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Birth outcomes including low birth weight, preterm birth, and delayed infant neurodevelopment are associated with secondhand smoke exposure while pregnant. The purpose of the study was to explore pregnant women's perspectives on secondhand smoke exposure to understand their experience and inform recommendations.Qualitative semistructured interviews were conducted with 15 secondhand smoke-exposed pregnant women in the United States.Four primary themes were identified: feeling powerless, trapped, and discomfort; enhancing women's self-advocacy and initiative; having conflicting feelings about secondhand smoke exposure; and desiring professional advice and education. Women expressed concern about prenatal secondhand smoke exposure, although they felt unable to request that people refrain from smoking in their presence or personal space. Women's strategies to minimize secondhand smoke exposure often involved their own social isolation. Women described sources of support, educational needs, and desire for practical advice in secondhand smoke avoidance.Findings underscore the role of nurses working with pregnant women living with household members who smoke to educate women about secondhand smoke risks and strategies for avoidance and to enhance women's self-confidence in advocating for themselves to reduce their exposure.

Background In many countries, hospital-based births are associated with the early initiation of breastfeeding, within the first hour postpartum, especially where the Baby Friendly Hospital Initiative guidelines have been adopted. While Indonesia has adopted the guidelines, there is a relatively low rate of early breastfeeding initiation in the country. Research Aim To determine the relationship between place of birth and early breastfeeding initiation in Indonesia. Method This study was a retrospective cross-sectional survey using national data from the 2017 Indonesia Demographic and Health Survey ( N = 14,279). The association between place of birth and early breastfeeding initiation was examined using logistic regression models, adjusting for potential confounders. Results The overall prevalence of early breastfeeding initiation in Indonesia was 60.9% with a greater proportion of mothers giving birth in health facilities. In the multivariate model, there was a significant interaction between wealth index, insurance status, and place of birth on the timing of breastfeeding initiation. In the subgroup of mothers residing in middle wealth index households, women who gave birth in clinics and hospitals had lower odds of early breastfeeding initiation compared to those who gave birth at home (0.56; 0.34, 0.90; p = .018) and (0.58; 0.40, 0.85; p = .005), respectively. Conclusions Place of birth was significantly associated with early breastfeeding initiation. There is a need to consider health disparities and to strengthen the implementation of the WHO guidelines, Baby Friendly Hospital Initiative, and International Code of Marketing of Breastmilk Substitutes, to increase early breastfeeding initiation in Indonesia.

Background & aims After the rise of lymphoma incidence in the 1990's, there is a paucity of epidemiologic studies describing the characteristics of primary gastrointestinal non-Hodgkin's lymphoma (PGIL). This epidemiologic survey aims to identify recent trends in PGIL. Methods A retrospective, population-based study describing adult patients with PGIL in the Israeli Negev region between 1998 and 2013. Results 131 patients were diagnosed with PGIL, representing an annual incidence rate of 22.42/100,000, compared to 35.87/100,000 in the overall Israeli population. Both incidence rates did not significantly change during the study period. The median age was 66 years, and the most common presentation was in the stomach (49.6%) and oral cavity (18.3%). Histologically, diffuse large B cell lymphoma (DLBCL) was predominant (55.0%). Most patients (66.4%) had early stage disease. Only T-cell lymphoma showed a male predominance (14.7% versus 5.4%, P=0.008). Fifty patients (44.2%) had H. pylori testing, and 35 (70.0%) were positive. Of these, 91.4% received eradication treatment, and 57.1% were negative thereafter.Most patients received CHOP or RCHOP protocols (16.0% and 48.1%, respectively). Complete response was achieved in 53.4%. Median follow-up was 48 months, and 62 patients (47.3%) died during the study period. Liver involvement had a worse prognosis, (33.0% 5-year survival) compared to upper and lower GI disease(70.5% and 46.8% respectively, P=0.003 for the comparison between liver and other locations). T-cell lymphoma had worse survival (11 months vs. not reached, P=0.003). Conclusions This study demonstrates the incidence, and clinical characteristics of PGIL in the Negev region. It is important to identify disease characteristics, thus facilitating better disease detection and prognostication.

Objective: To explore the perceived experience of polycystic ovary syndrome (PCOS) among PCOS-diagnosed Bangladeshi women with examination of the influence of culture. Methods: This qualitative study included 25 Bangladeshi women who had been diagnosed with PCOS. The qualitative interviews were completed via Skype and/or phone between December 2017 to March 2018. Transcriptions of recorded, de-identified responses were analyzed using qualitative manual coding and thematic analysis. Results and discussion: Three overarching themes were identified from the narratives: PCOS diagnosis experience, PCOS knowledge, and role of religion and culture in relation to PCOS. The women expressed an unsatisfactory experience with their PCOS diagnosis including having to change healthcare professionals, inadequate access to resources, and concerns related to infertility and pregnancy complications. Lack of available evidence-based information was associated with limited knowledge of PCOS among the PCOS-diagnosed Bangladeshi women and their families. The respondents perceived that culture influenced refraining from sharing of information about PCOS thereby limiting knowledge, muting women’s health experience, and contributing to a negative perception on PCOS and related conditions. Participants felt that cultural expectations and emphasis on childbearing placed constant pressure on women and stigmatized PCOS. Conclusions: Bangladeshi women with PCOS perceive various challenges and limited access to information and resources. To minimize some of the challenges associated with PCOS, public health efforts should focus on increasing awareness, education, and resources for women and their families.

Health professional organizations recommend exclusive breastfeeding for 6 months, but there are mothers, such as those with a history of breast cancer, who are unable to exclusively provide their milk for their infants. Minimal research has been published on mothers’ experience with lactation, breastfeeding, and bottle-feeding after breast cancer. This study explored mothers’ perspectives of infant feeding after a history of breast cancer. Qualitative interviews were completed with 20 mothers who had experience with infant feeding after breast cancer, including exclusive breastfeeding, partial provision of human milk with formula supplementation, and exclusive formula feeding. Mothers shared their perceptions, barriers, and experiences of infant feeding. Four themes were identified: miracle of motherhood after breast cancer, medical misinformation or no available information contributing to the exacerbation of mothers’ worries, post-breast-cancer feeding challenges, and desire for infant-feeding support rather than pressure. Mothers who have had breast cancer and have since given birth face specific challenges to infant feeding which are compounded by limited resources and knowledge among healthcare providers. Findings of the study highlight the importance of healthcare professionals becoming more educated to provide adequate support and evidence-based information on lactation and infant feeding for women with a history of breast cancer. Understanding the experiences of women who have given birth after breast cancer can help women in similar situations know that they are not alone, identify resources, access peer support, and seek evidence-based infant feeding advice from healthcare providers involved in their care.

