Although U.S. breastfeeding rates have steadily increased since 2000, there continues to be a disparity in breastfeeding rates for African American (AA) women compared to their non-Hispanic White counterparts. A male partner's perception, specifically his positive attitude toward breastfeeding, may influence breastfeeding initiation and duration rates. This study was an exploration of AA male perceptions and attitudes toward breastfeeding and what effect masculinity ideology (gender norms) has on such attitudes. The socio-ecological model (SEM) was used as the theoretical framework to examine the various environmental levels that intersect with one another to influence these attitudes. A mixed methods study design, using (a) an online survey combining the Iowa Infant Feeding Attitudes Scale (IIFAS) and the Male Role Norms Scales (MRNS) (N =206) and (b) 3 focus group sessions (N = 17), was used to collect data. African American men ages 18 and older were eligible to participate in the study. Results of the regression analysis showed a negative correlation between positive breastfeeding attitudes and traditional masculinity ideology. Nvivo analysis of focus group transcripts revealed themes of gender norms, knowledge of breastfeeding, and public opinions. The themes from the focus groups were categorized using the 4 levels of the SEM: Individual, Relationships, Community, and Societal; themes corresponded with Levels 1 (Individual) and 4 (Societal) of the SEM. These results indicate that a gender-transformative approach may be used to strengthen breastfeeding-promotion interventions targeting AA males. The positive social change implications of this research include a paradigm shift in views on gender norms and increased engagement of men in decisions that affect infant and child health and development.

The geographical focus of this study is on that section of Southeast Portland which has been designated by the Office of Econom1c Opportunity as a poverty pocket because of an incidence of low-income families exceeding ~. (See Figure 2, Appendix A.) As such, the area is under the jurisdiction of the Portland Metropolitan Steering Committee, the OEO community action agency for Portland. Under the auspices of this agency, the four neighborhoods in the area (Brooklyn, Buckman, Richmond and Sunnyside) in 1966 formed a separate non-profit delegate agency which was named Portland Action Committees Together, Incorporated (PACT). PACT originally was responsible for administering War on Poverty programs through three neighborhood centers in the area. Its functions have changed but it still remains very much involved, even providing the terms by which the area is known: the PACT target area. The particular focus of the study has to do with the mental health of elementary School age children in the PACT target area. The original, and still primary, purpose of this study was to provide a statistical data base for a grant proposal to fund a children's mental health service agency in the PACT target area of Southeast Portland. Since the original conception by Jack Tovey of the Child Psychiatry Department, University of Oregon Medical School, and PACT staff, the plan has been subsumed under the planning auspices of the Comprehensive Mental Health Planning Committee, a group whose aim is to work toward expanding and consolidating mental health services in all dimensions for the Southeast Portland area.

Indiana University-Purdue University Indianapolis (IUPUI) / Introduction Mobile health (mHealth) applications (apps) are increasingly accessible and popular. In 2015, over 60% of smartphone users used their phones to look up health related information. mHealth apps related to maternal and child health (MCH) are particularly prevalent and frequently used. As high as 73% pregnant women and new mothers reported the use of MCH apps, with 27% using them daily. Methods A cross-sectional sample of MCH apps was extracted from the Apple App and Google Play stores using a JavaScript Scraper program. A multivariable linear regression, and series of ordinal logistic regression assessed the relationship between MCH app characteristics and two outcomes, end users’ perceived satisfaction (star ratings), and intent to use (downloads). Next, theory-based content analysis reviewed the presence and use of behavior change techniques (BCTs) in popular MCH apps using the mHealth app taxonomy framework. Finally, a qualitative inductive analysis assessed user self-reported experiences, perceived benefits, and general feedback for MCH apps. Results Seven hundred and forty-two apps met the inclusion criteria. A large majority of MCH apps were developed by non-healthcare developers. Google Play store apps had higher user ratings; while, apps within health & fitness genre, with older updates, and no agerestrictions had fewer user ratings. Furthermore, lower priced apps, with high star ratings, in-app purchase options, and in-app advertisement presence had high downloads. And, apps belonging to medical and health & fitness genre had fewer user downloads. Content analysis revealed that popular MCH apps on an average include 7.4 behavior change techniques (BCTs) with a median of 6 BCTs. Apps developed by healthcare developers had higher BCTs present within app content. Qualitative analysis shows that consumers value apps that are low cost, with superior features, smooth technical aspects, high quality content, and easy to use. Conclusions Healthcare providers, app developers, and policymakers may benefit from a better understanding of MCH apps available in two popular app stores and may consider strategies to review and promote apps to consumers based on information accuracy and trustworthiness. / 2020-11-06

