Online Program

No child left behind: Policy relevant approaches to measuring and reporting time trends in socio-economic breastfeeding inequalities

Wednesday, November 6, 2013 : 11:42 a.m. - 12:00 p.m.

Nathan C. Nickel, MPH, PhD, Manitoba Centre for Health Policy, College of Medicine, University of Manitoba, Winnipeg, MB, Canada
Miriam Labbok, MD, MPH, FACPM, IBCLC, FABM, Carolina Global Breastfeeding Institute, Department of Maternal Child Health, Gillings School of Global Public Health, University of North Carolina-Chapel Hill, Chapel Hill, NC
Objective: Measuring and monitoring trends in health inequalities is a public health priority. Research has demonstrated that even when overall breastfeeding rates improve, inequality in rates can both persist and worsen. This presentation measures inequality in breastfeeding and illustrates policy-relevant approaches to measuring and assessing trends in inequality. Methods: Data come from the National Immunization Survey, 2005-2011. Outcome variables included “Ever Breastfed,” “Exclusive Breastfeeding at 3 Months,” and “Any Breastfeeding at 6 Months.” Inequality in breastfeeding was measured across income quintiles and racial/ethnic categories. Rate ratios and rate differences compared breastfeeding rates, across groups, at each time point. Concentration curves and indices measured the inequality of breastfeeding across groups, at each time point and provide a visual representation of inequality in breastfeeding. A modified Kakwani index was used to measure the degree that inequalities in breastfeeding reflect underlying socio-economic inequality. Trend analyses and two-sided Z-tests tested for changes, over time. Time by income-quintile and time by racial/ethnic group interactions tested whether breastfeeding rates were statistically significantly different, across groups. Results and Conclusions: Although overall breastfeeding initiation rates may improve, inequalities may persist or worsen. Reporting group-specific rates provides a picture of change across time and may facilitate knowledge translation. Rate ratios may suggest little to no change in inequality while rate differences more accurately reflect changes in disparities over time. Concentration curves and indices provide additional measures of inequality that are visual and easily interpreted. The Kakwani index demonstrates how the US context acts to amplify or mitigate breastfeeding inequalities.

Learning Areas:

Administer health education strategies, interventions and programs
Advocacy for health and health education
Program planning
Public health or related public policy
Social and behavioral sciences

Learning Objectives:
Describe four measures of inequality: rate ratios, rate differences, concentration curves/indeces, and Kakwani indeces. Explain what each measure (rate ratios, rate differences, concentration curves/indeces, and Kakwani indeces) communicates with respect to health inequality. Evaluate how readily each measure captures underlying changes in inequality. Describe changes in breastfeeding inequalities in the US, across time.

Keyword(s): Health Disparities, Breastfeeding

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have conducted breastfeeding-related research for several years. I have postdoctral training and research experience in measuring and analyzing trends in health inequalities, across time, as well as experience in intergrated knowledge translation with regard to breastfeeding-focused research.
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.