Maternal and Child Health Journal

, Volume 16, Supplement 1, pp 14–26

Racial/Ethnic Variation in Breastfeeding Across the US: A Multilevel Analysis from the National Survey of Children’s Health, 2007

  • Candice M. Belanoff
  • Beth M. McManus
  • Adam C. Carle
  • Marie C. McCormick
  • S. V. Subramanian
Article

Abstract

We examined whether differences across states in race/ethnicity-specific breastfeeding rates are due solely to state differences in individual factors associated with breastfeeding or additionally, certain state “contextual” factors. Using data from the 2007 National Survey of Children’s Health, multilevel models examined whether state variability in race/ethnicity specific breastfeeding initiation and duration to 6 months were explained by (1) individual sociodemographic characteristics of women in states, and (2) an aggregate state measure of the availability of evidence-based maternity care services related to breastfeeding. Observed variability of race/ethnicity-specific breastfeeding rates was only minimally reduced after adjusting for sociodemographic characteristics (Median Odds Ratios (MOR), breastfeeding initiation: non-Hispanic White = 1.46, non-Hispanic Black = 2.26; Hispanic = 1.89. MOR, breastfeeding for 6 months: non-Hispanic White = 1.36, non-Hispanic Black = 1.84; Hispanic = 1.56). Overall variability in the degree of state gaps changed little in adjusted models (breastfeeding initiation: non-Hispanic Black σ2 = 0.74, se 0.28, Hispanic σ2 = 0.45, se 0.11; breastfeeding to 6-months: non-Hispanic Black σ2 = 0.41, se 0.10, Hispanic σ2 = 0.22, se 0.05). The measure of maternity care services was positively associated with breastfeeding overall but generally did not explain a substantial portion of between-state variability nor the overall variability in racial/ethnic gaps. Contextual sources of variation in state breastfeeding practices and disparities remain poorly understood. Differences in the socioeconomic makeup of states do not fully explain variability. The association of state breastfeeding rates and disparities with relevant policy and practice factors should be further investigated.

Keywords

Breastfeeding Racial/ethnic disparities Multilevel modeling State-level variation 

