Impact of working status on breastfeeding in Singapore: evidence from the National Breastfeeding Survey 2001

BACKGROUND: This study uses data from the 2001 Singapore National Breastfeeding Survey to examine factors, including working status, associated with breastfeeding duration. METHODS: All women who delivered in the eight hospitals with obstetric services in Singapore from 1 April to 31 May 2001 were invited to participate in a survey on infant feeding and nutrition at 2 and 6 months postpartum. A total of 2149 respondents were interviewed for variables that were known or suspected to be associated with breastfeeding initiation and duration. Cox proportional hazards model was used to determine the associated effect of working status on breastfeeding duration. Kaplan-Meier estimate and survival curves were compared between working and non-working mothers. RESULTS: Working status had no effect on initiation of breastfeeding, but had an effect on breastfeeding duration. The median breastfeeding duration for non-working and working mothers was 9 weeks and 8 weeks, respectively. This difference was significant by log rank test [hazard ratio (HR) = 1.27, 95% confidence interval (CI) 1.14-1.41, P value <0.001]. About 31% of non-working mothers breastfed for up to 6 months as compared to 20% of working mothers. Working mothers were more likely to stop breastfeeding than non-working mothers (HR = 1.61, 95% CI 1.43-1.85, P value = 0.001) after adjusting for potential confounders. The most important reason for working mothers stopping breastfeeding between 2 and 6 months was attributable to work. CONCLUSION: More breastfeeding-friendly initiatives need to be put in place at workplaces to encourage working mothers to continue breastfeeding upon returning to work.     

Risk factors for overweight and obesity: results from the 2001 National Health Survey

OBJECTIVES: A significant rise in the proportion of overweight and obese adults has produced a serious health epidemic in Australia and worldwide. The current research aimed to identify sociodemographic and behavioural predictors of overweight and obesity among a large representative sample of Australian adults. STUDY DESIGN: We used the National Health Survey conducted by the Australian Bureau of Statistics in 2001. The survey involved a stratified multistage area sample of private dwellings and face-to-face interviews. METHODS: We analysed data from 8643 females and 7600 males who responded to the 2001 National Health Survey. Multinomial logistic regression examined the association of being overweight or obese versus a healthy weight with a range of sociodemographic and behavioural variables. RESULTS: Fewer females than males were overweight while similar proportions were obese. For females and males, overweight and obesity were significantly associated with older age, being born in Australia, not being in a marriage-like relationship, low education, physical inactivity, and being a non/ex-smoker. High household incomes are protective from obesity but not from being overweight. Additionally, females with high levels of area social disadvantage and males in professional or white-collar occupations were more likely to be overweight or obese than a healthy weight. CONCLUSIONS: Reductions in mortality and morbidity associated with overweight and obesity may be achieved by targeting health promotion strategies to high-risk groups such as those who are older, single, Australian born, socioeconomically disadvantaged, physically inactive, and non-smokers.     

The introduction of breast milk substitutes and solid foods: evidence from the 1995 National Health Survey

OBJECTIVE: To report the introduction of breast milk substitutes and solid foods to Australian children between 1992 and 1995. METHODOLOGY: Analysis of data from the 1995 Australian National Health Survey. Infant feeding questions were asked by personal interview in respect to 3,252 children aged under four years of age. RESULTS: By the age of 26 weeks, the majority of children had been given infant formula (56.9%) and solid food (61.5%). More than one-quarter (27.1%) of children received cow's milk regularly during the first 12 months. Only 7% of children were given solids in the first 12 weeks of life. Soy milk was given to 14.2% of children aged less than four years. CONCLUSION: The majority of children in Australia are not being exclusively breastfed for six months as recommended by the World Health Organization (WHO). The intake of cow's milk before 12 months of age and the timing of introduction of solids needs to be monitored. Future surveys should collect more detail about type of infant formula so that the proportion of infants receiving soy-based formula and other formula can be assessed.     

Patterns of medical pluralism among adults: results from the 2001 National Health Interview Survey in Taiwan

Background  

Medical pluralism (MP) can be defined as the employment of more than one medical system or the use of both conventional and complementary and alternative medicine (CAM) for health and illness. A population-based survey and linkage with medical records was conducted to investigate MP amongst the Taiwanese population. Previous research suggests an increasing use of CAM worldwide.     

