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Predictive Models for Characterizing Disparities in Exclusive Breastfeeding Performance in a Multi-ethnic Population in the US

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Abstract

Objectives Maternal lactation performance varies across populations, yet the relative impact of maternal sociodemographics, perinatal factors, and birth outcomes on disparities in exclusive breastfeeding (XBR) outcomes is not well known. We aimed to develop predictive models and compare the relative contribution of predictors for XBR initiation and XBR ≥ 6 months. Methods Infant feeding data were obtained from women with children aged 0–6 years (n = 1471) in a multi-ethnic cross-sectional study in the US (2011–2012). We compared discriminant ability of predictors for ever XBR and XBR ≥ 6 months using discriminant function analysis, respectively. We also calculated adjusted ORs for factors associated with XBR outcomes and breast-bottle feeding (BrBot) subgroups. Results Maternal sociodemographics (education level, marital status, nativity, and age at childbirth) had greater discriminating abilities in predicting ever XBR and XBR ≥ 6 months than birth outcomes and perinatal factors. Foreign-born women were two-fold more likely to initiate XBR but not necessarily continue to 6 months compared to their US-born counterparts. Factors associated with BrBot subgroups differed from those associated with XBR outcomes, whereas maternal age was the only predictor consistently associated with ever XBR, XBR ≥ 6 months, and BrBot subgroups. The areas under the receiver operating characteristic curves for models predicting ever XBR and XBR ≥ 6 months were 0.88 (95 % CI 0.85, 0.91) and 0.90 (95 % CI 0.88, 0.93), respectively. Conclusions Findings underscore the importance of educational, clinical, and social support to promote XBR in mothers with sociodemographic factors predictive of none or poor XBR outcomes.

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Acknowledgments

Dr. Zhu carried out data collection, analysis and interpretation, and wrote the manuscript; Drs. Hernandez and Forman collected the data and revised the manuscript; Mr. Dong and Drs. Mueller and Forman contributed to data analysis and interpretation; Drs. Hirschfeld and Forman designed and supervised the research. The authors are grateful to the participants and other investigators and staff at all study sites (Johns Hopkins University, Baltimore, MD; Michigan State University, East Lansing, MI; Saint Louis University, Saint Louis, MO; University of California—Irvine, Irvine, CA; University of California—Los Angeles, Los Angeles, CA; University of Minnesota, Minneapolis, MN; University of Texas at Austin/Baylor College of Medicine, Austin/Houston, TX; University of Texas Health Science Center at San Antonio, San Antonio, TX). This research was supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development award# HHSN275200800020C.

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  1. Yeyi Zhu

    Present address: Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, 20852, USA

Authors and Affiliations

  1. Department of Nutritional Sciences, University of Texas at Austin, Austin, TX, 78703, USA

    Yeyi Zhu, Ladia M. Hernandez, Yongquan Dong & Michele R. Forman

  2. Department of Mathematics, University of Texas at Austin, Austin, TX, USA

    Peter Mueller

  3. Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, USA

    Yeyi Zhu & Steven Hirschfeld

  4. School of Human Ecology, University of Texas at Austin, Austin, TX, USA

    Michele R. Forman

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  1. Yeyi Zhu
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Zhu, Y., Hernandez, L.M., Mueller, P. et al. Predictive Models for Characterizing Disparities in Exclusive Breastfeeding Performance in a Multi-ethnic Population in the US. Matern Child Health J 20, 398–407 (2016). https://doi.org/10.1007/s10995-015-1838-3

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