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The purposes of this study were to evaluate the psychometric properties of English and Spanish instruments that measure the nutrition behavior and practices of children and their parents. Orem’s self-care deficit nursing theory was used in this methodological study. A convenience sample of 333 children and 262 mothers participated from two schools in Washington, D.C. and two schools in Santiago, Chile. Principal component analysis indicated three component per instrument corresponding to Orem’s Theory of operations demonstrating construct validity of the instrument. The study findings showed evidence for validity and reliability of the English and Spanish versions and indicated that the instruments appropriately represented Orem’s operations. The results have implications for the development of health behavior measurement instruments that are valid, reliable, designed for children, culturally appropriate, and efficient. Measuring the nutrition behavior of children and parents is critical for determining the effectiveness of nutrition intervention programs. Furthermore, instruments are needed so that researchers can compare corresponding child and parent behaviors or compare behaviors across cultures.

Background Kenya did not meet its maternal mortality ratio (MMR) target under the Millennium Development Goals. The aim of this study was to examine the gaps in knowledge of intrapartum care among obstetric care providers (OCPs) in rural Nandi County, Kenya. Methods This cross-sectional study in 2015 surveyed 326 nurses, midwives, clinical officers and physicians about their knowledge, attitudes and practices related to normal labor and childbirth, immediate newborn care and management of obstetric complications. Results Self-reported intrapartum knowledge among OCPs was insufficient according to accepted international standards. The mean total knowledge score for all OCPs based on a validated 30-question inventory was 62% (range 23–90%). Only 14 providers (4%) scored as ‘competent’ (a score ≥80%). Scores were higher for OCPs who had received pre- and postemployment emergency obstetric care training and those with higher levels of confidence in their skills. Survey respondents identified a lack of knowledge as one of the greatest barriers to high-quality patient care. Conclusions Increasing training opportunities for OCPs may improve the quality of obstetric care provided to women in Kenya and other high-MMR locations in sub-Saharan Africa and enable progress toward achieving the ambitious Sustainable Development Goals target for maternal survival.

The purpose of this study was to examine the contribution of maternal financial, emotional, traumatic, and partner-associated stressors on breastfeeding initiation and duration.Data (216,756 records) from the Pregnancy Risk Assessment Monitoring System surveys were used in the analysis. Logistic regressions were conducted to estimate the magnitude and direction of associations between maternal stressors occurring in the 12 months prior to infant birth and both breastfeeding initiation and duration up to 4 weeks infant age.A substantial proportion of mothers (42%) reported having experienced one or two major stressors during the 12 months prior to the birth of their infant. Mothers who reported at least one major life stressor in the year before their baby was born were less likely to initiate breastfeeding and more likely to cease by 4 weeks infant age. Emotional and traumatic stressors were found to have the greatest impact on breastfeeding outcomes.Findings support the design and implementation of screening protocols for major maternal life stressors during regularly scheduled prenatal and newborn visits. Screening for at-risk mothers may lead to more targeted anticipatory guidance and referral with positive effects on breastfeeding outcomes and overall well-being of the mothers and their families.

Women exposed to intimate partner violence (IPV) and other forms of lifetime trauma may be at risk for negative mental health outcomes including posttraumatic stress disorder (PTSD). The purpose of this study was to examine potential predictors of PTSD among low-income women exposed to perinatal IPV. This study analyzed baseline cross-sectional data from 239 low-income pregnant women in the USA who participated in a nurse home visitation intervention between 2006 and 2012 after reporting recent IPV. PTSD was assessed with the Davidson Trauma Scale (DTS) in which participants answer questions about the most disturbing traumatic event (MDTE) in their lifetime that affected them the week before the interview. In total, 40 % of the women were identified as having PTSD (DTS ≥40). PTSD prevalence significantly increased with age to nearly 80 % of women ages 30 and older (n = 23). Age was also the strongest predictor of PTSD (p

Introduction This study examined postpartum depression, food insecurity, and underestimation of infant size as potential early life factors for overweight risk at 12 months among infants of Hispanic immigrant mothers. Method Weight-for-length (WFL) measurements and face-to-face interviews were completed during well child visits. Regression models estimated the impact of early life factors (0-6 months) on overweight risk at 1 year. Results WFL ≥ 85th percentile was found among 2.4% at birth and 42.7% at 1 year. Most mothers (78.6%) experienced food insecurity, a factor that increased the likelihood of infant overweight risk by 2.29 times (1.03–5.09). Maternal underestimation of infant size increased the likelihood of overweight risk 5.07 times (2.57–9.99). Postpartum depression risk did not contribute to infant weight status. Discussion Assessment for maternal food insecurity and underestimation of infant weight status during early infancy may help reduce overweight risk and subsequent obesity for this vulnerable population.

