Breastfeeding, Parenting, and Infant Attachment Behaviors.

Objectives Infants and toddlers need secure attachments in order to develop the social competence required to successfully navigate later peer and adult relationships. Breastfeeding is a parenting factor that has been associated with child emotional development-specifically the attachment between children and their mothers. Yet, this link may simply be the result of other parenting behaviors that are associated with breastfeeding. Thus, our objective is to examine whether the link between infant attachment behaviors and breastfeeding endures when accounting for a broad array of in-depth measures of parenting. Methods We use the Early Childhood Longitudinal Study of children from 9 months to 2 years of age collected by the National Center for Education Statistics. Using Ordinary Least Squares regression, data analyses examine the association between the Toddler Attachment Sort-45 (TAS-45) measures of toddler-parent attachment (infant attachment security and temperamental dependency) and breastfeeding practices. We also examine individual items of the TAS-45 to isolate specific attachment behaviors that have the strongest associations with breastfeeding. Results We find an enduring link between children who are predominantly breastfed for six or more months and infant attachment security. However, we find no evidence that breastfeeding is linked to a child's temperamental dependency. Of the nine items used to examine infant attachment behaviors, we find that breastfed children are rated as having slightly higher scores on two measures ("warm and cuddly," "cooperative") and lower scores on one measure ("demanding/angry"). Conclusions for Practice Breastfeeding has an important link to the child's use of their caregiver as a secure base for exploration and a place of comfort when distressed (infant attachment security). Yet, breastfeeding does not appear to reduce a child's temperamental dependency or level of clinginess as measured by how demanding, fussy or distressed the child becomes when separated.

Sad and lonely: body dissatisfaction among adolescent girls.

Purpose To further understand the association between body dissatisfaction and sadness/loneliness among adolescent girls, we examine how this association, as reported by pre-teen and adolescent girls, is mediated or moderated by the quality of peer and family relationships. Methods Our data are from the Health Behavior of School-Aged Children 2009-2010, a nationally representative survey of school-aged children in the US. We analyze a sample of 5658 girls in Grades 5 through 10. We utilize ordinary least squares (OLS) regression techniques and adjust for the complex sampling design. We explore how the link between body dissatisfaction and sadness/loneliness is mediated or moderated by family and peer relationships and also include controls for age, race, media exposure, and physical health. Results We find that body dissatisfaction is predictive of sadness/loneliness for girls at all grade levels and that the quality of peer and family relationships mediates 27%-38% of this association, particularly among early adolescent girls. Positive peer relationships also moderate or help mitigate the association between body dissatisfaction and sadness/loneliness among pre-teens. Conclusion Our findings underscore the association between body dissatisfaction and sadness/loneliness among early adolescent girls. In addition, our results highlight the importance of quality peer and family relationships in terms of how girls think about their bodies and respond emotionally to them. To evaluate feelings of sadness and loneliness among early adolescent girls, health care professionals need to consider not only body dissatisfaction but also the context of peer and family relationships.

Physical and social factors associated with early adolescent headache and stomachache pain.

PURPOSE: Approximately one third of adolescents in the United States report experiencing frequent headaches and stomachaches. We examined the association of psychosocial and physical factors with the report of weekly headaches or stomachaches using a representative sample of US teens. METHODS: Data for this project are from the survey of Health Behavior in School-Aged Children (HBSC), 2005-2006, a nationally representative sample of students in grades 6-10 in the United States. The total sample includes 12,070 students aged 11-17. Using logistic regression we modeled chronic headache and stomachache separately with the same set of physical predictors (dieting and substance use habits) and psychosocial predictors (attitudes towards self-image, peers, and family) along with demographic controls. RESULTS: Almost 20% of respondents experienced headaches weekly, and 12% experienced abdominal pain. Both physical and psychosocial factors were predictive of chronic symptoms. Increased substance usage and unhealthy eating practices were associated with the likelihood of experiencing both headaches and stomachaches. Negative self-image, family relationships, and school life were also predictive of symptom frequency. CONCLUSION: Headaches and stomachaches are associated with poor eating and substance use habits, as well as problems with self-image or social relationships among adolescents. For health care professionals, a holistic approach is needed to effectively address symptoms and prevent long-term health problems.

