Audrey J Buckland, PhD MSPH

All Publications

• Qualitative Study: Characterizing breastfeeding intentions of Latina women on the United States-Mexico border utilizing the Theory of Planned Behavior. The Journal of nutrition Buckland, A. J., Delaney, C. L., Holzberg, J. R., Luna-Cordova, J. A., King, S. E., Surkan, P. J., Caulfield, L. E., Hurley, K. M. 2025

  Abstract

  Intention to breastfeed is associated with initiation and exclusivity. Few studies have characterized breastfeeding intentions among those living along the U.S.-Mexico border.This study characterizes breastfeeding intentions among Latina women in a rural U.S.-Mexico border county.Qualitative methods characterized breastfeeding intentions using the Theory of Planned Behavior through in-depth interviews with third-trimester pregnant (n=8) and ≤2 months postpartum Latina women (n=28) in a rural Arizona border county. Through interviews with healthcare (n=5) and nutrition service providers (n=7), we also examined provider perceptions of intentions. Thematic analysis of transcripts identified and organized themes via deductive and inductive coding using Dedoose qualitative software.All pregnant and postpartum participants identified as Hispanic or Latina women; most spoke Spanish at home (n=28). Women expressed prenatal intention to breastfeed as either exclusive breastfeeding (n=4), breastfeeding (i.e., not specifying partial or exclusive) (n=22), partial breastfeeding (n=8), or formula-only (n=1). Women who intended to breastfeed or exclusively breastfeed consistently expressed positive breastfeeding attitudes (e.g., improved infant nutrition and immunity or enhances closeness and bonding). Women who intended to breastfeed generally or partially described partial breastfeeding as their family's norm. Perceived behavioral control, primarily related to returning to work, was discussed as a consideration for whether and when women intended to use formula, especially among those who intended to partially breastfeed or formula-only feed. Providers described a desire to not pressure patients to breastfeed. The perceptions of pregnant and postpartum women and service providers were concordant regarding the importance of family influence and breastfeeding challenges when returning to work. Yet, some women had a clear plan for pumping upon return to work.Breastfeeding intention is a strong, modifiable determinant of practice. Strengthening prenatal intention to breastfeed exclusively for six months while addressing barriers to breastfeeding intention provides an opportunity for intervention during pregnancy.

  View details for DOI 10.1016/j.tjnut.2025.10.012

  View details for PubMedID 41082977

• Opportunities and Constraints to Equitable Implementation of the Revised Infant Feeding Guidelines for Pregnant and Lactating Persons Living With HIV in the United States: A Qualitative Study JOURNAL OF THE INTERNATIONAL ASSOCIATION OF PROVIDERS OF AIDS CARE Buckland, A. J., Schmedtje, H., Paramasivam, A., Powell, A. M., Livingston, A., Gross, S. M., Agwu, A. L., Golden, W., Fowler, M., Clark, L. R., Bunch, C., Wendling, B., Ruff, A. J., Rosen, J. G. 2025; 24: 23259582251396636

  Abstract

  BackgroundThe United States recently expanded infant feeding guidelines for persons living with HIV to include chest/breastfeeding.MethodsA qualitative study was conducted through in-depth interviews with 15 service providers and 7 pregnant/lactating persons living with HIV about infant feeding preferences/experiences and implementation determinants of the revised guidelines. Thematic analysis, guided by the Health Equity Implementation Framework, identified opportunities and constraints to equitable adoption and implementation of the revised infant feeding guidelines for persons living with HIV in the United States.ResultsProviders and persons living with HIV embraced the revised guidelines, citing expanded autonomy in infant feeding choices, destigmatization and normalization of breastfeeding. Nevertheless, overlapping individual (breastfeeding reticence given quantifiable but residual vertical HIV transmission risks), institutional (inconsistent provider/organizational knowledge and resources), and structural (siloed care) implementation barriers were identified.ConclusionsEquitable guideline rollout should consider person-centered counseling, clear communication around risks, and coordinated public sector-led dissemination.

