Journal of Human Lactation - online first articles

Journal of Human Lactation, Ahead of Print.
Background:With rapid industrialization and urbanization, there is a growing need for women to enter the workforce, and affluent people are drawn to the infant formula market. The breastfeeding rates in China are below the optimal level. Large scale quantitative research studying breastfeeding practices after 2015 in China are lacking.Research aim:We aimed to (1) explore the latest patterns and (2) identify the determinants of breastfeeding in China.Methods:The study was a population-based, cross-sectional survey. A multi-stage sampling technique was adopted for the selection of participants. We recruited 10,408 mothers with children under 12 months old, in 12 regions of China, and conducted a questionnaire survey about breastfeeding patterns. The associations between social and biophysical determinants and breastfeeding outcomes were analyzed using a logistic regression model.Results:The exclusive breastfeeding rate was 29.32% (n = 3,052) decreasing from 32.71% (n = 3,404) to 15.83% (n = 1,648) among children aged 0–5 months. Cesarean section had a negative association with early breastfeeding initiation (OR = .33, 95% CI [.30, .36]), exclusive breastfeeding (OR = .78, 95% CI [.69, .89]), and predominant breastfeeding (OR = .73, 95% CI [.65, .83]). Compared to participants with an annual household income lower than 40,000 Yuan ($5,817 USD), those with over 100,000 Yuan ($14,542 USD) had an OR of .78 (95% CI [.67, .90]) in exclusive breastfeeding. Compared with illiterate and unemployed groups, middle/high school education and a current work status, respectively, were associated with a lower likelihood of exclusive breastfeeding (OR = .73, 95% CI [.63, .84]; OR = .58, 95% CI [.37, .89]).Conclusions:The prevalence of breastfeeding in 12 selected regions in China was low and interventions focusing on the targeted population should be strengthened.

Journal of Human Lactation, Ahead of Print.
Background:With rapid industrialization and urbanization, there is a growing need for women to enter the workforce, and affluent people are drawn to the infant formula market. The breastfeeding rates in China are below the optimal level. Large scale quantitative research studying breastfeeding practices after 2015 in China are lacking.Research aim:We aimed to (1) explore the latest patterns and (2) identify the determinants of breastfeeding in China.Methods:The study was a population-based, cross-sectional survey. A multi-stage sampling technique was adopted for the selection of participants. We recruited 10,408 mothers with children under 12 months old, in 12 regions of China, and conducted a questionnaire survey about breastfeeding patterns. The associations between social and biophysical determinants and breastfeeding outcomes were analyzed using a logistic regression model.Results:The exclusive breastfeeding rate was 29.32% (n = 3,052) decreasing from 32.71% (n = 3,404) to 15.83% (n = 1,648) among children aged 0–5 months. Cesarean section had a negative association with early breastfeeding initiation (OR = .33, 95% CI [.30, .36]), exclusive breastfeeding (OR = .78, 95% CI [.69, .89]), and predominant breastfeeding (OR = .73, 95% CI [.65, .83]). Compared to participants with an annual household income lower than 40,000 Yuan ($5,817 USD), those with over 100,000 Yuan ($14,542 USD) had an OR of .78 (95% CI [.67, .90]) in exclusive breastfeeding. Compared with illiterate and unemployed groups, middle/high school education and a current work status, respectively, were associated with a lower likelihood of exclusive breastfeeding (OR = .73, 95% CI [.63, .84]; OR = .58, 95% CI [.37, .89]).Conclusions:The prevalence of breastfeeding in 12 selected regions in China was low and interventions focusing on the targeted population should be strengthened.