Purposes Describe implementation of Institute of Medicine (IOM) early infant feeding recommendations for child obesity prevention by immigrant mothers from Central America; examine potential relationships with food insecurity and postpartum depressive symptoms. Design and Methods Using a cross-sectional, descriptive design, face-to-face interviews were conducted with 318 mothers of 2 month old infants at a large pediatric setting for low income families. Logistic regression models assessed feeding practices, food insecurity and postpartum depressive symptoms. Results Exclusive breastfeeding rates were low (9.4%); most mothers (62.7%) both breastfed and bottle fed their infants. Mothers who bottle fed at moderate and high intensity were twice as likely to affirm that if you give a baby a bottle, you should always make sure s/he finishes it (OR = 2.30, 95% CI = 1.13, 4.69; OR = 2.29, 95% CI = 1.26, 4.14). Food insecurity was experienced by 57% of mothers but postpartum depressive symptoms were low (Possible range = 0–30; M = 2.96, SD =3.6). However, for each increase in the postpartum depressive symptoms score, the likelihood of affirming a controlling feeding style increased by 11–13%. Conclusions Immigrant mothers from Central America were more likely to both breastfeed and bottle feed (las dos cosas) than implement exclusive breastfeeding. Bottle feeding intensity was associated with a controlling feeding style. Practice Implications Infant well visits provide the ideal context for promoting IOM recommendations for the prevention of obesity among children of immigrant mothers from Central America.

Introduction This study examined the association between early weight gain (0–6 months) and risk for overweight, as defined by the Institute of Medicine, at 1 year among infants of low-income Hispanic immigrant mothers. Method Weight-for-age data were extracted from electronic medical records of 335 infants with gestations of 37 weeks or longer and birthweights appropriate for gestational age and without medical problems likely to interfere with growth or feeding. Logistic regression models were constructed to examine the impact of early weight changes on weight status at 1 year. Results By 12 months, 36.7% of infants had crossed weight-for-age of 84.1% or greater on World Health Organization growth charts. In adjusted models, infants had 20.8 (95% confidence interval = [19.8, 44.0]) times the odds of reaching this benchmark at 1 year for each z score increase at 0 to 6 months. Discussion The study highlights a time-sensitive opportunity for interventions to reduce risk for overweight for this vulnerable population.

Hispanic preschoolers have higher rates of BMI ≥85th percentile than any other racial/ethnic group. To identify underpinnings of this disparity, we compared early feeding practices and subsequent weight status for a sample of infants of low-income, Hispanic immigrant mothers with participants from the Infant Feeding Practices Study II (IFPS II).Proyecto de Bebés Hispanos Saludables (PBHS) collected medical record data for mother-infant dyads (n = 550) from a large pediatric clinic for low-income families and merged it with IFPS II data (n = 1502) to compare early feeding practices and late infancy weight status.Mode of milk delivery for PBHS mothers was less likely to be exclusive breastfeeding at 6 months (9.0% vs. 27.5%), but more likely to be both breast and bottle feeding (43.5% vs. 26.3%) compared to IFPS II mothers. No difference was found in age for solid food introduction. Weight for age of PBHS infants was more likely to be ≥85th percentile at 12 months than IFPS II infants (39.1% vs. 25.4%). Both PBHS and IFPS II infants were more likely to be ≥85th percentile at 1 year if mode of milk delivery was bottle only at 6 months compared to those who were breastfed only, even after adjusting for potential confounders.Differences in PBHS and IFPS II feeding practices and weight status suggest additional studies of modifiable, early life risk factors are needed to inform clinical and public health interventions that reduce childhood obesity for this growing sector of the US population.

Childhood overweight/obesity is now epidemic in both developed countries and those undergoing economic transition. This study compared maternal and school-age child nutrition practices and body mass index in the United States and in Chile. Children (125 in the United States, 121 in Chile) and their mothers (116 in the United States, 101 in Chile) participated. Findings indicated that child nutrition practices were comparable, but mothers in the U.S. group demonstrated fewer healthy nutrition practices on behalf of their children. Significant associations were found between maternal and child nutrition practices. Substantially more children in the U.S. sample were overweight/obese. Implications for practice are presented.

Purpose To identify the contribution of life stressors and barriers to the untimely initiation of prenatal care for women with high-risk pregnancies living in rural and nonrural areas. Methods Data collected in 10 U.S. states by the 2006–2008 Pregnancy Risk Assessment Monitoring System (PRAMS) were used (n = 34,161). Data were weighted to reflect the PRAMS complex survey design. Separate logistic regression models derived adjusted odds ratios for untimely prenatal care initiation based on several life stressors and barriers. Results Women with high-risk pregnancies living in rural areas were more likely to report late initiation of prenatal care (17.5% vs. 14.6%). The most frequently reported life stressors were the same for both cohorts: Moving, having a very sick family member, arguing more than usual with their partners, and having bills they could not pay. The most frequently cited barriers were also the same for both groups: Not having enough money or insurance for health care visits and not being able to get an appointment when they wanted one. Having two or more barriers increased the risk of late prenatal care initiation by 2.85-fold for rural women and 2.01-fold for nonrural women. Conclusion To increase timely prenatal care initiation, preconception interventions are needed that address common life stressors and barriers shared by women living in rural and nonrural areas.