Profiling the mobile‐only population in Australia: insights from the Australian National Health Survey

Background: The Australian population that relies on mobile phones exclusively has increased from 5% in 2005 to 29% in 2014. Failing to include this mobile‐only population leads to a potential bias in estimates from landline‐based telephone surveys. This paper considers the impacts on selected health prevalence estimates with and without the mobile‐only population. Methods: Using data from the Australian Health Survey – which, for the first time, included a question on telephone status – we examined demographic, geographic and health differences between the landline‐accessible and mobile‐only population. These groups were also compared to the full population, controlling for the sampling design and differential non‐response patterns in the observed sample through weighting and benchmarking. Results: The landline‐accessible population differs from the mobile‐only population for selected health measures resulting in biased prevalence estimates for smoking, alcohol risk and private health insurance coverage in the full population. The differences remain even after adjusting for age and gender. Conclusions: Using landline telephones only for conducting population health surveys will have an impact on prevalence rate estimates of health risk factors due to the differing profiles of the mobile‐only population from the landline‐accessible population.     

Breakfast and the diets of Australian adults: an analysis of data from the 1995 National Nutrition Survey

The aim of this study was to describe the nutrients provided to Australian adults by the breakfast meal and to compare the food and nutrient intakes and health of regular breakfast eaters and breakfast skippers. The Australian Bureau of Statistics was commissioned to undertake additional analysis of data collected in the 1995 Australian National Nutrition Survey (NNS). The survey included 24-h recalls, physical measurements and a food habits questionnaire collected during the period February 1995-March 1996, with a nationally representative sample of 10,851 Australians aged 19 years and older. The median nutrient intakes at breakfast and the proportion of the daily total contributed by breakfast were calculated. Differences between regular breakfast eaters and breakfast skippers in terms of nutrient intake, body mass index and health status were compared using Student t-tests. The findings show the typical Australian breakfast was low in fat, high in carbohydrate and a good source of thiamin, riboflavin, niacin, calcium and magnesium. In the NNS regular breakfast eaters had more adequate diets overall, particularly those aged 65+ years. People who did not eat breakfast cereal were much more likely to have inadequate nutrient intakes, especially of thiamin, riboflavin, calcium, magnesium and iron. Regular breakfast eaters were more likely to rate their health as excellent or good than those who skip breakfast, but there was no difference between the fat intake or the body mass index of regular breakfast eaters compared with breakfast skippers. Regular breakfast consumption is associated with better diets for adults overall.     

Breakfast and the diets of Australian adults: An analysis of data from the 1995 National Nutrition Survey

The aim of this study was to describe the nutrients provided to Australian adults by the breakfast meal and to compare the food and nutrient intakes and health of regular breakfast eaters and breakfast skippers. The Australian Bureau of Statistics was commissioned to undertake additional analysis of data collected in the 1995 Australian National Nutrition Survey (NNS). The survey included 24-h recalls, physical measurements and a food habits questionnaire collected during the period February 1995–March 1996, with a nationally representative sample of 10,851 Australians aged 19 years and older. The median nutrient intakes at breakfast and the proportion of the daily total contributed by breakfast were calculated. Differences between regular breakfast eaters and breakfast skippers in terms of nutrient intake, body mass index and health status were compared using Student t-tests. The findings show the typical Australian breakfast was low in fat, high in carbohydrate and a good source of thiamin, riboflavin, niacin, calcium and magnesium. In the NNS regular breakfast eaters had more adequate diets overall, particularly those aged 65+ years. People who did not eat breakfast cereal were much more likely to have inadequate nutrient intakes, especially of thiamin, riboflavin, calcium, magnesium and iron. Regular breakfast eaters were more likely to rate their health as excellent or good than those who skip breakfast, but there was no difference between the fat intake or the body mass index of regular breakfast eaters compared with breakfast skippers. Regular breakfast consumption is associated with better diets for adults overall.     

