School of Public Health
Permanent URI for this communityhttp://hdl.handle.net/1903/1633
The collections in this community comprise faculty research works, as well as graduate theses and dissertations.
Note: Prior to July 1, 2007, the School of Public Health was named the College of Health & Human Performance.
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Item Familial sources of encouragement and breast-feeding practices among women participating in the US Special Supplemental Nutrition Programme for Women, Infants and Children(Cambridge University Press, 2023-04-05) Channell Doig, Amara; Aparicio, Elizabeth M; Gallo, SinaObjective: To explore how sources of familial encouragement are associated with breast-feeding initiation and duration among a national sample participating in the US Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). Design: This study uses the 2013–2015 WIC Infant and Toddler Feeding Practices Study 2 (WIC ITFPS-2) data. Breast-feeding initiation was measured at the first month, while duration was derived from a composite of the first 13 months. The analysis used logistic and linear regression to explore the association between encouragement sources and breast-feeding outcomes. Setting: A nationally representative sample of WIC participants in the USA. Participants: WIC participants who completed the 13-month interview of the WIC ITFPS-2 (n 2807). Results: Encouragement was significantly associated with both initiation and duration. Each source of encouragement was associated with a 3·2 (95 % CI 2·8, 3·8) increase in odds of initiating breast-feeding in the unadjusted model and 3·0 (95 % CI 2·5, 3·6) increased odds, controlling for age, education, nativity, poverty status, race and ethnicity (<0·0001). When predicting log duration, each percent increase in source of encouragement was associated with an increasing duration on average by 0·003 d (95 % CI 0·2, 0·3, <0·0001). When controls were added, it was associated with an increase of an average of 0·002 d (95 % CI 0·2, 0·3) per percent increase in encouragement source (<0·0001). Conclusions: Women who receive encouragement appear to be more likely to breastfeed. Additional work is needed to explore sources of encouragement and how to include them in intervention work.Item Maternal postpartum nutrition exposures, breastfeeding, and infant weight(2020) Cassar-Uhl, Diana; Steinberg, Julia R; Family Studies; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)Objective: This dissertation investigated relationships between postpartum maternal dietary intakes, breastfeeding exclusivity, intensity, and duration, reasons for weaning before 6 months, and infant weight at 6 months. Methods: Three aims examined 8 nutritional exposures: magnesium, added sugar, dairy, energy, glycemic load, and macronutrient distributions (percent of calories from carbohydrate, protein, and fat) among participants in the United States Food and Drug Administration (FDA) and Centers for Disease Control and Prevention (CDC)’s second Infant Feeding Practices Study (IFPS II). The first aim employed logistic regression to examine the association between intakes of dietary factors and exclusive breastfeeding at 3 months, partial breastfeeding at 3 months, and any breastfeeding at 6 months (n = 1099). The second aim used logistic regression to investigate the association between intakes of dietary factors and reasons for early weaning (n = 587). The third aim used multivariable linear regression to examine differences in infant weight and weight-for-age z-scores at 6 months by intakes of dietary exposures (n =186). Unadjusted models and models adjusted for relevant covariates were executed. Results: Those with consumption at or exceeding recommended daily intakes of magnesium, dairy, and energy were more likely to engage in recommended breastfeeding behaviors. Consuming a diet with a low average daily glycemic load was associated with not breastfeeding as recommended. Low average daily glycemic load was associated with a lower likelihood of citing “too much milk” as a reason to wean. No maternal intakes were associated with higher or lower weight or weight-for-age z-scores at 6 months. Conclusion: Findings support existing nutrition guidelines for women of childbearing age, and suggest that a higher daily intake of magnesium may be appropriate for lactating mothers. Average daily glycemic load may also be important, and should be studied further. Implications: This dissertation provides an exploration into specific maternal dietary intakes and important outcomes of infant feeding. It provides a foundation for future inquiries into the roles of magnesium and glycemic load in supporting breastfeeding.Item Gestational Weight Gain, Infant Feeding Practices, and Infant Growth(2014) DiBari, Jessica Noelle; Shenassa, Edmond; Family Studies; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)Suboptimal growth is apparent across generations. Gestational weight gain (GWG) and infant feeding have been linked to child growth trajectories. This study assessed the joint association of GWG and infant feeding with three growth outcomes: length, weight, and weight-for-length. I analyzed data from the Infant Feeding Practices Study II (2007), a nationally-based sample of mother/infant dyads followed from the third trimester of pregnancy through infancy (N=1939). GWG was defined as inadequate, adequate, and excessive. Predominant feeding categories were defined as ≥ 70% breast fed, ≥ 70% formula fed, and mixed fed. Linear multiple regression and mixed effect models were fit to achieve the study aims. At three months, compared to the adequate GWG group, the inadequate group were lighter (-0.24 lbs.; 95% CI: -0.36, -0.12) and shorter (-0.13 in.; 95% CI: -0.23, -0.03), while the excessive group was heavier (0.28 lbs.; CI: 0.19, 0.38) and longer (0.09 in.; 95% CI: 0.01, 0.17). At five months, compared to breastfed infants, formula fed infants were heavier (0.38 lbs.; 95% CI: 0.26, 0.50); and the association between feeding type and length was apparent at seven months, where formula fed were longer (0.24 in.; 95% CI: 0.10, 0.39). An association between feeding type and weight-for-length was evident at twelve months, where the ratio for formula fed was greater (0.03 lbs./in.; 95% CI: 0.03, 0.04). The weight gain trajectory of breastfed infants was lower than the other feeding groups. The length trajectories were highest among formula fed compared to breastfed and mixed fed infants. The interaction between GWG and feeding type was significant for weight (p<0.05) and marginally significant for length (p=0.06). My findings suggest existence of a difference in growth by GWG and feeding type. The weight trajectory of breastfed infants is steadier than that of other infants, highlighting the protective effect of breastfeeding on excessive weight gain. The growth rate for all feeding groups was fastest between 3-5 months, suggesting a critical window for growth during early infancy. Interventions targeting pregnancy and infancy can influence growth trajectories and contribute to a shift in intergenerational population growth trends.