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Breastfeeding is beneficial for women and infants, and medical contraindications are rare. Prenatal and labor-related complications may hinder breastfeeding, but supportive hospital practices may encourage women who intend to breastfeed. We measured the relationship between having a complex pregnancy (entering pregnancy with hypertension, diabetes, or obesity) and early infant feeding, accounting for breastfeeding intentions and supportive hospital practices. We performed a retrospective analysis of data from a nationally-representative survey of women who gave birth in 2011-2012 in a US hospital (N = 2400). We used logistic regression to examine the relationship between pregnancy complexity and breastfeeding. Self-reported prepregnancy diabetes or hypertension, gestational diabetes, or obesity indicated a complex pregnancy. The outcome was feeding status 1 week postpartum; any breastfeeding was evaluated among women intending to breastfeed (N = 1990), and exclusive breastfeeding among women who intended to exclusively breastfeed (N = 1418). We also tested whether breastfeeding intentions or supportive hospital practices mediated the relationship between pregnancy complexity and infant feeding status. More than 33% of women had a complex pregnancy; these women had 30% lower odds of intending to breastfeed (AOR = 0.71; 95% CI, 0.52-0.98). Rates of intention to exclusively breastfeed were similar for women with and without complex pregnancies. Women who intended to breastfeed had similar rates of any breastfeeding 1 week postpartum regardless of pregnancy complexity, but complexity was associated with >30% lower odds of exclusive breastfeeding 1 week among women who intended to exclusively breastfeed (AOR = 0.68; 95% CI, 0.47-0.98). Supportive hospital practices were strongly associated with higher odds of any or exclusive breastfeeding 1 week postpartum (AOR = 4.03; 95% CI, 1.81-8.94; and AOR = 2.68; 95% CI, 1.70-4.23, respectively). Improving clinical and hospital support for women with complex pregnancies may increase breastfeeding rates and the benefits of breastfeeding for women and infants.

INTRODUCTION To spot testicular most cancers in its early stages, Giulia Guerrini, lead pharmacist of virtual pharmacy Medino, recommends you often test for any lumps or swelling to your testicles, in addition to any adjustments in form or texture. Fuel poverty way being not able to find the money for to warmth your house to a secure and snug standard. Judy Jou Department of Health Policy and Management, University of Minnesota, USA

The availability of paid family leave has been widely researched in the context of a two-parent household with one mother and one father, yet few studies have explored whether households with same-sex parents have access to equal benefits. Expanding on previous cross-country comparisons of parental leave policies, this study examines parental leave policies in 34 OECD countries to compare the total duration of paid parental leave available to same-sex and different-sex parent families within a country. We find that same-sex female and different-sex couples receive equal durations of leave in the majority of countries. However, same-sex male couples often receive shorter durations of paid parental leave compared to both different-sex and same-sex female couples. In addition to addressing the implications of laws and policies surrounding same-sex marriage and same-sex adoption on parental leave availability, we highlight specific aspects of paid leave policies that may explain the unequal durations of paid leave between same-sex and different-sex couples.

Objectives The United States is one of only three countries worldwide with no national policy guaranteeing paid leave to employed women who give birth. While maternity leave has been linked to improved maternal and child outcomes in international contexts, up-to-date research evidence in the U.S. context is needed to inform current policy debates on paid family leave. Methods Using data from Listening to Mothers III, a national survey of women ages 18–45 who gave birth in 2011–2012, we conducted multivariate logistic regression to predict the likelihood of outcomes related to infant health, maternal physical and mental health, and maternal health behaviors by the use and duration of paid maternity leave. Results Use of paid and unpaid leave varied significantly by race/ethnicity and household income. Women who took paid maternity leave experienced a 47% decrease in the odds of re-hospitalizing their infants (95% CI 0.3, 1.0) and a 51% decrease in the odds of being re-hospitalized themselves (95% CI 0.3, 0.9) at 21 months postpartum, compared to women taking unpaid or no leave. They also had 1.8 times the odds of doing well with exercise (95% CI 1.1, 3.0) and stress management (95% CI 1.1, 2.8), compared to women taking only unpaid leave. Conclusions for Practice Paid maternity leave significantly predicts lower odds of maternal and infant re-hospitalization and higher odds of doing well with exercise and stress management. Policies aimed at expanding access to paid maternity and family leave may contribute toward reducing socio-demographic disparities in paid leave use and its associated health benefits.

Objectives. This study explored the use of strategic messaging by proponents of sugar-sweetened beverage (SSB) taxation to influence public opinion and shape the policy process, emphasizing the experiences in El Monte and Richmond, California, with SSB tax proposals in 2012. Methods. We conducted 18 semistructured interviews with key stakeholders about the use and perceived effectiveness of messages supporting and opposing SSB taxation, knowledge sharing among advocates, message dissemination, and lessons learned from their messaging experiences. Results. The protax messages most frequently mentioned by respondents were reinvesting tax revenue into health-related programs and linking SSB consumption to health outcomes such as obesity and diabetes. The most frequently mentioned antitax messages addressed negative economic effects on businesses and government restriction of personal choice. Factors contributing to perceived messaging success included clearly defining “sugar-sweetened beverage” and earmarking funds for obesity prevention, incorporating cultural sensitivity into messaging, and providing education about the health effects of SSB consumption. Conclusions. Sugar-sweetened beverage taxation has faced significant challenges in gaining political and public support. Future campaigns can benefit from insights gained through the experiences of stakeholders involved in previous policy debates.

