Barriers and Contributors to Breastfeeding in WIC Mothers: A Social Ecological Perspective.

BACKGROUND: In response to the Surgeon General's Call to Action to Support Breastfeeding, the goal of this research was to assess the barriers and positive contributors to breastfeeding initiation and duration in Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) participants using the social ecological model (SEM). MATERIALS AND METHODS: A cross-sectional design was used to survey WIC mothers (n = 283) in southern New Hampshire. Analysis of breastfeeding initiation and duration revealed statistically significant results primarily at the individual level of the SEM. Findings also showed influences at the interpersonal, community, and organizational levels. There were significant differences in beliefs toward breastfeeding between women who ever breastfed and women who never breastfed. Women who ever breastfed were more likely to agree that breastfeeding assists with losing baby weight (89% versus 77%; p = 0.03), babies fed breastmilk are less likely to get sick (86% versus 74%; p = 0.04), and breastfeeding helps mothers bond with their babies more quickly than formula feeding (88% versus 72%; p < 0.01). Breastfeeding duration was significantly related to employment status; among women who breastfed for 6 months or longer, 15% were employed full-time, 30% worked part-time, and 55% indicated "other" such as unemployed or stay-at-home mother (p = 0.01). Logistic regression revealed that maternal age was the most significant predictor of breastfeeding duration (odds ratio = 1.11; 95% confidence interval, 1.03, 1.19; p < 0.004). CONCLUSIONS: Results indicate opportunities to inform and support women in the prenatal and postpartum period, improve the social and built environment, and develop and advocate for policies in an effort to support breastfeeding.

Engaging field-based professionals in a qualitative assessment of barriers and positive contributors to breastfeeding using the social ecological model.

Despite broad recognition of benefits associated with breastfeeding, rates in the United States continue to be below targets established by Healthy People 2020, especially for economically disadvantaged women. This study engaged field-based professionals through a focus group process to collect perceptions on factors that determine a woman's decision to breastfeed. Field-based professionals participated in one of six focus groups. Following the social ecological model (SEM), focus group questions addressed barriers and contributors to breastfeeding at the individual, interpersonal, community, organizational, and public policy levels. Thematic content analysis was used in identifying, analyzing, and reporting on themes within the focus group data. Commonly reported themes were identified that negatively influence a mother's decision to breastfeed such as modesty/general discomfort to breastfeed in front of others, negative breastfeeding perceptions of family members, friends, boyfriends and co-workers, breastfeeding not being viewed as the societal "norm", and the availability of free formula samples. Despite identified barriers, commonly reported themes that positively influence a mother's decision to breastfeed included general knowledge on the benefits, positive breastfeeding perceptions of family members, friends, boyfriends, and co-workers, the availability of "mom and baby" groups, and Baby Friendly hospital practices. The findings provide field-based perspectives that identify opportunities to support breastfeeding through the lens of the SEM. Opportunities to better support breastfeeding include educating mothers and their social support systems on the specific benefits of breastfeeding, challenging existing breastfeeding norms, and working with hospitals on establishing policy to not provide free formula samples.

Comfort and utility of school-based weight screening: the student perspective.

BACKGROUND: Weight screening in schools has been proposed as one strategy to address childhood obesity. Students' response to such screening is unexplored, however. In this study we evaluated the perceived comfort, utility and impact of school-based weight screening from the perspective of middle school-aged students. METHODS: A cross-sectional study of 852 ethnically diverse 5th-8th grade students. Associations were investigated between measured height and weight screening data and responses to a self-administered questionnaire completed immediately following weight screening in physical education class. BMI categories were based on the revised 2000 CDC growth chart and definitions: 5th-85th BMI percentile = healthy weight, 85th-95th BMI percentile = at risk for overweight, and >95th percentile BMI = overweight. RESULTS: Overall, students' comfort level with weight screening varied depending on the student's own weight status. More overweight students (38.1%) reported being uncomfortable than healthy weight students (8.1%) (p < 0.001). In particular, overweight female students (54.8%) compared to healthy weight female students (21.6%) reported being uncomfortable (p < 0.01). About half (54.9%) of all students reported knowing their weight prior to screening, and 58.9% reported that it was useful to learn their height and weight. Compared to healthy weight students, overweight students were significantly more likely to report the intention to perform weight modification related activities such as visiting a doctor (Odds ratio (OR) = 2.0, 95% CI = 1.3, 3.1), eating more fruits and vegetables (OR = 2.7, 95% CI = 1.7, 4.1), and increasing physical activity (OR = 4.3, 95% CI = 2.7, 7.0). CONCLUSION: Overall, the majority of the middle school students did not report discomfort with school-based weight screening, did report that receiving height and weight information was useful, and generally report appropriate weight control intentions. These proportions varied across weight status categories, however, with students who were at risk for overweight or overweight reporting higher levels of discomfort. For schools that conduct weight screening, it is essential that they also provide comfortable and private settings as well as education or counseling regarding healthy weight control practices.