Caregiver Decision-Making: Household Response to Child Illness in sub-Saharan Africa.

We draw upon a framework outlining household recognition and response to child illness proposed by Colvin and colleagues (2013) to examine factors predictive of treatment sought for a recent child illness. In particular, we model whether no treatment, middle layer treatment (traditional healer, pharmacy, community health worker, etc.), or biomedical treatment was sought for recent episodes of diarrhea, fever, or cough. Based on multinomial, multilevel analyses of Demographic and Health Surveys from 19 countries in sub-Saharan Africa, we determine that if women have no say in their own healthcare, they are unlikely to seek treatment in response to child illness. We find that women in sub-Saharan Africa need healthcare knowledge, the ability to make healthcare decisions, as well as resources to negotiate cost and travel, in order to access biomedical treatment. Past experience with medical services such as prenatal care and a skilled birth attendant also increase the odds that biomedical treatment for child illness is sought. We conclude that caregiver decision-making in response to child illness within households is critical to reducing child morbidity and mortality in sub-Saharan Africa.

Factors associated with cognitive achievement in late childhood and adolescence: the Young Lives cohort study of children in Ethiopia, India, Peru, and Vietnam.

BACKGROUND: There is a well-established link between various measures of socioeconomic status and the schooling achievement and cognition of children. However, less is known about how cognitive development is impacted by childhood improvements in growth, a common indicator of child nutritional status. This study examines the relationship between socioeconomic status and child growth and changes in cognitive achievement scores in adolescents from resource-poor settings. METHODS: Using an observational cohort of more than 3000 children from four low- and middle-income countries, this study examines the association between cognitive achievement scores and household economic, educational, and nutritional resources to give a more accurate assessment of the influence of families on cognitive development. A composite measure of cognition when children were approximately 8, 12, and 15 years of age was constructed. Household factors included maternal schooling, wealth, and children's growth. RESULTS: A positive and statistically significant relationship between household factors and child cognition was found for each country. If parents have more schooling, household wealth increases, or child growth improves, then children's cognitive scores improve over time. Results for control variables are less consistent. CONCLUSION: Our findings suggest there is a consistent and strong association between parental schooling, wealth, and child growth with child cognitive achievement. Further, these findings demonstrate that a household's ability to provide adequate nutrition is as important as economic and education resources even into late childhood and adolescence. Hence, efforts to improve household resources, both early in a child's life and into adolescence, and to continue to promote child growth beyond the first few years of life have the potential to help children over the life course by improving cognition.

Breastfeeding, parenting, and early cognitive development.

OBJECTIVE: To explain why breastfeeding is associated with children's cognitive development. STUDY DESIGN: By using a nationally representative longitudinal survey of early childhood (N = 7500), we examined how breastfeeding practices, the early introduction of solid foods, and putting an infant to bed with a bottle were associated with cognitive development across early childhood. We also explored whether this link can be explained by parenting behaviors and maternal education. RESULTS: There is a positive relationship between predominant breastfeeding for 3 months or more and child reading skills, but this link is the result of cognitively supportive parenting behaviors and greater levels of education among women who predominantly breastfed. We found little-to-no relationship between infant feeding practices and the cognitive development of children with less-educated mothers. Instead, reading to a child every day and being sensitive to a child's development were significant predictors of math and reading readiness outcomes. CONCLUSIONS: Although breastfeeding has important benefits in other settings, the encouragement of breastfeeding to promote school readiness does not appear to be a key intervention point. Promoting parenting behaviors that improve child cognitive development may be a more effective and direct strategy for practitioners to adopt, especially for disadvantaged children.

Adolescent obesity and life satisfaction: perceptions of self, peers, family, and school.

This study contributes to research on adolescent life satisfaction by considering its association with body weight, as mediated by perceptions of self, peers, family, and school. Data from the Health Behaviors in School-Age Children Survey (2001-2002) and OLS regression techniques are used to examine the association between body weight and life satisfaction. We also model these relationships by gender. Results indicate lower life satisfaction among adolescents that are overweight and obese relative to healthy weight youth, and that most of the negative association operates through perceptions of self, peers, parents, and school. We find little or no gender difference in the association between body weight and perceptions of self, peers, parents, and school; however, we find perceptions of body weight are generally more strongly associated with low life satisfaction among girls compared to boys.

