Nativity/immigrant status, race/ethnicity, and socioeconomic determinants of breastfeeding initiation and duration in the United States, 2003

Are starting and continuing breastfeeding related to educational background? The generation R study

OBJECTIVE

To assess the effect of a woman's educational level on starting and continuing breastfeeding and to assess the role of sociodemographic, lifestyle-related, psychosocial, and birth characteristics in this association.

METHODS

We used the data of 2914 participants in a population-based prospective cohort study. Information on educational level, breastfeeding, sociodemographic (maternal age, single parenthood, parity, job status), lifestyle-related (BMI, smoking, alcohol use), psychosocial (whether the pregnancy was planned, stress), and birth (gestational age, birth weight, cesarean delivery, place and type of delivery) characteristics were obtained between pregnancy and 12 months postpartum. Odds ratios and 95% confidence intervals of starting and continuing breastfeeding for educational level were obtained by logistic regression, adjusted for each group of covariates and for all covariates simultaneously.

RESULTS

Of 1031 highest-educated mothers, 985 (95.5%) started breastfeeding; the percentage was 73.1% (255 of 349) in the lowest-educated mothers. At 6 months, 39.3% (405 of 1031) of highest-educated mothers and 15.2% (53 of 349) of lowest-educated mothers were still breastfeeding. Educationally related differences were present in starting breastfeeding and the continuation of breastfeeding until 2 months but not in breastfeeding continuation between 2 and 6 months. Lifestyle-related and birth characteristics attenuated the association between educational level and breastfeeding, but the association was hardly affected by sociodemographic and psychosocial characteristics.

CONCLUSIONS

Decisions to breastfeed were underlain by differences in educational background. The underlying pathways require further research. For the time being, interventions on promoting breastfeeding should start early in pregnancy and should increase their focus on low-educated women.

US national breastfeeding monitoring and surveillance: current status and recommendations

Eleven federally funded datasets assessing breastfeeding behaviors in the United States (Early Childhood Longitudinal Survey, Infant Feeding Practices Survey II, National Health and Nutrition Examination Survey, National Immunization Survey, National Survey of Children's Health, National Survey of Early Childhood Health, National Survey of Family Growth, Pediatric Nutrition Surveillance System, Pregnancy Nutrition Surveillance System, Pregnancy Risk Assessment Monitoring Survey, and WIC Participant and Program Characteristics) were reviewed to evaluate breastfeeding variables (initiation, duration and exclusivity) and determine whether relevant breastfeeding determinants were collected to evaluate breastfeeding practices from a health disparities perspective. The datasets used inconsistent breastfeeding definitions, limited ethnic descriptors, and varied regarding availability of relevant determinants. Multiple datasets collect breastfeeding data, but a coordinated US breastfeeding monitoring and surveillance system does not exist. Suggestions to improve this system include: standardizing breastfeeding definitions, expanding ethnic/racial descriptors, collecting additional relevant variables, and reducing recall periods.

Premigration exposure to political violence and perpetration of intimate partner violence among immigrant men in Boston

OBJECTIVES

We examined associations between premigration political violence exposure and past-year intimate partner violence (IPV) perpetration among immigrant men attending community health centers in Boston.

METHODS

A convenience sample of immigrant men (N = 379; aged 18-35 years), largely from the Caribbean and Cape Verde, who attend community health centers, completed an anonymous, cross-sectional survey on risk and protective factors for male-perpetrated IPV and respondents' exposure to political violence.

RESULTS

One in 5 (20.1%) immigrant men reported that they were exposed to political violence before arrival in the United States. Men reporting political violence exposure were significantly more likely to report IPV perpetration than were men not reporting such exposure (adjusted odds ratio [AOR] = 2.84; 95% confidence interval [CI] = 1.41, 5.74). Significant associations with political violence exposure were observed for both physical (AOR = 2.69; 95% CI = 1.11, 6.54) and sexual (AOR = 2.37; 95% CI = 1.04, 5.44) IPV perpetration.

CONCLUSIONS

To our knowledge, our findings document for the first time the significant association between premigration political violence exposure and recent IPV perpetration among immigrant men. Additional work is needed to examine underlying mechanisms to inform culturally appropriate programs.

Factors associated with exclusive breastfeeding among Latina women giving birth at an inner-city baby-friendly hospital

Latina women living in the United States initiate breastfeeding at high rates, but their exclusivity is low. We examined factors associated with exclusive breastfeeding prior to discharge among 349 healthy Latina women giving birth at a Baby-Friendlytrade mark hospital in Massachusetts in 2004 to 2005. Factors associated with exclusive breastfeeding included maternal age <25 years (P = .017), US-born mother (P = .023), and having a Birth Sister(sm) (doula) ( P = .030). In multivariate logistic regression analysis, maternal age <25 years (adjusted odds ratio [AOR] 2.29; 95% confidence interval [CI], 1.28-4.10), US-born mother (AOR 3.16; 95% CI, 1.20-8.29), and Birth Sister involvement (AOR 2.16; 95% CI, 1.18-3.97) remained positively associated with exclusive breastfeeding. Compared with women who gave 4 or more formula feeds, women who gave only 1 to 3 formula feeds were more likely to have a Birth Sister (AOR 1.95; 95% CI, 1.05-3.63), to deliver vaginally (AOR 3.05; 95% CI, 1.32-7.05), and to delay the first formula feed (AOR 1.04; 95% CI, 1.02-1.06).