Background: The World Health Organization has identified childhood obesity as a major threat to global health. Accumulating evidence indicates that excess weight early in life is predictive of later childhood and adolescent obesity. Clinical practice guidelines for infant feeding behaviors have been developed by national and international health organizations. The relationship between these guidelines and infant weight status has not been established. Aim: To examine the relationship between weight-for-age at 1 year and adherence to four clinical practice guidelines for feeding behaviors: no bottle-to-bed, minimal juice consumption, breastfeeding throughout the first year of life, and introduction to solid food no earlier than age 4–6 months. Methods: Data were obtained from the Infant Feeding Practices Study II, a longitudinal, national survey administered by the U.S. Food and Drug Administration and Centers for Disease Control and Prevention that followed mother–infant dyads from pregnancy through 1 year postpartum. The sample was comprised of 691 infants for whom 12-month survey data were available. Results: Significant associations with weight-for-age were found for juice consumption (p= 0.003), breastfeeding during the second half of infancy (p < 0.001), and introduction to solid foods prior to age 4 months (p < 0.001). A regression model that controlled for infant and maternal characteristics demonstrated that these feeding behaviors remained significant predictors of weight-for-age at 12 months. Conclusions and Implications: Modifiable infant feeding behaviors contributed to weight-for-age at 1 year. Replication studies with economically and culturally diverse samples are needed. Further, testing longitudinal interventions that address infant feeding practices is likely to yield the evidence needed for shaping future clinical practice guidelines that reduce the risk for childhood obesity and related pediatric comorbidities.

Women experiencing perinatal intimate partner violence (IPV) may be at increased risk for depression. Baseline data was analyzed from 239 low-income pregnant women participating in an intervention study designed to reduce exposure to IPV. Depression risk was assessed using the Edinburgh Postnatal Depression Scale (EPDS) and IPV factors were measured with the Conflict Tactics Scale-Revised (CTS-2). Stepwise regression was conducted to identify predictors of risk for depression. Race (p = 0.028), psychological IPV (p = 0.035) and sexual IPV (p = 0.031) were strongly associated with risk for depression. Regression results indicated that women experiencing severe psychological IPV were more likely to develop depression (OR 3.16, 95 % CI 1.246, 8.013) than those experiencing severe physical or sexual IPV. Experiencing severe psychological IPV during pregnancy is strongly linked to risk for depression. Routine screening for psychological IPV may increase identification and treatment of women at high risk for depression during pregnancy.

The purpose of the current study was to evaluate the validity of a single-item, self-rated mental health (SRMH) measure in the identification of women at risk for depression and posttraumatic stress disorder (PTSD). Baseline data of 239 low-income women participating in an intimate partner violence (IPV) intervention study were analyzed. PTSD was measured with the Davidson Trauma Scale. Risk for depression was determined using the Edinburgh Postnatal Depression Scale. SRMH was assessed with a single item asking participants to rate their mental health at the time of the baseline interview. Single-item measures can be an efficient way to increase the proportion of patients screened for mental health disorders. Although SRMH is not a strong indicator of PTSD, it may be useful in identifying pregnant women who are at increased risk for depression and need further comprehensive assessment in the clinical setting. Future research examining the use of SRMH among high-risk populations is needed. [ Journal of Psychosocial Nursing and Mental Health Services , 53 (11), 32–38.]

The purpose of this study was to describe early infant feeding practices among overweight/obese mothers using the Infant Feeding Practices Study II (IFPS II).In this study, we used data pertaining to the first 2 months postpartum of IFPS II. The data set includes 2387 mothers who provided information about infant feeding habits at the 2-month postpartum period.Overweight/obese mothers were less likely to breastfeed exclusively at 2 months infant age and more likely to breastfeed at low intensity the first 2 months compared to mothers of normal body mass index (BMI). Logistic regression analysis revealed, that after controlling for potential confounders, obese mothers were 1.38 (95% CI: 1.11, 1.72) times more likely to introduce solids to their infants before 4 months of age, and 1.37 (95% CI: 1.10, 1.89) times more likely to add cereal to the infant formula than their normal BMI counterparts.In conclusion, overweight/obese mothers not only fall short of clinical practice guidelines in regards to breastfeeding, but also are more likely to initiate early introduction (4 months infant age) to solid foods compared to their normal BMI counterparts. Interventions should be targeted to this group.

