Improving the Health of Alaska Native People Through Use of a Policy Change Model and Capacity Building.

Public health training often includes program and education development but not policy, systems, and environmental (PSE) strategies. The Alaska Native Tribal Health Consortium's Good Health and Wellness in Indian Country program works to build tribal PSE change capacity. Trainings included community health assessment, facilitation and leadership engagement, policy and systems, and digital storytelling. From 2014 to 2017, 30 PSE changes were made: 3 tobacco-free healthcare organization policies; 2 tobacco-free tribal resolutions; 1 tobacco-free school district policy; 3 healthy food policies and environmental changes; 4 improvements in patient-provider communication; 13 prediabetes, obesity, and/or tobacco screening and referral policies; 3 improvements to health care facility signage; and 1 Baby-friendly Hospital application, protecting the health of 46,000 tribal community members. Targeted training and technical assistance moved tribal staff from a focus on direct services to population-based improvements. This increased self-efficacy may increase the sustainability of chronic disease public health efforts and improve tribal health.

Impact of male-partner-focused interventions on breastfeeding initiation, exclusivity, and continuation.

Informal sources of support, particularly the male partner, have more influence on breastfeeding behaviors than formal support from health care providers. This systematic review examined the impact of male-partner-focused breastfeeding interventions on breastfeeding initiation, exclusivity, and continuation. Four unique interventions were identified that were tested through randomized controlled studies or quasi-experimental design. These 4 provided breastfeeding education to fathers, with breastfeeding outcomes reported by the mother. Three of the 4 studies compared initiation rates between intervention and control conditions, and 2 showed significantly higher rates of breastfeeding initiation in the intervention group. Although studies were inconsistent in their categorization and reporting of full, partial, or no breastfeeding, significantly higher rates of breastfeeding initiation, exclusivity, and/or continuation were seen for 2 interventions. Because all 4 interventions found at least 1 breastfeeding outcome to be superior in the treatment group, breastfeeding education should be offered to male partners. Future studies should test if intervention effectiveness can be increased if education is supplemented with other activities. Future studies also should use controlled designs and validated outcome measures.

Breastfeeding attitudes: association between maternal and male partner attitudes and breastfeeding intent.

Breastfeeding is considered the best infant feeding method, yet initiation and duration rates in the United States are lower than recommended by medical and public health professionals. Positive attitudes toward breastfeeding of the male partner are important in a mother's success at initiating and maintaining breastfeeding. This study measured the infant feeding attitudes of low-income women and their male partners using the Iowa Infant Feeding Attitude Scale (IIFAS), investigated the reliability and validity of the measure in male partners, and examined the associations of the partner's attitudes with the mother's attitudes and intention to breastfeed. A convenience sample of 112 pregnant women and their male partners completed a survey including sociodemographic items, the IIFAS, and their intended infant feeding method in the hospital and in the first few weeks after the infant's birth (breastfeeding, formula feeding, mixed, and don't know). Mother's and partner's IIFAS scores were highly correlated, and higher scores of both mothers and partners were significantly associated with their intentions to breastfeed. With each increased point on mother's and partner's IIFAS scores, the odds that the mother and her partner intended to breastfeed in the first few weeks increased 12% and 20%, respectively. This is the first U.S. study to validate the IIFAS with male partners. Future research on breastfeeding attitudes and attitude-changing interventions is needed to see if improving partners' attitudes toward breastfeeding will also improve mothers' attitudes and if that increases initiation and duration of breastfeeding.

Fathers' thoughts on breastfeeding and implications for a theory-based intervention.

OBJECTIVE: To explore male partner's perceptions of breastfeeding to inform the development of interventions to increase their support of breastfeeding. DESIGN: Qualitative grounded theory. SETTING: Participants were recruited and interviewed in two Special Supplemental Nutrition Program for Women, Infants and Children (WIC) clinics located Honolulu, Hawai'i. PARTICIPANTS: Fourteen male partners of low-income pregnant women or new mothers. METHODS: Male partner attitudes, knowledge, and feelings were collected through private interviews. Interviews were transcribed verbatim and data were analyzed using grounded theory methods. RESULTS: All men appreciated breastfeeding's health benefits, acknowledged that it was natural, and were empathetic to the efforts of their partners. The men also discussed not being involved in the breastfeeding decision, believing formula feeding was more convenient than breastfeeding, feeling left out of the infant-feeding process, and being uncomfortable with breastfeeding in public. CONCLUSIONS: Findings suggest that an intervention to increase male partner support of breastfeeding should include multiple components to enhance knowledge, to empower men to be more engaged in the breastfeeding decision, to provide specific tips on how men can be involved in breastfeeding, and to increase comfort with breastfeeding in public. A multicomponent framework such as the social cognitive theory could be useful in guiding the development of such an intervention.

