Effect on Baby-Friendly Hospital Steps When Hospitals Implement a Policy to Pay for Infant Formula

Background: The Baby-Friendly Hospital Initiative requires hospitals to pay market price for infant formula. No studies have specifically examined the effect of hospitals paying for infant formula on breastfeeding mothers' exposure to Baby-Friendly steps. Objectives: To investigate the effect of hospitals implementing a policy of paying for infant formula on new mothers' exposure to Baby-Friendly steps and examine the effect of exposure to Baby-Friendly steps on breastfeeding rates. Methods: We used a repeated prospective cohort study design. We recruited 2 cohorts of breastfeeding mother-infant pairs (n = 2470) in the immediate postnatal period from 4 Hong Kong public hospitals and followed them by telephone up to 12 months postpartum. We assessed participants' exposure to 6 Baby-Friendly steps by extracting data from the medical record and by maternal self-report. Results: After hospitals began paying for infant formula, new mothers were more likely to experience 4 out of 6 Baby-Friendly steps. Breastfeeding initiation within the first hour increased from 28.7% to 45%, and in-hospital exclusive breastfeeding rates increased from 17.9% to 41.4%. The proportion of mothers who experienced all 6 Baby-Friendly steps increased from 4.8% to 20.5%. The risk of weaning was progressively higher among participants experiencing fewer Baby-Friendly steps. Each additional step experienced by new mothers decreased the risk of breastfeeding cessation by 8% (hazard ratio = 0.92; 95% CI, 0.89-0.95). Conclusion: After implementing a policy of paying for infant formula, breastfeeding mothers were exposed to more Baby-Friendly steps, and exposure to more steps was significantly associated with a lower risk of breastfeeding cessation.postprin

Effect of a hospital policy of not accepting free infant formula on in-hospital formula supplementation rates and breast-feeding duration

OBJECTIVE: To investigate the effect of public hospitals in Hong Kong not accepting free infant formula from manufacturers on in-hospital formula supplementation rates and breast-feeding duration. DESIGN: Prospective cohort study. SETTING: In-patient postnatal units of four public hospitals in Hong Kong. SUBJECTS: Two cohorts of breast-feeding mother-infant pairs (n 2560). Cohort 1 (n 1320) was recruited before implementation of the policy to stop accepting free infant formula and cohort 2 (n 1240) was recruited after policy implementation. Participants were followed prospectively for 12 months or until they stopped breast-feeding. RESULTS: The mean number of formula supplements given to infants in the first 24 h was 2·70 (sd 3·11) in cohort 1 and 1·17 (sd 1·94) in cohort 2 (P<0·001). The proportion of infants who were exclusively breast-fed during the hospital stay increased from 17·7 % in cohort 1 to 41·3 % in cohort 2 (P<0·001) and the risk of breast-feeding cessation was significantly lower in cohort 2 (hazard ratio=0·81; 95 % CI 0·73, 0·90). Participants who non-exclusively breast-fed during the hospital stay had a significantly higher risk of stopping any or exclusive breast-feeding. Higher levels of formula supplementation also increased the risk of breast-feeding cessation in a dose-response pattern. CONCLUSIONS: After implementation of a hospital policy to pay market price for infant formula, rates of in-hospital formula supplementation were reduced and the rates of in-hospital exclusive breast-feeding and breast-feeding duration increased.postprin

Self-reported waist circumference: A screening tool for classifying children with overweight/obesity and cardiometabolic risk factor clustering

Objectives: The objectives of this study were twofold - (i) to assess the agreement between self-reported waist circumference (SRWC) and assessor measured waist circumference (MWC) and (ii) to evaluate the diagnostic ability of SRWC for classifying (i) a clustering of cardiometabolic risk factors (CMRFs) and (ii) overweight/obese status in Hong Kong Chinese children aged 6-18 years. Methods: A cross-sectional study with cluster random sampling was conducted. A self-administrated questionnaire, which included demographic data, body weight, body height and waist circumference, was given to children to bring home for completion. Children were asked to return the questionnaire and fast themselves for at least 8 h on the day of the survey. Anthropometric measurements and blood pressure were taken by trained research staff and fasting blood samples were collected for measurements of fasting plasma glucose, total cholesterol, triglyceride, high-density lipoprotein cholesterol and low-density lipoprotein cholesterol. Results: A total of 515 boys and 711 girls were included in the data analysis. Agreement between SRWC and MWC was assessed by intra-class correlation coefficient and it ranged from 0.77 to 0.87. The ability of sex-specific SRWC values to classify children with a clustering of CMRFs and overweight/obesity exhibited moderately high to high sensitivity and specificity, and the area under the receiver operating characteristics ranged from acceptable to excellent (from 0.76 to 0.84). Conclusions: SRWC has good agreement with MWC and could be used as a screening tool to classify children with a clustering of CMRFs and overweight/obesity status in Hong Kong Chinese children. © 2012 The Authors Pediatric Obesity © 2012 International Association for the Study of Obesity.link_to_subscribed_fulltex

Can self-reported waist circumference be used as a screening tool for identifying children with cardiovascular risk and overweight/obese status?

