Abstract
Factors associated with exclusive breastfeeding at hospital discharge among Hong Kong Chinese women
Laurie Ho, RN BN1, Kris Yuet Wan Lok, SRD PhD2, Vincci Chan, MSc2 and Marie Tarrant, RN MPH PhD3
(1)University of Hong Kong, Hong Kong, Hong Kong, (2)University of Hong Kong, Pokfulam, Hong Kong, (3)University of British Columbia, Kelowna, BC, Canada
APHA's 2018 Annual Meeting & Expo (Nov. 10 - Nov. 14)
Exclusive breastfeeding is recommended by the World Health Organization (WHO) for the first six months of life. Exclusive breastfeeding at hospital discharge has been shown to be associated with a significantly lower rate of breastfeeding cessation up to 6 months postpartum. However, rates of exclusive breastfeeding at hospital discharge in Hong Kong are low. The purpose of this study was to identify sociodemographic and perinatal factors that were associated with exclusive breastfeeding at hospital discharge. A cohort of 1265 mother-infant pairs was recruited from four public hospitals in Hong Kong. Chi-square tests were used to examine the relationship between various maternal sociodemographic characteristics and whether or not the mothers exclusively breastfeed their babies in hospital. Multivariable Logistic Regression was used to identify the adjusted associations between these factors and in-hospital exclusive breastfeeding. Of the 1265 participants, 525 (41.5%) were exclusively breastfeeding at hospital discharge. Planning to exclusively breastfeed (OR=2.13; 95% CI 1.51, 3.0), breastfeeding initiation in the delivery room (OR=3.36; 95% CI 2.56, 4.41), rooming-in (OR=2.77; 95% CI 1.64, 4.70), and on-demand breastfeeding (OR=2.14; 95% CI 1.21, 3.77) were all positively associated with in-hospital exclusive breastfeeding. A higher birth weight (≥3750 grams) deceased the likelihood of exclusive breastfeeding (OR=0.43, 95% CI 0.22, 0.84). In this cohort of healthy newborns, rates of exclusive breastfeeding at hospital discharge are suboptimal. Greater focus is needed on reducing unnecessary in-hospital formula supplementation and promoting and supporting exclusive breastfeeding.
Epidemiology Public health or related education Public health or related nursing Social and behavioral sciences
Abstract
Impact of Paid and Unpaid Maternity Leave on Breastfeeding Outcomes
Barbara Dennison, MD1, Trang Nguyen, MD, DrPH2 and Anne Radigan3
(1)NY State Dept. of Health, Albany, NY, (2)NY State Dept. Health, Albany, NY, (3)New York State Department of Health, Albany, NY
APHA's 2018 Annual Meeting & Expo (Nov. 10 - Nov. 14)
Purpose: Paid maternity leave is recommended as a strategy to improve maternal and infant health outcomes.
Background: A better understanding of the current usage of paid and unpaid maternity leave is needed prior to implementation of new laws requiring paid leave.
Methods: In 2016, a random sample of postpartum women in NY (excluding NYC) were surveyed as part of PRAMS.
Results: 947 women completed the survey (63% response rate). 647 (68%) reported working during pregnancy, of whom 534 planned/returned to work. 85 women used both paid/unpaid leave; 223 took only paid leave; and 207 took only unpaid leave. Women who took both paid/unpaid leave, compared to those using only paid or only unpaid leave, were better educated, and less likely to have Medicaid insurance or be Black or Hispanic. Women who used only unpaid leave were more likely than those with paid or both types of leave to cite lack of paid leave (58% vs. 7% and 18%) and financial concerns as limiting their leave taking (40% vs. 26% and 27%, respectively). Women who did not return to work (N=111) were less educated and more likely to have Medicaid insurance.
Women who used both paid/unpaid leave took more total time off (17 weeks) than those who used only paid or unpaid leave (11 weeks each). Women who took paid/unpaid leave, compared to those who took only paid or only unpaid leave, were more likely to initiate breastfeeding (94% vs. 87% and 89%) and to breastfeed through 4 weeks (90% vs. 79% and 85%) and through 8 weeks (84% vs. 68% and 73%), respectively.
