Adult cancer disparities have been documented for decades and continue to persist despite clinical advancements in cancer prevention, detection, and treatment. Pediatric cancer survival has improved significantly in the United States for the past 5 decades to over 80%; however, disparate outcomes among children and adolescents with cancer still affect many populations in the United States and globally, including racial and ethnic minorities, populations with low socioeconomic status, and residents of underserved areas. To achieve equitable outcomes for all children and adolescents with cancer, it is imperative that concerted multilevel approaches be carried out to understand and address health disparities and to ensure access to high-quality cancer care. Addressing social determinants of health, such as removing barriers to health care access and ensuring access to social supports, can reduce pediatric cancer disparities. Nevertheless, public health policy, health system interventions, and innovative delivery of evidence-based services are critically needed. Partnerships among patients, caregivers, and health care providers, and among health care, academic, and governmental institutions, have a pivotal role in reducing cancer disparities and improving outcomes in the 21st century.
Daily vitamin D supplementation is recommended for breastfed infants, but alternative methods include enriching breast milk with vitamin D through maternal supplementation or intermittent high-dose vitamin D. We determined maternal preferences for vitamin D supplementation in 140 mothers with exclusively breastfed infants, and 44 who used both breast and formula milk. Only 101 (55%) supplemented their infants with vitamin D. One hundred sixty (88%) preferred supplementing themselves rather than their infants, and 102 (57%) preferred daily to monthly supplementation. Safety was most important in choosing a method of supplementation. Taking maternal preferences into consideration may improve adequate intakes of vitamin D in breastfed infants. INTRODUCTIONV itamin D deficiency has become a global public health concern. Nutritional rickets is the most established consequence, and an increasing incidence of rickets has been observed in developed countries.1,2 In one study up to 18% of US children were vitamin D deficient, and 1% had severe deficiency. 4 Adherence to this recommendation, however, is poor. 5Several studies have explored alternative methods of supplementation. Breast milk can be enriched with vitamin D through daily or intermittent high-dose maternal supplementation to meet infants' vitamin D requirements. 6,7 Alternatively, oral vitamin D, 50,000 IU every 2 months, can be given to healthy infants with routine vaccinations to prevent vitamin D deficiency. 8Little is known about maternal preferences for different methods of vitamin D supplementation. Our aim was to assess maternal practices and preferences for vitamin D supplementation of their infants in primary care. METHODSMothers seeking care with infants for either 2-month or 4-month wellchild visits were surveyed regarding vitamin D supplementation. Eligible mothers were aged 18 years and older, spoke English, and had an infant aged between 6 weeks and 5 months that was receiving primary care at Mayo Clinic in Rochester, Minnesota. Practices included 1 urban site, 2 suburban sites, and 1 rural site.We collected data regarding infant feeding practices, vitamin D supplementation, and maternal preferences for the mode of vitamin D supplementation. Response options included either supplementation of the baby or mother with vitamin D and either daily or monthly high-dose The survey questionnaires were distributed to the mothers in the urban site in October 2013. Questionnaires were mailed to mothers at all 4 sites in November and December 2013. A second mailing was sent to nonrespondents 30 days later. The questionnaires had no patient-identifying information and included instructions not to complete it twice.The Mayo Clinic Institution Review Board approved the study. RESULTSA total of 601 questionnaires were mailed, 438 nonrespondents were sent a second mailing, and 31 completed the survey during well-child visits. In all, 236 mothers completed the survey. We report results for the 140 mothers with exclusively breastfed infants and 44 who use...
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