Objective: The objectives of this study were two-fold, (1) to validate the reliability of self-reported waist circumference (SRWC) against assessor measured waist circumference (MWC) and (2) to evaluate the diagnostic ability of SRWC for identifying (i) a clustering of cardiovascular risk factors (CVRFs) and (ii) overweight/obese status in Hong Kong Chinese children aged 6–18 years. Methods: A cross-sectional study with cluster random sampling was conducted. A self-administrated questionnaire which included demographic data, anthropometric measurement values such as body weight, body height, and waist circumference was given to children to bring home for completion. Children were asked to return the questionnaire and fast themselves for at least 8 hours on the day of the survey. Anthropometric measurements, blood pressure were taken by trained research staff and fasting blood samples were collected for measurements of fasting plasma glucose, total cholesterol, triglyceride, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol. Results: A total of 515 boys and 711 girls entered data analysis. The reliability of SRWC was assessed by ICC ranged from 0.77 to 0.87. The gender-specific test based on the SRWC values exhibited moderately high to high sensitivity and specificity and the area under the receiver operating characteristics (AUC-ROCs) ranged from acceptable to excellent (from 0.76 to 0.84) in identifying children with a clustering of CVRFs and overweight/obese. Conclusion: SRWC demonstrates high reliability in detecting MWC and could be an effective screening tool for identifying children with a clustering of CVRFs and overweight/obesity status in Hong Kong Chinese children.The CUHK-Mayo Clinic-Asia Cardiovascular Summit, Hong Kong, 26 - 27 March 2011. In International Journal Of Cardiology, 2011, v. 147 n. S1, p. S30-S3

Self-reported body weight and height: an assessment tool for identifying children with overweight/obesity status and cardiometabolic risk factors clustering

Body mass index (BMI) is commonly used for assessing body fat. Self-reported body weight and height derived BMI (SRDBMI) is a simple, low cost and non-invasive assessment tool and it may be a useful self-reported assessment tool to monitor the prevalence of overweight/obesity in community settings and for epidemiological research. We assessed the agreement of BW and BH between assessor measured and child self-reported values and evaluated the diagnostic ability of SRDBMI to identify children with overweight/obesity status and cardiometabolic risk factors (CMRFs) clustering. A cross-sectional study was conducted in school settings using a cluster sampling method. A total of 1,614 children aged 6-18 years were included in the analysis. Children were given a questionnaire to complete at home prior to the anthropometric measurements and blood taking at the schools. There was almost perfect agreement on BW, BH and BMI between self-reported and measured values [intraclass correlation coefficients ranged from 0.93 (95% CI: 0.93-0.94) to 0.99 (95% CI: 0.98-0.99)]. About half of the children reported their BW and BH absolute values within 1 kg and 2 cm of measured values, respectively. The SRDBMI demonstrated good diagnostic ability for identifying children with overweight/obesity status (sensitivity, specificity, positive and negative predictive values ranged from 0.83 to 0.98) and CMRFs clustering (AUC-ROCs values of BMI between measured and self-reported values were close ranging from 0.85 to 0.89). Self-reported BW and BH demonstrated almost perfect agreement with measured values and could substantially identify children with overweight/obesity status and CMRFs clustering. © 2012 Springer Science+Business Media, LLC.link_to_subscribed_fulltex

Measurement of pubertal status with a Chinese self-report Pubertal Development Scale

This cross sectional study of 290 Chinese children aged 8-18 years, evaluated a Chinese version of the self-reported Pubertal Development Scale (PDS) against both raters' and self-reported Tanner assessment of pubertal status. Children completed both the self-reported PDS and self-reported Tanner pubertal questionnaire prior to physical examination through visual depiction by a same gender rater. Puberty Category Scores (PCS) which were derived from the PDS, was used to categorize children into one of five pubertal development stages. Tanner derived composite stage (TDCS) which was derived from the Tanner pubertal questionnaires, was used to compare with PCS to obtain the inter-rater agreement. Moderately high agreements were found between raters' TDCS and PCS in girls [weighted kappa (WK) 0.57 (0.44, 0.71); Kendallτ-b 0.60 (0.51, 0.69)] and in boys [WK 0.58 (0.47, 0.69), Kendallτ-b 0.50 (0.38, 0.62)]. The correlation between selfreported PDS and rater's assessment was substantial in girls [Kendallτ-b 0.61 (0.54, 0.69)] and moderate in boys [Kendallτ-b 0.49 (0.38, 0.61)]. The Hong Kong Chinese children and adolescents were able to reliably estimate their own sexual maturation status (SMS) using a Chinese version PDS. This instrument may be useful in epidemiological studies when cost, privacy and other concerns preclude the use of other SMS assessment tools. © Springer Science+Business Media, LLC 2010.link_to_subscribed_fulltex