HIV/AIDS related knowledge and perceived risk associated with condom use among adolescents in Uganda.

While considerable attention has been paid to sexual behaviors among HIV high-risk populations in Africa, few studies have looked at the adolescent population. Using data from the 2004 National Survey of Adolescents in Uganda, logistic regression models were fitted to examine the odds that HIV/AIDS related knowledge and perceived risk of HIV infection are associated with condom use among adolescents. After including demographic measures, findings indicated that correct knowledge of condom use, as well as positive attitudes towards the use of condoms are associated with the likelihood that adolescents used condoms. Self assessment of the risk of HIV infection was not predictive of condom use, nor was knowing someone with AIDS. These findings further emphasize the need to encourage condom use and help protect adolescents at risk of HIV infection.

The wired generation: academic and social outcomes of electronic media use among university students.

Little is known about the influence of electronic media use on the academic and social lives of university students. Using time-diary and survey data, we explore the use of various types of electronic media among first-year students. Time-diary results suggest that the majority of students use electronic media to multitask. Robust regression results indicate a negative relationship between the use of various types of electronic media and first-semester grades. In addition, we find a positive association between social-networking-site use, cellular-phone communication, and face-to-face social interaction.

Staying out of trouble: intentions of young male offenders.

During the fall of 2005, we interviewed a sample of 103 young men aged 18 to 21 imprisoned at a young offender's prison in England. Drawing on the theory of planned behavior, as well as the theory of cognitive transformation, our purpose was to investigate prisoners' reports of their likelihood of reoffending following release from prison. Primary explanatory factors included measures of attitudes, behavioral control, and subjective norms. Attitudes measured inmates' plans of what they would do following release. Behavioral control variables included indicators of life control and self-efficacy. Subjective norms measured the number of peers inmates reported ever being imprisoned. Prison activities and background characteristics were also modeled. The data were analyzed using regression techniques and structural equation modeling. Intentions to stay out of trouble were most strongly associated with self-efficacy and the number of imprisoned friends reported. Intentions were also associated with the specificity of postrelease plans and life control. Offenders' feelings of life control were stronger among those who had more frequent contact with family members and friends while in prison. Employment prior to prison and family relationships were predictive of contacts with family and friends in prison. Specific policies consistent with our findings include encouragement of contact with family members and friends. In addition, interventions that help offenders make specific plans and increase feelings of control and self-efficacy have promise in helping released offenders successfully complete the transition from prison to the community.

HIV/AIDS related knowledge and perceived risk associated with condom use among adolescents in Uganda

While considerable attention has been paid to sexual behaviors among HIV high-risk populations in Africa, few studies have looked at the adolescent population. Using data from the 2004 National Survey of Adolescents in Uganda, logistic regression models were fitted to examine the odds that HIV/AIDS related knowledge and perceived risk of HIV infection are associated with condom use among adolescents. After including demographic measures, findings indicated that correct knowledge of condom use, as well as positive attitudes towards the use of condoms are associated with the likelihood that adolescents used condoms. Self assessment of the risk of HIV infection was not predictive of condom use, nor was knowing someone with AIDS. These findings further emphasize the need to encourage condom use and help protect adolescents at risk of HIV infection (Afr J Reprod Health 2011; 15[1]: 57-63)

Are US mothers meeting the Healthy People 2010 breastfeeding targets for initiation, duration, and exclusivity? The 2003 and 2004 National Immunization Surveys.

Using data from the National Immunization Surveys (2003 and 2004), the authors model the influence of child, maternal, and state- or metropolitan-level factors on the initiation, duration, and exclusivity of breastfeeding to determine the characteristics of groups meeting the Healthy People 2010 targets. Analyses indicate that only children of college graduates meet the targets for breastfeeding at initiation, 6 months, and 12 months; no groups meet the target for exclusive breastfeeding. Results indicate a low prevalence of breastfeeding among children of single mothers, less educated mothers, participants in the Women, Children, and Infants program, and those living in nonwestern states and in areas of high newborn risk. Hispanic children, children of college graduates, and children living in the West consistently have higher odds of breastfeeding. Only the prevalence of breastfeeding early postpartum is near the Healthy People 2010 target of 75%, the percentages for 6 or 12 months and exclusive breastfeeding are well below.