Journal of Human Lactation, Ahead of Print.
Background:Breastfeeding and optimal birth spacing are associated with improved maternal and infant health outcomes worldwide. Provision of contraceptive advice that is aligned with recommendations for breastfeeding has potential to maximize maternal and infant health. Although there is broad agreement regarding the breastfeeding compatibility of specific postpartum contraceptive methods, it is not known whether maternal breastfeeding intention influences prenatal provider contraceptive counseling.Research aim:We aimed to determine if maternal feeding intention is considered by prenatal providers during contraceptive counseling.Methods:This was a cross-sectional online author-created survey including all prenatal providers (N = 40) at two academic safety-net institutions in Cleveland, Ohio. Of 100 obstetrics/gynecology faculty members, 40 (40%) completed the survey, which included multiple-choice questions. Nominal and ordinal survey results were reported with percentages and frequencies, and categorical variables were compared using the Fisher exact test.Results:Participants appropriately promoted breastfeeding-compatible postplacental intrauterine device placement, even though maternal feeding intention was specifically considered by just 12 (30%). Endorsed barriers to contraception for breastfeeding mothers included provider medical worries, patient concerns, and colleague resistance. Postplacental levonorgestrel intrauterine devices were recommended for all mothers by 92.5% of participants (n = 37). Recommendations regarding progestin-only and combined oral contraceptive pills were influenced by maternal breastfeeding versus formula-feeding intention.Conclusion:Asking expectant women about their feeding intentions within each contraceptive discussion may create opportunities for shared decision making that can optimize perinatal outcomes for both mother and infant worldwide.

Journal of Human Lactation, Ahead of Print.
Background:Breastfeeding and optimal birth spacing are associated with improved maternal and infant health outcomes worldwide. Provision of contraceptive advice that is aligned with recommendations for breastfeeding has potential to maximize maternal and infant health. Although there is broad agreement regarding the breastfeeding compatibility of specific postpartum contraceptive methods, it is not known whether maternal breastfeeding intention influences prenatal provider contraceptive counseling.Research aim:We aimed to determine if maternal feeding intention is considered by prenatal providers during contraceptive counseling.Methods:This was a cross-sectional online author-created survey including all prenatal providers (N = 40) at two academic safety-net institutions in Cleveland, Ohio. Of 100 obstetrics/gynecology faculty members, 40 (40%) completed the survey, which included multiple-choice questions. Nominal and ordinal survey results were reported with percentages and frequencies, and categorical variables were compared using the Fisher exact test.Results:Participants appropriately promoted breastfeeding-compatible postplacental intrauterine device placement, even though maternal feeding intention was specifically considered by just 12 (30%). Endorsed barriers to contraception for breastfeeding mothers included provider medical worries, patient concerns, and colleague resistance. Postplacental levonorgestrel intrauterine devices were recommended for all mothers by 92.5% of participants (n = 37). Recommendations regarding progestin-only and combined oral contraceptive pills were influenced by maternal breastfeeding versus formula-feeding intention.Conclusion:Asking expectant women about their feeding intentions within each contraceptive discussion may create opportunities for shared decision making that can optimize perinatal outcomes for both mother and infant worldwide.

Journal of Human Lactation, Ahead of Print.
Background:Thirty-six percent of females are employed in Bangladesh, many in the readymade garments manufacturing industry. Inadequate access to health information, care, and long working hours makes exclusive breastfeeding particularly challenging for these employed mothers.Research aim:To describe the influence of a breastfeeding education and support program on breastfeeding patterns of mothers working in garment and other factories in Bangladesh.Methods:A descriptive two-group prospective, mixed methods, longitudinal prospective study was conducted from May 2015 to March 2017. Peer counselors were trained to provide home-based counseling from 6 months of pregnancy until infants completed 6 months for pregnant and lactating factory workers and neighboring unemployed women. The total evaluation sample (N = 304) consisted of participants still employed (n = 190) and unemployed (n = 144). Peer counselors recorded socioeconomic information, weights, and infant feeding patterns. Descriptive statistical analyses examined the peer counselors’ influence on breastfeeding practices.Results:Initiation of breastfeeding within 1 hr was high in both groups, 173 (91%) among the employed, and 101 (89%) among the unemployed participants. Exclusive breastfeeding at 6 months was reported by 107 out of 125 (86%) of the employed participants versus 72 out of 76 (95%) of those unemployed.Conclusions:Community-based peer counselors can help to inform, encourage, and support both factory workers and unemployed women with optimal breastfeeding patterns. Factories who have female workers should consider employing outreach peer counselors as part of their community social responsibility, and as a way to contribute to the sustainability of these programs.