Conclusion: Both paid and unpaid leave contribute to total maternity leave taken, which impacts breastfeeding initiation and duration. Further research is needed to determine the impact of increased paid leave on infant and maternal health outcomes.
Public health or related public policy
Abstract
Improving maternity-care practices and breastfeeding rates in hospitals serving underserved communities in the Carolinas
Catherine Sullivan, MPH, RD, LDN, IBCLC, FAND1, Kathleen Parry, MPH, IBCLC, LMBT1, Daina Huntley, MPH, CHES2, Gigi Lawless, BSN, RN, IBCLC, RLC2, Julia Bourg, BSN, RN, IBCLC, RLC2 and Kori Flower, MD, MS, MPH3
(1)University of North Carolina at Chapel Hill, Chapel Hill, NC, (2)UNC Chapel Hill, Chapel Hill, NC, (3)Population Health Improvement Partners, Chapel Hill
APHA's 2018 Annual Meeting & Expo (Nov. 10 - Nov. 14)
Healthcare facilities are encouraged by leading health organizations and accrediting agencies to promote and protect breastfeeding through patient education and evidence-based maternity care practices. Despite the clear literature on the benefits of breastfeeding for maternal and infant outcomes, maternity care practices may not be supportive of this physiological process. Considerable quality improvement is required to change care practices so that it is optimally supportive of breastfeeding. Hospitals and community stakeholders with access to direct technical support activities are more likely to provide optimal care to the dyad while creating sustainable models for maintenance.
This technical assistance (TA) model combines content expertise with quality improvement methodology that uniquely incorporates a comprehensive approach to communities by providing TA beyond maternity practices in the hospital setting. This model includes direct TA and implementation training related to Steps 3 and 10 of the Ten Steps. The model establishes sustainability of services to the community by building infrastructure for establishing ambulatory cost centers serving the community. Our hypothesis is that offering a more comprehensive model will bridge the gap from hospital to community improving long term breastfeeding outcomes.
Successful program implementation will increase the number of hospitals that are implementing the Ten Steps through a state recognition system or full Baby-Friendly designation. Over a 3 year period, at least 20 hospital communities will implement this full scale model in North and South Carolina. Launched in early 2018, presenters will share progress to date including baseline measures and lessons learned from TA activities.
Provision of health care to the public Public health or related organizational policy, standards, or other guidelines Public health or related research Systems thinking models (conceptual and theoretical models), applications related to public health
Abstract
Increasing breastfeeding initiation and continuation in African-American clients in the Nurse-Family Partnership program
Eleanor Yost, RN, MSN, BSN, PNP
University of Colorado, Aurora, CO
APHA's 2018 Annual Meeting & Expo (Nov. 10 - Nov. 14)
The benefits of breastfeeding for the mother and child have been well documented. The American Academy of Pediatrics recommends breastfeeding exclusively for the first 6 months of the infant’s life followed by breastfeeding and other foods up to at least one year of age. Healthy people 2020 provides national goals for breastfeeding initiation and continuation. Despite this information and attempts to improve breastfeeding rates among all women, African-American breastfeeding initiation and duration rates continue to be the lowest among all racial/ethnic groups in the United States.
Nurse-Family Partnership (NFP) is a home visiting program implemented in the U.S. and seven additional countries focused on first time pregnant, low income women. Registered nurses visit the family from pregnancy until the child is two years of age. National NFP client data suggests that African-American NFP clients have breastfeeding results similar to overall national data; falling below their counterparts and Healthy People 2010 goals in breastfeeding initiation and continuation.
In order to understand this situation and address it within NFP we conducted client discussion groups with 165 African-American NFP clients and family members, surveyed 100 nurse home visitors in 3 states with higher rates of African-American clients, and completed a literature review. We explored beliefs, attitudes and experiences of breastfeeding by the clients and their family members and nurse home visitors and factors that impact decisions and actions. From this information materials, processes and interventions were developed and implemented. These items and outcomes of implementation will be shared during this presentation.