To evaluate whether there is an association between prenatal smoking and gestational diabetes mellitus (GDM).We conducted a secondary data analysis using data from the Pregnancy Risk Assessment Monitoring System from 2009 to 2015. Outcome measures included self-reported GDM and change in smoking status during pregnancy (nonsmoker, quit smoking, reduced the amount smoked, smoked the same or more). Multivariable logistic regression analyses were performed to estimate the association between prenatal smoking and GDM status, adjusted for maternal age, race-ethnicity, prepregnancy body mass index (BMI) categories (underweight, normal [referent group], overweight, and obese), and gestational weight gain (inadequate, normal [referent group], and excessive), overall and stratified by prepregnancy BMI and gestational weight gain subgroups.A total of 222,408 women were included; 5.3% (n=12,897) had GDM. Most (48.1%) women had normal prepregnancy BMI, and 43.1% had excessive gestational weight gain. Mothers who continued to smoke the same or greater number of cigarettes or reduced the number of cigarettes smoked had higher odds of GDM (adjusted odds ratio [OR] 1.46, 95% CI 1.25-1.71 and OR 1.22, 95% CI 1.08-1.38, respectively). Smoking the same or more cigarettes was associated with higher odds of GDM in all subgroups of prepregnancy BMI or gestational weight gain.Prenatal smoking is associated with higher odds of GDM, after adjusting for known risk factors, and stratifying by prepregnancy BMI and gestational weight gain. Reducing smoking during pregnancy might reduce the risk of GDM and could be an additional reason for promoting smoking cessation among pregnant women.

Background and PurposeNipple shield use is common among breastfeeding mothers, yet no instrument measures maternal satisfaction. The new Maternal Nipple Shield Satisfaction Scale (MNSSS) was evaluated for reliability and validity.MethodsThe MNSSS for was tested in two phases: women (N = 128) using nipple shields in the previous 6 months and the second, women, (N = 57) within the first 3 weeks postpartum.ResultsFrom the original 21-item scale, content validity analysis, Cronbach's alpha, item to total correlation testing, exploratory factor analysis resulted in a one factor scale consisting of nine items with a Cronbach's alpha of .90. Convergent validity testing resulted in a small, but significant negative correlation.ConclusionThe MNSSS may be a useful instrument for examining satisfaction of women using nipple shields for breastfeeding.

PURPOSE Maternal self-confidence facilitates infant growth and new mother role development. Infant ability to breastfeed and maternal breastfeeding self-confidence are imperative to helping mothers meet their breastfeeding goals. Consistent opportunity for infant movement in the prone position has been shown to improve breastfeeding ability; however, families report a lack of knowledge of how to safely support this activity. Perceptions of maternal self-confidence, infant development, and breastfeeding success upon completion of an infant prone positioning program with focus on posture, movement, and connection were studied. STUDY DESIGN AND METHODS Qualitative interviews were conducted among breastfeeding mothers in three states to explore maternal perceptions of learning about infant prone positioning. RESULTS Thirty-five mothers who completed an infant prone positioning program shared their perceptions of infant interaction, prone play and positioning, and breastfeeding self-confidence. Four primary themes were identified from the analysis: maternal knowledge and self-confidence; strategies and practices learned; breastfeeding benefits of infant prone positioning; and motivation for program participation. CLINICAL IMPLICATIONS Our findings support consideration of teaching new mothers about prone positioning to enhance self-confidence in mothering, breastfeeding skills, infant development, and maternal-infant dyad bonding.

In the United States, the rates of cesarean delivery are well above the World Health Organization recommended target. Although obesity is a widely established risk factor for cesarean delivery, there is limited population-based research that examines the relationship between gestational weight gain and cesarean delivery.To determine the association between gestational weight gain and unplanned or emergency cesarean delivery.We examined 2107 mothers from the Infant Feeding Practices Study II 2005-2007. The Institute of Medicine's current guidelines were used to define categories of gestational weight gain: inadequate (less than the recommended guideline), adequate (within the recommended guideline) and excessive (above the recommended guideline).Approximately 49.3% and 13.6% of the participants had excessive weight gain and unplanned or emergency cesarean delivery, respectively. A Greater proportion of women with excessive weight gain had an unplanned or emergency cesarean delivery followed by women with adequate and inadequate weight gain, respectively (17.8%, 10.0%, 8.8%; p0.001). In the multivariable model, compared to women with adequate weight gain, the odds of unplanned or emergency cesarean delivery were higher among women with excessive weight gain (OR 1.56, 95% CI 1.07-2.27, p=0.020).Women with excessive gestational weight gain are more likely to experience an unplanned or emergency cesarean delivery, which increases the risk for poor maternal-infant health outcomes.It is critical to identify populations at increased risk of unplanned or emergency cesarean delivery and provide preconception and prenatal counseling to achieve and maintain the recommended weight gain for optimal maternal-infant health outcomes.

