[Show abstract][Hide abstract] ABSTRACT: Abstract
Grassroots stakeholder input results in relevant and timely Extension programs, but presents a challenge for performance measurement using common indicators. A balanced approach to program evaluation and reporting that is adequately valid and reliable while honoring the Extension culture of service is most likely to be successful. This article reviews recent advances in evaluation methodology of food and nutrition programs. It further describes how this evidence base informs the current set of national Extension program outcomes and indicators. Evaluation work is an essential step in documenting the public value of Extension programs.
[Show abstract][Hide abstract] ABSTRACT: Abstract
The study reported here aimed to identify the relationship of parents' calcium knowledge with diet-related parental practices and determinants of calcium knowledge. A cross-sectional survey was conducted measuring parental practices, calcium knowledge, and demographics. A convenience sample of 599 racially/ethnically diverse parents of children 10-13y completed questionnaires. Higher education and having a daughter were associated with higher calcium knowledge; being Asian or Hispanic and born outside the U.S. were associated with lower calcium knowledge. Parents with greater calcium knowledge were more likely to engage in healthy parenting practices. These factors may be important considerations for Extension educators in nutrition education.
[Show abstract][Hide abstract] ABSTRACT: Dietary calcium sources may differ by race/ethnicity and dietary acculturation. A cross-sectional, convenience sample including 587 United States (US) Asian, Hispanic and non-Hispanic White parent-child (10-13 years) pairs completed a calcium food frequency questionnaire. Calcium sources were ranked by mean percent contribution to total adjusted calcium intake, and compared by ethnic group and parents' location of birth. Five foods (fluid milk, cheese, milk on cereal, yogurt, and lattes) represented 49 % of total calcium intake for parents. The same foods (except lattes) represented 55 % of total calcium for early adolescent children. Fluid milk provided the largest mean percentage of intake for all race/ethnic groups among parents and children. Several food sources of calcium were greater for foreign-born versus US-born Asian or Hispanic parents and children. Understanding calcium food sources and changes in dietary patterns that affect calcium intake among parents and children is important to better promote adequate intake.
Journal of Immigrant and Minority Health 02/2015; 17(2). DOI:10.1007/s10903-014-0026-7 · 1.16 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background: Peer counseling (PC) breastfeeding support programs have proven effective in increasing breastfeeding duration in low-income women. Objectives: This study aimed to describe program participants and breastfeeding duration in a PC program according to (1) timing of enrollment (prenatal vs postnatal) and (2) breastfeeding status at program exit (discontinued breastfeeding, exited program while breastfeeding, and completed 1 year program) to improve understanding of how these groups differ and how services might be optimized when resources are limited. Methods: This study is a secondary analysis of data from low-income women enrolled in a PC breastfeeding support program. Participant characteristics and breastfeeding duration were described using chi-square tests, analyses of variance, and logistic regression. Results: Postnatal enrollees had longer breastfeeding duration than prenatal enrollees (F < .001) and were more likely to be older, to be married, to be more educated, and to have prior breastfeeding experience (each variable P < .01). Women who withdrew from the program while breastfeeding were more demographically similar to those who discontinued breastfeeding prior to 1 year than to those who continued in the program breastfeeding for 1 year, although they breastfed for significantly longer at exit (mean SD = 27.8 +/- 14.8 weeks) compared to women who discontinued breastfeeding while in the program (15.7 +/- 13.3 weeks) (P < .001). Conclusion: It may be advantageous for peer counselors to direct fewer resources to later postnatal enrollees and more to prenatal or early postnatal enrollees. It may also be advantageous to focus on supporting women at high risk of discontinuation rather than on retaining women who choose to withdraw from the program while breastfeeding.