Breastfeeding in Malaysia: Results of the Third National Health and Morbidity Survey (NHMS III) 2006

In Malaysia, the National Breastfeeding Policy recommends exclusive breastfeeding for the first six months of life and continued up to two years. Since the 1990s, several breastfeeding promotion programmes had been implemented in the country. This article reports the findings on the prevalence of breastfeeding practice from The Third National Health and Morbidity Survey (NHMS III) which was conducted in 2006. A total of 2167 mothers or carers of children below two years old were interviewed representing 804,480 of the estimated population of children aged below 2 years in Malaysia. Respondents were asked whether various types of liquid or solid food were given to the child at any time during the preceding 24-hour period. The overall prevalence of ever breastfed among children aged less than 12 months was 94.7% (CI: 93.0 - 95.9). The overall prevalence of exclusive breastfeeding below 6 months was 14.5% (CI: 11.7 - 17.9). Prevalence of timely initiation was 63.7% (CI: 61.4 - 65.9) and the continued prevalence of breastfeeding up to two years was 37.4% (CI: 32.9 - 42.2). The findings suggest that the programmes implemented in the last ten years were effective in improving the prevalence of ever breastfeeding, timely initiation of breastfeeding and continued breastfeeding up to two years. However, the challenge is to improve exclusive breastfeeding practice. Longterm community-based interventions need to be carried out in partnership with the existing health care system, focusing on discouraging the use of water and infant formula, especially in the first few months of life.     

Ethnic differences in female overweight: data from the 1985 National Health Interview Survey.

Ethnic differences in female overweight were analyzed using data from the 1985 National Health Interview Survey. The sample consisted of approximately 17,000 women, ages 18 and over. After adjusting for age and poverty status, there were clear differences in the proportions of women 20 per cent or more overweight among Black, Hispanic and other White women (35, 26 and 20 per cent, respectively). Black women were less likely than White women to perceive themselves as overweight when categorized by actual weight relative to ideal weight; however, within categories of weight relative to other women of the same ethnic group, all women not Hispanic were equally likely to consider themselves overweight. There was no difference by ethnicity in the proportion of women trying to lose weight among those who perceived themselves as overweight. These findings have implications for programs designed to modify weight, since they suggest that women use ethnic-specific standards in assessing overweight.     

Deafness and mortality: analyses of linked data from the National Health Interview Survey and National Death Index.

OBJECTIVE: To examine the association between age at onset of deafness and mortality. METHODS: The authors analyzed National Health Interview Survey data from 1990 and 1991--the years the Hearing Supplement was administered--linked with National Death Index data for 1990-1995. Adjusting for sociodemographic variables and health status, the authors compared the mortality of three groups of adults ages > or = 19 years: those with prelingual onset of deafness (< or = age 3 years), those with postlingual onset of deafness (> age 3 years), and a representative sample of the general population. RESULTS: Multivariate analyses adjusted for sociodemographics and stratified by age found that adults with postlingual onset of deafness were more likely to die in the given time frames than non-deaf adults. However, when analyses were also adjusted for health status, there was no difference between adults with postlingual onset of deafness and a control group of non-deaf adults. No differences in mortality were found between adults with prelingual onset of deafness and non-deaf adults. CONCLUSIONS: Adults with postlingual onset of deafness appear to have higher mortality than non-deaf adults, which may be attributable to their lower self-reported health status.     

How to calculate standard errors for population estimates based on Australian National Health Survey data

The National Health Surveys (NHS), conducted regularly by the Australian Bureau of Statistics, are designed to obtain benchmark information on a range of health-related issues and to enable the monitoring of health trends over time. Confidentialised Unit Record Files (CURFs), containing detailed individual-level NHS data, are available from the ABS. When using the CURF data to make an estimate relating to the Australian population, the precision of the estimate should also be calculated, but due to the complexity of the survey design and the limited survey design information in the CURF, this is not straightforward. This paper explains three different methods for calculating standard errors for population estimates obtained using CURF data: (i) using the estimates of relative standard errors published by the ABS; (ii) using the replicate weights provided by the ABS in the CURF; and (iii) assuming the survey design is a simple random sample. The most appropriate method will depend on which survey is being analysed and the type of population estimate; this is discussed in detail. Worked examples for each method using data from the 2001 NHS CURF are provided, together with Stata 9 code illustrating the implementation of each method.     