Administer health education strategies, interventions and programs Diversity and culture Other professions or practice related to public health
Abstract
Pumping breast milk at school: Comparing student mothers’ experiences at two New Jersey campuses
Lauren Dinour, DrPH, RD, CLC and Yeon Bai, PhD, RD
Montclair State University, Montclair, NJ
APHA's 2018 Annual Meeting & Expo (Nov. 10 - Nov. 14)
Federal law requires employers to provide a private, non-restroom space where employees can express breast milk, yet does not protect college students unless they are employed by their academic institution. This study compares factors associated with pumping breast milk on campus between students attending a two-year community college and those attending a four-year state university. Between January and October 2015, students at two New Jersey public institutions of higher education were invited to participate in a 20-minute online survey measuring breast milk pumping behaviors, psychosocial variables framed by the Theory of Planned Behavior, and demographic factors. Using stepwise regression analysis, the most influential theory-driven predictors [attitudes, subjective norm, perceived behavior control (PBC), and their underlying beliefs] of the intention to pump breast milk on campus were identified and compared. Demography of the 131 participants was statistically similar (p>0.05) between the two- and four-year schools: average age (26.0y vs. 25.9y), White (61.5% vs. 38.6%), and WIC eligible (25.0% vs. 21.1%). PBC dictated the intention to pump on both campuses; its relative importance on intention was significant for the two-year (𝛃=0.473, p=0.008) and four-year (𝛃=0.532, p<0.001) campus. Space for comfortable and safe pumping, supportive environments, and milk and equipment storage issues were equally important to the student mothers’ perception of their control over pumping. There is an urgent need to create equal support for all mothers on campus to provide a safe atmosphere that protects and promotes breastfeeding.
Public health or related research Social and behavioral sciences
Abstract
Work-place Barriers to Breastfeeding for Mothers at a Large Urban University
Claire Pearson, MD, MPH1, Margarita Abella, Medical Student2, Deepak Kamat, MD, PhD, FAAP2, Michelle Fecteau, Sarah Doyle, LMSW M.S.W. Academic Advisor2, Hieu T. Nguyen, Deepak Yadav, MD2, Amit Sharma, Alexandra Orchard, LaTonya Motley and Beena Sood, MD MS2
(1)Wayne State University, Detroit, MI, (2)Wayne State University School of Medicine
APHA's 2018 Annual Meeting & Expo (Nov. 10 - Nov. 14)
Background/Purpose: Breastfeeding (BF) has countless health benefits for both mother and child. Women may have a difficultly continuing to BF after returning to work. Since 2010, an amendment by the Affordable Care Act has required employers with > 50 employees to provide a private room and reasonable break time for employees to express breast milk. To describe the experience of mothers who have BF in a large urban university and medical campus center (U&MC).
Methods: An anonymized Qualtrics survey was sent to all employees at a U&MC between May 1st and June 30th, 2017. Continuous data were analyzed using descriptive analysis and chi-square test for categorical variables.
Results/Outcomes: Of 685 mothers who responded 85.6% BF. 39.3% of mothers wanted to BF for 10-12 months, only 18.1% did, while 25.3% planned to BF 12+ months, 19.1% did. Inconvenience, difficultly with baby, and returning to work were described as barriers who did not BF. The most common reason to stop BF was child 12+ months (20.9%), return to work (13.7%), and inconvenience (7.9%). 38.5% of women returned to work < 3 months after delivery, 38.1% returned at 3 months. Only 52.0% expressed BF at work, 20.9% of moms had access to a dedicated lactation room but only 15.6% used this room (72% noted inconvenient location as barrier).
Conclusions: To promote BF in the workplace and help women reach their goals of BF duration, space needs to be designated to express milk and other barriers to BF acknowledged.
