Breastfeeding: The Illusion of Choice

Background Breastfeeding is frequently described as a woman\u27s decision, yet this choice is often illusionary owing to suboptimal social and structural supports. Despite the passage of the Patient Protection and Affordable Care Act (2010) that requires all qualifying employers to provide mothers “reasonable” break time and a private, non-bathroom space to express breast milk, the majority of women in the United States still do not have access to both accommodations. The Problem At least three issues may be influencing this suboptimal implementation at workplaces: 1) federal law does not address lactation space functionality and accessibility, 2) federal law only protects a subset of employees, and 3) enforcement of the federal law requires women to file a complaint with the United States Department of Labor. Recommendations To address each of these issues, we recommend the following modifications to current law: 1) additional requirements surrounding lactation space and functionality, 2) mandated coverage of exempt employees, and 3) requirement that employers develop company-specific lactation policies. Conclusions If the goal is to give women a real choice of whether to continue breastfeeding after returning to work, we must provide the proper social and structural supports that will allow for a truly personal decision. No mother should have to choose between breastfeeding her child and earning a paycheck

Using a Model to Design Activity-Based Educational Experiences to Improve Cultural Competency among Graduate Students

To improve the cultural competency of 34 students participating in graduate nutrition counseling classes, the Campinha-Bacote Model of Cultural Competence in the Delivery of Health Care Services was used to design, implement, and evaluate counseling classes. Each assignment and activity addressed one or more of the five constructs of the model, i.e., knowledge, skill, desire, encounters, and awareness. A repeated measure ANOVA evaluated pre- and post-test cultural competence scores (Inventory for Assessing the Process of Cultural Competence among Healthcare Professionals). The overall cultural competence score significantly improved (p \u3c 0.001) from “culturally aware” (68.7 at pre-test) to “culturally competent” (78.7 at post-test). Students significantly improved (p \u3c 0.001) in four constructs of the model including awareness, knowledge, skill, and encounter. Factor analysis indicated that course activities accounted for 83.2% and course assignments accounted for 74.6% of the total variance of cultural competence. An activity-based counseling course encouraging self-evaluation and reflection and addressing Model constructs significantly improved the cultural competence of students. As class activities and assignments aligned well with the Campinha-Bacote Model constructs, the findings of this study can help guide health educators to design effective cultural competence training and education programs

Veggiecation: A Novel Approach to Improve Vegetable Consumption Among School-Aged Children

Children\u27s general preference for sweeter foods and aversion to bitter vegetables is explained partly by fear of new food and social and cultural influences. Reluctance to eat new foods is related to unfavorable facial expressions and is often learned from the child\u27s family, social circle, and culture.1 Researchers report that the fruit and vegetable consumption of children 6–12 years of age is associated with the accessibility and availability.2 School-based interventions that combine classroom curricula, parental, and nutrition service components show the greatest promise for fruit and vegetable promotion among children

Examination of Obesity Risk-Reduction Behaviors in Chinese Americans

The purpose of this survey research was to examine the psychosocial characteristics of obesity risk-reduction behaviors in Chinese Americans. Obesity risk-reduction behaviors and psychosocial variables derived from the Theory of Planned Behavior and the Health Belief Model were measured. A questionnaire was administered to a convenience sample of 300 young adult Chinese Americans residing in the New York metropolitan area. Results suggest that when communicating messages to low adopters of health behaviors, promoting positive attitudes and social influences for healthful eating should be emphasized. High behavior adopters may benefit from strategies to maintain self-efficacy to enact health-related behaviors conducive to obesity prevention

Alternative Hospital Gift Bags and Breastfeeding Exclusivity

The type of gift bags given to new mothers at the time of discharge from the hospital can influence their confidence in breastfeeding. Most hospitals in the US continue to distribute commercial gift bags containing formula samples despite the reported negative influence of commercial bags on the duration of breastfeeding. This study compared breastfeeding outcomes in women receiving three different kinds of gift bags at discharge. A prospective intervention study was conducted during the 2009-2010 in New Jersey. Three breastfeeding cohorts were recruited and assigned to three groups: COMMERCIAL received discharge bags containing formula samples, BF-INFO received breastfeeding information and supplies, and PUMP received breastfeeding information/supplies plus a manual breast pump. Follow-up contacts were at 2, 4, and 12 postpartum weeks to determine breastfeeding outcome. The mean duration of exclusive (EBF) and partial breastfeeding were compared between groups using ANOVA. A total of 386 participants completed the study. The mean EBF duration (weeks) in the PUMP (n=138, 8+/-4.86 ) and BF-INFO (n=121, 7.87+/-4.63) were significantly longer (P\u3c0.01) than COMMERCIAL (n=127, 6.12+/-4.49). The rate of EBF through 12 weeks in PUMP was most consistent. The mean duration of partial breastfeeding showed similar results: significantly longer in PUMP and BF-INFO than COMMERCIAL (P\u3c0.01)

Investigating obesity risk-reduction behaviours and psychosocial factors in Chinese Americans