The aim of this paper is to present an overview of the infancy-related guidelines from the Institute of Medicine (IOM, 2011) report “Early Childhood Obesity Prevention Policies” and highlight research studies that support their implementation in pediatric practice. Findings from recent studies of infant growth monitoring, feeding, sleep, and physical activity are presented. Research strategies that may be applied to today's clinical assessments and interventions are specified. Participation by pediatric nurses in the development of future multi-component interventions to prevent rapid infant weight gain is recommended.

Despite public health initiatives targeting the harmful effects of alcohol exposure on fetal growth, 12 % of pregnant women report current alcohol use. For women who reported drinking alcohol prior to pregnancy, we examined several factors as predictors of three alcohol use patterns during the third trimester of pregnancy: cessation, reduction and no reduction.Using the 2002-2009 Pregnancy Risk Assessment Monitoring System (PRAMS) dataset (311,428 records), a multinomial logistic regression model was constructed to compare alcohol risk by category: (1) cessation vs. reduction (2) no reduction vs. reduction.In this sample, 49.4 % drank alcohol before pregnancy. Among those who drank before pregnancy, ~87 % quit drinking during pregnancy, 6.6 % reduced, and about 6.4 % reported no reduction. Older women and those with higher education were more likely to reduce than quit their alcohol use. Conversely, women who were black or Hispanic, overweight, obese, or multiparas were more likely to quit than to reduce their prenatal alcohol consumption. Several stressors such as abuse during pregnancy increased their risk of not quitting or not reducing alcohol during the last trimester of pregnancy.Differentiating prenatal alcohol use patterns can inform the design of targeted interventions and public health policies to meet the Healthy People 2020 objective for achieving a national rate of 98.3 % alcohol abstinence during pregnancy.

The purpose of this study was to test Orem's theory of self-care deficit, one of three constituent theories included in her general self-care deficit theory of nursing. Specifically, the relationship between dependent care agent performance and basic conditioning factors was examined. Dependent care agent performance for children was defined as health promotion and self-care activities provided by a responsible adult on behalf of the child. The Dependent Care Agent Questionnaire was used with a sample of 380 mothers of children from ages 1 to 16 years. The hypothesis that basic conditioning factors influenced dependent care agent performance was supported (R2 = .13, p = .0001).

purpose.:To explore relationships between pregnant womens' childhood experiences with discipline and 1) prenatal plans for disciplining own child and 2) later maternal-infant interactions design. Prospective correlational study setting. Prenatal clinics and home visits participants. Low-income pregnant women (N = 205) with a mean educational level of 12 years main outcome measures. Adapted Ways of Handling Irritating Behaviors (Mother and you) Scales, NCAST Teaching Scale, Home Observation for Measurement of the Environment Scale results. Correlations between childhood experiences with discipline and 1) plans for later discipline strategies with own child and 2) infant components of maternal-infant interactions, including clarity of cues and responsiveness to the mother conclusions. Prenatal assessment for childhood experiences with discipline may uncover factors associated with a break in the trajectory for optimal maternal-child interactions described by Barnard's theoretical framework.

This study examined postpartum depression (PPD) as a potential risk factor for non-adherence to infant feeding guidelines and subsequent infant weight gain.Participants were mother-infant dyads from the Infant Feeding Practices Study II (N = 1447). Main study variables were PPD, breastfeeding intensity, addition of cereal to infant formula, and age of introduction to solid foods.In logistic models adjusted for sociodemographic factors, mothers with PPD were 1.57 times (95% confidence interval [CI]: 1.16, 2.13) more likely to breastfeed at low intensity and 1.77 times (95% CI: 1.16, 2.68) more likely to add cereal to infant formula. Although PPD was associated with the early introduction to solid foods (odds ratio: 1.42; 95% CI: 1.07, 1.89), this relationship was not significant after adjusting for potential confounders. A small but significantly greater average weight gain at 6 months was observed among infants of mothers with PPD (10.15 lb, SD = 2.32 vs. 9.85 lb, SD = 2.32).Screening for PPD at well-child visits may lead to improved maternal health outcomes and the prevention of early life risk factors for childhood obesity.

OBJECTIVE While socioeconomic status (SES) and race/ethnicity are known predictors of breastfeeding practices, the added disparity caused by the rising rates of obesity among women of childbearing age remains untested. The purpose of this study was to examine differences in breastfeeding initiation and duration among black, white and Hispanic women of low and middle SES within the context of prepregnancy body mass index (BMI). METHODS Data from the Early Childhood Longitudinal Study-Birth Cohort were analyzed. Adjusted logistic regression models were built to examine differences in breastfeeding initiation and duration for the three racial/ethnic groups of low and middle SES. RESULTS Normal BMI Hispanic women of low SES demonstrated higher rates of breastfeeding initiation (74%) compared to other groups. Overweight/obese black women of low SES had lower rates of breastfeeding initiation. Overweight/obese Hispanic women of middle SES were significantly less likely to continue breastfeeding up to 4 months (OR: 0.65, 95% CI: 0.41, 0.98) compared to their white counterparts. Among women who initiated breastfeeding, overweight/obese white women of low SES had the highest rate of stopping within two months of giving birth (66.7%). CONCLUSIONS Examination of SES and racial/ethnic differences within the context of prepregnancy weight revealed specific groups with low rates of breastfeeding initiation and duration. Interventions tailored for these at-risk groups are needed to increase the overall proportion of mothers and infants who benefit from the positive health outcomes associated with breastfeeding.

