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1.
Purpose
Likert scales are frequently used in public health research, but are subject to scale perception bias. This study sought to explore scale perception bias in quality-of-life (QoL) self-assessment and assess its relationships with commuting mode in the Sydney Travel and Health Study.Methods
Multilevel ordinal logistic regression analysis was used to analyse the association between two global QoL items about overall QoL and health satisfaction, with usual travel mode to work or study. Anchoring vignettes were applied using parametric and simpler nonparametric methods to detect and adjust for differences in reporting behaviour across age, sex, education, and income groups.Results
The anchoring vignettes exposed differences in scale responses across demographic groups. After adjusting for these biases, public transport users (OR = 0.37, 95 % CI 0.21–0.65), walkers (OR = 0.44, 95 % CI 0.24–0.82), and motor vehicle users (OR = 0.47, 95 % CI 0.25–0.86) were all found to have lower odds of reporting high QoL compared with bicycle commuters. Similarly, the odds of reporting high health satisfaction were found to be proportionally lower amongst all competing travel modes: motor vehicle users (OR = 0.31, 95 % CI 0.18–0.56), public transport users (OR = 0.34, 95 % CI 0.20–0.57), and walkers (OR = 0.35, 95 % CI 0.20–0.64) when compared with cyclists. Fewer differences were observed in the unadjusted models.Conclusion
Application of the vignettes by the two approaches removed scaling biases, thereby improving the accuracy of the analyses of the associations between travel mode and quality of life. The adjusted results revealed higher quality of life in bicycle commuters compared with all other travel mode users.2.
Objectives
To investigate factors associated with illicit opioid use among methadone maintenance treatment (MMT) population.Methods
Participants were recruited from Beijing (2 clinics), Shanghai (2 clinics), Guangdong (2 clinics), Chongqing (2 clinics) and Gansu (1 clinic) provinces. Information about heroin use and MMT was obtained from a self-reported questionnaire, illicit opioid use was obtained from monthly medical records. Binary logistic regression was used to investigate factors associated with illicit opioid use.Results
Five hundred ninety-eight eligible MMT participants were used for data analysis. Variables such as age, gender, route of heroin use and daily MMT dosages were associated with illicit opioid use. Compared with MMT participants aged <40 years, participants aged 40–44 years (P = 0.027, OR = 0.57, 95 % CI 0.35–0.94), 45–49 years (P < 0.001, OR = 0.41, 95 % CI 0.24–0.67) and ≥50 years (P = 0.008, OR = 0.52, 95 % CI 0.33–0.85) were more likely not to have illicit opioid use. Compared with male participants, females were more likely to have illicit opioid use (P = 0.044, OR = 1.53, 95 % CI 1.01–2.32). Compared with inhalation heroin abusers, abusers with route of inhalation + injection heroin use were more likely to have illicit opioid use (P = 0.009, OR = 2.00, 95 % CI 1.19–3.36). Compared with daily MMT dosages <60 mg participants, participants with daily MMT dosages >80 mg were more likely to have illicit opioid use (P = 0.003, OR = 2.37, 95 % CI 1.35–4.15).Conclusions
Age, gender, route of heroin use and daily MMT dosages were associated with illicit opioid use. A tailored intervention is needed for a promotion of MMT.3.
Yoshihiro Yoshino Shouhei Takeuchi Takahiko Katoh Yoshiki Kuroda 《Environmental health and preventive medicine》2016,21(2):100-104
Objectives
DNA repair genes play an important role in protection against environmental and endogenous DNA damage, and constitute the first line of defense against cancer. Xeroderma pigmentosum complementation group C (XPC) is involved in the damage recognition step during nucleotide excision repair. The relationship between XPC intron11 C/A polymorphism and cancer risk has not been widely studied. Hence, this study evaluated the relationship between the XPC intron11 C/A polymorphism and prostate cancer risk.Materials and methods
This hospital-based cohort consisted of 152 patients with prostate cancer and 142 male controls. The XPC intron11 C/A genotype was determined using the PCR–RFLP method. Medical, occupational, and cigarette-smoking history was obtained from each participant using questionnaires.Results
Logistic regression analysis revealed that compared to controls, the frequencies of the A/A and C/A genotypes were significantly higher than those of the C/C genotype in cancer patients (OR = 2.03, 95 % confidence interval (CI) 1.03–3.98 and OR = 1.91, 95 % CI 1.13–3.24, respectively). We also found that the frequency of the A/A genotype was significantly higher in cancer cases than in controls among non-smokers (OR = 7.7, 95 % CI 1.38–42.88, compared to the C/C genotype).Conclusion
We found that the XPC intron11 C/A polymorphism was associated with an increased risk of prostate cancer. Among non-smokers, the A/A genotype was significantly more prevalent in prostate cancer patients than in controls.4.
