BACKGROUND:Assessment of early-life exposure to environmental tobacco smoke (ETS) often relies on retrospective maternal report. We evaluated the validity of such reports up to 17 years later in dyads with prenatal and/or household smoke exposure. METHODS:Baby's Breath was a randomized controlled trial of a smoke avoidance intervention among 738 pregnant women and their infants followed through 6 months postpartum (2006-2009). Mothers reported their own smoking and infant ETS exposure at 6 months postpartum; bioverified with salivary cotinine. Pathways recruited 109 dyads from Baby's Breath when children reached adolescence (2021-2026). Mothers retrospectively reported infant ETS exposure. Positive and negative predictive value, sensitivity, specificity, Cohen's kappa, and cotinine levels across self-report categories were computed for maternal self-report of smoking and both concurrent and retrospective report of infant ETS exposure. RESULTS:Maternal self-reported smoking was concordant with bioverified cotinine whereas both concurrent and retrospective maternal reports of infant ETS exposure were not. The predictive value of retrospective reporting depended entirely on how exposure was characterized. CONCLUSION:In this cohort of families with smoke exposure, postpartum maternal reports of their own smoking closely aligned with bioverified cotinine, whereas concurrent and retrospective reports of infant ETS exposure showed poor concordance. IMPACT:Longitudinal validation of maternal retrospective reports of infant ETS exposure, using bioverified cotinine data, revealed systematic recall bias. Mothers accurately recalled confirmed exposure up to 17 years later but frequently denied or underestimated it when biomarkers indicated otherwise. Reports were sensitive to acknowledged exposure but showed poor specificity for non-exposure, increasing misclassification risk. These findings urge caution when using retrospective reports in etiologic research and underscore the importance of biomarker validation.

BACKGROUND:Like other positive health behaviors, researchers have documented large racial and ethnic disparities in breastfeeding initiation and continuation rates. Understanding contributing factors to these disparities is important for designing effective interventions. RESEARCH AIM:To examine whether sociodemographic and pregnancy-related factors explain racial and ethnic disparities in breastfeeding outcomes. METHODS:We conducted a cross-sectional, secondary analyses of the Pregnancy Assessment Monitoring Survey Phase 8, 2016-2022. We first examined breastfeeding outcomes (breastfeeding initiation, breastfeeding continuation at 8 weeks, and breastfeeding continuation at 8 weeks among those who initiated) across racial and ethnic groups (N = 193,917). Multivariable logistic regressions were used to examine these associations, adjusting for sociodemographic (race, age, insurance, marital status, and income) and pregnancy-related factors (WIC participation, adequacy of prenatal care, delivery type, and number of resources from which participants received breastfeeding information). RESULTS:A total of 87% of the sample initiated breastfeeding, with 68% still breastfeeding at 8 weeks. Non-Hispanic Black participants were less likely to initiate breastfeeding (aOR = .73; CI [.68, .78]) or be breastfeeding at 8 weeks (aOR = .90; CI [.86, .95]) compared to Non-Hispanic White participants, even after adjusting for sociodemographic and pregnancy-related factors. However, the association between Black race and continuation of breastfeeding to 8 weeks postpartum among those who initiated was completely attenuated after adjustment. Hispanic participants also had lower rates of continuation, but this was reversed when adjusting for sociodemographic and pregnancy-related factors. CONCLUSION:Sociodemographic and pregnancy-related factors contribute to, but do not fully explain, breastfeeding disparities. Efforts are needed to further understand and address breastfeeding disparities, especially breastfeeding initiation among Black mothers.