Journal of Human Lactation, Ahead of Print.
Background:Thirty-six percent of females are employed in Bangladesh, many in the readymade garments manufacturing industry. Inadequate access to health information, care, and long working hours makes exclusive breastfeeding particularly challenging for these employed mothers.Research aim:To describe the influence of a breastfeeding education and support program on breastfeeding patterns of mothers working in garment and other factories in Bangladesh.Methods:A descriptive two-group prospective, mixed methods, longitudinal prospective study was conducted from May 2015 to March 2017. Peer counselors were trained to provide home-based counseling from 6 months of pregnancy until infants completed 6 months for pregnant and lactating factory workers and neighboring unemployed women. The total evaluation sample (N = 304) consisted of participants still employed (n = 190) and unemployed (n = 144). Peer counselors recorded socioeconomic information, weights, and infant feeding patterns. Descriptive statistical analyses examined the peer counselors’ influence on breastfeeding practices.Results:Initiation of breastfeeding within 1 hr was high in both groups, 173 (91%) among the employed, and 101 (89%) among the unemployed participants. Exclusive breastfeeding at 6 months was reported by 107 out of 125 (86%) of the employed participants versus 72 out of 76 (95%) of those unemployed.Conclusions:Community-based peer counselors can help to inform, encourage, and support both factory workers and unemployed women with optimal breastfeeding patterns. Factories who have female workers should consider employing outreach peer counselors as part of their community social responsibility, and as a way to contribute to the sustainability of these programs.

Journal of Human Lactation, Ahead of Print.
Peer-review publishing has long been the gold standard for disseminating research. The peer-review process holds researchers accountable for their work and conveys confidence that the article is of value to the reader. Predatory journals and publishing pose a global threat to the quality of scientific literature, accuracy of educational resources, and safety of patient care. Predatory publishing uses an exploitative business model, substandard quality control measures, and deceptive publishing practices. Given the proliferation of these journals and the extreme measures utilized to disguise substandard publishing practices, avoiding them can prove difficult. Understanding the nature of predatory publishing and how to recognize the warning signs provide helpful measures to authors, researchers, students, and readers. Additional resources known to help avoid predatory publishers have been discussed in addition to reviewing the Journal of Human Lactation guidelines for publishing.

Journal of Human Lactation, Ahead of Print.

Journal of Human Lactation, Ahead of Print.
Background:Although exclusive breastfeeding of infants has several benefits, in Ghana only 52% of children under 6 months old are breastfed exclusively. However, researchers have not conducted longitudinal observational studies to examine exclusive breastfeeding discontinuation and determine risk factors.Research aims:(1) To determine exclusive breastfeeding discontinuation, and (2) to examine those factors linked to discontinued exclusive breastfeeding.Methods:A longitudinal, one-group observational study was conducted. A total of 322 mothers who had normal and full-term delivery at a district level referral hospital from January to December 2017 were recruited, followed-up every month, and subsequently interviewed after 6 months postpartum. Data were collected using validated questionnaires. Binary and multivariable Poisson regression analyses were the statistical analytical methods used.Results:Respondents’ mean age was 29.78 years (SD = 5.20). Among the 322 mothers who initiated breastfeeding with human milk at birth, 108 (34%) discontinued exclusive breastfeeding before 6 months postpartum. After controlling for possible covariates, attending antenatal care 4 or less times during pregnancy (aRR = 6.54; 95% CI [1.77–24.22]; p = .005); lack of support from family to breastfeed exclusively (aRR = 2.41; 95% CI [1.23–4.71]; p = .010), outside pressure to provide other food to the baby < 6 months postpartum (aRR = 1.87; 95% CI [1.01–3.46]; p = .045), and living in an urban area (aRR = 2.10; 95% CI [1.17-3.75]; p = .013) significantly increased the risks of discontinuing exclusive breastfeeding.Conclusion:Universal exclusive breastfeeding may not be achieved without tackling the key determinants of discontinuation of exclusive breastfeeding. Health facility and community-based exclusive breastfeeding promotion interventions are therefore needed.