Journal of Human Lactation 10/2014; 31(1). DOI:10.1177/0890334414554420 · 1.99 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background: Peer counseling programs have demonstrated efficacy in improving breastfeeding rates in the low-income population, but there is little research concerning why women enrolled in these programs ultimately discontinue breastfeeding. Objective: This study aimed to describe the self-reported reasons for discontinuing breastfeeding among women who are receiving peer counseling support by participant characteristics and timing of discontinuation. Methods: This study is a secondary analysis of data collected from 7942 participants who discontinued breastfeeding while enrolled in a peer counseling breastfeeding support program from 2005 to 2011. Reasons for discontinuing breastfeeding were assessed in relation to participant characteristics and weaning age using chi-square analyses and Kruskall-Wallis analyses of variance. Results: The most common reasons reported for discontinuing breastfeeding were mother's preference (39%) and low milk supply (21%), although reasons differed by age of infant weaning (P < .001). Among participants who discontinued the earliest, the most commonly cited reasons were breastfeeding challenges [median duration (interquartile range), 4.7 (2.0, 13.4) weeks], followed by low milk supply [8.9 (4.6, 19.1) weeks] and mother's preference [12.9 (5.0, 25.7) weeks]. Women who were younger, were less educated, were non-Hispanic black, were unmarried, and had no prior breastfeeding experience were the most likely to discontinue breastfeeding due to mother's preference. Conclusion: Peer counselors are in a unique position to offer breastfeeding education and encouragement and may be able to use evidence presented here to anticipate specified concerns either prenatally or postpartum, to prevent early breastfeeding discontinuation.
Journal of Human Lactation 08/2014; 31(1). DOI:10.1177/0890334414548070 · 1.99 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Objective
To estimate the causal effect of a Michigan peer counselor (PC) breastfeeding support program for low-income women on infant health outcomes.Data SourcesProgram referral forms, program forms (enrollment, birth, and exit data), and state administrative data from the Women Infants and Children program, Medicaid, and Vital Records.Study DesignQuasi-random enrollment due to the excess demand for PC breastfeeding support services allowed us to compare the infants of women who requested services and were enrolled in the program (the treatment group, N = 274) to the infants of women who requested services and were not enrolled (the control group, N = 572). Data were analyzed using regression.Principal FindingsThe PC program increased the fraction breastfeeding at birth by 19.3 percent and breastfeeding duration by 2.84 weeks. Program participation also reduced the fraction of infants with gastrointestinal disorders by a statistically significant 7.9 percent. The program, if anything, increased the overall health care utilization.Conclusions
This Michigan PC breastfeeding support program resulted in improvements in breastfeeding and infant health outcomes as measured by the diagnosis of ailments while increasing health care utilization.
Health Services Research 06/2014; 49(6). DOI:10.1111/1475-6773.12199 · 2.78 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Peer counselling (PC) programmes have been shown to improve breast-feeding outcomes in populations at risk for early discontinuation. Our objective was to describe associations between programme components (individual and combinations) and breast-feeding outcomes (duration and exclusivity) in a PC programme for low-income women.
Secondary analysis of programme data. Multivariable-adjusted Cox proportional hazards models were used to examine associations between type and quantity of peer contacts with breast-feeding outcomes. Types of contacts included in-person (hospital or home), phone or other (e.g. mail, text). Quantities of contacts were considered 'optimal' if they adhered to standard programme guidelines.
Programme data collected from 2005 to 2011 in Michigan's Breastfeeding Initiative Peer Counseling Program.
Low-income (n 5886) women enrolled prenatally.
For each additional home, phone and other PC contact there was a significant reduction in the hazard of discontinuing any breast-feeding by 6 months (hazard ratio (HR)=0·90 (95 % CI 0·88, 0·92); HR=0·89 (95 % CI 0·87, 0·90); and HR=0·93 (95 % CI 0·90, 0·96), respectively) and exclusive breast-feeding by 3 months (HR=0·92 (95 % CI 0·89, 0·95); HR=0·90 (95 % CI 0·88, 0·91); and HR=0·93 (95 % CI 0·89, 0·97), respectively). Participants receiving greater than optimal in-person and less than optimal phone contacts had a reduced hazard of any and exclusive breast-feeding discontinuation compared with those who were considered to have optimum quantities of contacts (HR=0·17 (95 % CI 0·14, 0·20) and HR=0·28 (95 % CI 0·23, 0·35), respectively).
Specific components of a large PC programme appeared to have an appreciable impact on breast-feeding outcomes. In-person contacts were essential to improving breast-feeding outcomes, but defining optimal programme components is complex.
Public Health Nutrition 05/2014; 18(03):1-11. DOI:10.1017/S1368980014000603 · 2.68 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To understand current practice of child feeding behaviors, and underlying factors influencing these practices in Asian Indian mothers, qualitative in-depth interviews were conducted with 27 immigrant Asian Indian mothers of children ages 5-10 years. Using the theory of planned behavior as a guiding framework, child feeding behaviors employed, beliefs about the outcomes of feeding behaviors, perceived ease or difficultly in practicing feeding behaviors, and social norms were explored during the interviews. Thematic analysis was conducted using coding and display matrices. Mothers were motivated by nutrition outcomes when practicing positive and negative controlling feeding behaviors. Outcomes related to preservation of Indian culture and values also influenced feeding behaviors. Pressuring to eat was often practiced despite the perception of ineffectiveness. Use of food rewards was found, and use of TV to control children's food intake despite the clear understanding of undesirable nutrition outcomes was a unique finding. Asian Indian mothers need effective child feeding strategies that are culturally appropriate. Integrating cultural beliefs in nutrition education could help support existing motivation and behavior modification.