As the aging U.S. population grows, so do healthcare challenges, particularly in nutrition and dietary quality. Older adults face a higher risk of malnutrition, affecting health and quality of life. Dietary intake is influenced by health, social environments, and food access, but their combined impact remains unclear among vulnerable populations. While food security is recognized as crucial for adequate nutrition, the role of social and environmental factors in dietary quality is less understood. The Deliver-EE trials aim to explore these relationships. The purpose of our investigation is to assess the relationships between social isolation, food insecurity, and dietary risk, contributing to a deeper understanding of nutrition among older adults. With a Dietary Screening Tool (DST) threshold of ≤ 60, 93% of the sample was categorized as at risk for low dietary quality. Food insecurity in the sample was 52%, yet a high proportion of both food-insecure and food-secure individuals were at risk for low dietary quality (48% and 45% respectively). No significant association was found between social isolation and DST scores. Dietary risk does not seem to be associated with food insecurity or social isolation. These findings suggest that systemic factors, rather than ability to afford food and social connectivity, drive dietary risk. Future research should examine nutritional gaps in food assistance programs and structural determinants of dietary quality in vulnerable populations.

BackgroundChildren in the U.S. drink too little water and too much juice and sugar sweetened beverages. Inadequate access to drinking water in locations where children spend substantial time, like family childcare homes (FCCH) could play a role in low child water intake. The aim of this qualitative study was to explore barriers and facilitators to water availability and accessibility in FCCH, and determine potential strategies for facilitating water accessibility and children’s intake in FCCH.MethodsWe conducted virtual interviews, in Spanish and/or English, with family child care providers (FCCP) from Rhode Island, Connecticut, and Massachusetts. Interviews were conducted by University of Connecticut graduate students, including two who were fluent in Spanish and English. These were audio-recorded, transcribed verbatim, and translated to English. We conducted a deductive analysis using a priori themes. Additional codes were developed and applied to capture emerging themes from the qualitative data.ResultsTwenty FCCP (100% identified as female; 50% as Latina) participated in the interviews. FCCP barriers to water availability at FCCH included focus on other beverages, e.g., milk; confusion with the Child and Adult Care Food Program (CACFP) guidelines regarding water, and concerns about: water quality, mess, children eating enough food/milk, bathroom accidents, and cost for filters/bottled water. Barriers to children drinking water included: children not liking or preferring water, parental preferences/role modeling, and parental concerns about water quality. Suggested potential strategies to facilitate water access and intake included water filters to ensure safe water access, self-serving stations and water bottles to encourage autonomy among children, and incorporating water into daily routines. Participants also favored materials and activities to educate and encourage children to drink water and to keep track of their intake.ConclusionThese findings suggest that interventions to increase water consumption at FCCH should provide resources to guarantee safe water access to children, encourage children to drink water, and help clarify misperceptions and confusion around CACFP beverage guidelines. Future research should evaluate the effectiveness of interventions to provide education and water access resources to FCCP and families on improving child water access, availability and intake.

BackgroundChildren in the United States have poor diet quality, increasing their risk for chronic disease burden later in life. Caregivers’ feeding behaviors are a critical factor in shaping lifelong dietary habits. The Strong Families Start at Home/Familias Fuertes Comienzan en Casa (SFSH) was a 6-month, home-based, pilot randomized-controlled feasibility trial that aimed to improve the diet quality of 2-5-year-old children and promote positive parental feeding practices among a predominantly Hispanic/Latine sample. The pilot saw significant improvements in children’s Healthy Eating Index-2015 total and whole fruit scores, as well as multiple food parenting practices, and it was received well by participants. ObjectiveBuilding on the success of the pilot study, this protocol paper describes the modifications, study design, and procedures for a fully powered randomized controlled trial. MethodsCaregiver-child dyads are randomized to a “healthy eating” intervention group or a “reading readiness” attention control group. In the intervention group, a trained community health worker conducts monthly home visits or phone calls for 6 months that focus on age-appropriate nutrition recommendations and food parenting practices. There are three home visits that include tailored nutrition education materials that address their child’s appetitive traits and eating habits, an interactive cooking activity, and a review of a family meal video with feedback. Community health workers use motivational interviewing and goal setting, which are key components of the program. The control group is similarly structured, with content focusing on reading and language development. Caregivers complete in-person and over-the-phone baseline and 6-month follow-up measurements to capture diet quality (primary outcomes: Healthy Eating Index-2015 scores via two 24-h dietary recalls and dermal carotenoids) and selected parental feeding practices and availability of healthy foods in the home (secondary outcomes). ResultsThis protocol was approved by the Brown University institutional review board (protocol number 2022003389). As of March 2025, a total of 81 participants were randomized. Of these, 29 participants completed the study, and 8 participants withdrew. Recruitment will continue until 257 participants have been randomized. Data analysis is expected to conclude in 2028. ConclusionsFindings will determine the efficacy of the intervention to improve child diet quality and parental feeding practices, which will ultimately inform future effectiveness and the real-world of home-based food parenting programs. Trial RegistrationClinicalTrials.gov NCT06099288; https://clinicaltrials.gov/study/NCT06099288 International Registered Report Identifier (IRRID)DERR1-10.2196/73923