Journal of Human Lactation, Ahead of Print.
Background:Although exclusive breastfeeding of infants has several benefits, in Ghana only 52% of children under 6 months old are breastfed exclusively. However, researchers have not conducted longitudinal observational studies to examine exclusive breastfeeding discontinuation and determine risk factors.Research aims:(1) To determine exclusive breastfeeding discontinuation, and (2) to examine those factors linked to discontinued exclusive breastfeeding.Methods:A longitudinal, one-group observational study was conducted. A total of 322 mothers who had normal and full-term delivery at a district level referral hospital from January to December 2017 were recruited, followed-up every month, and subsequently interviewed after 6 months postpartum. Data were collected using validated questionnaires. Binary and multivariable Poisson regression analyses were the statistical analytical methods used.Results:Respondents’ mean age was 29.78 years (SD = 5.20). Among the 322 mothers who initiated breastfeeding with human milk at birth, 108 (34%) discontinued exclusive breastfeeding before 6 months postpartum. After controlling for possible covariates, attending antenatal care 4 or less times during pregnancy (aRR = 6.54; 95% CI [1.77–24.22]; p = .005); lack of support from family to breastfeed exclusively (aRR = 2.41; 95% CI [1.23–4.71]; p = .010), outside pressure to provide other food to the baby < 6 months postpartum (aRR = 1.87; 95% CI [1.01–3.46]; p = .045), and living in an urban area (aRR = 2.10; 95% CI [1.17-3.75]; p = .013) significantly increased the risks of discontinuing exclusive breastfeeding.Conclusion:Universal exclusive breastfeeding may not be achieved without tackling the key determinants of discontinuation of exclusive breastfeeding. Health facility and community-based exclusive breastfeeding promotion interventions are therefore needed.

Journal of Human Lactation, Ahead of Print.
Background:A professional association journal should reflect the needs of its organization, its readers, and the field it represents. Evaluating the needs that the Journal of Human Lactation has met, and those it has not, is essential if it is to remain relevant to its readers.Aims:(1) Describe the characteristics of articles published from 1985 through 2018. (2) Describe content intended to educate lactation support providers and clinicians. (3) Explore the ways the content has illustrated the growth and development of lactation knowledge, and (4) identify the reoccurring content threads consistent throughout the 34 years.Methods:A prospective mixed methods approach incorporating a quantitative content analysis and a qualitative thematic analysis was used. Frequency distributions were done on all the variables extracted from published articles (N = 1586). The second level of analysis identified themes using an iterative and consensus approach.Results:Mirroring the growth in the lactation field, the volume of research articles published each year has increased along with the percent of research articles per issue. Research methods have become more diverse. The international scope and relevance, while always present, has been steadily increasing. Threads identified were; striving for international scope, advancing lactation education, developing a body of knowledge that informs clinical practice in lactation, and creating a centralized place for multidisciplinary research about lactation.Conclusion:The body of work published in the Journal of Human Lactation parallels the development of the lactation specialty. We have highlighted areas for improvement and possible further study.

Journal of Human Lactation, Ahead of Print.
Background:The Neonatal Eating Assessment Tool—Breastfeeding is a valid and reliable 62-item parent-report assessment of symptoms of problematic breastfeeding behavior intended for infants less than 7 months old.Research aim:The aim of this study was to describe the Neonatal Eating Assessment Tool—Breastfeeding total score and subscale scores within a sample of full-term, healthy, typically-developing infants under 7 months old.Methods:Parents of healthy, full-term breastfeeding infants (N = 475) less than 7 months old completed the Neonatal Eating Assessment Tool – Breastfeeding through an online survey. Descriptive statistics were calculated for the total score and seven subscale scores within each age group: 0–2, 2–4, 4–6, and 6–7 months.Results:Neonatal Eating Assessment Tool—Breastfeeding total scores were highest (i.e., more problematic symptoms) at 0–2 months and decreased in older infant age groups. All subscale scores also had a downward trajectory in symptoms of problematic breastfeeding except the subscale Compelling Symptoms of Problematic Feeding, which was very low across age groups. Scores on the Infant Regulation subscale remained elevated for the first 6 months of life, then declined markedly in the 6–7 month age group.Conclusion:The Neonatal Eating Assessment Tool—Breastfeeding now has reference values to facilitate interpretation of scores and guide decision-making, personalization of interventions, and assessment of response to interventions. For research, the Neonatal Eating Assessment Tool—Breastfeeding can be used to follow longitudinal development of breastfeeding as well as to test efficacy of breastfeeding interventions.

