Breastfeeding and risk of habitual snoring in children: A meta‐analysis

Research regarding the effects of breastfeeding on habitual snoring in children has yielded conflicting results. Therefore, a meta‐analysis was carried out to evaluate the effect of breastfeeding on the risk of habitual snoring in children. Relevant studies published in English or Chinese were identified by a search of PubMed, Embase, Web of Science, Chinese National Knowledge Infrastructure, China Biology Medical literature, and Wanfang databases up to October 2018. Random effects model was used to pool the findings, and results were expressed as odds ratios (OR) with 95% CIs. Eleven studies with 71,622 participants were included in the present meta‐analysis. The pooled OR of habitual snoring for more versus less breastfeeding (duration) was 0.74 (95% CI [0.62, 0.90]), and the result remained significant in cohort studies (OR, 0.74; 95%CI [0.66, 0.84]). We found no evidence of publication bias. This meta‐analysis of observational studies indicates that breastfeeding for a long time is associated with reduced risk of habitual snoring in children. The finding needs to be investigated in well‐designed prospective studies.     

Moderate and severe household food insecurity predicts stunting and severe stunting among Rwanda children aged 6–59 months residing in Gicumbi district

Household food insecurity (HFI) plays an important role in child malnutrition in many low‐income countries. We determined the association between HFI and stunting and severe stunting among Rwandan children from the Gicumbi district, aged 6–59 months using a cross‐sectional study of 2,222 children. HFI factor was calculated by summing all seven HFI (access) frequency questions and was categorised into food security, mildly food insecurity, moderately food insecurity, and severe food insecurity. The association between stunting, severe stunting, and HFI was determined using the multiple logistic regression analyses that adjust for clustering and sampling weights. The odds of moderate and severe HFI were significantly higher among stunted children aged 6–59 months than those who were not stunted (adjusted odds ratio [AOR] = 1.43; 95% confidence interval [CI] [1.11, 1.84] and AOR = 1.35; 95% CI [1.08, 1.69], respectively). Children from households with moderate food insecurity were 2.47 times more likely to be severely stunted (AOR = 2.47; 95% CI [1.77, 3.46]), and those from households with severe food insecurity were more likely to be severely stunted (AOR = 1.82; 95% CI [1.34, 2.48]), compared with children aged 6–59 months from households with food security. Other factors included male children and children who did not attend monthly growth monitoring sessions. This study showed that moderate and severe HFI correlated with stunting and severe stunting. Interventions to improve stunting in Gicumbi children should also focus on male children, children who did not attend monthly growth monitoring sessions, and households with moderate and severe food insecurity.     

Prevalence and determinants of gestational weight gain among pregnant women in Niger

Low gestational weight gain (GWG) and low mid‐upper arm circumference (MUAC) are associated with adverse pregnancy outcomes. We aimed to assess the prevalence and determinants of low GWG and low MUAC among pregnant women in rural Zinder, Niger. A community‐based survey was conducted among 1,384 pregnant women in the catchment areas of 18 integrated health centers in the region of Zinder, Niger. Weight and MUAC were measured during an in‐home visit and again 1 month later, when haemoglobin concentration and micronutrient status were also assessed. The prevalence of low GWG was defined based on the 2009 United States Institute of Medicine (U.S. IOM) guidelines (<0.35 kg/week) and less than the third centile of the International Fetal and Newborn Growth Consortium for the 21st Century (INTERGROWTH‐21st) standards. Factors associated with GWG and MUAC were identified using logistic regression models adjusting for season, village, and gestational age. The median (interquartile range) age was 25.0 (20.7, 30.0) years, and 16.4% were ≤19 years. The prevalence of low GWG were 62.9% and 27.5% according to 2009 IOM and less than the third INTERGROWTH‐21st centile, respectively; 24.9% had low MUAC. Higher α‐1‐acid glycoprotein (OR = 1.7, 95% CI [1.1, 2.8]) and C‐reactive protein (OR = 1.2, 95% CI [1.02, 1.50]) increased the odds of low GWG. Adolescents (OR = 2.7, 95% CI [1.8, 4.0]), housewives (OR = 1.97, 95% CI [1.36, 2.86]), and those who reported recent food assistance (OR = 1.80, 95% CI [1.04, 3.11]) had higher odds of low MUAC. Prevalence of low GWG and low MUAC was high among pregnant women. Determinants of GWG and MUAC included socio‐economic, demographic, and biological factors, although only markers of inflammation were consistent predictors across different definitions of low GWG.     