Female genital mutilation (FGM) is considered a human rights violation against women and girls causing serious short and long-term health complications. Despite being a criminal offence in Ethiopia since 2004, the practice continues. Minimal research has been published on factors associated with men's opinion about FGM in Ethiopia.The present cross-sectional study used secondary data to identify factors associated with men's opinions about the practice of FGM.Secondary data analysis was conducted using data from 8,718 men who responded to the 2016 Ethiopian Demographic and Health Surveys (EDHS). The dependent variable was men's opinion about FGM. Demographic, socioeconomic, and other characteristics were examined.Variables associated with men's support for FGM were lack of education (AOR = 2.91; 95% CI: 1.93, 4.40, p = 0.001), poor wealth index (AOR, 1.76; 95% CI 1.32, 2.35, p = 0.001), ethnically Afar (AOR = 2.50, 95% CI: 1.27, 4.95, p = 0.009) and Somali (AOR = 2.02, 95% CI: 1.15, 3.54, p = 0.015), Muslim religion (AOR = 1.58, 95% CI 1.13, 2.50, p = 0.007), and support for wife beating with at least one justification (AOR = 2.04, 95% CI: 1.66, 2.50, p = 0.001).Lack of education, poor household wealth index, being Muslim and being a member of the Afar or Somali ethnicity and having a tendency that it is appropriate for a husband to beat his wife, were positively associated support for FGM. These findings suggest that context-specific interventions are needed to eradicate the practice.

Background: Exclusive breastfeeding is the optimal manner of early infant nutrition but women with gestational diabetes mellitus (GDM) often experience challenges with lactation in the early postpa...

Young people aged 15–24 years account for half of all new sexually transmitted infections (STIs) in the United States. The aim of this study was to examine the cross-sectional associations of factors linked to STIs among US young adults (18–25 years). This study used the 2015–2018 pooled National Survey on Drug Use and Health data on 55,690 young adults. Almost 3.4% of the respondents reported having an STI in the past year. Among the participants, 38.4% used illicit drugs and 3.7% reported a history of delinquency in the past year. In the survey-weighted logistic regression model, odds for contracting STIs in the preceding year was higher among adults aged 22–25 versus 18–21 years (OR:1.26, 95%CI:1.12–1.42); male versus female (OR:2.44, 95%CI:2.11–2.82); non-Hispanic African American versus non-Hispanic White (OR:1.77, 95%CI:1.55–2.02); widowed/separated/divorced (OR:1.93, 95%CI:1.36–2.75) and never married (OR:1.29, 95%CI:1.07–1.55) versus married; full-time/part-time employed (aOR:1.17, 95% CI:1.04–1.31) compared to unemployed/other; history of delinquency (OR:2.31, 95%CI:1.89–2.83); and use of illicit drugs in the last year (OR:3.10, 95%CI:2.77–3.47). High incidence of illicit drug use by the young adults and its strong association with STI incidence in recent years warrant special attention. Tailored preventive measures should be focused on key predictors.

Objective The recent COVID-19 pandemic may catalyze smoking behavior modification. The purpose of the study was to examine factors associated with reducing smoking exposure during the COVID-19 outbreak. Design Cross-sectional design using the Health Belief Model to develop an online survey distributed throughout Ohio early during the outbreak. Sample 810 adults in Ohio (77.9% non-smokers, 22.1% current smokers). Measurements Sociodemographic factors, smoking and behavior changes since the COVID-19 outbreak, and perceived risk of infection were collected. Logistic regression analyses were conducted to determine factors associated with indoor smoking bans and factors associated with desire to quit smoking since the outbreak. Results For the overall sample, the odds of indoor smoking bans were significantly associated with never smoked, college education, single-family residence, not living with smokers, and perceived importance of avoiding public places. For smokers, the desire to quit smoking since the COVID-19 outbreak was associated with diabetes and perceived risk of severe infection. Conclusions Identified factors inform residential smoking exposure reduction through indoor smoking bans. Having an increased perceived risk of severe infection among smokers may motivate cessation. Public health nurses can provide accurate and accessible resources for smoking cessation during the COVID-19 pandemic to promote healthy lifestyle modification.

The COVID-19 pandemic has produced an unprecedented global health crisis. Vulnerable populations, such as breastfeeding mother-infant dyads, are in a particularly delicate situation. Before, during, and after birth mothers and their infants could be exposed to the virus. Due to fear of infection transmission, there has been an increase in separation of COVID-positive mothers and their infants and a decline in breastfeeding, despite research supporting the provision of mother's milk for her infant. During this crisis, evidence-based education counseling and resources can support healthful infant feeding which is necessary for short- and long-term infant growth and development. Using a framework of disaster preparedness and response, we delineate operational guidelines and policy recommendations to support maternal-infant dyads during the COVID pandemic outbreak. Key recommendations include promotion of breastfeeding and milk expression, avoiding the use of formula, engaging healthcare providers in supporting lactation, and incorporating evidence-based breastfeeding and lactation protocols and practices in disaster preparedness and disaster response plans.

Early initiation of breastfeeding increases the likelihood of longer duration of breastfeeding. Factors associated with breastfeeding include maternal sociodemographic, behavioral and health-related characteristics, infant health characteristics, and perinatal factors. Research aim: This study aimed to determine the association between type of birth attendant and early initiation of breastfeeding among women in Ghana.A cross-sectional study was conducted using women ( N = 3,087) who participated in the 2014 Ghana Demographic and Health Survey. The main outcome of interest was early initiation of breastfeeding, defined as provision of mother's milk to the infant within 1 hr of birth. Chi-square tests and multivariable logistic regression modeling were performed.Breastfeeding was initiated within 1 hr of birth by 58.3% of women. In the multivariable model, there was a significant interaction between type of birth attendant and place of residence on early initiation of breastfeeding. For rural areas, compared with women who had a nurse or midwife as their birth attendant, the multivariable odds ratios [95% confidence intervals] for early initiation of breastfeeding were lower among women whose birth attendant was a relative or other, 0.20 [0.07, 0.55], p = .002; village health volunteer or traditional health practitioner, 0.21 [0.07, 0.62], p = .005; none, 0.34 [0.12, 0.93], p = .035; community health officer, 0.42 [0.21, 0.85], p = .016; and doctor, 0.48 [0.24, 0.96], p = .037. For urban areas, no significant association was detected between type of birth attendant and early initiation of breastfeeding.Findings from the study highlight the need for focused, context-specific, early initiation of breastfeeding promotion and intervention, especially for women and their birth attendants in rural areas.