  View details for DOI 10.1177/23259582251396636

  View details for Web of Science ID 001613841500001

  View details for PubMedID 41232070

  View details for PubMedCentralID PMC12615913

• Patient receptivity to receiving vaccinations in the dental clinic at a rural federally qualified health center JOURNAL OF THE AMERICAN DENTAL ASSOCIATION Darisi, R. D., Hillier, B., Buckland, A. J., Harris, E., Holzberg, J. R. 2024; 155 (1): 17-25

  Abstract

  More than 28 million people in the United States visited their dentists but not a physician in 2018, yet only a few states allow dentists to administer vaccines to patients, and those vaccines are limited to influenza, COVID-19, and human papillomavirus.To assess the receptiveness of adult dental patients and caregivers of pediatric dental patients to receive necessary vaccines during their dental appointment, a survey was distributed to patients attending a dental visit at a rural federally qualified health center from June 28, 2021, through December 31, 2021.Among the responses from 643 adult patients and 625 pediatric caregivers, approximately one-half (54.2% and 49.9%, respectively) reported being receptive to receiving vaccines in the dental clinic, with 28.5% and 21.8% not being receptive to vaccines, respectively. Primary language, age group, number of children, and primary care center all were associated significantly with reported likelihood of receiving vaccines (P < .05). The most reported concern about receiving vaccines at a dental clinic was a preference for their primary care physician to provide all vaccinations, according to 22.2% of adult patients and 39.8% of pediatric caregivers.The authors' findings support efforts to administer vaccines during dental visits to improve immunization rates among adults and children. Ongoing communication with primary care physicians regarding administration of vaccines in the dental clinic could reduce concerns by adult patients and pediatric caregivers.Strategies and policies that establish protocols to ensure the safe and effective administration of vaccines in dental visits should be implemented and supported.

  View details for DOI 10.1016/j.adaj.2023.09.006

  View details for Web of Science ID 001348133400001

  View details for PubMedID 37943218

• Vaccine hesitancy and the willingness to recommend the COVID-19 vaccine to children in a rural country on the United States-Mexico border. Frontiers in public health Darisi, R. D., Buckland, A. J., Morales, M., Ingram, M., Harris, E., Holzberg, J. R. 2023; 11: 1127745

  Abstract

  As of October 26, 2022, only 9% of children in the United States aged 6 months to 4 years have received at least one dose of COVID-19 vaccine despite FDA approval since June 17, 2022. Rates are better yet still low for children aged 5 to 11 years as nearly 30% were fully vaccinated as of August 23, 2022. Vaccine hesitancy among adults is one of the major factors affecting low vaccine uptake rates in children against COVID-19, yet most studies examining vaccine hesitancy have targeted school-age and adolescent children.With the aim of assessing the willingness to recommend the COVID-19 vaccination to children under 5 years compared to children 5 to 12 years of age, a county-wide survey was conducted between January 11 and March 7, 2022, among adults on the United States-Mexico border.Among the 765 responses, 72.5% were female and 42.3% were Latinx. The most significant factor associated with likelihood to recommend the COVID-19 vaccine to children less than 5 years and 5-12 years of age was adult vaccination status. Ordinal logistic regression also indicated that ethnicity, primary language, being a parent, previous COVID-19 infection, and concern about getting COVID-19 in the future were significantly associated with likelihood of COVID-19 vaccine recommendation to children < 5 years and 5-12 years old.This study found high consistency among respondents in their willingness to vaccinate children aged < 5 years compared with children aged 5-12 years. Our findings support public health strategies that target adult vaccinations as an avenue to improve childhood vaccinations for young children.

  View details for DOI 10.3389/fpubh.2023.1127745

  View details for PubMedID 37206870

  View details for PubMedCentralID PMC10189097

• A longitudinal impact evaluation of a comprehensive nutrition program for reducing stunting among children aged 6-23 months in rural Malawi. The American journal of clinical nutrition Hurley, K. M., Phuka, J., Kang, Y., Ruel-Bergeron, J., Buckland, A. J., Mitra, M., Wu, L., Klemm, R. D., West, K. P., Christian, P. 2021; 114 (1): 248-256