Caesarean delivery and anaemia risk in children in 45 low‐ and middle‐income countries

Caesarean delivery (CD) may reduce placental transfusion and cause poor iron‐related haematological indices in the neonate. We aimed to explore the association between CD and anaemia in children aged <5 years utilising data from Demographic and Health Surveys conducted between 2005 and 2015 in 45 low‐ and middle‐income countries (N = 132,877). We defined anaemia categories based on haemoglobin levels, analysed each country's data separately using propensity‐score weighting, pooled the country‐specific odds ratios (ORs) using random effects meta‐analysis, and performed meta‐regression to determine whether the association between CD and anaemia varies by national CD rate, anaemia prevalence, and gross national income. Individual‐level CD was not associated with any anaemia (OR 0.95, 95% confidence interval (CI) [0.86, 1.06]; I² = 40.2%), mild anaemia (OR 0.91, 95% CI [0.81, 1.02]; I² = 24.8%), and moderate/severe anaemia (OR 0.97, 95% CI [0.85, 1.11]; I² = 47.7%). CD tended to be positively associated with moderate/severe anaemia in upper middle‐income countries and negatively associated with mild anaemia in lower middle‐income countries; however, meta‐regression did not detect any variation in the association between anaemia and CD by the level of income, CD rate, and anaemia prevalence. In conclusion, there was no evidence for an association between CD and anaemia in children younger than 5 years in low‐ and middle‐income countries. Our conclusions were consistent when we looked at only countries with CD rate >15% with data stratified by individual‐level wealth status and type of health facility of birth.     

Household food insecurity in Mexico is associated with the co‐occurrence of overweight and anemia among women of reproductive age,but not female adolescents

We aimed to determine the association between household food insecurity (HFI) and the co‐occurrence of overweight and anemia among women of reproductive age in the Mexican population. We analyzed data on 4,039 nonpregnant female adolescents (15–19 years) and 10,760 nonpregnant adult women of reproductive age (20–49 years) from the 2012 National Health and Nutrition Survey of Mexico. The survey uses a two‐stage sampling design, stratified by rural and urban regions. The Latin American and Caribbean Food Security Scale was used to assess HFI. We assessed overweight and obesity in women based on World Health Organization classifications for body mass index, and BMI‐for‐age Z‐scores for female adolescents, and defined anemia as an altitude‐adjusted hemoglobin (Hb) concentration < 120 g/L based on measurement of capillary Hb concentrations. In multiple logistic regression models adjusting for potential confounding covariates, HFI was not associated with the co‐occurrence of anemia and overweight among female adolescents. The adjusted odds of women of reproductive age from mildly and moderately food‐insecure households, respectively, experiencing concurrent anemia and overweight were 48% (OR: 1.48; 95% CI: 1.15, 1.91) and 49% (OR: 1.49; 95% CI: 1.08, 2.06) higher than among women from food‐secure households. Severe HFI was not associated with concurrent overweight and anemia among female adolescents or women. HFI may be a shared mechanism for dual forms of malnutrition within the same individual, simultaneously contributing to overconsumption and dietary inadequacy.     

Breastfeeding practices in the United Kingdom: Is the neighbourhood context important?

Breastfeeding is an important public health issue worldwide. Breastfeeding rates in the United Kingdom, particularly for exclusive breastfeeding, are low compared with other OECD countries, despite its wide‐ranging health benefits for both mother and child. There is evidence that deprivation in the structural and social organisation of neighbourhoods is associated with adverse child outcomes. This study aimed to explore whether breastfeeding initiation, exclusive breastfeeding for at least 3 months, and any type of breastfeeding for at least 6 months were associated with neighbourhood context measured by neighbourhood deprivation and maternal neighbourhood perceptions in a nationally representative U.K. sample. A cross‐sectional analysis was conducted using data from the Millennium Cohort Study. Logistic regression was carried out on a sample of 17,308 respondents, adjusting for individual‐ and familial‐level socio‐demographic characteristics. Neighbourhood deprivation was independently and inversely associated with breastfeeding initiation. Compared with the least deprived areas, the likelihood of initiating breastfeeding was 40% lower in the most deprived neighbourhoods (OR: 0.60, 95% CI [0.50, 0.72]). The relationship between both exclusive and any type of breastfeeding at 3 and 6 months respectively with neighbourhood deprivation after adjustment for potential confounders was not entirely linear. Breastfeeding initiation (OR: 0.78, 95% CI [0.71, 0.85]), exclusivity for 3 months (OR: 0.84, 95% CI [0.75, 0.95]), and any breastfeeding for 6 months (OR: 0.82, 95% CI [0.73, 0.93]) were each reduced by about 20% among mothers who perceived their neighbourhoods lacking safe play areas for children. Policies to improve breastfeeding rates should consider area‐based approaches and the broader determinants of social inequalities.     