Objective The aim of this study was to examine differences in fatty acid concentrations in colostrum of women with and without gestational diabetes mellitus (GDM). The effect of GDM on fatty acid composition of colostrum is not fully understood, although rates of GDM are increasing globally. Methods A prospective case–control study was conducted of postpartum women with and without GDM. Gas chromatographic analysis was conducted to examine differences in colostral fatty acids of the colostrum samples of 29 women with and 34 without GDM. Results Analyses of the fatty acid composition revealed significantly higher concentrations of four essential ω-6 polyunsaturated fatty acids—γ-linolenic, eicosatrienoic, arachidonic, and docosatetraenoic—in the colostrum of GDM women compared with non-GDM women. Timing of collection influenced saturated medium chain fatty acid and monounsaturated fatty acid levels. Conclusions Differences in concentrations of ω-6 fatty acids but not in dietary linoleic fatty acid or ω-3 fatty acids suggest that altered concentrations are attributed to changes in specific endogenous metabolic pathways. Implications of higher concentrations of ω-6 fatty acids in the colostrum of women with GDM have yet to be determined. Timing of colostrum collection is critical in determining colostral fatty acid and metabolite concentrations.

The infant mortality rate in Pakistan is one of the highest in the world with most cases attributed to diarrheal or respiratory diseases. Exclusive breastfeeding for the first 6 months of life is recommended by the World Health Organization to achieve optimal growth and health, however, in Pakistan the rate of exclusive breastfeeding by mothers is40%. The aim of this study was to investigate the relationship of exclusive breastfeeding, diarrhea, acute respiratory infections and fever among infants under the age of 6 months.The cross-sectional study analyzed secondary data from the 2017-18 Pakistan Demographic and Health-Survey. The sampling frame for the current study consisted of last-born children who were under the age of 6 months. The study sample consisted of 1033 infants under the age of 6 months.The prevalence of exclusive breastfeeding was 53.6%. Compared to infants who were not breastfed exclusively, infants who were had lower odds of diarrhea, acute respiratory infection, and fever. The observed association was independent of potential confounders.Exclusive breastfeeding reduces the odds of childhood illnesses. Plausible explanations for the observed association may be related to human milk's contents including necessary nutrients to fulfill an infant's needs within first months of life. Additionally, continued exposure to breastfeeding also reduces exposure to other contaminated foods to ensure adequate nutrition for the infant.The findings have important implications for educating families and healthcare providers about the benefits of exclusive breastfeeding for optimal child health outcomes.

Background: Over half of pregnant women in the United States do not meet the recommended gestational weight gain (GWG). In addition, the prevalence of gestational diabetes mellitus (GDM) is increasing. We examined the combined influence of GDM and GWG on breastfeeding practices on exclusive breastfeeding during the neonatal period and at 3 months postpartum. Materials and Methods: A cross-sectional study was performed on 173,603 women from the pregnancy risk assessment monitoring system, 2009-2015. Descriptive statistics and multivariable logistic regression modeling were performed. Results: The prevalence of GDM was 9.5%. Only 30.7% of women had weight gain within the Institute of Medicine (IOM) recommended guidelines. Approximately 21.7% and 10.3% of the participants exclusively breastfed their infants during the neonatal period and at 3 months postpartum, respectively. After adjusting for potential confounders, there was a significant multiplicative interaction between GWG and GDM on exclusive breastfeeding during the neonatal period and at 3 months postpartum. Among women with normal and excessive GWG, the odds of exclusively breastfeeding during the neonatal period were lower for women with GDM compared with women without GDM (odds ratio, 95% confidence interval: 0.74, 0.64-0.85 and 0.75, 0.66-0.85, respectively). Similarly, among women with normal and excessive GWG, the odds of exclusively breastfeeding at 3 months postpartum were lower for women with GDM compared to women without GDM (0.67, 0.55-0.81 and 0.71, 0.60-0.85, respectively). Conclusion: With the increasing prevalence of GDM and weight gain outside the IOM guidelines, it is critical to identify populations at risk and to promote exclusive breastfeeding practices.

PURPOSE The purpose of this study was to explore perspectives of healthcare providers in rural Appalachia who care for pregnant women with gestational diabetes, including management facilitators and barriers. STUDY DESIGN AND METHODS Qualitative study with interviews and thematic analysis. Thematic analysis was conducted using the sort and sift method after inductive content analysis with open coding, identifying categories, and abstraction. RESULTS Twenty-one advanced practice nurses and 10 physicians participated in the study. Three themes were identified: rural healthcare challenges including limited resources and lack of adherence to recommendations, cultural influences including normalization of diabetes and food culture, and collaborative care including accessible resources and patient motivation. CLINICAL IMPLICATIONS The themes provide insight into the perceived barriers and facilitators of healthcare providers caring for women with gestational diabetes in rural Appalachia. Consistent, evidence-based communication with cultural consideration supports effective education and care of women with gestational diabetes. Healthcare providers' knowledge of local resources, accessible electronic medical records, and communication among the various team members enhance collaboration in diabetic management in the rural setting.

Background: Despite the known benefits of breastfeeding, many women in the United States do not exclusively breastfeed for the recommended 6 months due to various factors. Limited studies ...

Breastfeeding is strongly endorsed in the Healthy People 2020 goals; however, there remain many disparities in breastfeeding prevalence. The purpose of this study was to examine the association between breastfeeding and the Federal Poverty Level in the United States. Data from 5,397 women in the National Survey of Family Growth 2011–2013 survey were included in this study. The data were analyzed for descriptive features and logistic regressions of the Federal Poverty Level on breastfeeding. There were 64.1% of women who reported breastfeeding. Over one-third (35.2%) of women reported having a household income of 0–99% of the Federal Poverty Level. There were 15.2% of women who reported an income of 400% and above the Federal Poverty Level. With statistical adjustment for maternal age, race/ethnicity, education, marital status, parity, preterm birth, birth weight, insurance, and dwelling, the Federal Poverty Level was not significantly associated with breastfeeding. In this recent survey of mothers, Federal Poverty Level was not shown to be a significant factor in breastfeeding.

