{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T19:45:49Z","timestamp":1787946349545,"version":"build-2784847793"},"reference-count":36,"publisher":"SAGE Publications","issue":"3","license":[{"start":{"date-parts":[[2024,3,1]],"date-time":"2024-03-01T00:00:00Z","timestamp":1709251200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Breastfeeding Medicine"],"published-print":{"date-parts":[[2024,3]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Breastfeeding is recommended globally for most infants, especially during and after natural disasters when risk of adverse outcomes increases because of unsanitary conditions and lack of potable water.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and Methods:<\/jats:title>\n                    <jats:p>Using 2017\u20132019 data from Puerto Rico's Pregnancy Risk Assessment Monitoring System for 2,448 respondents with a recent live birth, we classified respondents into 4 hurricane exposure time periods based on infant birth month and year relative to when Hurricanes Irma and Maria occurred: (1) prehurricane; (2) acute hurricane; (3) posthurricane, early recovery; and (4) posthurricane, long-term recovery. We examined the association between maternity care practices during delivery hospitalization and exclusive breastfeeding at 3 months overall and stratified by time period. We also examined the associations between each maternity care practice and exclusive breastfeeding separately by time period.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>Exclusive breastfeeding at 3 months was higher during the acute hurricane time period (adjusted prevalence ratio [aPR]: 1.43, 95% confidence interval: 1.09\u20131.87) than the prehurricane time period. Supportive maternity care practices were positively associated with exclusively breastfeeding, and practices that are risk factors for discontinuing breastfeeding were negatively associated with exclusive breastfeeding. Breastfeeding in the first hour (aPR range: 1.51\u20131.92) and rooming-in (aPR range: 1.50\u20132.58) were positively associated with exclusive breastfeeding across all time periods, except the prehurricane time period. Receipt of a gift pack with formula was negatively associated with exclusive breastfeeding (aPR range: 0.22\u20130.54) across all time periods.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>Maternity care practices during delivery hospitalization may influence breastfeeding behaviors and can improve breastfeeding during and after natural disasters. Strategies to maintain and improve these practices can be further supported during and after natural disasters.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1089\/bfm.2023.0261","type":"journal-article","created":{"date-parts":[[2024,3,15]],"date-time":"2024-03-15T15:35:07Z","timestamp":1710516907000},"page":"177-186","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":3,"title":["Changes in Breastfeeding and Related Maternity Care Practices After Hurricanes Irma and Maria in Puerto Rico"],"prefix":"10.1177","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7972-9117","authenticated-orcid":false,"given":"Katherine","family":"Kortsmit","sequence":"first","affiliation":[{"name":"Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Beatriz","family":"Salvesen von Essen","sequence":"additional","affiliation":[{"name":"Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erica","family":"Anstey","sequence":"additional","affiliation":[{"name":"Division of Nutrition, Physical Activity, and Obesity, Centers for Disease Control and Prevention, Atlanta, Georgia, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sascha","family":"Ellington","sequence":"additional","affiliation":[{"name":"Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wanda I.","family":"Hern\u00e1ndez Virella","sequence":"additional","affiliation":[{"name":"Division of Maternal, Child, and Adolescent Health in the Puerto Rico Department of Health, San Juan, Puerto Rico, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Denise V.","family":"D'Angelo","sequence":"additional","affiliation":[{"name":"Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Penelope","family":"Strid","sequence":"additional","affiliation":[{"name":"Division of Health Care Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Idennys","family":"Magly Olmos","sequence":"additional","affiliation":[{"name":"Division of Maternal, Child, and Adolescent Health in the Puerto Rico Department of Health, San Juan, Puerto Rico, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manuel","family":"Vargas Bernal","sequence":"additional","affiliation":[{"name":"Division of Maternal, Child, and Adolescent Health in the Puerto Rico Department of Health, San Juan, Puerto Rico, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lee","family":"Warner","sequence":"additional","affiliation":[{"name":"Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2024,3,14]]},"reference":[{"key":"e_1_3_7_2_2","unstructured":"United Nations Office for Disaster Risk Reduction (UNDRR). Human Cost of Disasters: An Overview of the Last 20 Years 2000\u20132019. 