Associations of body mass index and perceived weight with suicide ideation and suicide attempts among US high school students

BACKGROUND: Previous research with adolescents has shown associations of body weight and perceptions of body size with suicide ideation and suicide attempts, but it is unclear whether these associations are direct or whether a mediating effect exists. OBJECTIVES: To determine if body mass index and perceived weight are associated significantly with suicide ideation and suicide attempts, controlling for weight control practices, and if perceived weight mediates the associations of body mass index with suicide ideation and suicide attempts. DESIGN, SETTING, AND PARTICIPANTS: Data were analyzed from the 2001 Youth Risk Behavior Survey, a school-based survey administered to a nationally representative sample of students in grades 9 through 12 (N = 13 601). MAIN OUTCOME MEASURE: Self-reported past-year suicide ideation and suicide attempts, compared by perceived weight and body mass index category, calculated from self-reported height and weight. RESULTS: Body mass index category was associated significantly with suicide ideation (among all students) and suicide attempts (among white and Hispanic students) without perceived weight in the model but not with perceived weight added to the model. In contrast with those who perceive themselves as about the right weight, students who perceived themselves as very underweight (odds ratio [OR], 2.29 [95% confidence interval (CI), 1.46-3.59]), slightly underweight (OR, 1.36 [95% CI, 1.03-1.79]), slightly overweight (OR, 1.33 [95% CI, 1.12-1.58]), and very overweight (OR, 2.50 [95% CI, 1.73-3.60]) had greater adjusted odds of suicide ideation. Among white students, perceiving oneself as very underweight (OR, 3.04 [95% CI, 1.40-6.58]) or very overweight (OR, 2.74 [95% CI, 1.21-6.23]) was associated with greater odds of suicide attempts. Perceiving oneself as very underweight was associated with greater odds for suicide attempts among black (OR, 2.86 [95% CI, 1.10-7.45]) and Hispanic (OR, 3.40 [95% CI, 1.54-7.51]) students. CONCLUSIONS: How adolescents perceive their body weight may be more important than their actual weight in terms of increased likelihood of suicidal behavior. Regardless of body mass index, extreme perceptions of weight appear to be significant risk factors for suicidal behavior; important racial/ethnic differences exist.     

Relationship between cytotoxic T‐lymphocyte antigen 4 ‐318C/T (rs5742909) gene polymorphism and the risk of acute rejection in renal transplantation

Results on the relationship between CTLA4 ‐318C/T (rs5742909) gene polymorphism and risk of acute rejection in renal transplantation are still conflicting. This meta‐analysis was performed to update the association between CTLA4 ‐318C/T and risk of acute rejection in renal transplantation. The association investigations were identified from PubMed and Cochrane Library, and eligible studies were included and synthesized using meta‐analysis method. Twelve reports were included in this meta‐analysis for the association of CTLA4 ‐318C/T gene polymorphism with acute rejection risk in renal transplantation, consisting of 728 acute rejection patients and 1628 non‐acute rejection controls. The association between CTLA4 ‐318C/T gene polymorphism and acute rejection risk in renal transplantation for overall populations was not found in this meta‐analysis (T allele: OR=0.96, 95% CI: 0.60‐1.54, P=.88; TT genotype: OR=0.90, 95% CI: 0.47‐1.71, P=.74; CC genotype: OR=1.00, 95% CI: 0.62‐1.59, P=.98). Interestingly, T allele was associated with the risk of acute rejection in renal transplantation in African population. In conclusion, CTLA4 ‐318C/T gene polymorphism is not associated with the risk of acute rejection in renal transplantation in overall populations.     