The objective of this study was to examine agreement between parental preferences and self-reported food intake in Chilean children. In 2008,152 pairs, of 8 to 13 year old schoolchildren and their parents in Santiago were surveyed. Children self-reported their frequency of consumption of foods from various food groups. Parents reported how often they preferred their children to consume foods from these same food groups. Children reported consuming more sweets, high-calorie snacks, and fruit, and fewer grains than their parents reported preferring them to consume. Girls, 10 and 11 year olds, and children who watched television and used the computer for less than 2 hours per day had dietary patterns most closely aligned with their parents' reported preferences. Children 's dietary reports generally follow parental preferences. Intervention programs should include programs that facilitate parental guidance and encourage children to make healthy food choices at home and in school. Se estudia concordancia entre preferencias de padres y auto-reporte de niños chilenos en consumo de alimentos. En 2008, se encuestaron 152 escolares ente 8 y 13 años de edad y sus padres, en Santiago, Chile. Los niños reportaron frecuencia de consumo de diferentes grupos de alimentos y los padres, frecuencia con que prefieren que sus hijos los consuman. Los niños informaron mayor consumo de dulces, colaciones altas en calorías y frutas y menor consumo de cereales, que lo declarado por sus padres. Los patrones alimentarios más estrechamente alineados con lo reportado por los padres se observan en: niñas; edades entre 10 y 11 años; ver televisión y utilizar computador menos de 2 horas diarias. En general, lo reportado por niños sigue los patrones de los padres. Programas de intervención debieran incluir guía a padres y estimulo a niños para elegir opciones alimentarias saludables en el hogar y en la escuela.

The aim of the current study was to examine the role of maternal prepregnancy body mass index (BMI) on overweight/obesity among US Hispanic children ages 2 and 4 years old. We used US nationally representative data from preschoolers enrolled in the Early Childhood Longitudinal Study-Birth Cohort study. The findings revealed that a significantly higher percent (41.6%) of Hispanic mothers were overweight/obese prior to pregnancy compared to white mothers (34.8%). At 2 years of age, 38.3% of the children born to Hispanic mothers were overweight/obese compared to 29.4% of children born to white mothers. By the age of 4, overweight/obesity increased significantly for both racial/ethnic groups with preschoolers whose mothers were Hispanic being more likely to be overweight/obese (44.6%) compared to children whose mothers were white (34.2%). Further, preschoolers born to overweight/obese Hispanic mothers were more than twice as likely [odds ratio = 2.74 (95% confidence interval (CI) 1.60, 4.69)] to be overweight/obese than those born to Hispanic mothers of normal prepregnancy BMI. Preschoolers born to overweight/obese white mothers were approximately 1.4 (95% CI 1.05, 1.93) times more likely to be overweight/obese in comparison to those born to mothers with a normal prepregnancy BMI. Maternal prepregnancy weight is potentially a modifiable risk factor for preschooler overweight/obesity. Study findings support the design of early and targeted interventions to reduce this risk to the long-term health of Hispanic maternal and child dyads.

Tobacco use during pregnancy and postpartum is a leading cause of preventable morbidities for women and their infants. Over the past two decades, nursing research has addressed this recalcitrant clinical problem from a variety of conceptual and methodological perspectives. The 64 published studies (1988–2009) that met inclusion criteria for this systematic review represent the full research trajectory from concept development to intervention testing. Meta-analysis demonstrated an overall significant trend in nursing intervention efficacy (OR = 1.14, 95% CI = 1.08–1.2) for studies that examined comparable prenatal and postpartum smoking cessation outcomes. Implications for future nursing research and evidence-based policy are presented.