Background and Objective: To describe the intersection of tobacco smoke exposure with breastfeeding psychosocial predictors and practice. Methods: This is a secondary analysis of the Baby’s Breath study data among a free-living people from southeastern New England. Participants were 843 pregnant people who use (38%), recently quit (23%) or are exposed to (39%) tobacco smoke, who intended (77%) to breastfeed, and who were 55% married, 53% primiparous, 56% unemployed, 41% non-Hispanic White, 27% Hispanic, 13% non-Hispanic Black, and 28% <21, 39% 21-25 or 33%>25 years old. Main outcome measures were self-reported breastfeeding intentions and predictors at 16- and 32-weeks gestation, breastfeeding initiation and continuation at 3 and 6 months postpartum, and tobacco use and exposure at all timepoints. Chi-square and regression models assessed breastfeeding and smoking status and associations between psychosocial scores with breastfeeding intention and smoking status. Results: Breastfeeding variables differed by smoking exposure. Psychosocial scores were associated with breastfeeding intention. Knowledge, self-efficacy, and social support scores were associated with tobacco smoke exposure during pregnancy. Conclusions: Breastfeeding intention, practice, and associated knowledge, self-efficacy, and social support are associated with tobacco use and exposure. Tobacco smoke avoidance messaging and breastfeeding support addressing common antecedents will likely lead to less smoke-exposed, more successfully breastfed babies with better health outcomes.

Exploring health-care providers’ perspectives on cannabis use during pregnancy and breastfeeding is essential for improving patient–provider communication on these topics. Twenty medical providers caring for pregnant individuals were recruited to participate in semi-structured key informant interviews, which asked about strategies and challenges caring for pregnant individuals using cannabis. Health-care providers worried about the harmfulness of cannabis during the perinatal period, short appointment times, and having limited evidence-based guidance. In contrast to these concerns, participants worked with their patients to avoid potential punitive actions and reported supporting patient decisions when discussing cannabis use and breastfeeding. More provider-focused evidence-based resources about the health effects of cannabis use during and after pregnancy may strengthen clinical counseling and support patient cessation when appropriate or desired.

Lifestyle-related chronic disease increases in the United States have led to the need for innovative programs targeting dietary choices. Based on growing evidence supporting whole food plant-based (WFPB) nutrition to improve overall health, we devised a one-month WFPB intervention program, Jumpstart Your Health! (JYH), to introduce and encourage adoption of the WFPB dietary lifestyle. This paper investigates its effects on various health indicators associated with cardiovascular and metabolic diseases. Among the total of 150 participants, before and after physical measurements and blood chemistries demonstrate significant (p< 0.05) decreases in weight (-4.2 pounds), cholesterol (-25.3 mg/dl), LDL (-19.0 mg/dl), HDL (-5.6 mg/dl), hemoglobin A1c (-0.2%), and hsCRP (-1.9 mg/L). Among the high-risk participants, we found significant decreases in systolic blood pressure (-10 mmHg), diastolic blood pressure (-8.7 mmHg), weight (-4.3 pounds), cholesterol (-38.8 mg/dl), LDL (-22.7 mg/dl), HDL (-2.8 mg/dl), hemoglobin A1c (-0.2 %), and hsCRP (-2.3 mg/L). We demonstrate that a simple WFPB intervention implemented over one month resulted in significant reductions in physical measurements and blood chemistries that could translate to lowered risk or improvement for obesity, cardiovascular disease, and type-2 diabetes.

