***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: CONTEXT Lactation is associated with improved glucose and insulin homeostasis , independent of weight change . OBJECTIVE To evaluate the association between lactation history and incidence of type 2 diabetes . DESIGN , SETTING , AND PARTICIPANTS Prospect i ve observational cohort study of 83,585 parous women in the Nurses ' Health Study ( NHS ) and retrospective observational cohort study of 73,418 parous women in the Nurses ' Health Study II ( NHS II ) . MAIN OUTCOME MEASURE Incident cases of type 2 diabetes mellitus . RESULTS In the NHS , 5145 cases of type 2 diabetes were diagnosed during 1,239,709 person-years of follow-up between 1986 and 2002 , and in the NHS II , 1132 cases were diagnosed during 778,876 person-years of follow-up between 1989 and 2001 . Among parous women , increasing duration of lactation was associated with a reduced risk of type 2 diabetes . For each additional year of lactation , women with a birth in the prior 15 years had a decrease in the risk of diabetes of 15 % ( 95 % confidence interval , 1%-27 % ) among NHS participants and of 14 % ( 95 % confidence interval , 7%-21 % ) among NHS II participants , controlling for current body mass index and other relevant risk factors for type 2 diabetes . CONCLUSIONS Longer duration of breastfeeding was associated with reduced incidence of type 2 diabetes in 2 large US cohorts of women . Lactation may reduce risk of type 2 diabetes in young and middle-aged women by improving glucose homeostasis Objective . In the third quarter of 2001 , the National Immunization Survey ( NIS ) began collecting data on the initiation and duration of breastfeeding and whether it was the exclusive method of infant feeding . Using the data from the 2002 NIS , this study estimates breastfeeding rates in the United States by characteristics of the child , mother , or family . Methods . The NIS uses r and om-digit dialing to survey households nationwide with children 19 to 35 months old about vaccinations  and then vali date s the information through a mail survey of the health care providers who gave the vaccinations . In 2002 , ∼3500 households from the NIS were r and omized to 1 of the 3 rotating topical modules that covered breastfeeding . Results . More than two thirds ( 71.4 % ) of the children had ever been breastfed . At 3 months , 42.5 % of infants were exclusively breastfed , and 51.5 % were breastfed to some extent . At 6 months , these rates dropped to 13.3 % and 35.1 % , respectively . At 1 year , 16.1 % of infants were receiving some breast milk . Non-Hispanic black children had the lowest breastfeeding rates . Breastfeeding rates also varied by participation in day care or the Women , Infants , and Children program , socioeconomic status , and geographic area of residence . Conclusions . Although the rate of breastfeeding initiation in the United States is near the national goal of 75 % , at 6 and 12 months postpartum the rates of breastfeeding duration are still considerably below the national goals of 50 % and 25 % , respectively . In addition , rates of exclusive breastfeeding are low . Strenuous public health efforts are needed to improve breastfeeding behaviors , particularly among non-Hispanic black women and socioeconomically disadvantaged groups OBJECTIVES : Despite recent efforts to increase breastfeeding , young African American mothers continue to breastfeed at low rates , and commonly introduce complementary foods earlier than recommended . This study examines the effects of a community doula home visiting intervention on infant feeding practice s among young mothers . METHODS : Low-income , African American mothers ( n = 248 ) under age 22 years participated in a r and omized trial of a community doula intervention . Intervention-group mothers received services from paraprofessional doulas : specialized home visitors trained as childbirth educators and lactation counselors . Doulas provided home visits from pregnancy through 3 months postpartum , and support during childbirth . Control-group mothers received usual prenatal care . Data were obtained from medical records and maternal interviews at birth and 4 months postpartum . RESULTS : Intent-to-treat analyses showed that doula-group mothers attempted breastfeeding at a higher rate than control-group mothers ( 64 % vs 50 % ; P = .02 ) and were more likely to breastfeed longer than 6 weeks ( 29 % vs 17 % ; P = .04 ) , although few mothers still breastfed at 4 months . The intervention also impacted mothers ’ cereal/solid