Maternal and Child Health Journal 12/2013; 18(7). DOI:10.1007/s10995-013-1412-9 · 2.24 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background:The presence of barriers is not sufficient to explain breastfeeding rate disparities. A relatively unexplored area in coping with breastfeeding barriers is culture.Objective:This research aims to better understand the role of culture in a woman's infant feeding decision by using race and socioeconomic status as indicators of culture.Methods:Focus groups and individual interviews were conducted with 42 pregnant women or mothers of infants younger than 12 months. Focus group composition was determined by self-identified African American or white race and self-reported eligibility for the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) or ineligibility (non-WIC).Results:Most participants acknowledged that breastfeeding was best, yet differences arose between groups in the perception of, and reaction to, breastfeeding barriers. WIC and non-WIC participants of both races indicated that some circumstances necessitated formula use. WIC participants felt that this was personally and socially acceptable due to need, whereas non-WIC participants felt that this was personally and socially unacceptable. When a barrier arose, WIC participants of both races felt that the infant feeding choice was not theirs and formula use might be inevitable. In contrast, non-WIC participants of both races expressed that they persevered to continue breastfeeding and did so by establishing small, achievable goals and seeking mentors.Conclusion:Educational and public health efforts to reduce breastfeeding disparities may be enhanced if support is tailored to acknowledge cultural differences among women and address factors that make either breastfeeding or formula feeding acceptable, or even preferable, within their communities.
Journal of Human Lactation 11/2013; 30(2). DOI:10.1177/0890334413508338 · 1.99 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Manager attitude is influential in female employees' perceptions of workplace breastfeeding support. Currently, no instrument is available to assess manager attitude toward supporting women who wish to combine breastfeeding with work. We developed and piloted an instrument to measure manager attitudes toward workplace breastfeeding support entitled the "Managers' Attitude Toward Breastfeeding Support Questionnaire," an instrument that measures four constructs using 60 items that are rated agree/disagree on a 4-point Likert rating scale. We established the content validity of the Managers' Attitude Toward Breastfeeding Support Questionnaire measures through expert content review (n=22), expert assessment of item fit (n=11), and cognitive interviews (n=8). Data were collected from a purposive sample of 185 front-line managers who had experience supervising female employees, and responses were scaled using the Multidimensional Random Coefficients Multinomial Logit Model. Dimensionality analyses supported the proposed four-construct model. Reliability ranged from 0.75 to 0.86, and correlations between the constructs were moderately strong (0.47 to 0.71). Four items in two constructs exhibited model-to-data misfit and/or a low score-measure correlation. One item was revised and the other three items were retained in the Managers' Attitude Toward Breastfeeding Support Questionnaire. Findings of this study suggest that the Managers' Attitude Toward Breastfeeding Support Questionnaire measures are reliable and valid indicators of manager attitude toward workplace breastfeeding support, and future research should be conducted to establish external validity. The Managers' Attitude Toward Breastfeeding Support Questionnaire could be used to collect data in a standardized manner within and across companies to measure and compare manager attitudes toward supporting breastfeeding. Organizations can subsequently develop targeted strategies to improve support for breastfeeding employees through efforts influencing managerial attitude.
Journal of the American Academy of Nutrition and Dietetics 04/2012; 112(7):1042-7. DOI:10.1016/j.jand.2012.01.013 · 3.47 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Maternal employment has been cited as a barrier to continued breastfeeding, yet there have been few studies identifying company breastfeeding support.
The study objectives were to develop and pilot an instrument that measures formal breastfeeding support in companies.
A survey of company breastfeeding supports was developed, based on the literature and expert review, and the survey piloted with Michigan-based companies.