PURPOSE The opioid epidemic is a public health threat with consequences affecting newborns. Neonatal Abstinence Syndrome (NAS) is a constellation of withdrawal symptoms resulting primarily from in utero opioid exposure. The purpose of this study was to examine NAS and drug-specific trends in West Virginia (WV), where rurality-related issues are largely present. Methods The 2007-2013 WV Health Care Authority, Uniform Billing Data were analyzed for 119,605 newborn admissions with 1,974 NAS diagnoses. NAS (ICD9-CM 779.5) and exposure diagnostic codes for opioids, hallucinogens, and cocaine were utilized as incidence rate (IR) per 1,000 live births. Findings Between 2007 and 2013, NAS IR significantly increased from 7.74 to 31.56 per 1,000 live births per year (Z: -19.10, P Conclusions Statewide NAS IR increased 4-fold over the study period, with rates over 3 times the national annual averages. This alarming trend is deleterious for the health of WV mother-child dyads and it strains the state's health care system. Therefore, WV has a unique need for prenatal public health drug treatment and prevention resources, specifically targeting the southeastern region. Further examination of maternal drug-specific trends and general underutilization of neonatal exposure ICD-9-CM codes is indicated. Language: en

Maternal postpartum smoking increases the risk for poor infant health outcomes, while exclusive breastfeeding has been shown to support infant health. Limited population-based research has been published on the interaction between maternal smoking and exclusive breastfeeding. The objective of this study was to examine factors modifying the association between maternal postpartum smoking and exclusive breastfeeding among women in the United States.Secondary data analysis was conducted using the 2009-2011 Pregnancy Risk Assessment Monitoring System. Stratified analyses were used to examine the associations between maternal postpartum smoking and exclusive breastfeeding by sociodemographic factors.The postpartum smoking rate was 17.1%. The relationship between postpartum smoking and exclusive breastfeeding at 12 weeks varied by maternal education level, race/ethnicity, Medicaid use, and pregestational or gestational diabetes. The magnitude of reduction in the odds of exclusive breastfeeding at 12 weeks postpartum among the women who smoked in the postpartum period ranges from odds ratio (95% confidence interval) 0.52 (0.37-0.74) for non-Hispanic blacks to 0.31 (0.22-0.43) for women who had12 years of education.Women who smoked in the postpartum period, who also suffered from socioeconomic disadvantages, had a higher likelihood of not continuing exclusive breastfeeding. Identification of women at high risk for not exclusively breastfeeding is important for targeting populations in need of appropriate and timely support for prenatal and postpartum smoking cessation and breastfeeding promotion.

Background: Oral health is important for overall health of youth, although dental service utilization is lower than national goals. The purpose of the study was to identify sociodemographic and health behavioral characteristics of youth in the United States who reported having at least one dental visit in the past 12 months. Methods: Secondary data analysis was conducted using the 2015 Youth Risk Behavior Survey (YRBS) to examine factors associated with dental care utilization using Andersen's theory-based Behavioral Model of Health Care Utilization. Results: Among 5,814 youth, nearly 78 percent reported visiting a dentist in the past 12 months. After adjusting for potential confounders, characteristics significantly associated with higher likelihood of dental care utilization were: predisposing factors of non-Hispanic white ethnicity and health behavior characteristics of not using tobacco, not using illegal substances, not drinking soda, and wearing a seat belt; enabling factor of speaking English well; and perceived health of not being overweight. Discussion: Use of the Healthcare Utilization Model identified significant factors classified as predisposing, enabling, and need-related factors associated with youth's utilization of dental care services. Findings from the theory-based population-based study informs healthcare providers of factors to consider when promoting dental care among youth.

Background: Exclusive breastfeeding is recommended in the first 6 months of life, especially for infants born to women with a history of gestational diabetes mellitus (GDM). Yet, women with a history of GDM face challenges with exclusive breastfeeding in the early postpartum period, a critical period for setting up longer term breastfeeding success. Minimal research has been published on associated risk factors for not exclusively breastfeeding. Objective: The purpose of this study was to examine the association between GDM and exclusive breastfeeding at hospital discharge. Methods: We conducted a cross-sectional analysis including 2038 women who participated in the population-based Infant Feeding Practices Study II between May 2005 and June 2007. Results: Gestational diabetes mellitus prevalence was 5.8%. The crude prevalence of exclusive breastfeeding at hospital discharge was 62.2% among women with GDM compared to 75.4% of women without GDM ( P < .01). After adjusting for sociodemographic, behavioral, and anthropometric factors, the odds of exclusive breastfeeding were lower among women with GDM compared to women without diabetes (odds ratio = 0.59; 95% confidence interval, 0.39-0.92). Furthermore, women who had gestational weight gain (GWG) below the Institute of Medicine guidelines had lower odds of exclusive breastfeeding compared to women who had normal GWG (odds ratio = 0.62; 95% confidence interval, 0.45-0.85). Conclusion: Women with GDM history and women with inadequate GWG may need additional education to promote exclusive breastfeeding during maternal hospital stay. It is important for health care providers to assess both factors when providing education on exclusive breastfeeding and to support these women’s breastfeeding efforts in the early postpartum period to maximize potential for longer term breastfeeding success.

Studies that explored women's knowledge on mother-to-child transmission (MTCT) of HIV and its prevention (PMTCT) in the general population are currently lacking. This paper examined factors associated with having adequate knowledge of MTCT of HIV and PMTCT among a nationally representative sample of women in Tanzania. We conducted a cross-sectional analysis including 10,299 women from the 2011-2012 Tanzania HIV/AIDS and Malaria Indicator Survey. The outcome of interest was the presence of adequate knowledge on MTCT and PMTCT of HIV. We used multivariable logistic regression to identify factors associated with having adequate knowledge on MTCT and PMTCT of HIV. Results revealed that the overall prevalence of having adequate knowledge on MTCT and PMTCT of HIV was low (46%). We found a statistically significant difference in the proportions of having adequate knowledge between HIV-negative and HIV-positive women (45% vs. 56%; p

Proteomics of human milk has been used to identify the comprehensive cargo of proteins involved in immune and cellular function. Very little is known about the effects of gestational diabetes mellitus (GDM) on lactation and breast milk components. The objective of the current study was to examine the effect of GDM on the expression of proteins in the whey fraction of human colostrum. Colostrum was collected from women who were diagnosed with (n = 6) or without (n = 12) GDM at weeks 24-28 in pregnancy. Colostral whey was analyzed for protein abundances using high-resolution, high-mass accuracy liquid chromatography tandem mass spectrometry. A total of 601 proteins were identified, of which 260 were quantified using label free spectral counting. Orthogonal partial least-squares discriminant analysis identified 27 proteins that best predict GDM. The power law global error model corrected for multiple testing was used to confirm that 10 of the 27 proteins were also statistically significantly different between women with versus without GDM. The identified changes in protein expression suggest that diabetes mellitus during pregnancy has consequences on human colostral proteins involved in immunity and nutrition.