Aims: This study examines predictors of neonatal and postneonatal mortality among infants born to black, white, and Hispanic women. Methods: Linked birth/infant death records from North Carolina for the period 1999–2007 were the source of data. Logistic regression models were constructed to estimate the effect of maternal and infant characteristics on neonatal (

Background The epidemic of overweight/obesity among U.S. children has led to an alarming increase in health-related consequences, including early-onset diabetes and cardiovascular disease. Recent research has identified the independent contribution of several maternal and child factors to the development of childhood overweight/obesity. Few studies, however, have examined risk profiles of childhood obesity. Aim This study used classification and regression tree (CART) analysis to examine the combined effect of maternal and child factors in generating risk profiles for overweight/obesity among preschoolers. Study design Data from the Early Childhood Longitudinal Study-Birth Cohort (ECLS-B) study were used. The sample was comprised of preschool children. CART and logistic regression models were built and compared. Results Children who were overweight/obese at two years of age had an increased risk of being overweight/obese at four years of age. Children born to overweight/obese mothers were more likely to be overweight/obese by age four, even if their BMI at two years of age was normal. Children with high birth weight (≥4000g.) were also more likely to be overweight/obese at age four years if they were born to mothers with a normal pregravid BMI, but were of a lower socioeconomic status. Among preschoolers whose mothers were black or white and who had a high pregravid BMI, breastfeeding duration and parity played an important role in determining their risk of being overweight/obese. Conclusions Classification tree analysis confirms and extends current knowledge of preschool overweight/obesity by providing preliminary risk profiles that are structured within the context of prenatal and postnatal maternal and child characteristics.

To extend current knowledge of tobacco use by exploring whether subsets of mothers of infants have unique triggers for smoking relapse during the early stages of becoming a mother.Using data from a study of smoking relapse among mothers of infants (N = 133), comparative analyses were conducted for groups formed on the basis of their intention to be nonsmokers after delivery (yes/no) and their actual smoking behavior during the first 2 weeks of infant life (yes/no).The identified groups of mothers were found to be significantly different from one another in several ways, including self-reports that their baby's crying episodes caused them to think about smoking and their level of self-confidence to not smoke as response to infant crying.Pediatric nurses in primary and acute care settings are in a unique position to support mothers for whom the challenge of handling infant cry episodes is a trigger for smoking behavior. Interventions that teach mothers how to cope with infant irritability are likely to support the smoking cessation efforts, and consequently, interrupt the intergenerational cycle of tobacco-related maternal and child health morbidities.

Background: Recent research has shown that most women who stop or substantially reduce cigarette smoking during pregnancy return to previous levels of tobacco use soon after delivery. The determinants of postpartum tobacco use have not been adequately identified. To address this gap, the present study examined one potential contributor to postpartum smoking, namely, unexplained infant crying and fussiness. The purpose of this study was to describe mothers’ reflections about perceived infant irritability and postpartum tobacco use. Methods: A qualitative descriptive approach was applied to the responses of low-income women who participated in a mixed methods study of smoking relapse among mothers of infants. The subset of mothers for the present study (n = 86) was composed of women who intended to be nonsmokers after delivery. Thematic content analysis was conducted of the texts from their interviews. Results: Four major themes were identified with respect to perceptions of infant irritability and postpartum tobacco use: not knowing what to do, seeking renewal, seeking relief, and evaluating self. Conclusions: The reflections of the study participants suggest that the challenges of handling infant irritability often trigger thoughts of smoking or smoking behavior. Health practitioners may strengthen cessation interventions by using strategies to help mothers cope with this experience, which is unique to the first few months after delivery. (BIRTH 35:1 March 2008)

Purpose: To identify factors associated with becoming a mother that may contribute to postpartum smoking-related outcomes. Design: Cross-sectional, correlational. Methods: Postpartum women (N=133) who were clients in a nutrition supplement program for low-income families responded to questionnaires about smoking and early motherhood experiences. Inferential statistical tests included hierarchical multiple and logistic regression. Findings: After controlling for factors known to be associated with smoking outcomes for the general population, factors associated with becoming a mother significantly contributed to the amount of explained variance in both postpartum self-efficacy to refrain from smoking and smoking within 2 weeks after delivery. Conclusions: Study findings indicated that prenatal intentions about postpartum tobacco use and maternal response to infant cry episodes were areas for risk assessment that might lead to effective smoking cessation interventions uniquely tailored to women who experience becoming a mother.

With the dramatic increase in the number of foreign-born residents in many U.S. communities, it is increasingly important that nursing education address the requirements of culturally competent care, The author describes the experience of establishing a teaching and learning environment to foster this concept. The setting was a health assessment course with students from 13 countries of origin. Emphasis is placed on effective teaching strategies, student contributions to the process, and the challenges that remain.

Purpose: To propose an innovative, theoretically-derived conceptual framework for studies of postpartum smoking relapse including concepts of smoking abstinence self-efficacy and becoming a mother. Methods: Presentation of an existing research paradigm followed by evidence from intervention research and studies of factors associated with postpartum smoking behavior, leading to a new approach to postpartum smoking relapse. Findings: Effectiveness of current interventions to prevent relapse is limited. Variables associated with becoming a mother are missing from studies of postpartum smoking relapse. Conclusions: Context-specific variables that influence a woman's progression through the stages of becoming a mother might include protective or risk factors that should be incorporated into the design of postpartum smoking relapse studies.