Childhood overweight and parent- and teacher-reported behavior problems: evidence from a prospective study of kindergartners

OBJECTIVES: To determine if there is a relationship between overweight and behavior problems among children as young as 5 years old by studying the association between overweight and behavioral health at entry into kindergarten and to determine whether overweight status is a risk factor for the onset of new behavior problems during the first 2 years in school. DESIGN: We use data from a nationally representative sample of kindergartners in the United States-the Early Childhood Longitudinal Study-Kindergarten class. Data on height, weight, and parent- and teacher-reported behavior problems were collected 3 times during their first 2 years in school for 9949 children. We use a multivariate regression analysis that controls for sociodemographic characteristics, parent-child interaction, birth weight, and mother's mental health. RESULTS: Among girls, but not boys, there is a significant association between overweight and teacher-reported externalizing behavior problems (odds ratio [OR], 1.81; 95% confidence interval [CI], 1.23-2.68), teacher-reported internalizing behavior problems (OR, 1.54; 95% CI, 1.09-2.17), and parent-reported internalizing behavior problems (OR, 1.49; 95% CI, 1.08-2.06) at the beginning of kindergarten. However, overweight status was not a risk factor for the onset of new behavior problems over time for either girls (teacher-reported externalizing behavior problems: OR, 0.58 [95% CI, 0.25-1.33]; teacher-reported internalizing behavior problems: OR, 1.34 [95% CI, 0.88-2.03]; and parent-reported internalizing behavior problems: OR, 1.29 [95% CI, 0.82-2.01]) or boys (teacher-reported externalizing behavior problems: OR, 1.02 [95% CI, 0.67-1.57]; teacher-reported internalizing behavior problems: OR, 1.02 [95% CI, 0.68-1.52]; and parent-reported internalizing behavior problems: OR, 1.42 [95% CI, 0.94-2.15]), whereas low family income and maternal depression were strong predictors of such problems. CONCLUSIONS: Childhood overweight is already associated with behavior problems when girls start school, but not boys. In contrast to common belief, overweight status does not predict the onset of new internalizing or externalizing behavior problems during the first 2 years of school.     

The impact of rickets on growth and morbidity during recovery among children with complicated severe acute malnutrition in Kenya: A cohort study

The effects of rickets on children recovery from severe acute malnutrition (SAM) are unknown. Rickets may affect both growth and susceptibility to infectious diseases. We investigated the associations of clinically diagnosed rickets with life‐threatening events and anthropometric recovery during 1 year following inpatient treatment for complicated SAM. This was a secondary analysis of clinical trial data among non‐human immunodeficiency virus‐infected Kenyan children with complicated SAM (2–59 months) followed for 1 year posthospital discharge ( ClinicalTrials.gov ID NCT00934492). The outcomes were mortality, hospital readmissions, and growth during 12 months. The main exposure was clinically diagnosed rickets at baseline. Of 1,778 children recruited, 230 (12.9%, 95% CI [11.4, 14 .6]) had clinical signs of rickets at baseline. Enrolment at an urban site, height‐for‐age and head circumference‐for‐age z scores were associated with rickets. Rickets at study enrolment was associated with increased mortality (adjusted Hazard Ratio [aHR] 1.61, 95% CI [1.14, 2.27]), any readmission (aHR 1.37, 95% CI [1.09, 1.72]), readmission for severe pneumonia (aHR 1.37, 95% CI [1.05, 1.79]), but not readmission with diarrhoea (aHR 1.05, 95% CI [0.73, 1.51]). Rickets was associated with increased height gain (centimetres), adjusted regression coefficient 0.19 (95% CI [0.10, 0.28]), but not changes in head circumference, mid‐upper arm circumference, or weight. Rickets was common among children with SAM at urban sites and associated with increased risks of severe pneumonia and death. Increased height gain may have resulted from vitamin D and calcium treatment. Future work should explore possibility of other concurrent micronutrient deficiencies and optimal treatment of rickets in this high‐risk population.     