Mache Tsadik Yemane Berhane Alemayehu Worku Wondwossen Terefe 《Zeitschrift fur Gesundheitswissenschaften》2018,26(1):51-58
Aim
Partner notification (PN) is a key public health intervention aimed at preventing re-infection and controlling the spread of STIs. However, only limited research has been conducted to investigate factors associated with PN in Ethiopia.Subject and methods
A nested case-control study was undertaken within a cohort of individuals being treated for STIs in public health facilities in Ethiopia. Hierarchical binary logistic regression was used to identify socio-demographic, behavioral and psychosocial factors associated with PN.Results
A total of 250 patients on STI treatment who notified their partners (cases) were compared with 185 patients who did not notify their partners (controls). STI patients were less likely to notify their partner if they were single [AOR = 0.33, 95% CI: (0.15–0.73)], in a casual partnership [adjusted odds ratio (AOR) = 0.33, 95% CI: (0.15–73)], not knowledgeable about a partner’s sexual behavior [AOR = 0.43, 95% CI: (0.24–0.77)], had poor knowledge of risky sexual behavior [AOR = 0.23, 95% CI: (0.12–0.43)] and had no intention of notifying partners [AOR = 0.19, 95% CI: (0.10–0.36)]. The odds of PN were higher among highly educated respondents [AOR = 5.16; 95% CI: (1.83–14.54)].Conclusion
Capturing STI cases through patient referral partner notification is less likely to be successful among patients who are single and in a casual relationship.5.
6.
Objective
Previous research has examined associations of sedentary behavior (SB), light-intensity physical activity (LIPA) and moderate-to-vigorous physical activity (MVPA) with health-related quality of life (HRQOL) and mortality. However, most of these studies have been limited to examining their potential “independent” effects, as opposed to whether mortality risk and HRQOL vary as a function of waking time in these discretionary movement-related behaviors, which was this study’s purpose.Methods
Data from the 2003–2006 NHANES were employed, with follow-up mortality assessed through 2011 (5377 adults 20–85 years). HRQOL was assessed via survey, with physical activity assessed using an accelerometer over a 7-day monitoring period. Isotemporal substitution analyses were employed.Results
Participants engaged in little MVPA during their monitored waking time and higher mortality risk appeared to cluster more so among those spending a greater proportion of their day in SB with less LIPA engagement. Substituting 30 min/day of SB with MVPA would be expected to reduce mortality risk by 81 % (HRadjusted = 0.19; 95 % CI: 0.06–0.60; P = 0.006) and reduce worse HRQOL by 72 % (OR = 0.28; 95 % CI: 0.13–0.58; P = 0.001).Conclusions
Allocation of waking time in movement-based behaviors is associated with all-cause mortality and HRQOL. Thus, clinicians should encourage their patients to substitute SB with reasonable amounts of LIPA and MVPA.7.
Iana T. Parente Zaira R. Lima Luzia Hermínia Teixeira Mario R. Lisboa Iracema M. de Melo Paulo Roberto Santos Paula Goes 《Zeitschrift fur Gesundheitswissenschaften》2018,26(1):75-80
Aim
To perform a comprehensive analysis of the association between periodontal status and end-stage chronic kidney disease (ESCKD).Subjects and methods
Forty-five ESCKD and 26 healthy patients were clinically evaluated. The visible plaque index (VPI), gingival bleeding index (GBI) and community periodontal index were obtained from all patients. In addition, the association among gingivitis, increased probing depth, clinical attachment loss and edentulism with ESCKD was statistically assessed (chi-square test, p < 0.05). An additional Student’s t-test (p < 0.05) was performed to evaluate the differences in VPI and GBI between both groups of patients.Results
ESCKD was strongly associated with gingivitis (p = 0.002, OR = 8.76, 95% CI = 1.84-41.71), increased probing depth (p < 0.001, OR = 17.44, 95% CI = 4.14-72.33), clinical attachment loss (p < 0.001, OR = 5.59, 95% CI = 3.00-10.41) and edentulism (p = 0.013, OR = 1.95, 95% CI = 1.14-3.35). Moreover, patients with ESCKD had increased VPI and GBI (p < 0.05) compared to healthy individuals.Conclusion
Within the limits of this study, it was concluded that ESCKD patients showed greater plaque accumulation and a higher risk of presenting periodontal diseases compared to healthy subjects.8.