Indiana University-Purdue University Indianapolis (IUPUI) / Advancement of preconception and interconception health is a key element to improve women’s health as well as pregnancy outcomes. Little is known about the preconception and interconception health status of rural Midwestern populations in the United States. The primary objective of this study was to determine the preconception and interconception health status as well as behaviors of reproductive age women living in a rural Midwestern area. Secondary objectives were to quantify process measures of health care access and barriers to care, as well as determine disparities in preconception and interconception health status among women in this rural area as compared to statewide estimates. As existing national or state secondary data sources often have limitations in data derived from areas with low population densities or insufficient sample sizes to generate reliable estimates, a cross-sectional study was performed using a 34- item survey. Data were collected from February to May 2019 from 315 non-pregnant women ages 18-45 years in a rural county in northwestern Ohio. Nearly all women surveyed had at least one risk factor associated with poor pregnancy outcomes, many of which were modifiable. Nearly half of all respondents reported at least one barrier to receipt of health care services. Women in this rural county fared worse for several preconception and interconception health measures when compared to statewide estimates derived from Behavioral Risk Factor Surveillance System and Ohio Pregnancy Assessment Survey data. These findings illustrate the need for continued development of interventions to improve preconception and interconception health for rural women as well as improved methods to capture and analyze data on important subpopulations at risk. / 2021-03-09

Iron depletion (ID) is the most common nutrient deficiency worldwide and is the leading cause of anemia. Chronic arsenic (As) exposure is a major public health problem in Bangladesh and triggers inflammatory responses that render iron status assessment challenging. We assessed the prevalence of ID and iron deficiency anemia (IDA) in 147 arsenic-exposed Bangladeshi women (75 skin lesion cases; 72 controls), ages 18-33 years, who were part of a skin lesion study. Hemoglobin (Hb) was measured in whole blood; ferritin and hs-c-reactive protein (CRP) were measured in serum. The prevalence of anemia (Hb<120g/L) was 18%. Although the prevalence of ID (ferritin≤12mcg/L) did not differ between cases and controls, anemia was more common among cases (25% vs. 10%; p=0.02). Of anemic women, 27% (N=7) also had ID (Hb<120g/L and ferritin≤12mcg/L), indicating IDA. Women with normal iron status had higher toenail arsenic compared to iron-depleted women (2.9 vs 1.4 µg As/g toenail; p=0.00), and their water arsenic concentration was higher than that of iron-depleted women (18.8 vs 6.2 µg As/L; p=0.03); every 1µg increase in toenail As was associated with a 45% lowered risk of ID (OR=0.55, 95%CI=0.33,0.94). Much of the anemia in this cohort appears unrelated to ID, but could be linked to other nutrients, such as folate and vitamin B12, which are involved in both hematopoiesis and arsenic metabolism. It is possible that arsenic exposure in this cohort compromised folate and vitamin B12 status.

Adolescent Nutritional Status and its Association with Village-level Factors in Tanzania Undernutrition is associated with multiple risk factors operating at different levels, from the individual level to household and community levels. Empirical research has shown that contextual or environmental factors influence nutritional status, but very few studies have examined association between these factors and undernutrition among adolescents. This cross-sectional study used a two-level hierarchical nonlinear model to investigate the association between village-level factors and undernutrition (BMI for Age < 5th percentile of the WHO reference) among a sample of adolescents, (n=670) from 28 villages in Kilosa District, Tanzania. Our hypothesis that contextual factors are associated with undernutrition was supported. The odds of undernutrition were more than twice as high among adolescents from villages with low income expenditure values compared to villages with middle or high income expenditure values (OR: 2.28; CI: 1.429,3.645). Similarly, community food insecurity was a significant predictor of undernutrition (OR: 0.63; CI: 0.467, 0.847; p < 0.05). We also observed a positive association between improved nutritional status and dietary diversity. The multilevel analytic framework employed in this study has demonstrated that both individual-level and community-level characteristics are important predictors of undernutrition in adolescents. Our findings have important policy implications in relation to developing targeted intervention strategies that improve village SES and diversified diets, which in turn may contribute to improved nutritional health for adolescents and their household members.