food introduction ( P = .008 ) : fewer doula-group mothers introduced complementary foods before 6 weeks of age ( 6 % vs 18 % ) , while more waited until at least 4 months ( 21 % vs 13 % ) compared with control-group mothers . CONCLUSIONS : Community doulas may be effective in helping young mothers meet breastfeeding and healthy feeding guidelines . The intervention ’s success may lie in the relationship that develops between doula and mother based on shared cultural background and months of prenatal home visiting , and the doula ’s presence at the birth , where she supports early breastfeeding experiences BACKGROUND Breastfeeding peer counseling has improved breastfeeding rates in developing countries ; however , its impact in this country has not been adequately evaluated . OBJECTIVE To evaluate the effectiveness of an existing , breastfeeding peer counseling program within the United States . DESIGN R and omized , prospect i ve , controlled trial in which participants were recruited prenatally and r and omly assigned to receive either routine breastfeeding education or routine breastfeeding education plus peer counseling . SETTING An urban hospital serving a large population of low-income Latinas . PARTICIPANTS Pregnant women ( < or = 26 weeks ' gestation ) were recruited from the hospital 's prenatal clinic . Inclusion criteria specified that participants be low income , be considering breastfeeding , have delivered a healthy , full-term singleton , and have access to a telephone . Intervention Breastfeeding peer counseling services included 1 prenatal home visit , daily perinatal visits , 3 postpartum home visits , and telephone contact as needed . MAIN OUTCOME MEASURES Breastfeeding rates at birth and 1 , 3 , and 6 months postpartum . RESULTS The proportion not initiating breastfeeding was significantly lower in the intervention group than among controls ( 8/90 [ 9 % ] vs 17/75 [ 23 % ] ; relative risk , 0.39 ; 95 % confidence interval , 0.18 - 0.86 ) . The probability of stopping breastfeeding also tended to be lower in the intervention group at both 1 month ( 36 % vs 49 % ; relative risk , 0.72 ; 95 % confidence interval , 0.50 - 1.05 ) and 3 months ( 56 % vs 71 % ; relative risk , 0.78 ; 95 % confidence interval , 0.61 - 1.00 ) . CONCLUSION These findings demonstrate that , in the United States , peer counselors can significantly improve breastfeeding initiation rates and have an impact on breastfeeding rates at 1 and 3 months post partum Excess weight gain in American Indian/Alaskan native ( AI/AN ) children is a public health concern . This study tested ( 1 ) the feasibility of delivering community-wide interventions , alone or in combination with family-based interventions , to promote breastfeeding and reduce the consumption of sugar-sweetened beverages ; and ( 2 ) whether these interventions decrease  Body Mass Index ( BMI ) -Z scores in children 18–24 months of age . Three AI/AN tribes were r and omly assigned to two active interventions ; a community-wide intervention alone ( tribe A ; n = 63 families ) or community-wide intervention containing a family component  ( tribes B and C ; n = 142 families ) . Tribal staff and the research team design ed community-tailored interventions and trained community health workers to deliver the family intervention through home visits . Feasibility and acceptability of the intervention and BMI -Z scores at 18–24 months were compared between tribe A and tribes B & C combined using a separate sample pretest , posttest design . Eighty-six percent of enrolled families completed the study .  Breastfeeding initiation and 6-month duration increased 14 and 15 % , respectively , in all tribes compared to national rates for American Indians . Breastfeeding at 12 months was comparable to national data . Parents expressed confidence in their ability to curtail family consumption of sugar-sweetened beverages . Compared to a pretest sample of children of a similar age 2 years before the study begun , BMI -Z scores increased in all tribes . However , the increase was less in tribes B & C compared to tribe A ( −0.75 , P = 0.016 ) . Family , plus community-wide interventions to increase breastfeeding and curtail sugar-sweetened beverages attenuate BMI rise in AI/AN toddlers more than community-wide interventions alone OBJECTIVE The purpose of this study was to compare breastfeeding duration in mothers after delivery who were assigned r and omly to a behavioral educational intervention vs enhanced usual care . STUDY DESIGN We conducted a r and omized trial . Self-identified