Journal of Human Lactation, Ahead of Print.
Background:The Neonatal Eating Assessment Tool—Breastfeeding is a valid and reliable 62-item parent-report assessment of symptoms of problematic breastfeeding behavior intended for infants less than 7 months old.Research aim:The aim of this study was to describe the Neonatal Eating Assessment Tool—Breastfeeding total score and subscale scores within a sample of full-term, healthy, typically-developing infants under 7 months old.Methods:Parents of healthy, full-term breastfeeding infants (N = 475) less than 7 months old completed the Neonatal Eating Assessment Tool – Breastfeeding through an online survey. Descriptive statistics were calculated for the total score and seven subscale scores within each age group: 0–2, 2–4, 4–6, and 6–7 months.Results:Neonatal Eating Assessment Tool—Breastfeeding total scores were highest (i.e., more problematic symptoms) at 0–2 months and decreased in older infant age groups. All subscale scores also had a downward trajectory in symptoms of problematic breastfeeding except the subscale Compelling Symptoms of Problematic Feeding, which was very low across age groups. Scores on the Infant Regulation subscale remained elevated for the first 6 months of life, then declined markedly in the 6–7 month age group.Conclusion:The Neonatal Eating Assessment Tool—Breastfeeding now has reference values to facilitate interpretation of scores and guide decision-making, personalization of interventions, and assessment of response to interventions. For research, the Neonatal Eating Assessment Tool—Breastfeeding can be used to follow longitudinal development of breastfeeding as well as to test efficacy of breastfeeding interventions.

Journal of Human Lactation, Ahead of Print.
Research about lactation and breastfeeding has exploded since the Journal of Human Lactation (JHL) began publishing in 1985. To discuss the 3-decade-long role of the Journal in promoting, supporting, and disseminating lactation research, editors convened a multidisciplinary group of lactation researchers and providers which comprised three senior researchers and one clinical practitioner, all of whom have a long history of lactation advocacy. Their discussion took place on July 1, 2019. Dr Aimee Eden is a medical anthropologist who leads the qualitative research efforts in a small research department. Her dissertation research focused on the maternal and child healthcare workforce, and the professionalization of breastfeeding support. She served on the Board of Directors of the International Board of Lactation Examiners (2010–2016) and currently serves on the board of the Monetary Investment for Lactation Consultant Certification. Dr Karleen Gribble has been conducting research for 15 years about infant and young child feeding in emergencies, long-term breastfeeding, milk sharing, early childhood trauma, adoption, and fostering. She is an Australian Breastfeeding Association community educator and breastfeeding counselor and a member of the Infant and Young Child Feeding in Emergencies Core Group. Elien Rouw is a practicing physician in Germany specialized in healthy infant care, with a long-standing specialization in breastfeeding medicine. She serves on the Board of Directors of the Academy of Breastfeeding Medicine, is a member of the German National Breastfeeding Committee and their delegate to the World Alliance for Breastfeeding Action. Dr Jackie Wolf is an historian of medicine, whose research focuses on the history of childbirth and breastfeeding practices in the United States and how those practices have shaped women’s and children’s health, as well as public health, over time. Her latest book, published by Johns Hopkins University Press and funded by a 3 year grant from the National Institutes of Health, is Cesarean Section: An American History of Risk, Technology, and Consequence. Dr Sara Gill moderated the discussion. She was a member of the Board of Directors of the International Lactation Consultant Association for 5 years, and has been an Associate Editor of the Journal of Human Lactation for the past 4 years. Her research has focused on breastfeeding among vulnerable populations. (Participants’ comments are noted as AE = Aimee Eden; SG = Sara Gill; KG = Karleen Gribble; ER = Elien Rouw; JW = Jacqueline Wolf).