Background: Psychosocial predictors of breastfeeding and changes in those factors during pregnancy, along with the relationship of those changes with both breastfeeding and smoke use and exposure, are not well explored.Research Aim: The aim of this study was to identify distinct trajectories of psychosocial determinants of breastfeeding and smoking in pregnant women.Methods: We used a longitudinal study design and data from a randomized controlled trial conducted among smoke-exposed pregnant women and their infants. Participants were recruited early in pregnancy and were surveyed at <= 16 and 32 weeks gestation, delivery, 3 and 6 months postpartum for breastfeeding intentions, initiation, continuation, and smoke use and exposure. Psychosocial variables associated with breastfeeding were measured at baseline and 32 weeks gestation using the Mitra index, a structured questionnaire that assesses barriers and facilitators of breastfeeding intentions. Latent class growth analysis was performed using Mitra scores to identify distinct subgroups of participants with different trajectories. Sociodemographic characteristics, breastfeeding, and tobacco smoke use and exposure were compared across classes.Results: Three or four trajectories were identified for each of the six Mitra scores. Trajectories for all Mitra scores were associated with breastfeeding intention and initiation. Overall, Mitra, knowledge, self-efficacy, social support, and time barrier classes all differed by tobacco smoke use or exposure.Conclusion: Trajectories of breastfeeding knowledge, self-efficacy, social support, and time to breastfeed/social barriers are associated with tobacco smoke use and exposure during pregnancy. Encouragement to breastfeed and to cease and avoid tobacco smoke should start early in pregnancy, focusing on these determinants to improve health outcomes.

Abstract Background As food insecurity and healthcare costs are linked, healthcare entities (i.e., providers, healthcare systems, insurers) are increasingly interested in identifying and providing solutions to address food insecurity among their patients. Home-delivered meals are one long-standing solution to address food insecurity among homebound older adults. However, there is limited evidence about what mode of delivery is most effective in promoting community independence, reducing healthcare utilization, and improving quality of life as well as how these outcomes may vary as a function of people’s preferences for how meals are delivered to them. Methods With extensive stakeholder input, we designed and implemented a pragmatic randomized comparative effectiveness study in which we will enroll 2300 older adults on waiting lists at home-delivered meals programs across the country and randomize them to receive for 6 months, either (1) weekday lunchtime meals delivered by a local volunteer or driver who also provides socialization and wellness checks or (2) biweekly delivery of 10 frozen meals to participants’ homes. Participant data will be combined with Centers for Medicare and Medicaid Services (CMS) data to calculate post-randomization institutional vs. community days. Baseline and 3-month surveys will evaluate secondary outcomes (e.g., food insecurity, loneliness, quality of life) and exploratory outcomes (e.g., nutritional risk). To examine heterogeneity of treatment effects, we will test for interactions between the two types of meal delivery and participants’ preferred mode of meal delivery as well as participants’ living arrangements. Discussion This research will be the first to prospectively evaluate the comparative effectiveness of the two predominant meal delivery options. The knowledge generated from this research will be of value to healthcare providers, health systems, payers, community-based organizations, older adults, and their families, because it will identify the mode of meal delivery that best meets homebound older adults’ needs and promotes community independence. In addition, the experience of working closely with stakeholders in designing and conducting this trial will be useful to researchers seeking to engage with stakeholders in the development and evaluation of complex social service interventions while balancing regulatory, resource, and human subjects research considerations. Trial registration ClinicalTrials.gov. NCT05357261. Registered on May 02, 2022