2020. Available from: https:\/\/www.undrr.org\/publication\/human-cost-disasters-overview-last-20-years-2000-2019 [Last accessed: November13 2023]."},{"key":"e_1_3_7_3_2","first-page":"703","article-title":"Infant Feeding After a Disaster","volume":"695","author":"Calderon-Rodriguez C","year":"2022","unstructured":"Calderon-Rodriguez C, , Noble L. Infant Feeding After a Disaster. In: Breastfeeding\u2014A Guide for Medical Professionals. 9th ed. (Lawrence RA, Lawrence RM, Noble L, et al. eds.) Elsevier: Philadelphia, PA,, 2022; 695:703.","journal-title":"In: Breastfeeding\u2014A Guide for Medical Professionals. 9th ed. (Lawrence RA, Lawrence RM, Noble L, et al. eds.) 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Available from: https:\/\/www.cdc.gov\/nutrition\/emergencies-infant-feeding\/index.html [Last accessed: November13 2023]."},{"key":"e_1_3_7_10_2","unstructured":"American Academy of Pediatrics. Infant Feeding in Disasters and Emergencies. Available from: https:\/\/downloads.aap.org\/AAP\/PDF\/DisasterFactSheet6-2020.pdf [Last accessed: November13 2023]."},{"key":"e_1_3_7_11_2","first-page":"1","article-title":"Breastfeeding and maternal and infant health outcome in developed countries","author":"Ip S","year":"2007","unstructured":"Ip S, , Chung M, , Raman G, et al. Breastfeeding and maternal and infant health outcome in developed countries. Evid Rep Technol Assess (Full Rep), 2007:1\u2013186.","journal-title":"Evid Rep Technol Assess (Full Rep)"},{"key":"e_1_3_7_12_2","doi-asserted-by":"publisher","DOI":"10.1093\/ajcn\/nqy332"},{"key":"e_1_3_7_13_2","doi-asserted-by":"publisher","DOI":"10.1093\/ajcn\/nqy371"},{"key":"e_1_3_7_14_2","doi-asserted-by":"publisher","DOI":"10.1093\/ajcn\/nqy311"},{"key":"e_1_3_7_15_2","doi-asserted-by":"publisher","DOI":"10.1093\/ajcn\/nqy283"},{"key":"e_1_3_7_16_2","unstructured":"Centers for Disease Control and Prevention. Food Safety for Infants After a Natural Disaster. 2023. Available from: https:\/\/www.cdc.gov\/breastfeeding\/recommendations\/food-safety-for-infants-after-a-disaster.html [Last accessed: November13 2023]."},{"key":"e_1_3_7_17_2","doi-asserted-by":"publisher","DOI":"10.1017\/S1368980010003423"},{"key":"e_1_3_7_18_2","article-title":"Barriers to infant feeding in emergencies programming in middle and high-income countries","volume":"61","author":"Ververs M","year":"2019","unstructured":"Ververs M, , Hwang C. Barriers to infant feeding in emergencies programming in middle and high-income countries. Field Exchange, 61. 2019. doi: 10.1186\/s13006-021-00398-w","journal-title":"Field Exchange"},{"key":"e_1_3_7_19_2","unstructured":"Position Paper - Scientific & Technical Department Infant and Young Child Feeding in Emergencies Technical Department ACF - International. 2015. Available from: https:\/\/www.actionagainsthunger.org\/app\/uploads\/2022\/09\/ACF_IYCF-E_Position_Paper_Final.pdf [Last accessed: February9 2024]."},{"key":"e_1_3_7_20_2","unstructured":"Centers for Disease Control and Prevention; National Center for Health Statistics. Underlying Cause of Death 1999\u20132019 on CDC WONDER Online Database Released in 2020. Data are from the Multiple Cause of Death Files 1999\u20132019 as Compiled from Data Provided by the 57 Vital Statistics Jurisdictions Through the Vital Statistics Cooperative Program. Available from: http:\/\/wonder.cdc.gov\/ucd-icd10.html [Last accessed: April12 2021]."},{"key":"e_1_3_7_21_2","doi-asserted-by":"publisher","DOI":"10.1016\/S2214-109X(19)30541-8"},{"key":"e_1_3_7_22_2","doi-asserted-by":"publisher","DOI":"10.1089\/bfm.2015.0135"},{"key":"e_1_3_7_23_2","doi-asserted-by":"publisher","DOI":"10.1111\/mcn.12294"},{"key":"e_1_3_7_24_2","doi-asserted-by":"publisher","DOI":"10.1111\/mcn.13344"},{"key":"e_1_3_7_25_2","unstructured":"Cangialosi JP Latto AS Berg R et al. National Hurricane Center Tropical Cyclone Report\u2014Hurricane Irma (AL112017). 2021. Available from: https:\/\/www.nhc.noaa.gov\/data\/tcr\/AL112017_Irma.pdf [Last accessed: February 9 2024]."},{"key":"e_1_3_7_26_2","doi-asserted-by":"publisher","DOI":"10.1177\/00333549221142571"},{"key":"e_1_3_7_27_2","unstructured":"Pasch RJ Penny AB Berg R. National Hurricane Center Tropical Cyclone Report Hurricane Maria (AL152017). 2019. 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Regulations for Construction Operations Maintenance and Licensing of Hospitals in Puerto Rico (Regulation 9184)\u2014Article 11.12\u2014Natural Breastfeeding and Support Program for the Mother and Newborn. 2020. 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