Opioid and cocaine antenatal substance use can result in significant obstetric and pediatric health implications. Accurate detection of in utero-exposed neonates can improve patient care and health outcomes. Therefore, the effectiveness of mother-infant biological and diagnostic indicators collected at labor and delivery to provide accurate detection of in utero opiate and cocaine exposure was assessed.A retrospective medical chart review included 335 mother-infant dyads exposed to antenatal substances who were delivered between January 2009 and March 2014. Mother-infant dyads were a subset of a larger retrospective cohort of 560 substance-using mothers, who had a valid meconium drug screen (MDS) and anesthesia before delivery. Alternative biological and diagnostic indicators of maternal urine drug screens (UDS), maternal substance use International Classification of Disease, Ninth Revision, Clinical Modification (ICD-9-CM) codes, and neonatal exposure diagnostic ICD-9-CM codes were compared against MDS. Data were analyzed using classification accuracy measures.Compared with MDS, maternal UDS had the highest sensitivity [0.52, 95% confidence interval (CI), 0.39-0.65] and specificity (0.88, 95% CI, 0.79-0.97) to detect intrauterine opiate exposure. Maternal substance use diagnosis had the highest sensitivity (0.39, 95% CI, 0.16-0.61) and maternal UDS had the highest specificity (1.00, 95% CI, 0.99-1.00) to detect intrauterine cocaine exposure. Cocaine exposure had significantly higher accuracy scores across detection methods compared with opiate exposure.Alternative indicators collected at delivery were ineffective at identifying in utero substance exposure, especially neonatal-exposed ICD-9-CM codes. Low sensitivity scores indicate that many exposed neonates could be misdiagnosed or left untreated. Accurate antenatal exposure identification at delivery is an important form of tertiary assessment that warrants the development of improved screening methodology and standardization of hospital biological drug testing.

Introduction Although benefits of breastfeeding for infants, women, and society are well established, breastfeeding rates in the United States remain below the Healthy People 2020 goals. Various factors are known to influence breastfeeding practices. Limited research has been conducted to examine the influence of type of birth attendant on exclusive breastfeeding. Methods A cross-sectional analysis was conducted using data from the Infant Feeding Practices Study II collected between May 2005 and June 2007. Results The study sample included 2026 women, aged 18 years or older. At discharge, 74.6% of women exclusively breastfed, and 27.6% exclusively breastfed at 3 months postpartum. Bivariate analysis showed a statistically significant association between type of health professional at birth and exclusive breastfeeding at discharge (P = .001) and 3 months postpartum (P < .001). After adjusting for potential confounders, the association between type of health professional at birth and exclusive breastfeeding at discharge was no longer significant. However, the odds of exclusive breastfeeding at 3 months postpartum were higher among women whose birth was attended by a midwife or nurse-midwife compared to those whose birth was attended by an obstetrician (odds ratio [OR], 1.87; 95% confidence interval [CI], 1.34-2.61; P < .001). Discussion Exclusive breastfeeding continuation may be influenced by the type of health professional attending the birth. In addition to having a skilled workforce, health care professionals involved in perinatal care need to be educated and trained to promote and support exclusive breastfeeding as recommended. The complex and multifactorial nature of the maternal decision to exclusively breastfeed requires broader understanding of contextual factors.

Background Rates of smoking among pregnant women in West Virginia are higher than national prenatal smoking rates. Recent research has pointed to the benefit of smoking reduction among a sample of pregnant women who participated in a clinical study in West Virginia. The purpose of the current study is to examine trends associated with reduced smoking exposure among a representative sample of pregnant women in the state. Method Secondary data analysis was conducted using de-identified weighted PRAMS 2005–2010 data from West Virginia examining factors associated with favorable change in prenatal smoking behavior, either quitting or reducing smoking in pregnancy. Results Multivariable analyses results demonstrate that pregnant women are more likely to engage in a favorable smoking behavior change if they were younger (

The online learning environment not only affords accessibility to education for health sciences students, but also poses challenges to academic integrity. Technological advances contribute to new modes of academic dishonesty, although there may be a lack of clarity regarding behaviors that constitute academic dishonesty in the online learning environment.To evaluate an educational intervention aimed at increasing knowledge and improving attitudes about academic integrity in the online learning environment among health sciences students.A quasi-experimental study was conducted using a survey of online learning knowledge and attitudes with strong reliability that was developed based on a modified version of a previously developed information technology attitudes rating tool with an added knowledge section based on the academic integrity statement.Blended-learning courses in a university health sciences center.355 health sciences students from various disciplines, including nursing, pre-medical, and exercise physiology students, 161 in the control group and 194 in the intervention group.The survey of online learning knowledge and attitudes (SOLKA) was used in a pre-post test study to evaluate the differences in scores between the control group who received the standard course introduction and the intervention group who received an enhanced educational intervention about academic integrity during the course introduction.Post-intervention attitude scores were significantly improved compared to baseline scores for the control and intervention groups, indicating a positive relationship with exposure to the information, with a greater improvement among intervention group participants (p0.001). There was a significant improvement in the mean post-intervention knowledge score of the intervention group compared to the control group (p=0.001).Recommendations are provided for instructors in promoting academic integrity in the online environment. Emphasis should be made about the importance of academic integrity in the online learning environment in preparation for professional behavior in the technologically advancing health sciences arena.