Health outcomes among Hispanic subgroups: data from the National Health Interview Survey, 1992-95

BACKGROUND: Within the next 50 years, Hispanics will become the largest minority group in the United States. The largest Hispanic subgroups are those of Mexican, Cuban, and Puerto Rican descent. The Hispanic population is heterogeneous in terms of culture, history, socioeconomic status (SES) and health status. In this report, various health status measures are compared across Hispanic subgroups in the United States. METHODS: National Health Interview Survey (NHIS) data aggregated from 1992 through 1995 were analyzed. NHIS is one of the few national surveys that has a sufficiently large sample size to adequately compare the different subgroups. Data are presented for four Hispanic origin subgroups--Mexican, Cuban, Puerto Rican, and "other Hispanic" persons--for the Hispanic population as a whole and for the non-Hispanic white and non-Hispanic black populations. These groups are compared with respect to several health status outcomes, providing both age-adjusted and unadjusted estimates. RESULTS: The health indicators for Puerto Rican persons are significantly worse than for the other Hispanic origin subgroups. For example, about 21% of Puerto Rican persons reported having an activity limitation, compared with about 15% of Cuban and Mexican persons and 14% of "other Hispanic" persons. In contrast, the health indicators of Cuban persons are often better than those of the other subgroups. For example, Cuban persons reported an average of 3 days per year lost from school or work, compared with about 6 days for Mexican and Puerto Rican persons and 7 days for "other Hispanic" persons. Mexican persons fare better than Puerto Rican persons on measures such as restricted activity days, bed disability days and hospitalizations. CONCLUSION: These data demonstrate clear differences in health status as well as indicators of socioeconomic status across Hispanic subgroups in the United States. Data on Hispanic subgroups facilitate the planning of public health services for various underserved populations.     

Dietary patterns of children and adolescents analyzed from 2001 Korea National Health and Nutrition Survey

The purpose of this study was to identify dietary patterns among children and adolescents in Korea and to examine their associations with obesity and some blood profiles. One day food consumption data measured by 24-hour recalls on 2704 subjects aged 1 to 19 were used from 2001 Korea National Health and Nutrition Survey. The data of blood profiles available in the ages of 10 or older was also used. After categorizing each food consumed into 29 food or food groups, five dietary patterns were derived through a factor analysis and subjects were classified into three major dietary patterns via a cluster analysis using the factor scores. Three dietary patterns were identified as ''traditional diet'' (25.6%), ''westernized-fast food'' (6.2%), and ''mixed diet'' (68.2%). The ''traditional diet'' pattern had a higher percentage in boys. Both the ''traditional diet'' and the ''westernized-fast food'' had higher proportions of adolescents (12-19 y) than younger children, while the ''mixed diet'' had a higher percentage of preschool children (1-5 y). Obesity rate analyzed within each age group showed no differences among 3 dietary pattern clusters. Blood pressure and all plasma profiles were not different among dietary patterns when adjusted with age and gender. Conclusively, children and adolescents in Korea had three distinct dietary patterns, which were associated with gender and age. These patterns could be useful to plan nutrition interventions for teenager health promotion.     

Bias in proxies' reports of disability: data from the National Health Interview Survey on disability

OBJECTIVES: These studies examined whether differences between self-reports and proxy reports of disabilities reflect proxy response biases or only respondent selection factors. METHODS: The data were from the National Health Interview Survey on Disability (1994-1995, phases 1 and 2). In study 1, reports of disabilities were regressed on respondent status, self vs proxy, and demographic factors. In study 2, the ratios of the proportions of self-reports and proxy reports of disabilities were regressed on independent lay ratings of observability of these disabilities and their "interactional" nature. In study 3, the disability reports for people who differed in respondent status in one phase but self-reported the same disability in the other phase were compared. RESULTS: In study 1, proxies under-reported disabilities for people aged 18 to 64 years but overreported for people 65 years or older. In study 2, the observability and interactional scores accounted for more than 60% of the variance of self and proxy differences in an inverse relationship, study 3 confirmed the basic findings of study 1. CONCLUSIONS: Use of proxies in representative surveys on disability introduces systematic biases, affecting national disability estimates.     

Stroke Prevalence: an analysis of data from the 1977 National Health Interview Survey.

