Rachel Y Moon1, Jennifer LoCasale-Crouch2, Khara L P Turnbull2, Eve Colson3, Ann Kellams4, Timothy Heeren5, Stephen Kerr6, Fern R Hauck7, Michael J Corwin6. 1. Department of Pediatrics, University of Virginia School of Medicine (RY Moon and A Kellams), Charlottesville, Va. Electronic address: rym4z@virginia.edu. 2. Curry School of Education and Human Development, University of Virginia (J LoCasale-Crouch and KLP Turnbull), Charlottesville, Va. 3. Department of Pediatrics, Washington University School of Medicine (E Colson), St. Louis, Mo. 4. Department of Pediatrics, University of Virginia School of Medicine (RY Moon and A Kellams), Charlottesville, Va. 5. Slone Epidemiology Center, Boston University (T Heeren, S Kerr, and MJ Corwin), Boston, Mass; Department of Biostatistics, Boston University School of Public Health (T Heeren), Boston, Mass. 6. Slone Epidemiology Center, Boston University (T Heeren, S Kerr, and MJ Corwin), Boston, Mass. 7. Department of Family Medicine, University of Virginia School of Medicine (FR Hauck), Charlottesville, Va.
Abstract
BACKGROUND: Although higher education and healthier practices are positively associated, the explanatory mechanisms for this association remain unclear. The purpose of this study was to better understand mechanisms underlying this association by examining maternal adherence to 2 health-promoting infant care practices: supine placement and breastfeeding. METHODS: We analyzed nationally representative data from the Study of Attitudes and Factors Effecting Infant Care, which surveyed US mothers after infant birth and 2 months thereafter. Using the Theory of Planned Behavior as a framework, we used structural equation models to elucidate mediational pathways from maternal education to supine infant placement or any breastfeeding. RESULTS: Data from 3297 mothers demonstrated 77.0% of infants usually were placed supine, and 57.8% received any breastfeeding. The overall direct effect of maternal educational level on supine placement and any breastfeeding was odds ratio (OR) 1.31 (95% confidence interval [CI] 1.11-1.54) and OR 2.82 (95% CI 2.35-3.37), respectively. In pathway analyses, the strongest associations with both supine position and breastfeeding were seen with positive attitudes (supine: aOR 18.96, 95% CI 9.00-39.92; breastfeeding: aOR 3.86, 95% CI 2.19-6.82) and positive social norms (supine: aOR 6.69, 95% CI 4.52-9.89; breastfeeding: aOR 5.17, 95% CI 4.28-6.23). Mothers with more education had higher odds of both positive attitudes and positive norms for the 2 practices. CONCLUSIONS: The associations linking educational attainment with health practices are intricate, with multiple mediating pathways. Attitudes and social norms are powerful forces that mediate the association between maternal educational attainment and both infant supine positioning and breastfeeding, and may be important mediators for other health behaviors.
BACKGROUND: Although higher education and healthier practices are positively associated, the explanatory mechanisms for this association remain unclear. The purpose of this study was to better understand mechanisms underlying this association by examining maternal adherence to 2 health-promoting infant care practices: supine placement and breastfeeding. METHODS: We analyzed nationally representative data from the Study of Attitudes and Factors Effecting Infant Care, which surveyed US mothers after infant birth and 2 months thereafter. Using the Theory of Planned Behavior as a framework, we used structural equation models to elucidate mediational pathways from maternal education to supine infant placement or any breastfeeding. RESULTS: Data from 3297 mothers demonstrated 77.0% of infants usually were placed supine, and 57.8% received any breastfeeding. The overall direct effect of maternal educational level on supine placement and any breastfeeding was odds ratio (OR) 1.31 (95% confidence interval [CI] 1.11-1.54) and OR 2.82 (95% CI 2.35-3.37), respectively. In pathway analyses, the strongest associations with both supine position and breastfeeding were seen with positive attitudes (supine: aOR 18.96, 95% CI 9.00-39.92; breastfeeding: aOR 3.86, 95% CI 2.19-6.82) and positive social norms (supine: aOR 6.69, 95% CI 4.52-9.89; breastfeeding: aOR 5.17, 95% CI 4.28-6.23). Mothers with more education had higher odds of both positive attitudes and positive norms for the 2 practices. CONCLUSIONS: The associations linking educational attainment with health practices are intricate, with multiple mediating pathways. Attitudes and social norms are powerful forces that mediate the association between maternal educational attainment and both infant supine positioning and breastfeeding, and may be important mediators for other health behaviors.
Authors: Rachel Y Moon; Fern R Hauck; Eve R Colson; Ann L Kellams; Nicole L Geller; Timothy Heeren; Stephen M Kerr; Emily E Drake; Kawai Tanabe; Mary McClain; Michael J Corwin Journal: JAMA Date: 2017-07-25 Impact factor: 56.272
Authors: Rachel Y Moon; Michael J Corwin; Stephen Kerr; Timothy Heeren; Eve Colson; Ann Kellams; Nicole L Geller; Emily Drake; Kawai Tanabe; Fern R Hauck Journal: Pediatrics Date: 2019-05 Impact factor: 7.124
Authors: Cicely W Fadel; Eve R Colson; Michael J Corwin; Denis Rybin; Timothy C Heeren; Colin Wang; Rachel Y Moon Journal: J Pediatr Date: 2017-03-03 Impact factor: 6.314
Authors: Sydney A Martinez; Laura A Beebe; David M Thompson; Theodore L Wagener; Deirdra R Terrell; Janis E Campbell Journal: PLoS One Date: 2018-02-06 Impact factor: 3.240
Authors: Margaret G K Parker; Eve R Colson; Lauren Provini; Denis V Rybin; Stephen M Kerr; Timothy Heeren; Michael J Corwin Journal: Acad Pediatr Date: 2017-07-17 Impact factor: 3.107
Authors: Rebecca F Carlin; Benjamin Cornwell; Anita Mathews; Jichuan Wang; Yao I Cheng; Xuewen Yan; Linda Y Fu; Rachel Y Moon Journal: Breastfeed Med Date: 2021-05-18 Impact factor: 2.335