Rapid infant weight gain (RWG) in the first six months postpartum is a strong predictor for obesity during childhood and adolescence. Although biological factors can influence infant weight gain trajectories, the modifiable factor of parent feeding practices can also have an influence. The use of food to soothe (FTS), or the act of feeding a child when he/she is upset for reasons other than hunger, has been associated with unhealthy eating behaviors and less-favorable weight outcomes in children and older infants. However, limited studies have explored the use of FTS during early infancy before the introduction of solids foods. The present study was a secondary analysis of mothers who completed previous infant feeding studies (n = 134) and was aimed at exploring whether maternal-reported use of FTS was associated with greater infant weight gain during the first six months postpartum and whether feeding type (exclusive breastfeeding versus exclusive formula-feeding versus mixed feeding) or bottle-feeding intensity (percent of daily feedings from a bottle) moderated this association. Both maternal-reported and observational measures of maternal and infant characteristics and their associations with the use of FTS were also explored. Individual correlations as well as multiple and logistic regressions were used to assess whether FTS predicted change in weight-for-age, weight-for-length, and/or RWG from birth to study entry. One-way ANOVA tests were used to assess the differences in use of FTS by feeding type and/or bottle-feeding intensity. Individual correlations and multiple regressions were used to assess whether maternal feeding style and/or infant temperament, clarity of cues, and/or eating behavior predicted the use of FTS. The mean age for infants was 14.8 weeks (SD = 7.1, range = 1.7 - 31.0 weeks). The results showed that the use of FTS had a significant negative association with percent of daily feedings from a bottle (r = -0.20, p = 0.021), and a significantly higher association among mothers who reported mixed feeding (M = 2.87, SD = 0.20) versus exclusive formula feeding (M = 2.20, SD = 0.20). Greater pressuring feeding, greater infant negativity, and lower infant surgency were all significant predictors for the use of FTS (p < 0.05). FTS was not significantly associated with infant weight gain during the first 6 months postpartum. Neither feeding type or bottle-feeding intensity moderated the relationship between the use of FTS and infant weight gain. Future studies would benefit from recruiting a more diverse sample population, including measures of FTS that have been validated on infants younger than 3 months, and following the infants at more frequent time points from birth to 6 months postpartum.

The COVID-19 pandemic provides an important opportunity to understand how parenting stress during social crisis may predict child feeding practices and perceptions of child mealtime behaviors. The objective of the present study was to explore whether parents’ perceived increases in and overall levels of parenting stress during the pandemic were associated with controlling feeding practices and perceptions of child eating behaviors. Parents (n = 284) of 4–6-year-old children completed a cross-sectional online survey between March and April 2020. The survey assessed parents’ perceived change in parenting stress during the onset of the pandemic and levels of parenting stress during the pandemic (via the Parenting Stress Scale), as well as child feeding practices (via the Comprehensive Feeding Practices Questionnaire), and children’s eating behaviors (via the Child Eating Behavior Questionnaire). Ordinal linear regressions were used examine whether changes in and levels of parenting stress predicted use of controlling or responsive feeding practices and parents’ perceptions of child eating behaviors. The majority (63.7%, n = 181) of parents indicated their family was moderately or extremely emotionally affected by the pandemic and 56.7% (n = 161) indicated pandemic-related precautions had been moderately or extremely challenging. Perceived increases in parenting stress during the onset of the pandemic were associated with more frequent use of food as a reward (OR = 1.15, 95% CI = 1.04 – 1.26) and for emotional regulation (OR = 1.13, 95% CI = 1.04 – 1.23), as well as low child food responsiveness (OR = 0.91, 95% CI = 0.84 – 0.99) and lower odds of slow eating (OR = 0.92, 95% CI = 0.84 – 1.00). Higher overall levels of parenting stress were associated with more frequent use of food as a reward (OR = 1.05, 95% CI = 1.02 – 1.08) and for emotional regulation (OR = 1.05, 95% CI = 1.03 – 1.08) but also with use of pressuring feeding practices (OR = 1.03, 95% CI = 1.01 – 1.06) and encouraging a balanced diet less frequently (OR = 1.03, 95% CI = 1.01 – 1.06). Higher overall levels of parenting stress were associated with greater child food fussiness (OR = 1.05, 95% CI = 1.02 – 1.08), low enjoyment of food (OR = 1.05, 95% CI = 1.02 – 1.07), and low satiety responsiveness (OR = 0.95, 95% CI = 0.93 – 0.98). During the COVID-19 pandemic, increases in and high levels of parenting stress predicted parents’ use of food for emotion and behavioral regulation, but also with various domains of children’s eating behaviors. Results highlight the need for targeted efforts to support families during social crisis.