Planning of health education strategies, interventions, and programs
Abstract
Towards Reaching Breastfeeding Initiation Goal for the Newborn in South Carolina, 2004-2013: Determinants and Trend Analysis
Khairul Siddiqi1, Mohammad Rifat Haider, PHD, MPS, MHE, MBBS2, Mohammad Masudur Rahman, MBBS, MHE, MPS1 and M. Mahmud Khan, PhD1
(1)University of South Carolina, Columbia, SC, (2)Ohio University, College of Health Sciences and Professions, Athens, OH
APHA's 2018 Annual Meeting & Expo (Nov. 10 - Nov. 14)
Background:
Breastfed infants have more nutritional and developmental benefits and have lower risk of dying. We assessed yearly trends and maternal and infant factors associated with breastfeeding initiation in South Carolina (SC).
Methods:
We performed survey weighted analysis of SC Pregnancy Risk Assessment and Monitoring System (PRAMS) data, 2004 through 2013. ‘Breastfeeding initiation’ is defined as mothers breastfed or pumped breast milk to feed her newborn baby at least for single time. This study accounted for 10,951 mothers (weighted 534, 355) who have live birth. Trend analysis, bivariate, and multivariate analysis were done using Stata 14.2.
Results:
Breastfeeding rates have increased steadily, from 62% in 2004 to 80% in 2013, which showed significant upward trends (z=12.63, p<0.001) over the study years. Overall, 69% mothers were able to breastfeed her newborn. Multivariate model showed that, Hispanic mothers were 7.7 times more likely (OR 7.67, 95% CI 3.69-15.94) to initiate breastfeeding, however, African American mothers were 0.7 times less likely (OR 0.67, 95% CI 0.55-0.81) to do that compared to their White counterpart. Young mothers (≤20 years) were more likely to breastfeed their newborn compare to older mothers (30-39 years). Likelihood of breastfeeding increased with educational attainment of the mothers and adequate prenatal care visits. Mothers went through C-section, lived in rural areas, and enrolled in WIC food program had lower odds of breastfeeding initiation. Low birth weight babies (<25,00 gram) and babies born in normal weight mothers had higher odds of breastfeeding initiation.
Conclusion:
Although breastfeeding initiation rate continues to rise in South Carolina, some maternal and child health factors and health conditions discourage to increase breastfeeding initiation rate. Higher breastfeeding practices among some groups of mothers needs to be explored more to suggest active intervention strategies for the mothers yet to begin breastfeeding.
Provision of health care to the public Public health administration or related administration Public health or related organizational policy, standards, or other guidelines Public health or related public policy Public health or related research Social and behavioral sciences
Abstract
Breastfeeding as a predictor of serum concentrations of per- and polyfluorinated alkyl substances in reproductive-aged women and young children: A rapid systematic review
Brianna VanNoy, MPH candidate1, Ami Zota, ScD, MS1 and Juleen Lam, PhD, MHS, MS2
(1)George Washington University, Washington, DC, (2)University of California, San Francisco, Program on Reproductive Health and the Environment, San Francisco, CA
APHA's 2018 Annual Meeting & Expo (Nov. 10 - Nov. 14)
Per- and polyfluorinated alkyl substances (PFASs) are synthetic chemicals widely detected in human serum, and at low levels in breast milk. We conducted a rapid systematic review on breastfeeding practices and serum concentrations of PFASs – specifically PFOS and PFOA - among reproductive-aged women and young children using the Navigation Guide systematic review methodology. We identified 14 studies examining associations between breastfeeding and PFASs in infants/toddlers or pregnant/postnatal women, and evaluated each study for the risk of bias, quality of the evidence, and strength of the evidence. Breastfeeding was significantly associated with lower PFASs exposure among women and higher PFASs exposure among children. The risk of bias across studies was rated as “probably low risk.” We concluded that there was “sufficient” evidence supporting an association between breastfeeding and serum PFASs concentrations among women, and “limited” evidence of an association among children due to issues with sample size, confounding, and exposure assessment. These findings reinforce that lactation is an important excretion route of PFASs for women, and that breast milk may be an important exposure pathway for young children. Future studies should further investigate the implications of our findings for maternal and child health.