References

  1. 1.
    Ball, T. M., & Wright, A. L. (1999). Health care costs of formula-feeding in the first year of life. Pediatrics, 103, 870–876.PubMedGoogle Scholar
  2. 2.
    Chantry, C. J., Howard, C. R., & Auinger, P. (2006). Full breastfeeding duration and associated decrease in respiratory tract infection in US children. Pediatrics, 117, 425–432.PubMedCrossRefGoogle Scholar
  3. 3.
    Duffy, L. C., Faden, H., Wasielewski, R., Wolf, J., & Krystofik, D. (1997). Exclusive breastfeeding protects against bacterial colonization and day care exposure to otitis media. Pediatrics, 100, E7.PubMedCrossRefGoogle Scholar
  4. 4.
    Gartner, L. M., Morton, J., Lawrence, R. A., et al. (2005). Breastfeeding and the use of human milk. Pediatrics, 115, 496–506.PubMedCrossRefGoogle Scholar
  5. 5.
    Jordan, S. J., Siskind, V., Green, C., Whiteman, D. C., & Webb, P. M. (2010). Breastfeeding and risk of epithelial ovarian cancer. Cancer Causes and Control, 21, 109–116.PubMedCrossRefGoogle Scholar
  6. 6.
    Labbok, M. H. (1999). Health sequelae of breastfeeding for the mother. Clinics in Perinatology, 26, 491–503, viii-ix.Google Scholar
  7. 7.
    Labbok, M. H. (2001). Effects of breastfeeding on the mother. Pediatric Clinics of North America, 48, 143–158.PubMedCrossRefGoogle Scholar
  8. 8.
    Liu, B., Jorm, L., & Banks, E. (2010). Parity, breastfeeding, and the subsequent risk of maternal type 2 diabetes. Diabetes Care, 33, 1239–1241.PubMedCrossRefGoogle Scholar
  9. 9.
    Shinde, S. S., Forman, M. R., Kuerer, H. M., et al. (2010). Higher parity and shorter breastfeeding duration: Association with triple-negative phenotype of breast cancer. Cancer, 116, 4933–4943.PubMedCrossRefGoogle Scholar
  10. 10.
    Grummer-Strawn, L., Scanlon, K. S., Darling, N., & Conrey, E. J. (2006). Racial and socioeconomic disparities in breastfeeding–United States, 2004. MMWR Morbidity and Mortality Weekly Report, 55, 335–339.Google Scholar
  11. 11.
    Scanlon, K. S., Grummer-Strawn, L., Li, R., Chen, J., Molinari, N., & Perrine, C. G. (2010). Racial and ethnic differences in breastfeeding initiation and duration, by state–National Immunization Survey, United States, 2004–2008. MMWR Morbidity and Mortality Weekly Report, 59, 327–334.Google Scholar
  12. 12.
    Grummer-Strawn, L. (2006). Racial and socioeconomic disparities in breastfeeding–United States, 2004. MMWR. Morbidity and Mortality Weekly Report, 55, 335–339.Google Scholar
  13. 13.
    Kogan, M. D., Singh, G. K., Dee, D. L., Belanoff, C., & Grummer-Strawn, L. M. (2008). Multivariate analysis of state variation in breastfeeding rates in the United States. American Journal of Public Health, 98, 1872–1880.PubMedCrossRefGoogle Scholar
  14. 14.
    Merewood, A., Brooks, D., Bauchner, H., MacAuley, L., & Mehta, S. D. (2006). Maternal birthplace and breastfeeding initiation among term and preterm infants: A statewide assessment for Massachusetts. Pediatrics, 118, e1048–e1054.PubMedCrossRefGoogle Scholar
  15. 15.
    Phares, T. M., Morrow, B., Lansky, A., et al. (2004). Surveillance for disparities in maternal health-related behaviors–selected states, Pregnancy Risk Assessment Monitoring System (PRAMS), 2000–2001. MMWR. Surveillance Summaries, 53, 1–13.Google Scholar
  16. 16.
    Haider, S. J., Jacknowitz, A., & Schoeni, R. F. (2003). Welfare work requirements and child well-being: Evidence from the effects on breast-feeding. Demography, 40, 479–497.PubMedCrossRefGoogle Scholar
  17. 17.
    Venancio, S. I., & Monteiro, C. A. (2006). Individual and contextual determinants of exclusive breast-feeding in Sao Paulo, Brazil: A multilevel analysis. Public Health Nutrition, 9, 40–46.PubMedCrossRefGoogle Scholar
  18. 18.
    Digirolamo, A. M., Grummer-Strawn, L. M., & Fein, S. (2001). Maternity care practices: Implications for breastfeeding. Birth, 28, 94–100.PubMedCrossRefGoogle Scholar
  19. 19.
    Digirolamo, A. M., Grummer-Strawn, L. M., & Fein, S. B. (2003). Do perceived attitudes of physicians and hospital staff affect breastfeeding decisions? Birth, 30, 94–100.PubMedCrossRefGoogle Scholar
  20. 20.
    Digirolamo, A. M., Grummer-Strawn, L. M., & Fein, S. B. (2008). Effect of maternity-care practices on breastfeeding. Pediatrics, 122(Suppl 2), S43–S49.PubMedCrossRefGoogle Scholar
  21. 21.
    Murray, E. K., Ricketts, S., & Dellaport, J. (2007). Hospital practices that increase breastfeeding duration: Results from a population-based study. Birth, 34, 202–211.PubMedCrossRefGoogle Scholar
  22. 22.
    Dewey, K. G., Nommsen-Rivers, L. A., Heinig, M. J., & Cohen, R. J. (2003). Risk factors for suboptimal infant breastfeeding behavior, delayed onset of lactation, and excess neonatal weight loss. Pediatrics, 112, 607–619.PubMedCrossRefGoogle Scholar
