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- WIC Peer Counselors' Perceptions of Breastfeeding in African American Women with Lower Incomes. [JOURNAL ARTICLE]
- J Hum Lact 2014 Dec 5.
African American women have the lowest breastfeeding rates among all racial/ethnic groups in the United States. Peer counseling is an effective intervention in improving breastfeeding in this population. However, little is known on peer counselors' perceptions of breastfeeding in African American women.As part of a larger qualitative study, the goal of this study was to understand the contextual factors influencing breastfeeding decisions of low-income African American women from the perspective of breastfeeding peer counselors (PCs).Three focus groups were conducted with 23 PCs from the Women, Infants, and Children program in a southeastern state. All focus group discussions were audio-recorded, professionally transcribed, and analyzed using thematic analysis. Bronfenbrenner's socioecological model was used to group categories into themes.Of the sample, 47.8% were African American, 78.2% were married, and 56.5% had some college education. Five main themes emerged to describe factors at multiple levels influencing breastfeeding in PCs' low-income African American clients: individual, microsystem, exosystem, macrosystem, and chronosystem. Novel findings included (1) having breast pumps may give African American women a "sense of security," (2) cultural pressures to be a "strong black woman" can impede breastfeeding support, and (3) breastfeeding "generational gaps" have resulted from American "slavery" and when formula was "a sign of wealth."As PCs described, low-income African American women's breastfeeding decisions are affected by numerous contextual factors. Findings from this study suggest a need to broaden the public health approach to breastfeeding promotion in this population by moving beyond individual characteristics to examining historical and sociocultural factors underlying breastfeeding practices in African American women.
- Influence of Maternal Depression on Household Food Insecurity for Low-Income Families. [JOURNAL ARTICLE]
- Acad Pediatr 2014 Nov 12.
To examine whether maternal depression predicts future household food insecurity for low-income families.This was a secondary data analysis using data from the Early Childhood Longitudinal Study, Birth Cohort (ECLS-B). The study cohort consisted of 2917 low-income mothers, defined as <185% federal poverty level, who were food secure at baseline. Maternal data collected when children were 9 and 24 months of age were used. Data at 9 months were considered baseline, and data at 24 months were considered follow-up. Baseline maternal depressive symptoms were measured by a 12-item abbreviated version of the Center for Epidemiologic Studies Depression Scale. Household food insecurity at follow-up was measured by the US Department of Agriculture Household Food Security Scale.At baseline, 16% of mothers were depressed (raw score >9). Most mothers were white, unemployed, and born in the United States. The majority received Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) (86%); 39% received Supplemental Nutrition Assistance Program (SNAP). At follow-up, 11.8% of mothers reported household food insecurity. In multivariable analysis, maternal depression at baseline was significantly associated with food insecurity at follow-up (adjusted odds ratio 1.50; 95% confidence interval 1.06-2.12).Our results suggest that maternal depression is an independent risk factor for household food insecurity in low-income families with young children. Multidisciplinary interventions embedded within and outside the pediatric medical home should be developed to identify depressed mothers and link them to community-based mental health and food resources. Further longitudinal and interventional studies are needed to understand and address the complex relationship between poverty, maternal depression, social safety nets, and food insecurity.
- Addressing Language Barriers in Client-Centered Health Promotion: Lessons Learned and Promising Practices From Texas WIC. [JOURNAL ARTICLE]
- Health Promot Pract 2014 Dec 1.
The growing population of nonnative English speakers in the United States challenges program planners to offer services that will effectively reach limited English proficiency (LEP) audiences. This article presents findings from evaluation research conducted with the Special Supplemental Program for Women, Infants, and Children (WIC) to identify best practices and areas of concern for working with LEP clients. Data were collected through online surveys of 338 WIC teaching staff in 2010 and 65 WIC local agency directors in 2011 as part of an implementation evaluation of client-centered nutrition education. Data identified current practices, facilitating factors, and challenges in working with LEP clients. Facilitating factors included cultural competency, material and translation resources, linguistic competency, professional development opportunities, and rapport with clients. Challenges cited included linguistic challenges, lack of cultural competencies, issues related to the client-staff interaction, and insufficient time, materials, and staffing. Best practices inferred from the data relate to developing linguistic standards for bilingual staff, considerations for translating written materials, interpretation services, cultural competency, and staff training. Findings may help inform the development of this and other linguistically and culturally appropriate health promotion programs.
- Association of Infant Feeding with Adiposity in Early Childhood in a WIC Sample. [Journal Article]
- J Health Care Poor Underserved 2014; 25(4):1542-51.
- Articulations of Health and Poverty Among Women on WIC. [JOURNAL ARTICLE]
- Health Commun 2014 Nov 20.:1-11.