Environmental health sciences Public health or related research
Abstract
Predictors of pregnant woman’s breastfeeding intention and motivation using the modified version of the Integrated Behavioral Model and the patient-provider communication process
Na'Tasha Evans, Ph.D., M.Ed, Yu-Lin Hsu, MS, MPH, Obianuju Aguolu, PHD, MBBS, MPH and Grace Battaglia-Hoffman, MPH
Kent State University, Kent, OH
APHA's 2018 Annual Meeting & Expo (Nov. 10 - Nov. 14)
Background: Prenatal care is an entry point to the health care system for many pregnant women and can influence their breastfeeding practices. Breastfeeding is the best source of infant nutrition and immunologic protection to prevent adverse health outcomes. However, there is limited research about how patient-provider communication influences woman’s breastfeeding intention and motivation. This study aimed to examine the predictors of pregnant woman’s breastfeeding intention and motivation using the modified version of the Integrated Behavioral Model and patient-provider communication process.
Methods: A 98-item questionnaire modified from preexisting instruments were administered to a diverse population of pregnant women (18-45 years) in their second or third trimester (n=300) who were recruited via Qualtrics. Multivariate analyses was used to examine the significant predictors of intention and motivation to breastfeed.
Results: Stepwise multiple linear regression determined that attitude (β=.50, t=9.01, p<.001) and self-efficacy (β=.39, t=5.93, p<.001) were statistically significant predictors for intention to breastfeed. Further, stepwise multiple linear regression determined that attitude (=0.38, t=6.30, p<0.001), self-efficacy (=0.37, t=6.78, p<0.001), benefits (=0.18, t=3.24, p<0.001) and patient-provider communication (=-0.12, t=-2.66, p<0.001) were statistically significant predictors for motivation to breastfeed.
Conclusion: This study contributes to the emerging body of evidence demonstrating the significant predictors of intention and motivation to breastfeed. Findings from this study could increase the understanding of many complex variables affecting breastfeeding and prenatal care among pregnant women. Incorporating findings from this study may provide evidence for clinical and community interventions to promote breastfeeding.
Public health or related education Public health or related research
Abstract
Supportive workplace accommodations for breastfeeding: All about the pump
Margaret L. Walsh-Buhi, MPH, PhD1, Amber Sparks, MSW2 and Dawn Schoonhoven Scott, MSW2
(1)San Diego State University, Academy for Professional Excellence, San Diego, CA, (2)San Diego State University, Academy for Professional Excellence, San Diego
APHA's 2018 Annual Meeting & Expo (Nov. 10 - Nov. 14)
Since 2010 supportive workplace breastfeeding measures have been enacted. Women returning to work, who want to continue to breastfeed, now have legal backing to do so. However, many workplace policies are designed to accommodate time and space for expression/pumping only, not including exclusive nursing (EN). EN defined as only providing breast milk directly from the breast, is often grouped into breastfeeding-breast milk given to a child regardless of feeding mechanism (e.g., bottle). This systematic review explored workplace accommodations for EN and how breastfeeding is operationalized into practice. Following PRISMA guidelines, literature from 2008-2018, retrieved from databases CINAHL, PsycInfo and PubMed, resulted in 23 articles. Publications were assessed for description of workplace accommodations, how breastfeeding was operationalized into practice, and barriers to cultivating a supportive work environment for sustained breastfeeding. Zero articles mentioned supportive workplace accommodations for EN; only one mentioned EN when a respondent in their study stated it “would be impossible unless you had an accommodating workplace and a good nanny”. All articles described the space for breastfeeding as one that supports a comfortable area equipped with storage for pumping/expression of milk. There was no mention of accommodations for expressing breastmilk for immediate on-site consumption (e.g., a room with space for mother and child). Implications indicate a lack of knowledge around EN as a viable method of breastfeeding. Moreover, how breastfeeding is defined drives how policies and practices are created and enacted. When EN is removed from the breastfeeding definition (either intentionally or unintentionally) it impacts women and how they are able to feed their babies when returning to work. If the goal is to sustain breastfeeding practices, would we not want to support and accommodate all forms of breastfeeding in the workplace?
Advocacy for health and health education Other professions or practice related to public health Public health or related laws, regulations, standards, or guidelines Public health or related research