Most women who quit smoking during pregnancy return to tobacco use within 6 months after delivery. Findings demonstrate that minimal intervention effectiveness exists with strategies to prevent postpartum smoking relapse. This article provides a synthesis of current research on postpartum tobacco use. Whether in the labor and delivery suite, the postpartum floor, or the neonatal ICU, acute and critical care nurses have a valuable role to help reduce the incidence of tobacco-related maternal and child outcomes.

A necessary prerequisite for reducing infant morbidity associated with passive smoking is effective measurement of this health risk factor. The purpose of this review was to evaluate questionnaires currently used in research to measure infant environmental tobacco smoke (ETS) exposure. Systematic searches were conducted using MEDLINE and CINAHL databases to identify current studies of infant ETS exposure. Sixty research reports published between 1996 and 2002 met the selection criteria. All of these investigations used brief investigator-developed, parental self-reports; no two studies used the same questionnaire. Reliability testing for questionnaires was lacking. Preliminary support for concurrent and construct validity is presented. Nursing studies are needed that lead to the development of ETS exposure questionnaires with established reliability and validity that measure both risk and protective mechanisms that occur in the infant environment.

The transition from high school to college begins a time of personal growth accompanied by normal developmental stressors. Some young women use smoking as a coping mechanism. The immediate danger for these students is nicotine dependence, with subsequent maternal and child morbidities. College provides an optimal time to break this devastating trajectory. With an understanding of psychosocial de-velopment, nurses who care for college-age women can effect changes in smoking behavior.

The purpose of this cross-cultural, correlational study was to evaluate two popular clinical/research assessment tools, the NCAST Teaching Scale and the Home Observation Measurement of the Environment (HOME) Inventory, as measures of infant health promotion behaviors for low-income, foreign-born Hispanic mothers in the United States. Based on the assumption that both measures tap universal attributes of the mother-infant relationship, it was hypothesized that maternal performance for the study group and a comparison group of U.S.-born, low-income mothers would be similar. Comparable performance on the NCAST Teaching Scale included a full range of scores, including the capacity to identify mothers most in need of clinical intervention. Study findings supported the clinical use of this assessment scale with mothers represented by the study sample. Consistently lower scores by the foreign-born Hispanic mothers on the HOME Inventory led to the conclusion that the instrument may not tap cultural universals in the mother-infant relationship.

PURPOSE: To examine the relationships among four maternal variables: 1) prenatal report of discipline expectant mothers received when they were children, 2) prenatal intentions for disciplining one's own child, 3) report of intended child discipline strategies when infant is 8 months old, and 4) observed maternal role sufficiency behaviors. DESIGN: Replication and extension study; 3-wave prospective longitudinal design. METHODS: The procedure consisted of prenatal clinic interviews in which women (N = 185) reported how their mothers handled specific child behaviors and how they intended to handle the same behaviors with their children. During a home visit when their babies were 8 months old, the mothers (n = 126) were again asked how they intended to handle these behaviors, and observations were made of maternal role sufficiency behaviors. Correlation and regression analyses were performed with data generated from an adaptation of the Ways of Handling Irritating Behavior scale, the NCAST Teaching Scale, and the HOME scale. RESULTS: A significant relationship was found between mothers' prenatal reports of discipline received as a child and prenatal reports of intentions for disciplining their own children. For mothers of infants, reported intentions for future child discipline strategies were predicted by their prenatal reports. Mothers with clinically at-risk scores on the NCAST Teaching Scale and HOME scale reported more intended harsh child discipline strategies than those not at-risk. CLINICAL IMPLICATIONS: Assessment for harsh, nonnurturing child discipline strategies during prenatal and well-baby health maintenance checks may assist in uncovering "red flags" for early intervention to reduce the risk of later child abuse and neglect. Language: en

Purpose: To identify infant health outcomes that have been empirically associated with environmental tobacco smoke (ETS) exposure in current international research literature. Methods: Reports of infant ETS exposure, obtained using computerized searches of CINAHL and Medline databases, were reviewed. Studies of infant health outcomes published between 1995 and 2000 were included if they met specific criteria including the selection of infant ETS exposure as a major study variable. Findings: The 10 studies in this integrative review of the literature were conducted in a variety of international health care settings. Positive associations were found between infant ETS exposure and gastroesophageal reflux, colic, sudden infant death syndrome, lower respiratory tract infections, and other infant morbidities. Parental self-reports were the predominant measures of ETS exposure. Maternal smoking was reported as a significant predictor of infant health outcomes. Conclusions: Nurses who care for mother-infant dyads in the first year of life are needed to support the development of a ‘gold standard’ for the measurement of ETS exposure that is reliable, valid, and economical. In the interim, the global nursing community may use the findings of these current studies as justification for directing infant health care resources to smoking cessation interventions specifically tailored to meet the needs of mothers who smoke.