  Abstract

  Growth failure in sub-Saharan Africa leads to a high prevalence of child stunting starting in infancy, and is attributed to dietary inadequacy, poor hygiene, and morbidity.To evaluate the impact of a program in Malawi providing a lipid-based nutrient supplement to infants from 6-23 months of age, accompanied by a social and behavior change communication intervention to optimize caregiver feeding and handwashing practices.This impact evaluation was a quasi-experimental, longitudinal study with 1 program and 1 comparison district. Infants were enrolled at 6-7 months of age. Anthropometry, child morbidity, and caregiver feeding and handwashing practices were assessed at enrollment and at 6, 12, and 18 month follow-ups (ages 6, 12, 18, and 24 months, respectively). Changes in the length-for-age z-score (LAZ), weight-for-length z-score (WLZ), and midupper arm circumference (MUAC) were compared using mixed-effects models. Program impacts on child stunting (LAZ < -2), wasting (WLZ < -2), morbidity, and feeding and handwashing practices were estimated using difference-in-differences.We enrolled 367 infants across the program (n = 176) and comparison (n = 191) districts. The combined prevalences of stunting and wasting at enrollment were 42.1% and 1.4%, respectively, and did not differ by district. At enrollment, the prevalence of severe stunting (LAZ < -3) was higher in the program (15.5%) versus comparison (7.6%) district (P = 0.02), with corresponding lower LAZ scores (-1.9 vs. -1.7, respectively; P = 0.12). Growth velocities favored program children, such that LAZ, WLZ, and MUAC measurements increased by +0.12/y (P = 0.06), +0.12/y (P = 0.04), and +0.24 cm/y (P < 0.001), respectively, leading to comparable LAZ distributions across districts by 24 months of age. Program exposure was associated with 19.8 percentage point (pp) and 13.8 pp reductions in the prevalences of malaria (P = 0.001) and fever (P = 0.02), respectively, at the 18-month follow-up. Improvements of 20 pp (P < 0.01) in minimum dietary diversity and minimum acceptable diet were seen in the program versus comparison district at 18 months of follow-up.The program improved child growth patterns, with benefits to health and diet apparent after 18 months of exposure. This trial was registered at clinicaltrials.gov as NCT02985359.

  View details for DOI 10.1093/ajcn/nqab010

  View details for PubMedID 33742208

• Assessing the play and learning environments of children under two years in peri-urban Lima, Peru: a formative research study. BMC public health Rothstein, J. D., Buckland, A. J., Gagnier, K., Ochoa, M., Allen-Valley, A., Jivapong, B., Cabrera, L. Z., Leontsini, E., Fisher, K. R. 2021; 21 (1): 108

  Abstract

  Home-based interventions have potential for improving early child development (ECD) in low-resource settings. The design of locally acceptable strategies requires an in-depth understanding of the household context. In this formative research study, we aimed to characterize the home play and learning environments of children 6-23 months of age from low-income households in peri-urban Lima, Peru.Drawing on the developmental niche framework, we used quantitative and qualitative methods to understand children's physical and social settings, childcare practices, and caregiver perspectives. We conducted interviews, unstructured video-recorded observations, and spot-checks with 30 randomly selected caregiver-child dyads, 10 from each child age group of 6-11, 12-17, and 18-23 months of age, as well as key informant interviews with 12 daycare instructors. We analyzed the data for key trends and themes using Stata and ATLAS.ti and employed an adapted version of the Indicator of Parent-Child Interaction to evaluate the observations.Children's social settings were characterized by multi-generational homes and the presence of siblings and cousins as play partners. Access to books and complex hand-eye coordination toys (e.g., puzzles, building blocks) in the home was limited (30.0 and 40.0%, respectively). Caregivers generally demonstrated low or inconsistent levels of interaction with their children; they rarely communicated using descriptive language or introduced novel, stimulating activities during play. Reading and telling stories to children were uncommon, yet 93.3% of caregivers reported singing to children daily. On average, caregivers ascribed a high learning value to reading books and playing with electronic toys (rated 9.7 and 9.1 out of 10, respectively), and perceived playing with everyday objects in the home as less beneficial (rated 6.8/10). Daycare instructors reinforced the problems posed by limited caregiver-child interaction and supported the use of songs for promoting ECD.The features of the home learning environments highlighted here indicate several opportunities for intervention development to improve ECD. These include encouraging caregivers to communicate with children using full sentences and enhancing the use of everyday objects as toys. There is also great potential for leveraging song and music to encourage responsive caregiver-child interactions within the home setting.