Data gathered in the 1977 National Health Interview Survey indicate that stroke continues to be a major health problem in the United States. It affects approximately 2 percent of the civilian noninstitutionalized population over age 20. An examination of the stroke population revealed differences in the prevalence rates by various demographic factors, particularly age. More than 70 percent of the stroke victims were limited in their activities, and about 85 percent of all the victims had been informed of their condition by a physician. Only 62 percent indicated that they were hospitalized for their first stroke, and this finding remained unchanged when only recent strokes were examined. The low hospitalization rate may reflect a lack of information on patients who died during the interval of on those who did not associate their hospitalizations with their strokes.     

Paternal Pregnancy Intention and Breastfeeding Duration: Findings from the National Survey of Family Growth

Objectives Despite the benefits of breastfeeding, less than a fifth of American mothers breastfeed for the recommended duration. Paternal support plays a major role in maternal and child health outcomes; however, the influence of paternal pregnancy intention on breastfeeding duration is under investigated. This study examines the relationship between fathers’ pregnancy intention and breastfeeding duration. Methods Data from the 2011–2013 National Survey of Family Growth were analyzed using cross-sectional methodology. Women who were pregnant, never received medical help to become pregnant, whose partner was aged 18–49 years, and who responded to questions related to paternal pregnancy intention and breastfeeding were included in the analysis (N = 2089). Multinomial logistic regression, odds ratios and 95 % confidence intervals were calculated. There was a statistically significant interaction between father’s age and father’s pregnancy intention (P = 0.0385) and all models were stratified by paternal age. Results Fathers aged 18–24 years with a mistimed pregnancy were 2.3 times more likely to have a child who was never breastfed, (AOR 2.27, 95 % CI 1.39–3.70) and 1.7 times more likely to have a child who was breastfed 6 months or less (AOR 1.69, 95 % CI 1.28–2.23) compared to fathers with an intended pregnancy. No statistically significant association was observed among fathers aged 25–49 years. Conclusion Findings from this study show a relationship between mistimed pregnancies and breastfeeding duration among younger fathers. Healthcare professionals should develop breastfeeding interventions targeting fathers and young families.

     

Sociodemographic variations in breast cancer screening behavior among Australian women: results from the 1995 National Health Survey

BACKGROUND: Knowledge of sociodemographic variations in breast cancer screening can help identify population groups that are at risk of underutilization of breast cancer screening procedures and practices. We examined sociodemographic variations in breast cancer screening behavior among Australian women. METHODS: We used a subsample of women aged 18 years and older (n = 10,179) from the 1995 National Health Survey. We examined the association of sociodemographic variables with mammography, clinical breast examination, and breast self-examination. RESULTS: Being in the oldest age group, never being or previously being married, living in rural regions (except in the case of breast self-examination), residing in more disadvantaged areas (except in the case of breast self-examination), and having lower levels of education were all associated with a smaller likelihood of screening. Ethnicity was also significantly associated with screening. CONCLUSION: Strategies to promote breast cancer screening practices should pay particular attention to the underserved groups and should be part of a more comprehensive policy that ensures the accessibility to regular health care of these population groups.     

Population norms for the AQoL derived from the 2007 Australian National Survey of Mental Health and Wellbeing

Objective : To provide Australian health‐related quality of life (HRQoL) population norms, based on utility scores from the Assessment of Quality of Life (AQoL) measure, a participant‐reported outcomes (PRO) instrument. Methods: The data were from the 2007 National Survey of Mental Health and Wellbeing. AQoL scores were analysed by age cohorts, gender, other demographic characteristics, and mental and physical health variables. Results: The AQoL utility score mean was 0.81 (95%CI 0.81–0.82), and 47% obtained scores indicating a very high HRQoL (>0.90). HRQoL gently declined by age group, with older adults’ scores indicating lower HRQoL. Based on effect sizes (ESs), there were small losses in HRQoL associated with other demographic variables (e.g. by lack of labour force participation, ES_median: 0.27). Those with current mental health syndromes reported moderate losses in HRQoL (ES_median: 0.64), while those with physical health conditions generally also reported moderate losses in HRQoL (ES_median: 0.41). Conclusions: This study has provided contemporary Australian population norms for HRQoL that may be used by researchers as indicators allowing interpretation and estimation of population health (e.g. estimation of the burden of disease), cross comparison between studies, the identification of health inequalities, and to provide benchmarks for health care interventions.