Multivariate analysis of state variation in breastfeeding rates in the United States

OBJECTIVES

We sought to determine the impact of sociodemographic and behavioral factors and state legislation on breastfeeding initiation (child ever fed breastmilk) and duration.

METHODS

We used data from a nationally representative study of children aged 6 to 71 months (N = 33 121); we calculated unadjusted and adjusted state estimates for breastfeeding initiation and duration. We used logistic regression models to examine factors associated with never breastfeeding or breastfeeding less than 6 months. We conducted a multilevel analysis of state legislation's role.

RESULTS

There were wide state variations in breastfeeding initiation and duration. The western and northwestern states had the highest rates. Covariate adjustment accounted for 25% to 30% of the disparity. Multivariate analysis showed that the adjusted odds of not being breastfed were 2.5- to 5.15-times greater in southern states compared with Oregon (reference). Children in states without breastfeeding legislation had higher odds of not being breastfed.

CONCLUSIONS

Sociodemographic and maternal factors do not account for most breastfeeding rate variation. The association with breastfeeding legislation should be explored and may reflect cultural norms.

Influence of moving to the UK on maternal health behaviours: prospective cohort study

OBJECTIVE

To compare health behaviours during pregnancy (smoking and alcohol consumption) and after birth (initiation and duration of breast feeding) between British/Irish white mothers and mothers from ethnic minority groups; and, in mothers from ethnic minority groups, to examine whether indicators of acculturation (generational status, language spoken at home, length of residency in the United Kingdom) were associated with these health behaviours.

DESIGN

Prospective nationally representative cohort study.

SETTING

England.

PARTICIPANTS

6478 British/Irish white mothers and 2110 mothers from ethnic minority groups.

MAIN OUTCOME MEASURES

Any smoking during pregnancy; any alcohol consumption during pregnancy; initiation of breast feeding; breast feeding for at least four months.

RESULTS

Compared with British/Irish white mothers, mothers from ethnic minority groups were less likely to smoke (15% v 37%) or consume alcohol (14% v 37%) during pregnancy but more likely to initiate breast feeding (86% v 69%) and breast feed for at least four months (40% v 27%). Among mothers from ethnic minority groups, first and second generation mothers were more likely to smoke during pregnancy (odds ratio 3.85, 95% confidence interval 2.50 to 5.93, and 4.70, 2.49 to 8.90, respectively), less likely to initiate breast feeding (0.92, 0.88 to 0.97, and 0.86, 0.75 to 0.99), and less likely to breast feed for at least four months (0.72, 0.62 to 0.83, and 0.52, 0.30 to 0.89) than immigrants, after adjustment for sociodemographic characteristics. There were no consistent differences in alcohol consumption. Among immigrants, for every additional five years spent in the UK the likelihood of mothers smoking during pregnancy increased by 31% (4% to 66%) and they were 5% (0% to 10%) less likely to breast feed for at least four months.

CONCLUSIONS

After immigration, maternal health behaviours worsen with length of residency in the UK. Health professionals should not underestimate women's likelihood of engaging in risky health behaviours because of their ethnicity.

Race, education, and breastfeeding initiation in Louisiana, 2000-2004

Although it is well documented that race and education are associated with breastfeeding initiation, the possible interaction between these 2 demographic variables has not been explored in a geographically stable, biracial population. This study explores the relationship between race, education, and breastfeeding among women in Louisiana.

Ethnic variation in infant-feeding practices in the Netherlands and weight gain at 4 months

This prospective study of 4438 infants (0-4 months) examined differences in infant-feeding patterns in relation to the ethnic origin of their mothers, based on the mother's native language: Dutch (87%), Turkish (4%), Moroccan (3%), other European languages (3%), and various other languages (4%). Breastfeeding at birth varied between 75% and 94%. Dutch and Moroccan mothers breastfed for a shorter period (32% and 37% at 4 months, respectively) than did Turkish mothers and mothers with a native European language other than Dutch (47% and 51% at 4 months, respectively; P < .001). Of all mothers, 71% started exclusive breastfeeding at birth, and 21% continued exclusive breastfeeding for at least 4 months. The reasons why mothers discontinued breastfeeding (both exclusive breastfeeding and breastfeeding) were generally infant related. The average weight gain between birth and day 133 was 3.45, 3.87, and 3.69 kg for Dutch, Turkish, and Moroccan infants, respectively. Weight gain was influenced by ethnicity of the mothers and exclusive breastfeeding.