  View details for DOI 10.1186/s12889-020-10119-3

  View details for PubMedID 33422022

  View details for PubMedCentralID PMC7796591

• Nutrition data use and needs: Findings from an online survey of global nutrition stakeholders. Journal of global health Buckland, A. J., Thorne-Lyman, A. L., Aung, T., King, S. E., Manorat, R., Becker, L., Piwoz, E., Rawat, R., Heidkamp, R. 2020; 10 (2): 020403

  Abstract

  There is growing global demand for country-specific information to track nutritional status and its determinants, including intervention coverage. Periodic population-based surveys form the backbone of most national nutrition information systems. However, data on the coverage of many nutrition specific and sensitive interventions remain sparse.An online survey was administered to the international nutrition community in 2018 through relevant listservs and professional networks to characterize their use of nutrition-related indicators and data sources. Respondents were asked about their professional background, access and use of specific indicators and data sources in the previous year, and unmet data needs. Results were tabulated by respondent characteristics and χ2 tests used for statistical testing.Complete survey responses were received from 235 respondents, the majority from non-governmental organizations and research communities, and few from governments. Demographic Health Surveys (DHS) were the most frequently accessed country-specific data source and the Global Nutrition Report (GNR) was the most accessed consolidated data source, each accessed by approximately 75% of respondents. Respondents with a multi-country focus were more likely to have accessed DHS than those with a single-country focus (85% vs 60%, P < 0.001). Similarly, respondents with a multi-country focus were more likely to have accessed the GNR compared to those with a single-country focus (82% vs 66%, P < 0.05). The most commonly accessed indicators overall were the prevalence of exclusive breastfeeding (69%), child minimum dietary diversity (66%), under-5 stunting (65%), and under-5 wasting (65%). Reported data gaps included adult and household diet quality indicators (n = 32), nutrition-sensitive intervention coverage (n = 25), and infant and young child feeding promotion coverage (n = 11). Lack of data availability for the desired geographic level (82%) or demographic group of interest (82%) and out-of-date data (77%) were common data challenges experienced by respondents.The survey results highlight the continued need for high-quality, actionable nutrition data to help facilitate progress towards national and global nutrition targets.

  View details for DOI 10.7189/jogh.10.020403

  View details for PubMedID 33282221

  View details for PubMedCentralID PMC7688248

• Impact Evaluation of a Comprehensive Nutrition Program for Reducing Stunting in Children Aged 6-23 Months in Rural Malawi. The Journal of nutrition Christian, P., Hurley, K. M., Phuka, J., Kang, Y., Ruel-Bergeron, J., Buckland, A. J., Mitra, M., Wu, L., Klemm, R., West, K. P. 2020; 150 (11): 3024-3032

  Abstract

  The prevalence of stunting in central rural Malawi is ∼50%, which prompted a multipronged nutrition program in 1 district from 2014 to 2016. The program distributed a daily, fortified, small-quantity lipid-based nutritional supplement, providing 110 kcal and 2.6 g of protein to children aged 6-23 mo, and behavior change messages around optimal infant and young child feeding (IYCF) and water, sanitation, and hygiene.Our objective was to perform an impact evaluation of the program using a neighboring district as comparison.Using a quasi-experimental study design, with cross-sectional baseline (January-March, 2014; n = 2404) and endline (January-March, 2017; n = 2453) surveys, we evaluated the program's impact using a neighboring district as comparison. Impact on stunting was estimated using propensity score weighted difference-in-differences regression analyses to account for baseline differences between districts.No differences in mean length-for-age z-score or prevalence of stunting were found at endline. However, mean weight, weight-for-length z-score, and mid-upper arm circumference were higher at endline by 150 g, 0.22, and 0.19 cm, respectively, in the program compared with the comparison district (all P < 0.05). Weekly reports of high fever and malaria were also lower by 6.4 and 4.7 percentage points, respectively, in the program compared with the comparison district (both P < 0.05). There was no impact on anemia. Children's dietary diversity score improved by 0.17, and caregivers' infant and young child feeding and hand-washing practices improved by 8-11% in the program compared with the comparison district (all P < 0.05).An impact evaluation of a comprehensive nutrition program in rural Malawi demonstrated benefit for child ponderal growth and health, improved maternal IYCF and hand-washing practices, but a reduction in stunting prevalence was not observed.

