Turning tobacco taxes into breastfeeding support services: Increases in longer-term breastfeeding from First 5 Sacramento's Enhanced-Community Lactation Assistance Project

Background: The Enhanced-Community Lactation Assistance Project is funded by First 5 Sacramento though a statewide tax on tobacco products. Services at 10 sites include one-on-one breastfeeding support by Peer Counselors or Lactation Consultant Assistants, or by International Board Certified Lactation Consultants for more advanced breastfeeding problems. Mothers also receive support through phone calls (initiated by PC/LAC and IBCLC staff or by mothers calling the breastfeeding helpline), support groups, breast pump loans, and education for breastfeeding mothers returning to work or school.

Methods: First 5 Sacramento families (n=538) were randomly sampled for a longitudinal survey. Trained field interviewers administered the questionnaire (English, Spanish, Hmong, Ukrainian, or Russian), which included the CDC's National Immunization Survey breastfeeding items. Linear mixed model analyses controlled for confounders.

Results: In 2008/09, 5,818 clients received breastfeeding support services. The primary language of over one-third of mothers was Spanish; 40% spoke a language other than English at home. One-quarter of families had an education level less than high school. Six month exclusive breastfeeding rates were unchanged over a year's time, but at 28% far exceeded the national average. Twelve month breastfeeding rates (based on the WIC criteria: breast milk plus other supplemental nutrition, but no formula) increased significantly to 22% by one-year follow-up. Two of the strongest predictors of 12-month breastfeeding rates were the breastfeeding helpline and staff initiated phone contacts.

Conclusions: Breastfeeding support services funded by First 5 Sacramento are related to longer-term breastfeeding behaviors regardless of mother's race/ethnicity, language, or family education levels.