Objectives
To explore chimney sweeping work tasks, chimney sweeps’ use of protective equipment, and type of fuel used by clients, over time. Further, to assess work-relatedness of current eye and airway symptoms.Methods
In a cross-sectional study in 2011, male Swedish chimney sweeps (n = 483; age 21–69 years) answered a questionnaire about their occupational history and eye and airway symptoms.Results
Between 1960 and 2010, black-soot-sweeping in private homes was the major task, although it decreased during the time period, for chimney sweeps. Between 1975 and 2010, the use of petroleum oil decreased, whereas the use of pellets and wood increased. Also, the use of gloves and masks increased significantly. Black-soot-sweeping in industry was associated with work-related eye symptoms (prevalence odds ratio POR = 3.76, 95% CI: 1.72–8.24, for every 10% increment of working time, adjusted for age and tobacco smoking). Chimney sweeps also had slightly higher prevalence of cough with increasing black-soot-sweeping (POR = 1.06, 95% CI: 0.99–1.13 for every 10% increment, further adjusted for the use of mask), and the association was more pronounced, although nonsignificant, for black-soot-sweeping in industry (adjusted POR = 1.26, 95% CI: 0.98–1.61).Conclusions
Chimney sweeping tasks and use of protective equipment as well as type of fuel used by the clients changed significantly over the last 35 years, which may have changed chimney sweeps’ exposure to soot. Still, chimney sweeps in Sweden have black-soot-sweeping-related eye and airway symptoms.9.
Lieselotte Lieding Sophia Mählmann Beate Blättner 《Pr?vention und Gesundheitsf?rderung》2018,13(1):76-84
Background
Teen dating violence is discussed as a potential risk factor for harmful behaviour. For prevention strategies it is interesting to see the extent to which evidence can be found in epidemiological studies.Methods
We searched the databases CINAHL, EMBASE, PsycINFO, Cochrane Library, Web of Science as well as in the free web for longitudinal studies which examined substance consumption as a result of teen dating violence.Results
Seven studies fulfilled the inclusion criteria. Each one study described teen dating violence to increase marijuana consumption among girls (odds ratio [OR] 2.1, 95% confidence interval [95% CI] 1.22–3.70) and boys (OR 1.34, 95% CI 1.03–1.74), two studies with mixed sex population in boys (class 8: b = 0.55, p < 0.01; class 12: b = 1.14, p < 0.001) and in both sexes (ERR = 1.21, 95% CI 0.96–1.52; ERR = 1.30, 95% CI 0.81–2.11). Four studies observed increased consumption of tobacco in mixed sex group populations (B = 0.31, SE = 0.14, p < 0.03), in girls (OR 2.28, 95% CI 1.39–3.74; OR 1.53, 95% CI 1.13–2.06; OR 2.15, 95% CI 1.07–4.35) or boys (OR 3.04, 95% CI 1.16–7.95), whereas alcohol consumption was measured in 2 studies: in girls (OR 1.44, 95% CI 1.03–1.74) and in mixed sex study populations (B = 0.25, SE = 0.14; p < 0.5). Two studies described an increased substance dependence in girls (ß = 0.16; CI 0.06–0.26) and in mixed sex study population (OR = 10.61; p < 0.011).Conclusion
The low effect dimensions, limitations caused by the study design and the lack of consideration of confounders presuppose that such interpersonal violence cannot be considered as a risk factor.10.
