Changes in Breastfeeding Attitudes in a Metropolitan Community in Tennessee.

BACKGROUND: The Southern United States has low breastfeeding rates, particularly among African Americans. Breastfeeding rates are influenced by community attitudes and norms. OBJECTIVE: This study aimed to examine changes in breastfeeding attitudes and demographic factors related to these attitudes. METHODS: Cross-sectional data from a community-based survey, repeated annually from 2004 to 2008, were analyzed. Univariable analysis examined trends over time and log binomial regression estimated the strength of the association between year of the survey, demographic factors, and outcome responses related to the survey questions. RESULTS: After adjusting for sex, race, marital status, age, and education, compared to 2004, 2008 respondents were 26% more likely to rate breastfeeding as extremely important compared to formula feeding (prevalence ratio [PR] = 1.26; 95% confidence interval [CI], 1.10-1.43). Similarly, 2008 respondents were 29% more likely to rate the importance of breastfeeding for long-term health as extremely important (PR = 1.29; 95% CI, 1.14-1.46). Comfort levels with breastfeeding outside the home also increased. Respondents to the 2008 survey were more likely to report that they were comfortable with a mother breastfeeding in their workplace (PR = 1.20; 95% CI, 1.11-1.31) and in a mall or restaurant (PR = 1.15; 95% CI, 1.06-1.26). After controlling for demographic factors, there were no significant differences in responses between African Americans and other races. CONCLUSION: Despite significantly lower breastfeeding rates among African Americans, this analysis revealed significant positive changes in attitudes regarding breastfeeding between 2004 and 2008, regardless of race. These changes in attitude coincided with increased breastfeeding initiation rates, suggesting that federal, state, and local breastfeeding promotion efforts had an effect.

Comparison of FIMR programs with other perinatal systems initiatives.

OBJECTIVES: While the goals of fetal and infant mortality review (FIMR) programs and other perinatal systems initiatives (PSI) are similar, our knowledge of the processes they use to meet their goals is limited. This article compares a nationwide sample of FIMR programs and PSIs with regard to their roles and involvement in performance of eight essential maternal and child health services (EMCHS) as part of a national evaluation of FIMR. METHODS: The evaluation was a cross-sectional observational study in which geographic units were sampled based on the presence or absence of a FIMR or other PSI using FIMRs as the sampling frame of reference. Telephone interviews were conducted with 74 FIMR and 62 PSI directors in the sampled communities. RESULTS: Both programs performed several of the essential MCH services. FIMRs were significantly more likely to be located in a local health department than were PSIs. The results of multiple logistic regression analyses indicate that the performance of the essential MCH services by the programs was increased when both a FIMR and a PSI were in the community. FIMR programs alone had reduced odds of performing several essential MCH services than did PSIs alone. The findings also indicate that performance of some essential MCH services was reduced for FIMR programs and PSIs located in a local health department. CONCLUSIONS: Comparisons between FIMR and other PSIs suggest that both programs are currently engaged in diverse efforts to attain their goal of improving the health and health care delivery system for pregnant women, infants, and their families. FIMR programs appear to be more circumscribed in their activities than PSIs, but the presence of both programs in a community appears to enhance the programs' performance of the essential MCH services.

The relation of FIMR programs and other perinatal systems initiatives with maternal and child health activities in the community.

OBJECTIVES: To evaluate the association of the presence of a fetal and infant mortality review (FIMR) program, other perinatal systems initiative (PSI), or both in a community with the performance of essential maternal and child health (MCH) services by local health departments (LHDs). METHODS: Data were obtained from telephone interviews with professionals from LHDs across the United States. Logistic regression was used to estimate the odds of a LHD conducting each essential MCH service in communities with and without FIMR programs or with and without PSIs, adjusted for geographic area. RESULTS: Of the 193 communities in the sample, 41 had only a FIMR program, 36 had only a PSI, 47 had both programs, and 69 had neither. The presence of a FIMR was related to greater performance of essential MCH services in LHDs in six areas: data assessment and analysis; client services and access; quality assurance and improvement; community partnerships and mobilization; policy development; and enhancement of capacity of the health care work force. Similar findings were noted for the same broad essential services for PSIs. The comparisons of LHDs in FIMR and non-FIMR communities, however, showed greater involvement of communities with a FIMR program in essential MCH services related to data collection and quality assurance than were found for comparisons of LHDs in communities with and without a PSI. The presence of a PSI was uniquely associated with conducting needs assessments for pregnant women and infants, participation in coalitions for infants, promoting access for uninsured women to private providers and involving local officials and agencies in health plans for both populations. When both programs were present, LHDs had a greater odds of engaging in essential MCH services related to assessment and monitoring of the health of the population, reporting on progress in meeting the health needs of pregnant women and infants, and presenting data to local political officials than when either program alone was in the community. CONCLUSIONS: Local health departments in communities with FIMR programs or PSIs appear to be more likely to conduct essential MCH services in the community. Some of these relations are unique to FIMR, particularly for data collection and quality assurance services, and some are unique to PSIs, for example those that involve interaction with other community agencies or groups. Performance of the essential MCH services also appears to be enhanced when both a FIMR program and a PSI are present in the community.