With the global financial meltdown, the crisis of poverty has deepened in communities across the United States. This essay reports results from a culture-centered project on fostering spaces for listening to the voices of the poor in CrossRoads County, Indiana. It highlights the intersections of health and poverty as they emerge from the narratives of mothers utilizing the Supplemental Nutrition Program for Women, Infants, and Children (WIC). Depression, humiliation, and inaccessibility to health care and healthy living outline the struggles of women as they negotiate their access to health. The articulations of agency are situated around competing cultural narratives that, on the one hand, draw on the threads of individual responsibility which resonate through mainstream discourses of poverty in the United States and, on the other hand, interrogate the structural erasure of the basic capacities of health.
- Cost Effectiveness of Human Papillomavirus-16/18 Genotyping in Cervical Cancer Screening. [JOURNAL ARTICLE]
- Appl Health Econ Health Policy 2014 Nov 11.
There is limited understanding of the health economic implications of cervical screening with human papillomavirus (HPV)-16/18 genotyping.The aim of this study was to evaluate the cost effectiveness of cervical cancer primary screening with a HPV-16/18 genotyping test which simultaneously detects 12 other high-risk HPV types.A Markov cohort model compared four strategies: (1) cytology with reflex HPV testing for atypical squamous cells of undetermined significance (ASC-US); (2) co-testing with cytology and HPV testing; (3) HPV with reflex to cytology; and (4) HPV with 16/18 genotyping and reflex cytology (ASC-US threshold). Screening began at age 30 and was performed triennially over 40 years. Screening sensitivity and specificity values for cervical intraepithelial neoplasia (CIN) 3 were obtained from the Addressing THE Need for Advanced HPV Diagnostics (ATHENA) trial. Outcomes for a 1-year follow-up scenario wherein persistent disease was detected were estimated. Screening and cancer treatment costs were calculated from a US payer's perspective in 2013. Costs and quality-adjusted life-years (QALYs) were discounted at 3 % annually.Applying a US$50,000/QALY threshold, strategy (4) dominated strategies (2) and (3) by reducing costs and cancer incidence and improving QALYs, and was cost effective versus strategy (1). Accounting for persistent ≥CIN 3 at 1 year, strategy (4) was cost effective versus all other strategies. Detecting HPV-16/18 resulted in earlier diagnosis of clinically relevant ≥CIN 3 at initial screening and efficient use of follow-up resources. Outcomes were most influenced by strategy performance.Incorporating HPV-16/18 genotyping is cost effective and may improve detection of CIN, thereby preventing cervical cancer.
- Effect of a new remineralizing biomaterial on the color of dental enamel. [Comparative Study, Journal Article, Research Support, Non-U.S. Gov't]
- Acta Odontol Latinoam 2014; 27(1):3-8.
The aim of this research was to describe the effects of altering the composition of a modified remineralizing agent (MRA) and the osmotic pressure on tooth color by using spectrophotometric analysis. One hundred and four (104) human premolars and molars were randomly divided into 2 groups of 52 specimens each. Group 1 was treated with the remineralizing agent MRA 55, (remineralizing agent 1), a 50% - 50% by weight mixture of coarse-grain and fine-grain generating minerals, and group 2 was treated with the remineralizing agent MRA 91 (remineralizing agent 2), containing the same minerals in a 90% - 10% proportion. Each group was divided into 2 subgroups with 26 specimens each, which were stored as follows: subgroups A were stored in synthetic saliva with isotonic osmotic pressure (IP), and subgroups B in hypotonic osmotic pressure saliva (HP). The initial and final readings were taken with a Vita Easy Shade spectrophotometer. Color parameters (L*, a*, b*) and whiteness indices (WIC, WIO, W) were calculated from the readings. The color changes (deltaL, deltaA, deltaB, and deltaE) and whiteness indices were compared and analyzed with descriptive analyses. The variables deltaL, deltaA, deltaB, deltaE, and the whiteness index W were analyzed with an analysis of variance (ANOVA), and the indices WIC and WIO were analyzed with a nonparametric Kruskal-Wallis ANOVA. The results indicate that combination A2 (MRA 91 and IP) affected variables deltaB and deltaE, while combination B1 (MRA 55 and HP) affected variables deltaA, deltaB and the whiteness index WIO. Only MRA 91 affected the variable deltaL. The osmotic pressure of saliva and the remineralizing agent used affect the color of dental enamel.
- Intestinal microbiota of preterm infants differ over time and between hospitals. [Journal Article]
- Microbiome 2014.:36.