Tobacco companies use price discounts, including coupons and rebates, to market their products. Lesbian, gay, bisexual, transgender, and queer (LGBTQ+) communities are targeted by these marketing strategies, contributing to inequitably high tobacco use. Some localities have adopted policies restricting tobacco price discounts; for successful implementation, community buy-in is crucial. From July–October 2018, Equality California staff conducted semi-structured interviews with seven participants in Los Angeles, CA. Themes included familiarity with tobacco price discounts, their perceived impact on tobacco use in LGBTQ+ communities, and attitudes toward potential policy restrictions. Interview notes were analyzed using a deductive approach to qualitative analysis. Awareness of tobacco price discounts varied; some interviewees were familiar, while others expressed surprise at their ubiquity. Price discounts were seen to disproportionately impact LGBTQ+ individuals, especially those who additionally identify with other vulnerable groups, including young people and communities of color. Support for policy restrictions was unanimous; however, interviewees expressed concern over political opposition and emphasized a need for culturally competent outreach to LGBTQ+ communities. Community organizations are essential in mobilizing support for policy reform. Understanding the perceptions and recommendations of community leaders provides tools for policy action, likely improving outcomes to reduce LGBTQ+ tobacco use through restricting tobacco price discounts.

Preventing childhood obesity requires innovative, evidence-based policy approaches. This study examines the use of research evidence by obesity policy stakeholders in Minnesota and develops pilot tools for communicating timely evidence to policymakers. From November 2012 to January 2013, semistructured interviews were conducted with 51 Minnesota stakeholders in childhood obesity prevention. Interviewees included 16 state legislators and staff; 16 personnel from the Minnesota Department of Education, Minnesota Department of Health, and Minnesota Department of Transportation; and 19 advocates for and against childhood obesity prevention legislation (response rate = 71%). Participants were asked their views on 3 themes: (1) Whether and how they used research evidence in their current decision-making processes; (2) barriers to using research evidence for policymaking; and (3) suggestions for improving the evidence translation process. All interviews were audio-recorded and transcribed. A team approach to qualitative analysis was used to summarize themes, compare findings across interviewees' professional roles, and highlight unexpected findings, areas of tension, or illuminating quotes. Stakeholders used research evidence to support policy decisions, educate the public, and overcome value-based arguments. Common challenges included the amount and complexity of research produced and limited relationships between researchers and decision makers. Responding to interviewee recommendations, we developed and assessed 2 pilot tools: a directory of research experts and a series of research webinars on topics related to childhood obesity. Stakeholders found these materials relevant and high-quality but expressed uncertainty about using them in making policy decisions. Stakeholders believe that research evidence should inform the design of programs and policies for childhood obesity prevention; however, many lack the time and resources to consult research consistently. Future efforts to facilitate evidence-informed policymaking should emphasize approaches to designing and presenting research that better meets the needs of policy and programmatic decision makers.

OBJECTIVE:This study evaluates the associations between workplace accommodations for pregnancy, including paid and unpaid maternity leave, and changes in womenʼs health insurance coverage postpartum. METHODS:Secondary analysis using Listening to Mothers III, a national survey of women ages 18 to 45 years who gave birth in U.S. hospitals during 2011 to 2012 (N = 700). RESULTS:Compared with women without access to paid maternity leave, women with access to paid leave were 0.4 times as likely to lose private health insurance coverage, 0.3 times as likely to lose public health coverage, and 0.3 times as likely to become uninsured after giving birth. CONCLUSION:Workplace accommodations for pregnant employees are associated with health insurance coverage via work continuity postpartum. Expanding protections for employees during pregnancy and after childbirth may help reduce employee turnover, loss of health insurance coverage, and discontinuity of care.

Women in the United States face uniquely challenging circumstances regarding employment and childbirth. Unlike all but two other countries worldwide, the U.S. does not guarantee paid leave to employed women who give birth, and the 12 weeks of unpaid leave provided under the Family and Medical Leave Act falls far short of most industrialized nations. This dissertation examines the associations between family-friendly workplace policies such as paid maternity leave and indicators for maternal and child health outcomes, care utilization, and access to health care services in the U.S. context. Data from Listening to Mothers III, a national survey of U.S. women ages 18-45 who gave birth in 2011-12, were used to conduct multivariate logistic regression predicting infant health, maternal physical/mental health, and maternal health behavior outcomes by use and duration of paid maternity leave among 700 women who indicated working during pregnancy. A second aim explored the associations between workplace accommodations during pregnancy and women’s access to health insurance coverage after childbirth, via employment continuity. Data from the National Survey of Family Growth 2006-10 were then used to examine variations in access to paid and unpaid maternity leave across U.S. states by state-level leave policies among a sample of 2,708 U.S. women ages 18-44 who gave birth in 2001-2010. Across all three aims, paid maternity leave was consistently associated with positive indicators for maternal and infant health. Women taking paid maternity leave had significantly lower odds of re-hospitalizing themselves and their infants after giving birth and higher odds of positive health behaviors. Availability of maternity leave predicted women’s return to work postpartum, and in turn, lowered the odds of losing health insurance coverage. Women in states with more generous maternity leave policies were more likely to take leave, and for longer durations; this association was especially pronounced for lower-income women, suggesting that public policies may play an important role in addressing socio-demographic disparities in maternal/child health via access to paid maternity leave. Future research, especially using longitudinal or prospective cohort designs, is recommended to shed further light on the potential benefits of expanded access to paid leave for maternal/child health.