This population-based study examined obstructive sleep apnea (OSA) symptoms predictive of anxiety in middle-aged men.Secondary analyses were conducted on the National Health and Nutrition Examination Survey (NHANES) 2007-2008 data using weighted samples and complex sample analysis techniques (unweighted N=1,217).Nonrefreshing sleep (χ(2)=69.333, p0.001), excessive daytime sleepiness (χ(2)=47.766, p0.001), and sleep fragmentation (χ(2)=30.692, p0.001) were significantly associated with anxiety. Nonrefreshing sleep (OR 3.582, p0.001) and awakenings due to apneic episodes (OR 2.047, p=0.001) were predictive of anxiety.Comorbid anxiety and OSA symptoms are common and have implications for activities of daily living, social responsibilities, and quality of life. Screening for anxiety among men with OSA symptoms is recommended.

ObjectiveTo examine (i) the prevalence of and associations between breast-feeding initiation and continuation by maternal diabetes status and (ii) the reasons for not initiating and/or continuing breast-feeding by maternal diabetes status.DesignSecondary data analyses of a population-based cross-sectional study were conducting using data from the US Centers for Disease Control and Prevention’s Pregnancy Risk Assessment Monitoring System (PRAMS), 2009–2011. Multivariable logistic regression was used to investigate the associations between breast-feeding initiation and continuation by diabetes status.SettingThirty states and New York City, USA.SubjectsMothers of recently live-born infants, selected by birth certificate sampling.ResultsAmong 72755 women, 8·8 % had gestational diabetes mellitus (GDM) and 1·7 % had pregestational diabetes mellitus (PDM). Breast-feeding initiation was similar among GDM and no diabetes mellitus (NDM) women (80·8 % v. 82·2 %, respectively, P=0·2), but continuation was lower among GDM (65·7 % v. 68·8 %, respectively, P=0·01). PDM women had lower initiation and continuation compared with NDM (78·2 %, P=0·03 and 60·4 %, PConclusionsDifferences in breast-feeding initiation and continuation prevalence by maternal diabetes status may reflect differences in prenatal education, indicating the need for increased efforts among PDM women. Additionally, non-smoking women with PDM or GDM would benefit from additional breast-feeding education.

Nearly half a million preterm infants are born each year in the United States. Preterm delivery has significant psychosocial implications for mothers, particularly when their baby spends time in the neonatal intensive care unit (NICU). The decrease in length of gestation causes mothers to have to parent prematurely, without the less time for emotional preparation than mothers of full-term infants. Parents of NICU infants experience stress related to feelings of helplessness, exclusion and alienation, and lack sufficient knowledge regarding parenting and interacting with their infants in the NICU. There are a number of interventions that nurses can do that help reduce the stress of mothers of infants in the NICU.

Context: Existing literature suggests participation in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) in the prenatal and postnatal periods is associated with lower rates of breastfeeding among WIC-eligible mothers. However, minimal research has been published on the association between WIC enrollment and exclusive breastfeeding. Objective: To examine the association between WIC exposure and exclusive breastfeeding at 3 months postpartum. Methods: We conducted a secondary data analysis using information on 784 low-income women who participated in the longitudinal population-based Infant Feeding Practices Study II between May 2005 and June 2007. The main outcome of interest was exclusive breastfeeding at 3 months postpartum. Logistic regression analysis was used to estimate OR and 95% CI for exclusive breastfeeding relative to WIC enrollment status, controlling for the confounding effects of other maternal characteristics. We further conducted a subgroup analysis among those participating in WIC prenatally to examine the association between receipt of information about infant feeding from WIC and exclusive breastfeeding at 3 months postpartum. Results: The crude prevalence of exclusive breastfeeding at 3 months postpartum was 18.1% of women enrolled in WIC and 41.1% of WIC-eligible nonparticipants (P Conclusion: Women who were enrolled in WIC and who received information about feeding infants were less likely to exclusively breastfeed than women not in WIC. Continued improvement and adjustment to the existing WIC breastfeeding program could potentially improve these rates. Additional studies that examine the quality of WIC services provided, especially those pertaining to breastfeeding programs, are warranted.

Objective The purpose of this study was to examine the association between prenatal smoking and small for gestational age (SGA) infants among adolescent women in West Virginia, taking into account sociodemographic and health-related factors. Methods Secondary data analysis was conducted using the 2005–2010 West Virginia Pregnancy Risk Assessment and Monitoring Systems weighted dataset. The study population using complete case analysis procedure consisted of 886 adolescent women ages 19 and younger who delivered a live singleton infant in West Virginia. Results The prevalence of smoking among adolescents during the last 3 months of pregnancy was 67 %. Nearly a quarter (22.0 %) of the adolescents gave birth to SGA infants. Results from the logistic regression analysis showed that after controlling for sociodemographic and health-related variables, adolescents who smoked during the last 3 months of pregnancy were more likely to have SGA infants than those who did not smoke during the last 3 months of pregnancy (OR = 1.86, 95 % CI 1.06–3.27, P = 0.0307). Conclusion This study highlights the importance of recognizing that prenatal smoking is an issue among West Virginia adolescents and the need for evidence-based, culturally, and developmentally appropriate interventions for this Appalachian population.

Context: Studies have shown that exclusive breastfeeding at hospital discharge is associated with longer duration of breastfeeding. Method of delivery (MOD) is a barrier that may hinder breastfeeding practices. However, research examining the association between MOD and exclusive breastfeeding at hospital discharge is lacking. Objective: To examine the association between MOD and exclusive breastfeeding at hospital discharge. Methods: We used a cross-sectional study design to conduct a secondary data analysis of 1494 women who participated in the Infant Feeding Practices Study II between 2005 and 2007. Multiple logistic regression was conducted to estimate the OR and 95% CI for the association between MOD and exclusive breastfeeding at hospital discharge, after adjusting for potential confounding variables. Results: The crude prevalence rates of vaginal delivery and cesarean delivery were 74.8% and 25.2%, respectively. The prevalence of exclusive breastfeeding at hospital discharge was 70.6% among respondents who gave birth by cesarean delivery compared with 79.9% of women who gave birth vaginally (P=.001). After adjusting for sociodemographic, behavioral, and anthropometric factors, the odds of exclusive breastfeeding at hospital discharge were lower among women who gave birth by cesarean delivery compared with women who gave birth vaginally (OR, 0.41; 95% CI, 0.24-0.71). Conclusion: Women who give birth by cesarean delivery may require additional attention, assistance, and encouragement during their hospital stay to improve rates of exclusive breastfeeding at discharge. Health care professionals should address the issue of MOD when promoting exclusive breastfeeding to maximize the potential for longer-term breastfeeding success.