Understanding the double burden of malnutrition in food insecure households in Brazil

Household food insecurity (HFI) has been associated with both obesity among mothers and undernutrition among children. However, this association has not been well investigated in mother/child pairs living in the same household. The objective of this study was to examine the relationship of coexistence of maternal overweight and child stunting with HFI in Brazil. We conducted secondary data analyses of the 2006 Brazilian National Demographic and Health Survey. We analyzed the nutritional status of 4299 pairs of 15–49‐year‐olds mothers and their children under 5 years of age. The double burden of malnutrition (DBM) was defined as the presence of an overweight mother and a stunted child in the same household. HFI was measured with the Brazilian HFI Measurement Scale. The association between DBM and HFI was examined with hierarchical multivariable logistic regression analyses. Severe HFI was associated with DBM after adjusting for macroeconomic and household level socio‐economic and demographic variables (Adjusted OR: 2.65 – CI: 1.17–8.53). Findings suggest that policies and programmes targeting HFI are needed to prevent the coexistence of child chronic undernutrition and maternal overweight/obesity in the same household. These investments are likely to be highly cost‐effective as stunting has been identified as one of the major risk factors for poor child development and adult overweight/obesity and a strong risk factor for the development of costly chronic diseases including type 2 diabetes and cardiovascular disease.     

Improving exclusive breastfeeding in low and middle‐income countries: A systematic review

Exclusive breastfeeding (EBF) rates until 6 months in most low and middle income countries (LMICs) are well below the 90% World Health Organization benchmark. This systematic review sought to provide evidence on effectiveness of various interventions on EBF until 6 months in LMICs, compared with standard care. Experimental and observational studies with concurrent comparator promoting EBF, conducted in LMICs with high country rates of breastfeeding initiation, were included. Studies were identified from a systematic review and PUBMED, Cochrane, and CABI databases. Study selection, data abstraction, and quality assessment were carried out independently and in duplicate. Relative risks (RRs) with 95% confidence intervals (CIs) were calculated for individual studies and pooled. High heterogeneity was explored through prespecified subgroup analyses for the primary outcome (EBF until 6 months) by context and by intervention for the randomized controlled trials. Prediction intervals were calculated for each effect estimate. Sixty‐seven studies with 79 comparisons from 30 LMICs were included. At 6 months, intervention group infants were more likely to be exclusively breastfed than controls (RR = 2.19, 95% CI [1.73, 2.77]; I² 78.4%; 25 randomized controlled trials). Larger effects were obtained from interventions delivered by a combination of professional and laypersons (RR 3.90, 95% CI [1.25, 12.21]; I² 46.7%), in interventions spanning antenatal and post‐natal periods (RR 2.40, 95% CI [1.70, 3.38]; I² 83.6%), and when intensity was between four to eight contacts/sessions (RR 3.20, 95% CI [2.30, 4.45]; I² 53.8%). Almost every intervention conducted in LMICs increased EBF rates; choice of intervention should therefore be driven by feasibility of delivery in the local context to reduce infant mortality.     

Association of cytotoxic T‐lymphocyte antigen 4 +49A/G gene polymorphism with acute rejection risk in renal transplantation

The conclusions on the association between cytotoxic T‐lymphocyte antigen 4 (CTLA4) +49A/G gene polymorphism and acute rejection risk in renal transplantation are still debated. This meta‐analysis was performed to update the association between CTLA4 +49A/G and acute rejection risk in renal transplantation. The association investigations were identified from PubMed and Cochrane Library, and eligible studies were included and synthesized using meta‐analysis method. Fourteen reports were included into this meta‐analysis for the association of CTLA4 A/G gene polymorphism and acute rejection risk in renal transplantation, consisting of 962 acute rejection patients and 2084 non‐acute rejection controls. The association between CTLA4 G allele/GG genotype and acute rejection risk in renal transplantation was found in this meta‐analysis (G allele: OR=1.21, 95% CI: 1.03‐1.44, P=.02; GG genotype: OR=1.37, 95% CI: 1.10‐1.69, P=.004). However, the AA genotype was not associated with acute rejection risk in renal transplantation. In conclusion, CTLA4 G allele/GG genotype is associated with the acute rejection risk in renal transplantation.     