Completion of the surveys and open-ended comments indicated survey items were generally well understood. In the study sample (N = 151), significantly more support was offered in companies having more employees as compared to fewer, and in companies from the health care versus all other sectors (P < .01). More support was also found in companies reporting requests for support, upper management combining breastfeeding and work, and a population that they felt likely to require breastfeeding support (P < .01). Few companies (3%) had written policies on breastfeeding or pumping at work. However, the majority of companies allow women to pump milk at the worksite (94%), and provide time (73%) and nonrestroom space to pump (78%). Fewer companies allow breastfeeding at the company (22%) or designate a room solely for breastfeeding or pumping (32%).
The survey instrument is appropriate to determine breastfeeding supports in companies. In Michigan, larger companies and those in the health care sector provide more supports, most companies provide some type of space and time to pump, but other supports are limited.
Journal of Human Lactation 02/2012; 28(1):20-7. DOI:10.1177/0890334411430666 · 1.99 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Poor feeding practices during infancy contribute to obesity risk. As infants transition from human milk and/or formula-based diets to solid foods, these practices interfere with infant feeding self-regulation and healthy growth patterns. Compared with other socioeconomic groups, lower-income mothers are more likely to experience difficulty feeding their infants. This may include misinterpreting feeding cues and using less-than-optimal feeding styles and practices, such as pressuring infants during mealtimes and prematurely introducing solid food and sweetened beverages. The Healthy Babies trial aims to determine the efficacy of a community-based randomized controlled trial of an in-home intervention with economically and educationally disadvantaged mother-infant dyads. The educational intervention is being conducted during the infant's first 6 months of life to promote healthy transition to solids during their first year and is based on the theory of planned behavior.
We will describe our study protocol for a multisite randomized control trial being conducted in Colorado and Michigan with an anticipated sample of 372 economically and educationally disadvantaged African American, Hispanic, and Caucasian mothers with infants. Participants are being recruited by county community agency staff. Participants are randomly assigned to the intervention or the control group. The intervention consists of six in-home visits by a trained paraprofessional instructor followed by three reinforcement telephone contacts when the baby is 6, 8, and 10 months old. Main maternal outcomes include a) maternal responsiveness, b) feeding style, and c) feeding practices. Main infant outcome is infant growth pattern. All measures occur at baseline and when the infant is 6 and 12 months old.
If this project is successful, the expected outcomes will address whether the home-based early nutrition education intervention is effective in helping mothers develop healthy infant feeding practices that contribute to improving infant health and development and reducing the risk of early-onset childhood obesity.
Current Controlled Trials ACTRN126100000415000.
BMC Public Health 11/2011; 11:868. DOI:10.1186/1471-2458-11-868 · 2.26 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The study aimed to (i) segment parents of early adolescents into subgroups according to their Ca-rich-food (CRF) practices and perceptions regarding early adolescent CRF intake and (ii) determine whether Ca intake of parents and early adolescents differed by subgroup.
A cross-sectional convenience sample of 509 parents and their early adolescent children completed a questionnaire in 2006-2007 to assess parent CRF practices and perceptions and to estimate parent and child Ca intakes.
Self-administered questionnaires were completed in community settings or homes across nine US states.
Parents self-reporting as Asian, Hispanic or non-Hispanic White with a child aged 10-13 years were recruited through youth or parent events.
Three parent CRF practice/perception segments were identified, including 'Dedicated-Milk Providers/Drinkers' (49 %), 'Water Regulars' (30 %) and 'Sweet-Drink-Permissive Parents' (23 %). Dedicated-Milk Providers/Drinkers were somewhat older and more likely to be non-Hispanic White than other groups. Ca intakes from all food sources, milk/dairy foods and milk only, and milk intakes, were higher among early adolescent children of Dedicated-Milk Providers/Drinkers compared with early adolescents of parents in other segments. Soda pop intakes were highest for early adolescents with parents in the Water Regulars group than other groups. Dedicated-Milk Providers/Drinkers scored higher on culture/tradition, health benefits and ease of use/convenience subscales and lower on a dairy/milk intolerance subscale and were more likely to report eating family dinners daily than parents in the other groups.
Parent education programmes should address CRF practices/perceptions tailored to parent group to improve Ca intake of early adolescent children.
Public Health Nutrition 06/2011; 15(2):331-40. DOI:10.1017/S1368980011001133 · 2.68 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Most adults do not meet calcium intake recommendations. Little is known about how individual and family factors, including parenting practices that influence early adolescents' intake of calcium-rich foods, affect calcium intake of parents. This information could inform the development of effective nutrition education programs.
To identify individual and family factors associated with intake of calcium-rich foods among parents of early adolescents (aged 10 to 13 years).