BACKGROUND:Cancer screening is effective in reducing the burden of breast, cervical, and colorectal cancers, but not all communities have appropriate access to these services. In this study, we aimed to identify under-resourced communities by assessing the association between the Social Vulnerability Index (SVI) with screening rates for breast, cervical, and colorectal cancers in ZIP-code tabulation areas (ZCTAs) in Rhode Island. METHODS:This study leveraged deidentified health insurance claims data from HealthFacts RI, the state's all-payer claims database, to calculate screening rates for breast, cervical, and colorectal cancers using Healthcare Effectiveness Data and Information Set measures. We used spatial autoregressive Tobit models to assess the association between the SVI, its four domains, and its 15 component variables with screening rates in 2019, accounting for spatial dependencies. RESULTS:In 2019, 73.2, 65.0, and 66.1% of eligible individuals were screened for breast, cervical, and colorectal cancer, respectively. For every 1-unit increase in the SVI, screening rates for breast and colorectal cancer were lower by 0.07% (95% CI 0.01-0.08%) and 0.08% (95% CI 0.02-0.15%), respectively. With higher scores on the SVI's socioeconomic domain, screening rates for all three types of cancers were lower. CONCLUSION:The SVI, especially its socioeconomic domain, is a useful tool for identifying areas that are under-served by current efforts to expand access to screening for breast, cervical, and colorectal cancer. These areas should be prioritized for new place-based partnerships that address barriers to screening at the individual and community level.

ObjectiveTo explore the goals, barriers, and facilitators set by caregivers of preschool-aged children to improve food parenting practices and household food environments.DesignSecondary qualitative analysis of collaborative goal sheets completed during in-home and telephone visits as part of a home-based pilot intervention.ParticipantsThirty-three Hispanic/Latinx caregivers, predominantly of low income.Phenomenon of InterestPatterns in goal content and anticipated barriers and facilitators.AnalysisThematic analysis of goal sheets with a mixed inductive-deductive approach.ResultsAlmost half of the goals were to support a healthy environment (40.7%) by increasing the availability of healthy foods through food shopping and meal planning. Other goals were to increase structure (33.7%) by establishing food-related routines and decreasing distractions. Goals related to autonomy support (25.4%) included involving their children (eg, cooking together). Caregivers’ perceived barriers encompass individual (eg, stress, lack of time), interpersonal (eg, other family members’ eating behaviors), and environmental-level (eg, food availability) factors. Caregivers only identified facilitators at the individual and interpersonal levels (eg, motivation).Conclusions and ImplicationsUnderstanding goals, barriers, and facilitators can be used to tailor key messages to improve food parenting practices and children's diets. Future interventions can target broader environmental barriers while increasing awareness of individual, interpersonal, and environmental-level facilitators.

Childhood eating behaviors are associated with weight status and laboratory assessments of dietary intake. However, little is known about how eating behaviors relate to the eating patterns and diet quality of children from marginalized populations when assessed in their natural environments. Therefore, we examined the association of food avoidant (e.g., food fussiness and satiety responsiveness) and food approach (e.g., food responsiveness and enjoyment of food) eating behaviors with children's meal size, eating frequency, and diet quality. We analyzed data from 61 predominately low-income Hispanic/Latinx preschool-aged children. Caregivers completed the Childhood Eating Behavior Questionnaire and two 24-h dietary recalls. From the recalls, we calculated meal size, eating frequency, and modified Diet Quality Index Scores (DQIS), and evaluated associations with eating behaviors using multivariable linear models. We also explored the relationship between eating behaviors and DQIS components. Food-avoidant subscales were associated with smaller meals and satiety responsiveness were associated with decreased snack frequency. Food approach subscales were not associated with meal size or eating frequency. Both food-avoidant and food-approach behaviors were associated with components of diet quality and caloric beverages outside of meal and snacks. These findings can inform future research on the relationship between child eating behaviors and dietary intake so that we can develop more tailored and effective interventions to promote healthy eating habits for low-income, Hispanic/Latinx preschool-aged children.