Disparities in self-reported postpartum depression among Asian, Hawaiian, and Pacific Islander Women in Hawaii: Pregnancy Risk Assessment Monitoring System (PRAMS), 2004-2007.

Postpartum depression affects 10-20% of women and causes significant morbidity and mortality among mothers, children, families, and society, but little is known about postpartum depression among the individual Asian and Pacific Islander racial/ethnic groups. This study sought to indentify the prevalence of postpartum depression among common Asian and Pacific Islander racial/ethnic groups. Data from the Hawaii Pregnancy Risk Assessment and Monitoring System (PRAMS), a population-based surveillance system on maternal behaviors and experiences before, during, and after the birth of a live infant, were analyzed from 2004 through 2007 and included 7,154 women. Questions on mood and interest in activities since giving birth were combined to create a measure of Self-reported Postpartum Depressive Symptoms (SRPDS). A series of generalized logit models with maternal race or ethnicity adjusted for other sociodemographic characteristics evaluated associations between SRPDS and an intermediate level of symptoms as possible indicators of possible SRPDS. Of all women in Hawaii with a recent live birth, 14.5% had SRPDS, and 30.1% had possible SRPDS. The following Asian and Pacific Islander racial or ethnic groups were studied and found to have higher odds of SRPDS compared with white women: Korean (adjusted odds ratio [AOR] = 2.8;95% confidence interval [CI]: 2.0-4.0), Filipino (AOR = 2.2;95% CI: 1.7-2.8), Chinese (AOR = 2.0;95% CI: 1.5-2.7), Samoan (AOR = 1.9;95% CI: 1.2-3.2), Japanese (AOR = 1.6;95% CI: 1.2-2.2), Hawaiian (AOR = 1.7;95% CI: 1.3-2.1), other Asian (AOR = 3.3;95% CI: 1.9-5.9), other Pacific Islander (AOR = 2.2;95% CI: 1.5-3.4), and Hispanic (AOR = 1.9;95% CI: 1.1-3.4). Women who had unintended pregnancies (AOR = 1.4;95% CI: 1.2-1.6), experienced intimate partner violence (AOR = 3.7;95% CI: 2.6-5.5), smoked (AOR = 1.5;95% CI: 1.2-2.0), used illicit drugs (AOR = 1.9;95% CI: 1.3-3.9), or received Women, Infant, and Children (WIC) benefits during pregnancy (AOR = 1.4;95% CI: 1.2-2.6) were more likely to have SRPDS. Several groups also were at increased risk for possible SRPDS, although this risk was not as prominent as seen with the risk for SRPDS. One in seven women reported SRPDS, and close to a third reported possible SRPDS. Messages about postpartum depression should be incorporated into current programs to improve screening, treatment, and prevention of SRPDS for women at risk.

How can the University of Hawai'i meet needs for public health education? Results of a students' needs assessment.

INTRODUCTION: A strong public health workforce is necessary to maintain the health and well-being of any community. Currently, the ability of the public health workforce to meet demand is being challenged in Hawai'i and the Pacific. This is due, in part, to the downsizing of the public health program at the University of Hawai'i (UH) in the year 2000. Knowing the current perceptions of the community in regards to public health and identifying ways to attract more students to public health are essential in reversing this trend. MATERIALS AND METHODS: Students from a class on needs assessment and program planning at the UH Department of Public Health Sciences assessed public health education needs. The class first conducted a literature review, focus groups, and interviews to inform the development of an on-line survey. The survey was sent to 200 individuals, including current public health students, faculty, workers, employers, and alumni. RESULTS: Of the 200 individuals invited to participate in the on-line survey, 128 (64%) responded. Almost half of the respondents were >50 years of age, and another 19% were between ages 41 and 50. Of the 118 who responded to this question, 85 had degrees in public health (80%from UH), and 62% had worked in public health for at least 10 years. However, only 50% of the total respondents knew that UH Masters of Public Health (MPH) and the Masters of Science (MS) programs were accredited. Forty percent or more of public health workers noted continuing education needs in 1) policy development and program planning skills, 2) analytical skills, 3) leadership and systems thinking skills, and 4) financial planning and management skills. Fully 43 of the respondents would consider applying to a DrPH program at UH, and 27 public health workers without an MPH would consider pursuing one. However potential students noted lack of time and timing of classes as barriers to attending school. Specific ideas for attracting students to public health were provided. Respondents also called for a greater commitment to public health from top leadership at UH and in Hawai'i. DISCUSSION: Findings confirm a need for a strong public health education program in Hawai'i and a lack of awareness about the MPH and MS programs at UH. Expanding options and opportunities for public health education will require better marketing and a cohesive commitment to public health education at UH.