  View details for DOI 10.1093/jn/nxaa236

  View details for PubMedID 32840613

• Process Evaluation of a Large-Scale Community-Based Nutrition Program in Malawi. Current developments in nutrition Ruel-Bergeron, J. C., Hurley, K. M., Buckland, A., Mlambo, T., Kang, Y., Chirwa, E., Farhikhtah, A., Aburto, N., Christian, P. 2020; 4 (1): nzz131

  Abstract

  Global attention to the study of nutrition program implementation has been inadequate yet is critical for effective delivery and impact at scale.The objective of this mixed-methods process evaluation study was to measure the recruitment, fidelity, and reach of a large-scale, community-based nutrition program in Malawi.The nutrition program delivered a small-quantity lipid-based nutrient supplement (SQ-LNS) and social and behavior change communication (SBCC) to improve infant and young child feeding (IYCF) and water, sanitation, and hygiene (WASH) practices in households with children aged 6-23 mo. Program monitoring and evaluation data were used to measure program recruitment, reach, and fidelity. Structured direct observations and knowledge questionnaires with program volunteers measured quality aspects of program fidelity. The number of times activities were done correctly was used to tabulate proportions used to represent program functioning.Half (49.5%) of eligible children redeemed program benefits by 8 mo of age during the first 4 y of program implementation. Implementation of training activities for SBCC cadres exceeded program targets (100.6%), but the completion of certain modules (breastfeeding and complementary feeding) was lower (22.9% and 18.6%, respectively). Knowledge of IYCF, WASH, and SQ-LNS messages by volunteers was >85% for most messages, except ability to list the 6 food groups (35.7%). Structured direct observations of SQ-LNS distributions indicated high fidelity to program design, whereas those of household-level counseling sessions revealed lack of age-appropriate messaging. Program reach showed participation in monthly distribution sessions of 81.0%, group counseling of 93.3%, and individual-level counseling of 36.9%.This community-based nutrition program was implemented with high fidelity and quality, with specific interventions requiring further attention. The documentation of implementation contributes to our understanding about how program impacts were achieved.

  View details for DOI 10.1093/cdn/nzz131

  View details for PubMedID 32258986

  View details for PubMedCentralID PMC7101488

• Ethics Guidance for the Public Health Containment of Serious Infectious Disease Outbreaks in Low-Income Settings: Lessons from Ebola Kass, N., Kahn, J., Buckland, A., Paul, A. Johns Hopkins Berman Institute of Bioethics. Baltimore, Maryland. 2019
• Assessment of the Acceptability and Feasibility of Child Potties for Safe Child Feces Disposal in Rural Bangladesh AMERICAN JOURNAL OF TROPICAL MEDICINE AND HYGIENE Hussain, F., Luby, S. P., Unicomb, L., Leontsini, E., Naushin, T., Buckland, A. J., Winch, P. J. 2017; 97 (2): 469–76

  Abstract

  Indiscriminate defecation among young children and the unsafe disposal of their feces increases fecal contamination in the household environment and the risk of diarrheal disease transmission. Improved sanitary technology for children too young to use a latrine may facilitate safe feces disposal and reduce fecal contamination in the household environment. We assessed the acceptability and feasibility of child potties in rural Bangladesh in 2010. Our team introduced child potties into 26 households for 30 days, and conducted semistructured interviews, group discussions, and observations to assess the acceptability and feasibility of their use for parents and children. Residents of this rural Bangladeshi community accepted the child potties and caregivers found them to be a feasible means of managing child feces. The color, shape, design, and size of the potty influenced its acceptability and use. These residents reported that regular use of the potty improved the household's physical environment and caregiver and child personal hygiene. Regular potty use also reduced caregivers' work load by making feces collection and disposal easier. Primary caregivers viewed 4-6 months as the appropriate age to initiate potty training. Sanitation interventions should integrate and emphasize potties for children's feces management to reduce household environmental contamination.

  View details for PubMedID 28722606

  View details for PubMedCentralID PMC5544061