Objective: The socioemotional climate when feeding is a focus in childhood obesity prevention efforts. However, little is known about why caregivers create nonsupportive or supportive climates. This crosssectional study used a Self-Determination Theory perspective to identify factors associated with the socioemotional climate when feeding in ethnically diverse families with low income. Methods: Caregivers of children aged 2-5 years (n = 66) completed the Parent Socioemotional Context demographic surveys at baseline. Multivariable regressions assessed the association between BPN satisfaction/frustration with autonomy-supportive, structured, controlling, and chaotic feeding climates. Results: Participants were predominately Hispanic/Latinx (86.6%), women (92.5%), and born outside the US (60%). Their BPN frustration was positively associated with controlling (0= 0.96; SE = 0.26; P = 0.001) and chaotic (0= 0.79; SE = 0.27; P = 0.01) feeding. Conclusions and Implications: This analysis suggests that BPN frustration is associated with controlling and chaotic feeding and may be important to consider when encouraging responsive feeding. Key Words: feeding environment, parenting, Self-Determination Theory (J Nutr Educ Behav. 2023;55:363 -370.)

Background: Individuals with mobility impairments (MI; use equipment to ambulate) have a high prevalence of both smoking and depression. Behavioral activation (BA) purports that depressed mood is remediated through valued activity engagement and may facilitate smoking cessation in MI populations. Objective: We examined cross-sectional associations between activity engagement and variables important for smoking cessation among a high-risk group of smokers (people with MIs) and also describe a smoking cessation intervention based on BA, given the lack of studies on smokers with MIs. Methods: This study used data from a smoking cessation trial enrolling smokers with MIs (n 1/4 263). We assessed valued activities, activity type, activity restriction due to MI, and replacement of restricted activities. Motivation and confidence to quit smoking, number of cigarettes per day, and mood were also assessed. Analysis was performed with generalized linear (or logistic) regression models adjusted for age and physical functioning using aggregated data at baseline. Results: Greater number and frequency of valued activities was associated with less smoking, depression, negative affect, and stress and higher positive affect and self-efficacy to quit. Activity restriction was associated with greater odds of major depression, and activity replacement with lower odds of major depression, lower stress, and higher positive affect and self-efficacy. Strength of associations varied by activity type. Conclusions: Consistent with our theoretical model, BA activity constructs were associated with several mediators of smoking outcomes in the expected directions. Smokers engaging in valued activities have more favorable profiles for smoking cessation and mood management. (c) 2023 Elsevier Inc. All rights reserved.

Background A growing gap in exclusive breastfeeding across racial/ethnic groups in the United States includes a very low proportion of African American/Black women, with only 17.4% breastfeeding exclusively in 2015. While many quantitative studies examine these disparities, few qualitative studies have examined the overall experience of breastfeeding for Black women. Objective The aim of this study is to evaluate the existing qualitative literature on experiences of African American/Black women who breastfeed to gain insight on barriers and facilitators unique to this population. Methods This scoping review included studies that had a focus on any qualitative study design. Evidence was identified by searching electronic databases (PubMed, CINAHL, and PsychINFO). Results Thirteen papers met the inclusion criteria for this review. Each study was summarized and then analyzed for content to produce a synthesis. Seven themes that influence Black women’s experience with breastfeeding were identified: influence of interpersonal relationship on intention to and sustained breastfeeding experiences, influence of institutional systems on initiating and sustaining infant feeding decision, influence of personal beliefs on breastfeeding decisions and experience, material barriers and facilitators to breastfeeding experience, traditional stigma of breastfeeding, historical stigma of breastfeeding influences feeding choice in Black women, and negative impacts of body image. Conclusion The breastfeeding experience for Black women is unique and poses additional areas for intervention based on cultural and historical stigma. Incorporating the identified factors into intervention design is key to creating more effective policies for improving breastfeeding rates in the Black women and closing the gap across racial/ethnic demographics in the United States. Still, more qualitative research with culturally relevant theories needs to be done to investigate the full scope and complexities of breastfeeding as a Black woman to develop messaging to encourage the behavior.

