Online Program

282419
A missing step: Assessing breastfeeding initiation rates at the community level


Tuesday, November 5, 2013 : 12:30 p.m. - 12:50 p.m.

Ann M. Dozier, PhD, RN, Public Health Sciences/Social and Behavioral Sciences, University of Rochester, Rochester, NY
Elizabeth A. Brownell, MA PhD, Departments of Neonatology and Research, CT Childrens Medical Center, Hartford, CT
Kelly Thevenet-Morrison, MS, Public Health Sciences/Social and Behavioral Sciences, University of Rochester, Rochester, NY
Hongmei Yang, PhD, Department of Biostatistics and Computational Biology, University of Rochester, Rochester, NY
Cynthia Howard, MD, MPH, Department of Pediatrics, Rochester General Hospital; University of Rochester, Rochester, NY
Alice Nelson, Public Healtlh Sciences, University of Rochester Medical Center, Rochester, NY
Joseph Duckett, Public Health Sciences/Social and Behavioral Sciences, University of Rochester, Rochester, NY
Barbara Suter, RN, MPH, Public Health Sciences/Social and Behavioral Sciences, University of Rochester, Rochester, NY
Holly Widanka, MS, Public Health Sciences, University of Rochester, Rochester, NY
Patricia Brantingham, MA, Perinatal Network of Monroe County, Rochester, NY
Christopher Seplaki, PhD, Public Health Sciences, University of Rochester, Rochester, NY
Nancy Chin, PhD, MPH, Public Health Sciences, University of Rochester, Rochester, NY
Deborah Ossip, PhD, Public Health Sciences, University of Rochester, Rochester, NY
Ruth Lawrence, MD DD(hon), Department of Pediatrics., University of Rochester School of Medicine, Rochester, NY
Background. Many breastfeeding initiatives begin at the state or federal level, success requires sustained local implementation. Understanding the local factors influencing breastfeeding rates warrants community wide data rather than institutional (e.g. WIC) or birth certificate data. Local data more clearly identify gaps in programs and outcomes. Methods. Analyses of population level breastfeeding initiation we employed a modified Pregnancy risk Assessment Monitoring surveillance methodology. We assessed differences between low (LIM; Medicaid funded delivery or prenatal WIC enrollment) and non-low income (NLIM) mothers. Over 1000 mothers (50.9% LIM) completed the survey (births May 2009-May 2010) representing 6,139 mothers after weighting. Three logistic regression models (all participants, LIM-only and NLIM-only) identified independent predictors of not initiating breastfeeding. Potential confounders (e.g. education, age, stresses, prenatal care start, intendedness, insurance, abuse, birth outcomes) were identified in bivariate analyses (p≤0.1) and included in a backwards selection model building process. Results. Initiation was relatively high (82.3%). In the first model (all participants) income was not significant but unmarried, Black race, multiparous, fewer pre-pregnancy preventive practices and less overall prenatal provider counseling were risk factors for non-initiation. Additionally in the LIM stratified model Hispanic and more pre-pregnancy positive health behaviors increased initiation. By contrast only three factors in the NLIM model were significant: financial stress increased initiation while multiparous and Hispanic decreased initiation. Conclusions. Using local, granular data we identified risk factors for not initiating breastfeeding particularly among low income mothers . These findings have implications for pre/interconception care given that few are modifiable during pregnancy.

Learning Areas:

Clinical medicine applied in public health
Public health or related research

Learning Objectives:
Discuss assessment of community wide breastfeeding rates factors Describe local factors that contribute to these and how they differ between low and non-low income mothers

Keyword(s): Breastfeeding, Community-Based Health Promotion

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am a PhD nurse researcher and have worked in MCH for over 30 years including brestfeeding. I am the PI for the project that this abstract is about.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.