Aimée M. Lulebo Didine K. Kaba Silvestre E.-H. Atake Mala A. Mapatano Eric M. Mafuta Julien M. Mampunza Yves Coppieters 《BMC health services research》2017,17(2):698
Background
The Democratic Republic of the Congo (DRC) is characterized by a high prevalence of hypertension (HTN) and a high proportion of uncontrolled HTN, which is indicative of poor HTN management. Effective management of HTN in the African region is challenging due to limited resources, particularly human resources for health. To address the shortage of health workers, the World Health Organization (WHO) recommends task shifting for better disease management and treatment. Although task shifting from doctors to nurses is being implemented in the DRC, there are no studies, to the best of our knowledge, that document the association between task shifting and HTN control. The aim of this study was to investigate the association between task shifting and HTN control in Kinshasa, DRC.Methods
We conducted a cross-sectional study in Kinshasa from December 2015 to January 2016 in five general referral hospitals (GRHs) and nine health centers (HCs). A total of 260 hypertensive patients participated in the study. Sociodemographic, clinical, health care costs and perceived health care quality assessment data were collected using a structured questionnaire. To examine the association between task shifting and HTN control, we assessed differences between GRH and HC patients using bivariate and multivariate analyses.Results
Almost half the patients were female (53.1%), patients’ mean age was 59.5 ± 11.4 years. Over three-fourths of patients had uncontrolled HTN. There was no significant difference in the proportion of GRH and HC patients with uncontrolled HTN (76.2% vs 77.7%, p = 0.771). Uncontrolled HTN was associated with co-morbidity (OR = 10.3; 95% CI: 3.8–28.3) and the type of antihypertensive drug used (OR = 4.6; 95% CI: 1.3–16.1). The mean healthcare costs in the GRHs were significantly higher than costs in the HCs (US$ 34.2 ± US$3.34 versus US$ 7.7 ± US$ 0.6, respectively).Conclusion
Uncontrolled HTN was not associated with the type of health facility. This finding suggests that the management of HTN at primary healthcare level might be just as effective as at secondary level. However, the high proportion of patients with uncontrolled HTN underscores the need for HTN management guidelines at all healthcare levels.11.
Background
Anemia is responsible for 20% of maternal mortality worldwide, and it is associated with premature birth, low birth weight, and infant mortality. In Ethiopia, about 22% of pregnant women are anemic. However, literatures are limited, therefore, this study aimed to investigate the prevalence and associated factors of anemia among pregnant women attending antenatal care (ANC) in Asossa Zone Public Health Institutions, northwest Ethiopia.Methods
A facility based cross-sectional study was conducted from February to March 2016. Data were collected by interviewer administered, pretested and structured questionnaires. A multi-stage sampling technique was used to select 762 pregnant women. The hemoglobin level was determined by taking 5 ml of venous blood using Sahli’s method. A multivariate binary logistic regression model was fitted to identify factors associated with anemia. Adjusted Odds Ratio (AOR) with a 95% Confidence Interval (CI) was computed to show the strength of association and statistical significance was determined at a P-value of <0.05.Results
The prevalence of anemia was 31.8% [95% CI: 28.9, 35.5]. In the adjusted analysis, maternal age of 30–34 years [AOR = 0.34, 95% CI: 0.14, 0.86], household size of ≥6 [AOR = 4.27, 95% CI: 1.58, 11.45], dietary diversity [AOR = 0.58, 95% CI: 0.38, 0.93], no meat consumption [AOR = 1.80, 95% CI: 1.11, 2.91], not drinking soft beverages [AOR =1.96, 95% CI: 1.19, 3.23], undernutrition [AOR = 7.38, 95% CI: 4.22, 12.91], not consuming fruits [AOR = 3.29, 95% CI: 1.59, 6.82], inter-pregnancy interval of ≥2 years [AOR = 0.59, 95% CI: 0.34, 0.99], and third trimester of pregnancy [AOR = 0.33, 95% CI: 0.20, 0.57] were significantly associated with anemia.Conclusions
The prevalence of prenatal anemia is high in the Asossa Zone; suggesting a moderate public health concern. Socio-demographic and dietary intake characteristics were significantly associated with anemia. Therefore, improving dietary diversity and animal food consumption are the key to reduce the high burden of anemia. It is also important to strengthen interventions aiming to reduce closed birth interval and teenage pregnancy.12.
Objectives
To analyze the association between physical inactivity in different domains and direct public healthcare expenditures in adults and to identify whether the clustering of physical inactivity in different domains would contribute to increased public healthcare.Methods
The sample composed of 963 adults randomly selected in a middle-size Brazilian city. Annual healthcare expenditure was estimated including all items registered in the medical records in the last 12 months prior to the interview. Habitual physical activity was estimated using Baecke questionnaire, which considers three components of physical activity (work, sports and leisure-time activities).Results
Higher healthcare expenditures of medicines were associated with lower physical activity at work (OR 1.58 [1.06–2.35]), sport (OR 1.57 [1.12–2.18]) and physical inactivity in three domains (OR 2.12 [1.18–3.78]). Expenditures related to medicine (r = 0.109 [95 % CI 0.046–0.171]) and overall expenditures (r = 0.092 [95 % CI 0.029–0.155]) were related to physical inactivity, independently of age, sex, smoking, blood pressure and obesity.Conclusions
Physically inactive subjects in different domains of physical activity have increased likelihood to be inserted at groups of higher healthcare expenditure.13.
