/fruit" dietary pattern was positively associated with length of residence in the U.S. (p0.05) and education level (p0.05) in women.Dietary pattern analysis can be used to understand dietary behaviors regarding health risks of ethnically different immigrants including KAs.

Background: Certain nutrients are well established as dietary risk factors for cardiovascular disease (CVD), but dietary patterns may be a better predictor of CVD risk. Objective: This study tested the hypothesis that the complex dietary behaviors of US adults can be grouped into major dietary patterns that are related to risk factors for CVD. Design: With the use of food-frequency questionnaire data from the third National Health and Nutrition Examination Survey, dietary patterns of healthy US adults ( 20 y old; n 13 130) were identified by factor analysis. Log-transformed biomarker data were associated with major dietary patterns after control for confounding variables in regression analyses. All statistical analyses accounted for the survey design and sample weights. Results: Of 6 dietary patterns identified, 2 patterns emerged as the most predominant: the Western pattern was characterized by high intakes of processed meats, eggs, red meats, and high-fat dairy products, and the American-healthy pattern was characterized by high intakes of green, leafy vegetables; salad dressings; tomatoes; other vegetables (eg, peppers, green beans, corn, and peas); cruciferous vegetables; and tea. The Western pattern was associated (P 0.05) positively with serum C-peptide, serum insulin, and glycated hemoglobin and inversely with red blood cell folate concentrations after adjustment for confounding variables. The American-healthy pattern had no linear relation with any of the biomarkers examined. Conclusions: The identification of common dietary patterns among free-living persons is promising for characterizing highrisk groups at the US population level. The dietary patterns identified here are similar to those reported in other nonrepresentative samples and are associated with biomarkers of CVD risk, which confirms that dietary pattern analysis can be a valuable method for assessing dietary intakes when predicting CVD risk. Am J Clin Nutr 2003;78:1103–10.

Background Recommendations for preventing and treating type 2 diabetes include consuming carbohydrates, predominantly from whole grains, fruit, vegetables, and low-fat milk. However, the quantity and type of carbohydrates consumed may contribute to disorders of glycemic control. Objective We evaluated the association between carbohydrate intakes and biomarkers of glycemic control in a nationally representative sample of healthy US adults who participated in a cross-sectional study, the third National Health and Nutrition Examination Survey. Design The sample (5730 men and 6125 women aged > or = 20 y) was divided into quintiles of carbohydrate intake (as a percentage of energy). Carbohydrate intakes were examined in relation to glycated hemoglobin (Hb A(1c)), plasma glucose, serum C-peptide, and serum insulin concentrations by using logistic regression. Results Carbohydrate intakes were not associated with Hb A(1c), plasma glucose, or serum insulin concentrations in men or women after adjustment for confounding variables. Carbohydrate intakes were inversely associated with serum C-peptide concentrations in men and women. Odds ratios for elevated serum C-peptide concentrations for increasing quintiles of carbohydrate intake were 1.00, 0.88, 0.57, 0.39, and 0.75 (P for trend = 0.016) in men, and 1.00, 0.69, 0.57, 0.36, and 0.41 (P for trend = 0.007) in women. When carbohydrate intakes were further adjusted for intakes of total and added sugar, the association of serum C-peptide with carbohydrate intakes was strengthened in men. Conclusions Carbohydrate intakes were not associated with Hb A(1c), plasma glucose, or serum insulin concentrations but were inversely associated with the risk of elevated serum C-peptide; this supports current recommendations regarding carbohydrate intake in healthy adults.