Background: Early childhood obesity is a growing public health concern. Current infant feeding practice guidelines call for 1) no bottle-to-bed, 2) ) minimal juice consumption, 3) exclusive breastfeeding up to 4-6 months with continued breastfeeding up to one year, and 4) introduction of solid foods no earlier than 4-6 months infant age. However, associations between these recommended practices and weight-for-age in late infancy remain to be identified. Study Question: To what extent are bottle-to-bed behavior, late infancy juice consumption intensity, late infancy breastfeeding intensity, and early introduction to solid foods associated with weight-for-age among one year old infants?

The purpose of this study was to compare the incidence of empirically established prenatal risk factors for low birthweight (LBW) outcomes among two groups of low-income mothers: foreign-born Central American women and nonimmigrant, non-Hispanic women. Two hundred ninety-six women who were part of a larger study of maternal role sufficiency were included in the present study: 127 Central American women and 169 nonimmigrant, non-Hispanic women who identified themselves as Black (n = 59) or White (n = 110). Data were collected by public health nurses (PHNs) during home visits and by research nurses in prenatal health department clinics. Comparisons were made between the two groups in areas of demographic characteristics, prenatal health behaviors, and prenatal stressful life-events. Foreign-born Central American mothers were found to be less educated, more likely to be living with their partners, less likely to engage in prenatal health risk behaviors, and less likely to identify stressors in their lives. The initiation of prenatal PHN services by the target group was similar to the comparison group. Their rate of LBW deliveries did not reflect the protective effect often attributed to foreign-born Hispanic mothers. Findings are discussed in light of the paradox of LBW and Hispanic heritage. Recommendations for practice, clinical research, and public policy are also addressed.

To compare stressful events, including violent episodes, experienced by pregnant Salvadoran women with those experienced by two other groups of low-income, pregnant women living in the United States (non-Salvadoran Hispanics and non-Hispanics) and to examine the association between episodes of violence and drug or alcohol use among the three groups.Comparative, descriptive study.Public health prenatal clinics.One hundred four Salvadoran, 69 non-Salvadoran Hispanic, and 187 non-Hispanic pregnant women.Difficult Life Circumstances (DLC) scale and psychosocial history assessment.Statistically significant differences were found among the three groups in total DLC scores, F(2, 357) = 14.98, p.001; reported episodes of violence, F(2, 357 = 17.82, p.001; and drug or alcohol use, F(2, 357) = 6.33, p.001. A significant difference was found to the extent that alcohol or drug use accounted for the variance in violence among the three groups, F(3, 360) = 6.28, p.001.Cross-cultural comparisons revealed group differences in the number of stressful events, including episodes of violence and alcohol or drug use.A comparative, descriptive study was conducted among 104 Salvadoran, 69 non-Salvadoran Hispanic, and 187 non-Hispanic pregnant women concerning the stressful events including episodes of violence experienced. Furthermore, it also compared the relationship between episodes of violence and drug or alcohol use among the three groups. The measures used are the Difficult Life Circumstances scale and psychosocial history assessment. Results showed that stressful events were found to occur more frequently among the non-Hispanic mothers than among either Hispanic subgroups. However, cultural distinctions between Salvadoran and non-Salvadoran Hispanic mothers did not emerge. Alcohol and drug use differed significantly among the groups in this study. In conclusion, cross-cultural comparisons revealed group differences in the number of stressful events, including episodes of violence and alcohol or drug use.

In 1975 Meleis set forth a conceptual framework for nursing practice centered on the concepts of role insufficiency and role supplementation. Later, Millor introduced a parental role sufficiency model for nursing research in child abuse and neglect. Based on the works of Meleis and Millor, a nursing practice model is proposed that focuses on maternal role sufficiency. It includes assessment of prenatal characteristics, measurement of developmental and health-illness outcomes, and preventive role supplementation intervention.

Early exchanges between a mother and her infant are the foundation on which future human relationships are built. Maternal attachment studies underscore the significance of this early interactional phenomenon and suggest that the attachment process may have underpinnings in the prenatal period. This article presents an overview of recent findings in maternal attachment research. Special emphasis is placed on measurement instruments and findings associated with prenatal maternal attachment.

One who performs self-care activities for another is known as a dependent care agent, according to Orem. Attempts to study mothers' performance of self-care activities for children have been impeded by the lack of an instrument with which to measure dependent care agent performance. Findings based on a sample of 475 women indicate that the Dependent Care Agent (DCA) questionnaire developed in this study had a coefficient alpha of .91, with item-total correlations ranging from .27 to .63. Although Orem's expected dimensions of universal, developmental, and health deviation requisites were not represented in the factor analysis, individual requisites for self-care were clearly present.