Journal of Human Lactation, Ahead of Print.
Background:Peer support may help mothers to feel satisfied with their breastfeeding and to continue breastfeeding. However, previous researchers have not examined the influence of peer support on the three breastfeeding-satisfaction domains.Research aim:We aimed to examine the influence of telephone-based peer support on the following three domains of breastfeeding satisfaction among Japanese mothers: maternal satisfaction, perceived benefit to the infant, and lifestyle compatibility with breastfeeding.Methods:Breastfeeding mothers were recruited at four maternity hospitals in Japan to participate in a randomized controlled trial. Data were collected 1 month and 4 months postpartum. Among all of the participants (N = 114), those in the intervention group (n = 60) received telephone-based peer support until 4 months postpartum, and participants in the control group (n = 54) received conventional support. Breastfeeding satisfaction was measured using the short version of the revised Japanese Maternal Breastfeeding Evaluation Scale. Generalized estimating equations and effect size analyses were used to examine the influence of the intervention.Results:On the subscale measuring lifestyle compatibility, participants with peer support had a higher score than those without peer support: regression coefficient 1.54 (95% confidence interval [0.03, 3.04]). The effect size was 0.40 standard deviations among participants with low and mid-level scores at baseline.Conclusion:Although peer support did not change maternal satisfaction or perceived benefit to the infant, it did increase lifestyle compatibility with breastfeeding among these Japanese mothers. This is evidence in favor of increasing the use of peer support.

Journal of Human Lactation, Ahead of Print.
Background:Peer support may help mothers to feel satisfied with their breastfeeding and to continue breastfeeding. However, previous researchers have not examined the influence of peer support on the three breastfeeding-satisfaction domains.Research aim:We aimed to examine the influence of telephone-based peer support on the following three domains of breastfeeding satisfaction among Japanese mothers: maternal satisfaction, perceived benefit to the infant, and lifestyle compatibility with breastfeeding.Methods:Breastfeeding mothers were recruited at four maternity hospitals in Japan to participate in a randomized controlled trial. Data were collected 1 month and 4 months postpartum. Among all of the participants (N = 114), those in the intervention group (n = 60) received telephone-based peer support until 4 months postpartum, and participants in the control group (n = 54) received conventional support. Breastfeeding satisfaction was measured using the short version of the revised Japanese Maternal Breastfeeding Evaluation Scale. Generalized estimating equations and effect size analyses were used to examine the influence of the intervention.Results:On the subscale measuring lifestyle compatibility, participants with peer support had a higher score than those without peer support: regression coefficient 1.54 (95% confidence interval [0.03, 3.04]). The effect size was 0.40 standard deviations among participants with low and mid-level scores at baseline.Conclusion:Although peer support did not change maternal satisfaction or perceived benefit to the infant, it did increase lifestyle compatibility with breastfeeding among these Japanese mothers. This is evidence in favor of increasing the use of peer support.

Journal of Human Lactation, Ahead of Print.
Background:Although the reasons for discontinued breastfeeding are multifactorial, an unsupportive work environment is consistently reported as a barrier to continued breastfeeding. In the United States, several state breastfeeding advocates have taken a distinctive approach to promote worksite lactation support by developing statewide recognition initiatives aimed at incentivizing employers to support breastfeeding employees by offering public recognition for the worksites’ efforts.Research aim:To identify and describe statewide worksite lactation support recognition initiatives in the United States.Methods:Between May 2016 and June 2017, semi-structured phone interviews were conducted with breastfeeding experts in each U.S. state (N = 60 participants) for this cross-sectional study. Experts in states with a recognition initiative were asked about the background, structure, and requirements of the initiative.Results:Twenty-six states had a current initiative, and some had requirements for providing a private space (n = 19; 73%) and time (n = 18; 69%) for employees to express human milk, as well as a written worksite lactation support policy (n = 10; 38%).Conclusions:This was the first study in which researchers systematically identified ongoing worksite lactation support recognition initiatives in the United States. The results of this work also served to highlight both the similarities and the variety between initiatives. Future researchers should aim to determine the components of an initiative that increase employer support and, in turn, breastfeeding rates.