Intestinal microbiota are implicated in risk of necrotizing enterocolitis (NEC) and sepsis, major diseases of preterm infants in neonatal intensive care units (NICUs). Rates of these diseases vary over time and between NICUs, but time and NICU comparisons of the intestinal microbiota of preterm infants are lacking.We included 66 singleton infants <29 weeks gestational age with stool samples collected between postnatal days 3 to 21 of life who survived free of NEC and sepsis. Infants were enrolled during 2010 and 2011. Twenty-six infants were enrolled at hospital 1 in Cincinnati, OH, and 40 infants were enrolled at hospital 2 in Birmingham, AL. Samples collected from days 3-9 ("week 1") and days 10-16 ("week 2") were compared between years and hospitals. Microbial succession was compared between hospitals in 28 infants with samples from the first 3 weeks of life. DNA extracted from stool was used to sequence the 16S rRNA gene by Illumina MiSeq using universal primers. Resulting operational taxonomic unit tables were analyzed for differences between years and hospitals using linear discriminant analysis effect size algorithm (LEfSe; significance, p < 0.05).Significant variation was observed in infant microbiota by year and hospital. Among hospital 1 infants, week 1 samples had more phylum Firmicutes (class Bacilli, families Clostridiaceae and Enterococcaceae) in 2010 and more phylum Proteobacteria (family Enterobacteriaceae) in 2011; week 2 samples did not significantly vary over time. However, among hospital 2 infants, the week 1 shift was nearly opposite, with more Proteobacteria (Enterobacteriaceae) in 2010 and more Firmicutes (Bacilli) in 2011; week 2 samples exhibited the same pattern. Regression analysis of clinical covariates found that antibiotic use had an important influence but did not explain these observed shifts in microbiota over time and between hospitals. Microbial succession also differed by hospital, with greater change in microbiota in hospital 1 than hospital 2 infants (p < 0.01, Jaccard distance).Colonizing microbiota differ over time and between NICUs in ways that could be relevant to disease. Multi-site, longitudinal studies are needed to reliably define the impact of intestinal microbiota on adverse outcomes of preterm infants.
- Neighborhood disparities in prevalence of childhood obesity among low-income children before and after implementation of New York City child care regulations. [Journal Article, Research Support, Non-U.S. Gov't]
- Prev Chronic Dis 2014.:E181.
New York City Article 47 regulations, implemented in 2007, require licensed child care centers to improve the nutrition, physical activity, and television-viewing behaviors of enrolled children. To supplement an evaluation of the Article 47 regulations, we conducted an exploratory ecologic study to examine changes in childhood obesity prevalence among low-income preschool children enrolled in the Nutrition Program for Women, Infants, and Children (WIC) in New York City neighborhoods with or without a district public health office. We conducted the study 3 years before (from 2004 through 2006) and after (from 2008 through 2010) the implementation of the regulations in 2007.We used an ecologic, time-trend analysis to compare 3-year cumulative obesity prevalence among WIC-enrolled preschool children during 2004 to 2006 and 2008 to 2010. Outcome data were obtained from the New York State component of the Centers for Disease Control and Prevention's Pediatric Nutrition Surveillance System.Early childhood obesity prevalence declined in all study neighborhoods from 2004-2006 to 2008-2010. The greatest decline occurred in Manhattan high-risk neighborhoods where obesity prevalence decreased from 18.6% in 2004-2006 to 15.3% in 2008-2010. The results showed a narrowing of the gap in obesity prevalence between high-risk and low-risk neighborhoods in Manhattan and the Bronx, but not in Brooklyn.The reductions in early childhood obesity prevalence in some high-risk and low-risk neighborhoods in New York City suggest that progress was made in reducing health disparities during the years just before and after implementation of the 2007 regulations. Future research should consider the built environment and markers of differential exposure to known interventions and policies related to childhood obesity prevention.
- Insights in public health: the special supplemental nutrition program for women, infants and children: strengthening families for 40 years. [Journal Article]
- Hawaii J Med Public Health 2014 Sep; 73(9):295-300.
The Special Supplemental Nutrition Program for Women, Infants and Children (WIC) is a proven, cost-effective investment in strengthening families. As part of the United States Department of Agriculture's (USDA) 15 federal nutrition assistance programs for the past 40 years, WIC has grown to be the nation's leading public health nutrition program. WIC serves as an important first access point to health care and social service systems for many limited resource families, serving approximately half the births in the nation as well as locally. By providing nutrition education, breastfeeding promotion and foods in addition to referrals, WIC plays a crucial role in promoting lifetime health for women, infants and children. WIC helps achieve national public health goals such as reducing premature births and infant mortality, increasing breastfeeding, and reducing maternal and childhood overweight. Though individuals and families can self-refer into WIC, physicians and allied health professionals have the opportunity and are encouraged to promote awareness of WIC and refer families in their care.