Birth size and early pneumonia predict linear growth among HIV‐exposed uninfected infants

Stunting remains a global health priority, particularly in sub‐Saharan Africa. Identifying determinants of linear growth in HIV‐exposed uninfected (HEU) infants can inform interventions to prevent stunting in this vulnerable population. HIV‐infected mothers and their uninfected infants were followed monthly from pregnancy to 12‐month post‐partum in Nairobi, Kenya. Mixed‐effects models estimated the change in length‐for‐age z‐score (LAZ) from birth to 12 months by environmental, maternal, and infant characteristics. Multivariable models included factors univariately associated with LAZ. Among 372 HEU infants, mean LAZ decreased from ?0.54 (95% confidence interval [CI] [?0.67, ?0.41]) to ?1.09 (95% CI [?1.23, ?0.96]) between 0 and 12 months. Declines in LAZ were associated with crowding (≥2 persons per room; adjusted difference [AD] in 0–12 month change: ?0.46; 95% CI [?0.87, ?0.05]), use of a pit latrine versus a flush toilet (AD: ?0.29; 95% CI [?0.57, ?0.02]), and early infant pneumonia (AD: ?1.14; 95% CI [?1.99, ?0.29]). Infants with low birthweight (<2,500 g; AD: 1.08; 95% CI [0.40, 1.76]) and birth stunting (AD: 1.11; 95% CI [0.45, 1.78]) experienced improved linear growth. By 12 months of age, 46 infants were stunted, of whom 11 (24%) were stunted at birth. Of the 34 infants stunted at birth with an available 12‐month LAZ, 68% were not stunted at 12 months. Some low birthweight and birth‐stunted HEU infants had significant linear growth recovery. Early infant pneumonia and household environment predicted poor linear growth and may identify a subgroup of HEU infants for whom to provide growth‐promoting interventions.     

Prevalence of and factors associated with current asthma symptoms in school children aged 6–7 and 13–14 yr old in Bogotá, Colombia

This cross‐sectional study of children aged 6–7 years and adolescents aged 13–14 years in Bogotá, Colombia, assessed the prevalence of asthma symptoms and their associations with dietary, health, and behavioral habits. This study is part of the International Study of Asthma and Allergies in Childhood (ISAAC)‐phase III. Asthma prevalence among the children was assessed using a parental self‐administered written questionnaire (WQ), and among adolescents using a WQ together with a video questionnaire (VQ). Associations were estimated with bivariate and multivariate analysis. The study found that the 6–7 year age‐group were more likely to report current asthma symptoms than the 13–14 year age‐group (10.4% [WQ] vs. 8.6% [WQ] and 8.0% [VQ], respectively). Factors associated with current asthma symptoms among the 6–7 year age‐group included higher maternal education (OR = 1.7, [95% CI 1.2–2.6], p = 0.007), a cat in the home during the last year (OR = 1.5, [95% CI 1.0–2.3], p = 0.036), watching TV 1–2 hours/day (OR = 2.1, [95% CI 1.2–3.9], p = 0.013), and medication with acetaminophen in the first and most recent year of life (OR = 1.8, [95% CI 1.3–2.4], p < 0.001; OR = 2.2, [95% CI 1.7–2.8], p < 0.001, respectively) or antibiotics in the first year of life (OR = 1.9, [95% CI 1.4–2.5], p < 0.001). Among the 13–14 year age‐group, factors associated with current asthma symptoms included medication with acetaminophen during the last year (OR = 1.8, [95% CI 1.4–2.3], p < 0.001); cereal, milk, and fruit consumption 3 or more times weekly (OR = 1.5, [95% CI 1.1–1.9], p = 0.010; OR = 0.8, [95% CI 0.6–1.0], p = 0.046; OR = 0.6, [95% CI 0.4–1.0], p = 0.031, respectively). Overall, compared with that in other Latin American centers, asthma prevalence in Bogotá is close the lower estimates. However, associations with dietary, health, and behavioral habits need further study to assess their complex relationship with asthma.     