A cross-sectional survey was used with 14 scales to assess attitudes/preferences and parenting practices regarding calcium-rich foods and a calcium-specific food frequency questionnaire (2006-2007).
A convenience sample of self-reporting non-Hispanic white, Hispanic, and Asian (n=661) parents was recruited in nine states. Parents were the primary meal planner/preparer and completed questionnaires in homes or community settings.
Predictors of calcium intake from three food groupings-all food sources, dairy foods, and milk.
Multivariate regression analyses identified demographic, attitude/preference, and behavioral factors associated with calcium intake.
Most respondents were women (∼90%) and 38% had a college degree. Education was positively associated with calcium intake from all three food groupings, whereas having an Asian spouse compared to a non-Hispanic white spouse was negatively associated with calcium intake only from all food sources and from dairy foods. Expectations for and encouragement of healthy beverage intake for early adolescents were positively associated with calcium intake from dairy foods and milk, respectively. Parental concern regarding adequacy of intake was negatively associated, whereas perception of health benefits from calcium-rich foods was positively associated with calcium intake from all food sources and from dairy foods. Between 20% and 32% of the variance in calcium intake from all food groupings was explained in these models.
Individual factors and positive parenting practices may be important considerations for nutrition education programs targeted to parents.
Journal of the American Dietetic Association 03/2011; 111(3):376-84. DOI:10.1016/j.jada.2010.11.020 · 3.92 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Managers' attitudes influence female employees' perceptions of workplace breastfeeding support. Five focus groups were conducted with managers in the state of Michigan (N = 25) to assess their attitudes toward supporting breastfeeding. All focus group discussions were recorded, transcribed verbatim, and analyzed for themes. Participants supported efforts by managers and companies to assist breastfeeding employees, but the extent of accommodations they supported varied. Most participants reported no company breastfeeding policy or were unaware of their company having one and showed mixed attitudes about needing a policy. Participants acknowledged the potential for lower productivity and coworker jealousy toward time for breastfeeding or expressing milk but believed that benefits of support included employee recruitment and retention. Participants demonstrated some understanding of breastfeeding benefits. They identified barriers and facilitators for breastfeeding support at both the organizational and individual levels. Results of this study will be used for instrument development to measure managers' attitudes toward supporting breastfeeding.
Journal of Human Lactation 03/2011; 27(2):138-46. DOI:10.1177/0890334410391908 · 1.99 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: We examined the effectiveness of a peer counseling breastfeeding support program for low income women in Michigan who participate in WIC. Because there was more demand for services than could be met by the program, many women who requested services were not subsequently contacted by a peer counselor. We used a quasi-experimental methodology that utilized this excess demand for services to estimate the causal effect of the support program on several breastfeeding outcomes. We relied on data derived from administrative and survey-based sources. After providing affirmative evidence that our key assumption is consistent with the data, we estimated that the program caused the breastfeeding initiation to increase by about 27 percentage points and the mean duration of breastfeeding to increase by more than 3 weeks. The support program we evaluated was very effective at increasing breastfeeding among low income women who participate in WIC, a population that nationally breastfeeds at rates well below the national average and below what is recommended by public health professionals. Given the substantial evidence that breastfeeding is beneficial for both the child and mother, the peer counseling breastfeeding support program should be subjected to a cost/benefit analysis and evaluated at other locales.
Maternal and Child Health Journal 11/2009; 14(1):86-93. DOI:10.1007/s10995-008-0430-5 · 2.24 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The early introduction of solids to infants is a risk factor associated with later health problems including allergies, overweight, and diabetes. The Infant Feeding Series (TIFS), a newly designed curriculum that promotes the appropriate transition to solids through parenting education and behavior change among low-income mothers, used the Theory of Planned Behavior and the Transtheoretical Model of Change to develop TIFS curricular foci and activities. Using a pre-post design, pilot study results indicate that after exposure to the TIFS curriculum, mothers had significantly increased knowledge about appropriate infant feeding, could more accurately identify developmental indicators of infants' readiness for solids, and reported greater feelings of self efficacy about initiating and maintaining healthy feeding practices. Editors' Strategic Implications: replication is necessary, but TIFS appears to be a promising prevention program based on short-term knowledge and long-term behavioral outcomes (i.e., healthy feeding practices).
The Journal of Prevention 04/2009; 30(2):191-208. DOI:10.1007/s10935-009-0169-9