14.
Aim
Lymphatic filariasis is an important public health problem that causes economic loss and poverty in many endemic regions of India. This study explores the influence of socioeconomic factors on filariasis prevalence in the Chittoor district of Andhra Pradesh.Subjects and methods
To understand the influence of socioeconomic variables on lymphatic filariasis, a pilot-scale epidemiological and socioeconomic study was conducted in 30 villages of Chittoor district, Andhra Pradesh, India, from 2004 to 2007. Data were analyzed statistically by frequency distribution, multivariate logistic regression and principal component analysis (PCA).Results
A total of 5133 blood samples were collected and screened for microfilaria; 77 were found to be positive (1.52 %). The multivariate analysis showed that variables such as age (OR?=?2.4, 95 % CI: 1.47–4.01), income [Indian rupees (INR): <1000: OR?=?4.2, 95 % CI: 1.48–11.76; INR: 1000–3000: OR?=?3.84, 95 % CI:1.92–7.68], drainage system (OR?=?3.5, 95 % CI: 1.62–7.5), mosquito avoidance (OR?=?1.41, 95 % CI: 0.69–2.87) and participation in mass drug administration (MDA) programs (OR?=?1.33, 95 % CI:0.74–2.38) were risk factors for filariasis. The socioeconomic index derived from the PCA was categorized into low (1.7 %), medium (1.7 %) and high (1.3 %) in relation to the percentage of parasite prevalence.Conclusion
This study reveals that filariasis is largely associated with various socioeconomic factors. Hence, health officials should focus on improving the quality of life to minimize the filarial incidence in the endemic villages by considering the socioeconomic index as a marker for targeting low and medium socioeconomic level groups for disease control programs.15.
A.?Shao A.?Drewnowski D.?C.?Willcox L.?Kr?mer C.?Lausted M.?Eggersdorfer J.?Mathers J.?D.?Bell R.?K.?Randolph R.?Witkamp J.?C.?Griffiths
Purpose
Laboratory studies suggested that caffeine and other nutrients contained in coffee and tea may protect against non-melanoma skin cancer (NMSC). However, epidemiological studies conducted so far have produced conflicting results.Methods
We performed a literature review and meta-analysis of observational studies published until February 2016 that investigated the association between coffee and tea intake and NMSC risk. We calculated summary relative risk (SRR) and corresponding 95 % confidence intervals (95 % CI) by using random effects with maximum likelihood estimation.Results
Overall, 37,627 NMSC cases from 13 papers were available for analysis. Intake of caffeinated coffee was inversely associated with NMSC risk (SRR for those in the highest vs. lowest category of intake: 0.82, 95 % CI 0.75–0.89, I 2 = 48 %), as well as intake of caffeine (SRR 0.86, 95 % CI 0.80–0.91, I 2 = 48 %). In subgroup analysis, these associations were limited to the basal cell cancer (BCC) histotype. There was no association between intake of decaffeinated coffee (SRR 1.01, 95 % CI 0.85–1.21, I 2 = 0) and tea (0.88, 95 % CI 0.72–1.07, I 2 = 0 %) and NMSC risk. There was no evidence of publication bias affecting the results. The available evidence was not sufficient to draw conclusions on the association between green tea intake and NMSC risk.Conclusions
Coffee intake appears to exert a moderate protective effect against BCC development, probably through the biological effect of caffeine. However, the observational nature of studies included, subject to bias and confounding, suggests taking with caution these results that should be verified in randomized clinical trials.16.