Objective:To describe the feasibility, acceptability and results of Strong Families Start at Home, a 6-month pilot trial of a home-based food parenting/nutrition intervention. Design:Pilot randomised controlled trial. Setting:Participants received six visits with a community health worker trained in motivational interviewing (three home visits, three phone calls); an in-home cooking or reading activity; personalised feedback on a recorded family meal or reading activity; text messages and tailored printed materials. Participants:Parents and their 2-5-year-old child were randomised into intervention (responsive food parenting practices/nutrition) or control (reading readiness) groups. Results:Parents (n 63) were mostly mothers (90 %), Hispanic/Latinx (87 %), born outside the USA (62 %), with household incomes <$25 k (54 %). Despite delivery during COVID-19, 63 % of dyads were retained at 6 months. The intervention was delivered with high fidelity. All parents in the intervention group (n 24) expressed high levels of satisfaction with the intervention, which produced positive treatment effects for whole and total fruit component Healthy Eating Index-2015 scores (point estimate (PE) = 2 center dot 14, 95 % CI (0 center dot 17, 1 center dot 48); PE = 1 center dot 71, 95 % CI (0 center dot 16, 1 center dot 47), respectively) and negative treatment effects for sodium (PE = -2 center dot 09, 95 % CI (-1 center dot 35, -0 center dot 04)). Positive treatment effects also resulted for the following food parenting practices: regular timing of meals and snacks (PE = 1 center dot 08, 95 % CI (0 center dot 61, 2 center dot 00)), reducing distractions during mealtimes (PE = -0 center dot 79, 95 % CI (-1 center dot 52, -0 center dot 19)), using food as a reward (PE = -0 center dot 54, 95 % CI (-1 center dot 35, -0 center dot 04)) and providing a supportive meal environment (PE = 0 center dot 73, 95 % CI (0 center dot 18, 1 center dot 51)). Conclusion:Given the continued disparities in diet quality among low-income and diverse families, continued efforts to improve child diet quality in fully powered intervention trials are needed.

Cancer is an enormous public health challenge in the United States and around the world. Early detection through screening can identify cancer when it is most treatable and can result in greater survival rates; however, racial and ethnic disparities in breast and cervical screening result in late diagnosis and a higher risk of poor outcomes and death for women of color.

Breastfeeding rates fall short of public health goals, but barriers are poorly understood. We examined whether excessive sleepiness during pregnancy and the postpartum period was associated with breastfeeding intentions, attitudes, initiation, and continuation in a tobacco-exposed sample participating in a randomized controlled trial to reduce smoke exposure (n = 399). We used the Epworth Sleepiness Scale (ESS) to examine associations between excessive sleepiness in early (12-16 weeks gestation) and late (32 weeks gestation) pregnancy and at 6 months postpartum, with breastfeeding attitudes using the Mitra index, intentions, initiation, and continuation, as well as other infant feeding practices using the Infant Feeding Questionnaire. Logistic regression models adjusted for age, racial/ethnic identity, parity, marital status, and maternal education showed that excessive sleepiness in late pregnancy was associated with less favorable attitudes toward breastfeeding. In addition, in unadjusted models, excessive sleepiness at 6 months postpartum was associated with less of a tendency to use feeding to calm a fussy infant. Excessive sleepiness was not associated with intent, initiation, or continuation of breastfeeding. Assessing excessive sleepiness in late pregnancy may assist in identifying individuals with negative attitudes to breastfeeding and lead to novel approaches to promoting breastfeeding in populations with lower breastfeeding rates.