Journal of Human Lactation, Ahead of Print.
Background:Although the reasons for discontinued breastfeeding are multifactorial, an unsupportive work environment is consistently reported as a barrier to continued breastfeeding. In the United States, several state breastfeeding advocates have taken a distinctive approach to promote worksite lactation support by developing statewide recognition initiatives aimed at incentivizing employers to support breastfeeding employees by offering public recognition for the worksites’ efforts.Research aim:To identify and describe statewide worksite lactation support recognition initiatives in the United States.Methods:Between May 2016 and June 2017, semi-structured phone interviews were conducted with breastfeeding experts in each U.S. state (N = 60 participants) for this cross-sectional study. Experts in states with a recognition initiative were asked about the background, structure, and requirements of the initiative.Results:Twenty-six states had a current initiative, and some had requirements for providing a private space (n = 19; 73%) and time (n = 18; 69%) for employees to express human milk, as well as a written worksite lactation support policy (n = 10; 38%).Conclusions:This was the first study in which researchers systematically identified ongoing worksite lactation support recognition initiatives in the United States. The results of this work also served to highlight both the similarities and the variety between initiatives. Future researchers should aim to determine the components of an initiative that increase employer support and, in turn, breastfeeding rates.

Journal of Human Lactation, Ahead of Print.
Background:The World Health Organization (WHO) and the United Kingdom Committee for UNICEF recommend that secondary schools include infant feeding education in the curriculum. However, little attention has been given to the study of educators’ views and practices regarding infant feeding education.Aims:The aims of this research were to (1) explore North Carolina Family and Consumer Sciences teachers’ attitudes towards infant feeding education in secondary schools and (2) describe North Carolina Family and Consumer Sciences teachers’ infant feeding education practices.Methods:Researchers conducted interviews (N = 19) and a survey (N = 137) using a sequential mixed methods design. The constant comparative method was used to analyze interview transcripts. Subsequently, a 33-item survey was developed to assess teachers’ attitudes and practices, and this survey was tested for validity and reliability.Results:The majority of participants supported including infant feeding (n = 119, 86.9%) and breastfeeding (n = 116, 84.7%) education in high school. Approximately half of the participants supported including infant feeding (n = 71, 51.9%) and breastfeeding (n = 64, 46.7%) education in middle school. Participants reported that they taught infant feeding at both levels; topics taught included complementary foods, patterns of infant feeding, and the safe preparation of infant formula. Breastfeeding content was covered primarily in the high school Parenting and Child Development course.Conclusions:North Carolina Family and Consumer Sciences teachers have positive attitudes towards teaching about breastfeeding at the secondary school level. Content about infant nutrition and breastfeeding is currently included in courses that cover child development and human nutrition.

Journal of Human Lactation, Ahead of Print.
Background:The World Health Organization (WHO) and the United Kingdom Committee for UNICEF recommend that secondary schools include infant feeding education in the curriculum. However, little attention has been given to the study of educators’ views and practices regarding infant feeding education.Aims:The aims of this research were to (1) explore North Carolina Family and Consumer Sciences teachers’ attitudes towards infant feeding education in secondary schools and (2) describe North Carolina Family and Consumer Sciences teachers’ infant feeding education practices.Methods:Researchers conducted interviews (N = 19) and a survey (N = 137) using a sequential mixed methods design. The constant comparative method was used to analyze interview transcripts. Subsequently, a 33-item survey was developed to assess teachers’ attitudes and practices, and this survey was tested for validity and reliability.Results:The majority of participants supported including infant feeding (n = 119, 86.9%) and breastfeeding (n = 116, 84.7%) education in high school. Approximately half of the participants supported including infant feeding (n = 71, 51.9%) and breastfeeding (n = 64, 46.7%) education in middle school. Participants reported that they taught infant feeding at both levels; topics taught included complementary foods, patterns of infant feeding, and the safe preparation of infant formula. Breastfeeding content was covered primarily in the high school Parenting and Child Development course.Conclusions:North Carolina Family and Consumer Sciences teachers have positive attitudes towards teaching about breastfeeding at the secondary school level. Content about infant nutrition and breastfeeding is currently included in courses that cover child development and human nutrition.