black and Latina mothers early after delivery were assigned r and omly to receive a behavioral educational intervention or enhanced usual care . The 2-step intervention aim ed to prepare and educate mothers about postpartum symptoms and experiences ( including tips on breastfeeding and breast/nipple pain ) and to bolster social support and self-management skills . Enhanced usual care participants received a list of community re sources and received a 2-week control call . Intention-to-treat analyses examined breastfeeding duration ( measured in weeks ) for up to 6 months of observation . This study was registered with clinical trial.gov ( NCT01312883 ) . RESULTS Five hundred forty mothers were assigned r and omly to the intervention ( n = 270 ) vs control subjects ( n = 270 ) . Mean age was 28 years ( range , 18 - 46 years ) ; 62 % of the women were Latina , and 38 % were black .  Baseline sociodemographic , clinical , psychosocial , and breastfeeding characteristics were similar among intervention vs control subjects . Mothers in the intervention arm breastfed for a longer duration than did the control subjects ( median , 12.0 vs 6.5 weeks , respectively ; P = .02 ) Mothers in the intervention arm were less likely to quit breastfeeding over the first 6 months after delivery ( hazard ratio , 0.79 ; 95 % confidence interval , 0.65 - 0.97 ) . CONCLUSION A behavioral educational intervention increased breastfeeding duration  among low-income , self-identified black and Latina mothers during the 6-month postpartum period This study compared breastfeeding attitudes , intention , and initiation among low-income women exposed or not exposed to the Best Start program .  A between- ( experimental vs control group ) and within-factor ( pretest vs posttest ) repeated measures design was employed . A nonprobability sample of 54 subjects was r and omly assigned to a control group ( n = 28 ) or an experimental group ( n = 26 ) . Using the Breastfeeding Attrition Prediction Tool , statistically significant group by time interaction effects were found for negative breastfeeding sentiment , positive breastfeeding sentiment , and breastfeeding control scales . Compared to the control group , the experimental group had significantly increased positive breastfeeding sentiment ( P < .01 ) , decreased negative breastfeeding sentiment ( P < .01 ) , and increased breastfeeding control ( P < .01 ) from pretest to posttest . Following exposure to the Best Start program , subjects in the experimental group showed statistically significantly higher breastfeeding intention and initiation than did those in the control group . Practical implication s are discussed . J Hum Lact . 20(3):300 - 305 A r and omized controlled trial study design was used to investigate the effectiveness of a Healthy Families America model prenatal intervention for increasing breastfeeding rates among Latina immigrants residing in an impoverished New York City community . Exposure to the intervention did not affect mother report of any breastfeeding ( ABF ) during the first week postpartum , but it did affect mother report of exclusive breastfeeding ( EBF ) . Thirty-two percent ( 44/137 ) of mothers exposed to the intervention reported EBF during the first week postpartum compared to 20 % ( 20/101 ) of mothers not exposed to the intervention ( odds ratio 1.92 ; 95 % confidence interval 1.05 - 3.52 ) . This positive effect of the intervention on EBF remained statistically significant after controlling for the negative effect of household income on EBF ( adjusted odds ratio , 1.89 ; 95 % confidence interval , 1.02 - 3.50 ) . Additional research is needed on the effectiveness of breastfeeding promotion programs targeting low-income Latinas . J Hum Lact . 25(4):404 - 411 OBJECTIVE : By the preschool years , racial/ethnic disparities in obesity prevalence are already present . The objective of this study was to examine racial/ethnic differences in early-life risk factors for childhood obesity . METHODS : A total of 1343 white , 355 black , and 128 Hispanic mother – child pairs were studied in a prospect i ve study . Mother 's reported child 's race/ethnicity . The main outcome measures were risk factors from the prenatal period through 4 years old that are known to be associated with child obesity . RESULTS : In multivariable models 
    Output:
    
Racial and ethnic minority women continue to have lower breastfeeding rates than white women and are not close to meeting the Healthy People 2020 goals .
Minority women report many barriers to breastfeeding .