  23. 23.
    Rosenberg, K. D., Eastham, C. A., Kasehagen, L. J., & Sandoval, A. P. (2008). Marketing infant formula through hospitals: The impact of commercial hospital discharge packs on breastfeeding. American Journal of Public Health, 98, 290–295.PubMedCrossRefGoogle Scholar
  24. 24.
    Paterson, L., & Goldstein, H. (1991) New statistical methods for analysing social structures: An introduction to multilevel models. British Educational Research Journal, 17, 387–393.Google Scholar
  25. 25.
    Goldstein, H. (1991). Multilevel modelling of survey data. The Statistician, 40, 235–244.CrossRefGoogle Scholar
  26. 26.
    Luke, J., & Blumberg, S. J. (2003) Multiple imputation of missing household poverty level values from the national survey of children with special health care needs, 2001, and the National Survey of Children’s Health, 2003. June 22, 2007. Centers for Disease Control and Prevention, National Center for Health Statistics.Google Scholar
  27. 27.
    Saadeh, R., & Akre, J. (1996). Ten steps to successful breastfeeding: A summary of the rationale and scientific evidence. Birth, 23, 154–160.PubMedCrossRefGoogle Scholar
  28. 28.
    DiGirolamo, A. M., & Manninen, D. L. (2008). Breastfeeding-related maternity practices at hospitals and birth centers–United States, 2007. MMWR. Morbidity and Mortality Weekly Report, 57, 621–625.Google Scholar
  29. 29.
    Begg, M. D., & Parides, M. K. (2003). Separation of individual-level and cluster-level covariate effects in regression analysis of correlated data. Statistics in Medicine, 22, 2591–2602.PubMedCrossRefGoogle Scholar
  30. 30.
    Larsen, K., & Merlo, J. (2005). Appropriate assessment of neighborhood effects on individual health: Integrating random and fixed effects in multilevel logistic regression. American Journal of Epidemiology, 161, 81–88.PubMedCrossRefGoogle Scholar
  31. 31.
    Carle, A. C. (2009) Fitting multilevel models in complex survey data with design weights: Recommendations. BMC Medical Research Methodology, 9. Google Scholar
  32. 32.
    SAS Institute Inc. (2003) CNU. SAS Version 9.1.Google Scholar
  33. 33.
    MLwiN Version 2.02 (2005) Centre for Multilevel Modelling, University of Bristol.Google Scholar
  34. 34.
    Centers for Disease Control and Prevention (2009). Breastfeeding among U.S. children born 1999–2005, CDC National Immunization Survey. http://www.cdc.gov/breastfeeding/data/NIS_data/index.htm [serial online]; Accessed January 31, 2009.
  35. 35.
    Merewood, A., Mehta, S. D., Chamberlain, L. B., Philipp, B. L., & Bauchner, H. (2005). Breastfeeding rates in US Baby-Friendly hospitals: Results of a national survey. Pediatrics, 116, 628–634.PubMedCrossRefGoogle Scholar
  36. 36.
    Chien, L. Y., Tai, C. J., Chu, K. H., Ko, Y. L., & Chiu, Y. C. (2007). The number of baby friendly hospital practices experienced by mothers is positively associated with breastfeeding: A questionnaire survey. International Journal of Nursing Studies, 44, 1138–1146.PubMedCrossRefGoogle Scholar
  37. 37.
    Murtagh, L., & Moulton, A. D. (2011). Working mothers, breastfeeding, and the law. American Journal of Public Health, 101, 217–223.PubMedCrossRefGoogle Scholar
  38. 38.
    Applebaum, E., & Milkman, R. (2011) Leaves that pay: Employer and worker experiences with paid family leave in California. Center for Economic and Policy Research; University of California, Los Angeles.Google Scholar
  39. 39.
    Gibson-Davis, C. M., & Brooks-Gunn, J. (2006). Couples’ immigration status and ethnicity as determinants of breastfeeding. American Journal of Public Health, 96, 641–646.PubMedCrossRefGoogle Scholar
  40. 40.
    Centers for Disease Control and Prevention (2011) CDC national survey of maternity practices in infant nutrition and care (mPINC), mPINC Results. http://www.cdc.gov/breastfeeding/data/mpinc/results.htm [serial online] 2011; Accessed April 30, 2011.

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • Candice M. Belanoff
    • 1
  • Beth M. McManus
    • 2
  • Adam C. Carle
    • 3
    • 4
    • 5
  • Marie C. McCormick
    • 6
  • S. V. Subramanian
    • 6
  1. 1.Department of Community Health SciencesBoston University School of Public HealthBostonUSA
  2. 2.University of ColoradoDenverUSA
  3. 3.University of Cincinnati School of MedicineCincinnatiUSA
  4. 4.Cincinnati Children’s Hospital Medical CenterCincinnatiUSA
  5. 5.University of Cincinnati College of Arts and SciencesCincinnatiUSA
  6. 6.Harvard University School of Public HealthBostonUSA

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