Hearing native voices: contraceptive use in Matemwe Village, East Africa.

Although fertility declines have been documented in various parts of Africa, fertility rates remain high in Tanzania. Widespread resistance to modern contraception is one factor associated with high fertility in Tanzania. The aim of this study was to identify cultural barriers to modem contraceptive use in Matemwe village, Zanzibar. In May 2003, more than 50 in-depth interviews were conducted with community leaders, health care workers and couples in Matemwe. Despite free and easy access to contraceptives, only 2% of Matemwe women participated in the village's family planning programme. Several factors were found to influence contraceptive use, including strong Muslim beliefs, male dominance over females (especially in polygynous relationships), and limited exposure to modern ideas via education and travel. Interviews indicated that in order to lower fertility in Matemwe, cultural barriers to family planning must be confronted. Successful implementation of a family planning programme hinges on the ability of policymakers to integrate modern ideas about contraception with Matemwe's traditional religious and political culture.

Cross-national variation in family influences on child health.

Drawing on the family process literature, child health models, and recent studies of macro-level effects on health, we examine the effects of household structure, resources, care-giving, reproduction, and communication on child nutritional status and infant mortality. Using Demographic and Health Surveys, we analyze the influence of these factors across 42 countries in Latin America, Africa, and Asia. We also consider country-level including nontraditional family structure, level of economic development and expenditures on health care. Our results underscore the importance of family resources, decision-making, and health and feeding practices on child well-being in less developed countries. Although there is cross-national variability, the size of the variability was small relative to the overall effect. The country-level measures had modest effects on infant mortality and child nutritional status.

Maternal education and child nutritional status in Bolivia: finding the links.

This study models various pathways linking maternal education and child nutritional status in Bolivia, using a national sample of children. Pathways examined include socioeconomic status, health knowledge, modern attitudes towards health care, female autonomy, and reproductive behavior. The data come from the 1998 Bolivia Demographic and Health Survey. Logistic regression results suggest that socioeconomic factors are the most important pathways linking maternal education and child nutritional status, and that modern attitudes about health care also explain the impact of education. Health care knowledge accounts for less of the effect of maternal education on child nutritional status, with autonomy being the weakest pathway. Other pathways, such as reproductive behaviors, appear to influence nutritional status independent of maternal education. Overall, the pathways examined accounted for 60 percent of the effect of maternal education on child nutritional status.

The transition of adolescent males to first sexual intercourse: anticipated or delayed?

CONTEXT: Recognition of the different social, psychological and behavioral contexts within which adolescents initiate sexual activity broadens the understanding of teenage sexual behavior beyond the typical dichotomy of sexual experience vs. inexperience. METHODS: Data from the National Survey of Adolescent Males (1988 and 1990-1991) were used in logistic regression analyses to examine the influence of background factors on the transition to first intercourse among 265 teenagers who were not expecting to initiate sex in the next year (delayers) and 187 teenagers expecting to do so (anticipators). RESULTS: The most common reason for sexual inexperience among delayers was a desire to wait until marriage (32%); among anticipators, it was a lack of opportunity to initiate intercourse (35%). Anticipators were significantly more likely than delayers to have first intercourse within one year of the survey (53% vs. 13%). They also were more likely to report risky behaviors, precoital activities and approval of premarital sex; risky behavior predicted their onset of first sex (odds ratio, 1.5). Delayers were more likely to attend, church and have strict parents and a college-educated mother. Having a mother with at least some college education increased the odds of transition to first intercourse for anticipators (5.2) but decreased the odds for delayers (0.2). Having a mother who gave birth as a teenager significantly increased the odds for anticipators (14.5). CONCLUSIONS: Anticipators' sexual behavior occurs in a high-risk context, whereas delayers may have internalized the decision to delay first intercourse and have background factors that encourage the delay.