Luzitu Severin Nangana Ben Monga Nlandu Roger Ngatu Etongola Papy Mbelambela Lukuke Hendrick Mbutshu Kaj Francoise Malonga 《Environmental health and preventive medicine》2016,21(5):350-355
Objectives
Road traffic accident (RTA)-related trauma remains a public health issue. The aim of this study was to determine the frequency, causes and human impact of motor vehicle-related RTA in Lubumbashi, Democratic Republic of Congo.Methods
A prospective cross-sectional study was conducted in the first semester of the year 2015 in which 288 drivers (144 RTA-causing drivers and 144 control drivers who have been declared not guilty by road safety agents) involved in 144 motor vehicle-related RTA were interviewed, and only data on all RTA involving two motor vehicles with at least four wheels were recorded and analyzed.Results
Results showed a total of 144 RTA that involved two motor vehicles with four wheels occurring during the study period which affected 104 people, including 93 injury and 11 fatality cases. The mean age of RTA-causing drivers was 33.8 ± 7.4, whereas it was 35 ± 8.8 for control drivers. The majority of RTA-causing drivers (53.4 %) did not attend a driving school. Over speeding (32 %), distracted driving (22 %), overtaking (16 %) and careless driving/risky maneuver (15 %) and driving under the influence of alcohol (9 %) were the main causes of RTA occurrence. In addition, the absence of a valid driving license [aOR = 12.74 (±2.71); 95 % CI 3.877–41.916; p = 0.015], unfastened seat belt for the RTA-causing driver [aOR = 1.85 (±0.62); 95 % CI 1.306–6.661; p = 0.048] and presence of damages on RTA-causing vehicle [aOR = 33.56 (24.01); 95 % CI 1.429–78.352; p = 0.029] were associated with the occurrence of RTA-related fatality.Conclusion
This study showed a relatively high frequency of RTA occurring in Lubumbashi and suggests the necessity to reinforce road traffic regulation.17.
Jing Tian Alison J. Venn Leigh Blizzard George C. Patton Terry Dwyer Seana L. Gall 《Quality of life research》2016,25(3):669-685
Purpose
The possibility that tobacco use affects health-related quality of life (HRQoL) has attracted interest. However, a lack of prospective evidence weakens the case for a causal relationship. The aim was to examine the longitudinal relationship between change in smoking status and change in HRQoL in young adults.Methods
We conducted a population-based cohort study with data collected in 2004–2006 (aged 26–36) and 2009–2011 (aged 31–41). Exposure was change in self-reported smoking status during follow-up. Outcomes were changes in physical and mental HRQoL measured by SF-12.Results
For physical HRQoL (n = 2080), quitters had a 2.12 (95 % confidence interval (CI) 0.73, 3.51) point improvement than continuing smokers, whereas former smokers who resumed smoking had a 2.08 (95 % CI 0.21, 3.94) point reduction than those who maintained cessation. Resumed smokers were 39 % (95 % CI 10, 75 %) more likely to have a clinically significant (>5 point) reduction of physical HRQoL than former smokers who maintained cessation. In contrast, quitters were 43 % (95 % CI 3, 98 %) more likely to have a clinically significant (>5 point) improvement in physical HRQoL than continuing smokers. Change in smoking status was not significantly associated with change in mental HRQoL (n = 1788).Conclusions
Smoking by young adults was cross-sectionally associated with lower physical HRQoL and longitudinally associated with reductions in physical HRQoL. The expectation of short- to medium-term gains in physical HRQoL as well as long-term health benefits may help motivate young adult smokers to quit.18.
19.
Jennifer S. Pitonyak Amy B. Jessop Laura Pontiggia Andrea Crivelli-Kovach 《Maternal and child health journal》2016,20(2):240-249
Introduction
Exclusive breastfeeding (EBF) benefits the life course health development of infants, families, and society. Professional health associations recommend EBF for 4 months, and many now recommend EBF for 6 months. Yet only 18.8 % of US infants born in 2011 were exclusively breastfed. Numerous studies on breastfeeding are published, but few describe EBF. This study describes characteristics of women who initiated EBF and examines the associations of those factors with EBF lasting ≥4 months. The Life Course Health Development (LCHD) framework was used to structure the analysis and interpret results.Methods
Data collected through the Infant Feeding Practices Study II survey (2005–2007) were used to identify a cohort of women (n = 1226) practicing EBF at the time of hospital discharge and their sociodemographic, health, work, and childcare characteristics. Associations of these characteristics with EBF lasting ≥4 months were studied by bivariate and logistic regression analyses.Results
College education [odds ratio (OR) 2.14, 95 % confidence interval (CI) 1.58–2.89] and marriage (OR 2.19, 95 % CI 1.43–3.37) were associated with greater odds of EBF lasting ≥4 months, whereas the plan to return to work after birth (OR 0.57, 95 % CI 0.43–0.74), living in the south (OR 0.67, 95 % CI 0.47–0.95), and postpartum depression risk (OR 0.43, 95 % CI 0.28–0.66) were associated with lower odds of EBF lasting ≥4 months.Discussion
Several factors associated with disparities in continued EBF were identified. The application of the LCHD framework furthers understanding of the multiple and interacting risks associated with early discontinuation of EBF.20.