AIM: The purpose of this research was to examine the attitudes, beliefs, and behaviors related to obesity risk reduction in Chinese Americans. METHODS: A questionnaire was administered to a convenience sample of 300 US-born and foreign-born Chinese Americans residing in the New York metropolitan area, ranging from 18 to 40 years of age. Obesity risk reduction behaviors and psychosocial variables derived from the Theory of Planned Behaviour and Health Belief Model were measured. Acculturation was assessed using a modified Suinn-Lew Asian Self-Identity Acculturation Scale. Frequency distributions were delineated and stepwise regression analyses were analyzed for different acculturation groups. RESULTS: 65% of the respondents were female and the mean age of the sample was 26 years. Respondents indicated the most commonly practiced behavior to be eating home-cooked meals instead of restaurant-prepared foods. Perceived barriers to adopting obesity risk-reduction behaviors included the convenience of consuming fast foods, cost, lack of time to prepare home-cooked meals, and the physical environment of unhealthy foods. In predicting intention to perform obesity risk-reduction behaviors, the attitude was significant for \u27Western-identified\u27 individuals. In \u27Asian-identified\u27 individuals, perceived behavioral control, self-efficacy and perceived benefits were salient. CONCLUSIONS: Nutrition educators working with Chinese Americans need to address self-efficacy in preparing plant-based, home-cooked meals and making healthy choices at fast-food restaurants with portion control. Concrete and perceived barriers such as lack of time and convenience need to be addressed in nutrition education interventions. Educators need to identify new channels and media outlets to disseminate practical, easy-to-implement behaviors for obesity risk reduction that are socially acceptable

The Effect of Active Video Games on the Heart Rate of Older Adults

Background: Heart rate is used as a health biomarker. This aim of this study was to investigate the effects of playing active video games on the heart rate of older adults, in comparison to the heart rate after common table recreational activity. Methods: An experimental study with 40 participants was conducted: a control group (n=20) participated in common Pokeno® card games; an experimental group (n=20) played WiiTM bowling. The participants’ pre- and post-activity heart rates were measured and compared between and within groups using t-tests. Results: The findings signified an 11.9% increase (p Conclusions: The inclusion of active video games in older adults’ recreational activities can increase their daily activity level to bring long-term health benefits

A Pilot Study for Plant the Seed: A Nutrition Education Program Using Local Food Environment to Put Theory into Action

The purpose of this study is to implement Plant the Seed, a garden-based nutrition education program designed to reconnect children with locally grown food, food environments of the past and present, and the benefits of eating seasonal foods. The pilot study investigates the environmental context and theory variables known to influence healthy food choice behavior. Social Cognitive Theory (SCT) provided a framework for the program’s curriculum and evaluation. The target audience is middle school students. Plant the Seed is a two-part program. In Part 1 (classroom), students participate in practical, interactive activities based on specific educational objectives that target theory mediators. In Part 2 (field trip), students rotate through the community farm, kitchen herb garden, and historic kitchen to engage in hands-on program activities. Pretest/posttest evaluation compared to control and intervention students from two schools measured program effectiveness. Intervention school students (n = 16) improved behavioral intention (3.40 vs 3.53, P = 0.34), historical social norm (3.40 vs 3.79, P = 0.03), and outcome expectations (3.91 vs 4.19, P = 0.03). No change in variables among control students (n = 10). Plant the Seed had a positive impact on factors associated with healthy eating behavior. This program demonstrates how to effectively engage community resources, to promote the development and implementation of gardening environments that create hands-on opportunities for children to become directly connected to local food production, to learn about the environmental benefits of eating locally grown foods and to allow children to have access to a positive, sustainable food environment. Plant the Seed can serve as a model for future theory and garden-based nutrition intervention programs

Predicting Intentions to Continue Exclusive Breastfeeding for 6 Months: a Comparison Among Racial/Ethnic Groups

The purpose of this study was to explore how mothers of different races/ethnicities make decisions to continue exclusive breastfeeding (EBF) for 6 months under the Theory of Planned Behavior. Participants were recruited from hospitals and WIC clinics in Central Indiana and Southern New Jersey from 2008 to 2009. Mothers (N = 236: 93 non-Hispanic African American, 72 non-Hispanic white, 71 Hispanic/Latina) completed a self-administered questionnaire that measured theoretical constructs and beliefs related to their intention to practice EBF for 6 months. Intentions to continue EBF for 6 months were similar (P = 0.15) across racial/ethnic groups. Significant proportions of the intention (P \u3c 0.001) were explained by the three theoretical constructs (attitude, subjective norm, and perceived behavioral control). The relative importance of each construct in predicting the intention varied by group. The most influential predictors (P \u3c 0.001) were the attitude for white mothers, the subjective norm for African American mothers, and perceived behavioral control for Latina mothers. Latent beliefs strongly associated with attitude in white mothers were ‘bonding with the baby’ and ‘easy feeding.’ Beliefs held by family members and the general public contributed to the subjective norm of African American mothers. Perceived behavioral control in Latina mothers was highly correlated with ‘pumping breast milk’. Development of policy and intervention programs that focus on shaping strong predictors and beliefs within racial/ethnic groups could reduce disparities in EBF rates and establish EBF for 6 months as a cultural norm

Validation of a Short Questionnaire to Assess Mothers’ Perception of Workplace Breastfeeding Support

The purpose of this study was to create and establish the validity of a short questionnaire to measure mothers\u27 perceived support for breastfeeding from the workplace. The items in the workplace breastfeeding support scale (WBSS) were derived from a literature review. The scale was self-administered in central Indiana during the fall of 2005 to a convenience sample of 66 volunteers who were primiparous, 6 to 12 months postpartum, worked outside the home and had initiated breastfeeding prior to the survey. Internal consistency (α) and split-half reliability (r) test and factor analysis were done to establish reliability and construct validity of the scale. The WBSS showed acceptable reliability (α=.77, r=0.86). Content validity was established by review using a panel of experts. Four distinct constructs of the scale were identified that accounted for 62.1% of the total variability of the scale: technical, environmental, facility, and peer support, thus establishing construct validity of the scale. Lactation consultants and worksite lactation program planners can use the WBSS to help mothers returning to work and to assess the needs for improvement of support programs