To examine the association between sociodemographic, economic and health-related lifestyle factors and receipt of pre-pregnancy dental cleaning in West Virginia.A population-based secondary data analysis was conducted using the 2009-2010 West Virginia Pregnancy Risk Assessment Monitoring System (PRAMS) dataset. The study population consisted of 3050 women who answered the survey question about pre-pregnancy dental cleaning.Approximately 47% of the participants visited a dentist during the 12 months before pregnancy. Results from the logistic regression model showed that pre-pregnant Non-Hispanic white women were more likely to get their teeth cleaned compared to women from other racial/ethnic backgrounds (OR = 1.75; 95% CI: 1.01-3.04). Women with more than a high-school education (OR = 1.79; 95% CI: 1.22-2.62), young women20 years of age (OR = 2.75; 95% CI: 1.86-4.06), women with private health insurance (OR = 2.65; 95% CI: 1.98-3.55) and women who had intended pregnancy (OR = 1.3; 95% CI: 1.04-1.64) were more likely to have dental cleaning before pregnancy compared to women with less than a high-school education, women between the ages of 20-29, uninsured women and women who had unintended pregnancy, respectively.Identifying factors associated with dental cleaning can aid healthcare providers and policy makers in developing approaches to promoting oral care among women of childbearing age.

Although the effectiveness of tetanus toxoid (TT) immunization during pregnancy in preventing maternal and neonatal tetanus is well established, in many developing countries, TT immunization programs are underutilized. The objective of this study was to examine factors associated with sufficient TT immunization among postpartum women in Kenya. Population based secondary data analysis was conducted using de-identified data from the 2008-2009 Kenyan Demographic and Health Survey (KDHS) for 1,370 female participants who had a live birth during or within 12 months of the cross-sectional survey. Chi-square test and independent sample t test were conducted to assess bivariate associations and a multivariable logistic regression analysis was conducted to examine associations before and after adjustment for demographic, socioeconomic, cultural, and access to care factors. The main factors contributing to having been sufficiently immunized against tetanus were lower birth order, higher household wealth index, women's employment, making joint health-related decisions with a partner, and higher number of antenatal care visits. Implications for health care providers and other professionals involved in development of strategies and interventions aimed at improving immunization rates are discussed.

One of the primary barriers to smoking cessation among pregnant women who smoke is having a partner who smokes. Prenatal tobacco exposure has been demonstrated to negatively affect infant health outcomes. Many smoking cessation interventions have been targeted at women who smoke in pregnancy, although research has indicated that one of the main barriers to cessation is lack of partner support. The family systems theory frames prenatal smoking cessation interventions in an inclusive manner for the woman and her partner. The aim of this article is to review smoking cessation intervention studies for partners of pregnant women. Efforts to promote smoking cessation among pregnant women should be inclusive of partners, recognizing that partners influence maternal prenatal health behaviors.

Breastfeeding is the best source of nutrition for infants. Approximately half of women with schizophrenia become mothers, yet the issue of breastfeeding is often overlooked by the health professional community. The aim of this study was to survey attitudes among registered nurses regarding breastfeeding by schizophrenic women. Cross-sectional descriptive design was used involving a sample of nurses (40 midwives, 37 psychiatric and 33 postpartum) in two medical centres in southern Israel. The validated semistructured questionnaire included sociodemographic and professional questions, personal and professional breastfeeding experience, attitudes and knowledge concerning schizophrenia and attitudes towards breastfeeding by schizophrenic women. The study results indicate that 70% of the respondents held positive attitudes towards breastfeeding in women with schizophrenia, although no significant differences were found between the different types of nurses. Multivariate analysis reveals that academic education was the only variable associated with positive attitudes, while negative feelings towards women with schizophrenia, and extensive knowledge regarding schizophrenia were negatively associated. This study can serve as a foundation for future research to further examine nurses' role in providing postpartum education and care for women with schizophrenia.

Purpose: To describe the maternal experience of having type 2 or gestational diabetes in pregnancy using focus groups and individual telephone interviews. Data sources: Eight women who had type 2 or gestational diabetes in at least one pregnancy and participated in the qualitative study addressing the open-ended guiding questions on their experience. Conclusions: This phenomenological study gave voice to the women's experience with and concerns about having diabetes in pregnancy. Three primary themes emerged and were identified: (a) feeling concern for the infant related to diabetes, (b) feeling concern for self related to diabetes, and (c) sensing a loss of personal control over their health. Subthemes for each of the primary themes were also identified. Implications for practice: The experiences shared by these women may serve to inform the development of interventions aimed at meeting the needs of women with diabetes in pregnancy. By learning from the themes of the phenomenological study, advance practice nurses may anticipate the needs of the women diagnosed with diabetes in pregnancy to augment their care, education, and promotion of diabetes self-management in pregnancy.

Prenatal maternal intent to breastfeed can indicate postnatal breastfeeding practices and may serve to indicate potential barriers to breastfeeding. Breastfeeding rates in West Virginia, a primarily rural state, are among the lowest in the United States, and minimal research has been published to date on population-based prenatal intent to breastfeed among rural women.Secondary data analysis of population-based data was conducted using two state-linked datasets. State data included all live singleton births from at least 20 weeks of gestation in West Virginia from 2004 to 2006, for a total of 52,899 births.Results from the logistic regression model for the population-based study indicate that variables predicting intent to breastfeed among pregnant women in West Virginia include insurance status, maternal education, maternal age, parity, marital status, timing of prenatal care initiation, and prenatal smoking status.Prenatal identification of characteristics associated with lack of intent to breastfeed can serve to inform healthcare providers of women who are at risk for not breastfeeding for directed breastfeeding promotion and intervention, complementing education of healthy lifestyle choices such as breastfeeding promotion with smoking cessation.