Prospective associations of breastfeeding and smoking cessation among low‐income pregnant women

Although low‐income pregnant women have high rates of smoking and low rates of breastfeeding, few studies have examined prospective associations between these risk factors in community samples. Doing so may help improve breast‐feeding support programs in this population. We used a secondary analysis of 247 low‐income pregnant smokers in Memphis, Tennessee, who were interviewed up to 4 times (twice during pregnancy and twice through 6 months postpartum). Smoking cessation during prepartum and postpartum was defined as a self‐report of not smoking for ≥1 week and an expired carbon monoxide level of <10 ppm. Multivariable logistic regression analyses were used to determine whether intent to breastfeed was associated with smoking cessation and whether smoking cessation was associated with actual breastfeeding. Models were adjusted for sociodemographic, pregnancy‐related, and smoking‐related confounders. Thirty‐nine percent of participants intended to breastfeed, and 38% did so. Women who intended to breastfeed were 2 times more likely to quit smoking prepartum (adjusted OR = 1.99, 95% CI [1.06, 3.74]), but not postpartum (adjusted OR = 1.27, 95% CI [0.57, 2.84]). Quitting smoking at baseline and during pregnancy was associated with subsequent breastfeeding (adjusted OR 2.27, 95% CI [1.05, 4.94] and adjusted OR = 2.49, 95% CI [1.21, 5.11]). Low‐income women who intended to breastfeed were more likely to quit smoking during pregnancy and those who quit smoking at baseline and prepartum were more likely to breastfeed. Simultaneously supporting breastfeeding and smoking cessation may be very useful to change these important health behaviours among this high‐risk population.     

Nutrition,hygiene, and stimulation education to improve growth,cognitive, language,and motor development among infants in Uganda: A cluster‐randomized trial

Stunting is associated with impaired cognitive and motor function. The effect of an education intervention including nutrition, stimulation, sanitation, and hygiene on child growth and cognitive/language/motor development, delivered to impoverished mothers in Uganda, was assessed. In a community‐based, open cluster‐randomized trial, 511 mother/children dyads aged 6–8 months were enrolled to an intervention (n = 263) or control (n = 248) group. The primary outcome was change in length‐for‐age z‐score at age 20–24 months. Secondary outcomes included anthropometry and scores on the 2 developmental scales: Bayley Scales of Infant and Toddler Development‐III and the Ages and Stages Questionnaire. There was no evidence of a difference in mean length‐for‐age z‐score at 20–24 months between the 2 study groups: 0.10, 95% CI [?0.17, 0.36], p = .49. The intervention group had higher mean composite development scores than the controls on Bayley Scales of Infant and Toddler Development‐III, the mean difference being 15.6, 95% CI [10.9, 20.2], p = .0001; 9.9, 95% CI [6.4, 13.2], p = .0001; and 14.6, 95% CI [10.9, 18.2], p = .0001, for cognitive, language, and motor composite scores, respectively. The mean difference in scores from the Ages and Stages Questionnaire were 7.0, 95% CI [2.9, 11.3], p = .001; 5.9, 95% CI [1.2, 10.3], p = .01; 4.2, 95% CI [1.7, 6.7], p = .001; 8.9, 95% CI [5.3, 12.3], p = .0001; and 4.4, 95% CI [0.0, 8.8], p = .05, for communication, gross motor, fine motor, problem solving, and personal–social development, respectively. The intervention education delivered to mothers promoted early development domains in cognitive, language, and motor development but not linear growth of small children in impoverished rural communities in Uganda. Our study showed that child development may be improved with a relatively low cost intervention strategy. This trial was registered at ClinicalTrials.gov as NCT02098031.     

A Longitudinal Study of Risk Factors for Sexual Victimization in Puerto Rican Youth

ObjectiveTo determine whether youth, family, and neighborhood factors and minoritized status are associated with youth-reported sexual victimization from childhood through young adulthood.MethodsWe analyzed longitudinal data from 2 population-based samples of Puerto Rican youth living in the South Bronx (as a minoritized group) and Puerto Rico (as a nonminoritized group). Waves 1 to 3 were collected annually beginning in 2000 (youth age 5–13). Wave 4 was collected 2013 to 2017 (youth age 15–29). We estimated multivariable associations between youth, family, and neighborhood factors and minoritized status at Wave 1 (independent variables); and youth-reported sexual victimization at Waves 1 to 4 (dependent variables).ResultsNone of the factors was associated with youth-reported sexual victimization at Wave 1 (N = 1911). Among youth reporting no previous history of sexual victimization at Wave 1 (n = 1823), youth in the South Bronx vs Puerto Rico were more likely to report sexual victimization at Waves 2 or 3 (odds ratio (OR) [95% confidence interval (CI)] = 3.62 [1.46–8.97]). Older youth were less likely to report sexual victimization (OR [95% CI] = 0.77 [0.65–0.91]) (all P < .01). Among youth reporting no history of sexual victimization at Waves 1 to 3 (n = 1782), youth in the South Bronx (OR [95% CI] = 2.53 [1.52–4.22]), female youth (OR [95% CI] = 2.81 [1.83–4.30]), and youth whose parents had more than a high school degree (OR [95% CI] = 2.25 [1.38–3.67]) were more likely to report sexual victimization at Wave 4 than their counterparts (all P ≤ .001).ConclusionsFuture research should investigate how living as a minoritized youth may contribute to an increased risk of sexual victimization.     