To determine if carbohydrate intake, as a % of energy, was related to diet quality and risk factors for cardiovascular disease (CVD) in adults in a cross-sectional and population-based study in the U.S.Data from the third National Health and Nutrition Examination Survey (NHANES III, 1988-1994) were utilized. The nationally representative sample of the U.S. population (3,754 men, 4,074 women, ages 25 to 64 years) was divided into quintiles of carbohydrate intake (% of energy), which was examined in relation to risk factors for CVD: systolic blood pressure, body mass index (BMI), and concentrations of serum triglyceride, serum total and HDL cholesterol and plasma glucose.When covariates (age, ethnicity, smoking, alcohol intake and total energy intake) were adjusted in multivariate analyses, carbohydrate intakes (% of energy) were inversely associated with BMI and serum total cholesterol concentration in men and BMI in women and positively associated with serum triglyceride concentration in women. When total sugar intake (% of energy) was further controlled as a step to understand the quality of carbohydrate, carbohydrate intakes (% of energy) was a stronger predictor of BMI and plasma glucose in men and BMI in women. A high carbohydrate diet (57.4% of energy in men and59.1% of energy in women) was associated with a low serum HDL-cholesterol concentration in men and high serum triglyceride in women.Moderately high carbohydrate (50% to 55% of energy) diets were associated with low CVD risks with favorable lipid profiles.

ObjectivePeer counselling (PC) programmes have been shown to improve breast-feeding outcomes in populations at risk for early discontinuation. Our objective was to describe associations between programme components (individual and combinations) and breast-feeding outcomes (duration and exclusivity) in a PC programme for low-income women.DesignSecondary analysis of programme data. Multivariable-adjusted Cox proportional hazards models were used to examine associations between type and quantity of peer contacts with breast-feeding outcomes. Types of contacts included in-person (hospital or home), phone or other (e.g. mail, text). Quantities of contacts were considered ‘optimal’ if they adhered to standard programme guidelines.SettingProgramme data collected from 2005 to 2011 in Michigan’s Breastfeeding Initiative Peer Counseling Program.SubjectsLow-income (n 5886) women enrolled prenatally.ResultsFor each additional home, phone and other PC contact there was a significant reduction in the hazard of discontinuing any breast-feeding by 6 months (hazard ratio (HR)=0·90 (95 % CI 0·88, 0·92); HR=0·89 (95 % CI 0·87, 0·90); and HR=0·93 (95 % CI 0·90, 0·96), respectively) and exclusive breast-feeding by 3 months (HR=0·92 (95 % CI 0·89, 0·95); HR=0·90 (95 % CI 0·88, 0·91); and HR=0·93 (95 % CI 0·89, 0·97), respectively). Participants receiving greater than optimal in-person and less than optimal phone contacts had a reduced hazard of any and exclusive breast-feeding discontinuation compared with those who were considered to have optimum quantities of contacts (HR=0·17 (95 % CI 0·14, 0·20) and HR=0·28 (95 % CI 0·23, 0·35), respectively).ConclusionsSpecific components of a large PC programme appeared to have an appreciable impact on breast-feeding outcomes. In-person contacts were essential to improving breast-feeding outcomes, but defining optimal programme components is complex.

Breastfeeding peer counseling programs have demonstrated efficacy in improving exclusive breastfeeding (EBF) rates, but the impact of specific program protocols on this outcome is unknown. OBJECTIVE: To describe associations between individual and combinations of program components and EBF cessation in a peer counseling breastfeeding support program. METHODS: Data was collected for 5,886 low-income women prenatally enrolled in Michigan’s Breastfeeding Initiative Program from 2005-2011. Cox proportional hazards models and chi-square analyses were used to determine the impact of program components on EBF cessation. “Optimal” quantities of contacts were based on program guidelines. RESULTS: Each home, phone and other contact had a similar impact on risk of EBF cessation at three months postpartum (HR (95% CI): 0.92 (0.89, 0.94); 0.90 (0.88, 0.91); and 0.94 (0.91, 0.98) respectively). Women who received a more in-person and less phone contacts than were considered optimum had the lowest risk of EBF cessation ...

2. Breastfeeding challenges were most likely to lead to discontinuing breastfeeding when the baby was what age? a. Birth to 4 weeks b. 4 weeks to 3 months c. 3 to 6 months d. 6 to 12 months 3. By identifying specific reasons for discontinuing breastfeeding and approximate weaning ages for those reasons, peer counseling programs can: a. Learn and recognize that low-income mothers will always wean earlier than the rest of the population. b. Anticipate that “low milk supply” will be a problem and provide low-income breastfeeding mothers with formula just in case it is needed. c. Design more preventive age-related interventions to address reasons behind early weaning. d. Provide more video clips of celebrities breastfeeding to encourage low-income mothers to breastfeed.