Background: Multiple micronutrient deficiencies are prevalent in pregnant women in developing countries and can result in adverse effects to both the mother and infant. Multiple micronutrient supplements or supplementary foods may be a way to combat micronutrient deficiencies. Objective: To assess change in micronutrient and protein levels in moderately malnourished pregnant Malawian women after receiving one of three nutritional interventions. Methods: Serum retinol, 25-hydroxyvitamin D, ferritin, vitamin B12, folate, zinc, albumin and C-reactive protein concentrations were measured in pregnant women with MUAC >20.6 cm and Results: Baseline micronutrient concentrations indicated high rates of deficiency in zinc (29-39%) and albumin (37-46%), and marginal status of retinol (26-37%) and vitamin D (31-32%). Adjusted mean changes in vitamin B12 concentrations from week 0 to week 10 were -17.1, -36.1, and -52.9 pg/mL for RUSF, CSB-UNIMMAP, and CSB-IFA, respectively (p=0.007). Adjusted mean changes in vitamin D concentrations from week 0 to week 10 were 6.1, 3.1, and 1.7 ng/mL for RUSF, CSB-UNIMMAP, and CSB-IFA, respectively (p=0.007). Adjusted mean changes in folate concentrations from week 0 to week 10 were 2.2, 1.7, and 4.0 ng/mL for RUSF, CSB-UNIMMAP, and CSB-IFA, respectively (p=0.37 for effect of treatment; p=0.06 for the interaction effect of time*treatment). Changes in ferritin, zinc, albumin, retinol, and CRP were not significantly different between treatment groups. Conclusions: Deficiencies in zinc and albumin, and marginal status of vitamin D and retinol, are common among this population of moderately malnourished pregnant Malawian women. Significant changes in vitamin D and vitamin B12were observed from week 0 to week 10, with the RUSF group having the greatest improvements compared to the CSB-UNIMMAP and CSB-IFA treatments.

The HIV pandemic has affected millions of people around the world both medically and socially, since there is a stigma associated with this disease. Common methods of transmission include sexual intercourse and sharing needles, but there are other lesser known methods through which people can contract this disease. One such way is mother-to-child transmission (MTCT), in which a mother could transmit the virus to her child either during pregnancy, childbirth, or through breastfeeding. This paper focuses on the role of breastfeeding in the transmission of HIV from mother to child. Many studies have investigated how breastfeeding results in the transmission of the virus, and effective common treatment methods have been established. However, the issue of MTCT of HIV still exists even though it can easily be eradicated with the proper techniques. This suggests that there are still factors that contribute to HIV transmission from mother to child that have yet to be eliminated. Thus, this paper reviews the breastfeeding rates and breastfeeding practices of three different countries: South Africa, India, and the United Kingdom. This paper analyzes epidemiological data, studies from medical journals, and studies from anthropology journals to determine what social influences surround breastfeeding practices in each of these countries to see how these may contribute to MTCT of HIV via breastfeeding. While there were no apparent trends between child HIV prevalence rates and breastfeeding rates in these countries, there were some social and cultural factors that were similar across all three nations. This information may be useful in creating more effective treatment plans that are conducive to the social environments in these countries.