Breastfeeding practices and child growth outcomes in Haiti: an analysis of data from Demographic and Health Surveys

Haiti's national nutrition policy prioritises breastfeeding, but limited data are available to inform strategy. We examined national trends in early initiation of breastfeeding (ErIBF) and exclusive breastfeeding (EBF) over a 10‐year period using data from three Haitian Demographic and Health Surveys (1994–1995, 2000 and 2005–2006). We used multivariate regression methods to identify determinants of ErIBF and EBF in the 2005–2006 data set and to examine relationships to growth. There was no change in ErIBF across surveys [1994–1995: 36.6%, 95% confidence interval (CI) 29.9–43.9; 2000: 49.4%, 95% CI 44.1–54.8; 2005–2006: 43.8%, 95% CI 40.5–47.1]. EBF among 0–5‐month‐olds increased sharply (1994–18995: 1.1%, 95% CI 0.4–3.2; 2000: 22.4%, 95% CI 16.5–29.5; 2005–2006: 41.2%, 95% CI 35.4–47.2). The proportion of breastfeeding children 0–5 months who received soft, solid or semi‐solid foods decreased (1994–1995: 68.5%, 95% CI 57.3–77.9; 2000: 46.3%, 95% CI 39.3–53.4; 2005–2006: 30.9%, 95% CI 25.9–36.5). Child age at time of survey [odds ratio (OR) 1.73; P = 0.027], lower maternal education (OR = 2.14, P = 0.004) and residence in the Artibonite Department (OR 0.31; P = 0.001) were associated with ErIBF among children 0–23 months. Age group and department were significant predictors of EBF among children 0–5 months. ErIBF was associated with higher weight‐for‐age z‐scores [effect size (ES) 0.22; P = 0.033] and height‐for‐age z‐scores (ES 0.20; P = 0.044). There was no statistically significant relationship between EBF and growth. The 10‐year ErIBF and EBF trends in Haiti echo global and regional trends. ErIBF and EBF are related practices but with different determinants in the Haitian context. These differences have implications for intervention delivery.     

A meta‐analysis of nutrition interventions on mental development of children under‐two in low‐ and middle‐income countries

Interventions to improve nutritional status of young children in low‐ and middle‐income countries (LMIC) may have the added benefit of improving their mental and motor development. This meta‐analysis updates and goes beyond previous ones by answering two important questions: (1) do prenatal and postnatal nutritional inputs improve mental development, and (2) are effects on mental development associated with two theoretically interesting mediators namely physical growth and motor development? The meta‐analysis of articles on Medline, PsycINFO, Global Health and Embase was limited to randomized trials in LMICs, with mental development of children from birth to age two years as an outcome. The initial yield of 2689 studies was reduced to 33; 12 received a global quality rating of strong. Of the 10 prenatal and 23 postnatal nutrition interventions, the majority used zinc, iron/folic acid, vitamin A or multiple micronutrients, with a few evaluating macronutrients. The weighted mean effect size, Cohen's d (95% CI) for prenatal and postnatal nutrition interventions on mental development was 0.042 (?0.0084, 0.092) and 0.076 (0.019, 0.13), respectively. Postnatal supplements consisting of macronutrients yielded an effect size d (95% CI) of 0.14 (0.0067, 0.27), multiple micronutrients 0.082 (?0.012, 0.18) and single micronutrients 0.058 (?0.0015, 0.12). Motor development, but not growth status, effect sizes were significantly associated with mental development in postnatal interventions. In summary, nutrition interventions had small effects on mental development. Future studies might have greater effect if they addressed macronutrient deficiencies combined with child stimulation and hygiene and sanitation interventions.