Abstract
Objective To estimate the associations between neighborhood disadvantage and neighborhood affluence with breastfeeding practices at the time of hospital discharge, by race-ethnicity. Methods We geocoded and linked birth certificate data for 111,596 live births in New Jersey in 2006 to census tracts. We constructed indices of neighborhood disadvantage and neighborhood affluence and examined their associations with exclusive (EBF) and any breastfeeding in multilevel models, controlling for individual-level confounders. Results The associations of neighborhood disadvantage and affluence with breastfeeding practices differed by race-ethnicity. The odds of EBF decreased as neighborhood disadvantage increased for all but White women [Asian: Adjusted odds ratio (AOR) 0.82 (95% confidence interval (CI) 0.69–0.97); Black: AOR 0.77 (95% CI 0.70–0.86); Hispanic: AOR 0.78 (95% CI 0.70–0.86); White: AOR 0.99 (95% CI 0.91–1.08)]. The odds of EBF increased as neighborhood affluence increased for Hispanic [AOR 1.19 (95% CI 1.08–1.31)] and White [AOR 1.12 (95% CI 1.06–1.18)] women only. The odds of any breastfeeding decreased with increasing neighborhood disadvantage only for Hispanic women [AOR 0.85 (95% CI 0.79–0.92)], and increased for White women [AOR 1.16 (95% CI 1.07–1.26)]. The odds of any breastfeeding increased as neighborhood affluence increased for all except Hispanic women [Asian: AOR 1.31 (95% CI 1.13–1.51); Black: AOR 1.19 (95% CI 1.07–1.32); Hispanic: AOR 1.08 (95% CI 0.99–1.18); White: AOR 1.30 (95% CI 1.24–1.38)]. Conclusions Race-ethnic differences in associations between neighborhood disadvantage and affluence and breastfeeding practices at the time of hospital discharge indicate the need for specialized support to improve access to services.
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Acknowledgements
Brian Frizzelle performed the geocoding, linked the data, and created the maps. UNC’s Breastfeeding Umbrella Support Team provided suggestions. Julien Teitler and Nancy Reichman obtained the data. Yourkavitch and Miles were supported in part by the Training Program in Reproductive, Perinatal and Pediatric Epidemiology, (T32-HD52468; Anna Maria Siega-Riz, PI) and by NICHD K99/R00 HD075860 (PI: Kane). Kane was supported by NICHD K99/R00 HD075860.
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Online Resource 2—Plots of neighborhood disadvantage and affluence indices for urban neighborhoods in New Jersey, by race-ethnicity (DOCX 234 KB)
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Yourkavitch, J., Kane, J.B. & Miles, G. Neighborhood Disadvantage and Neighborhood Affluence: Associations with Breastfeeding Practices in Urban Areas. Matern Child Health J 22, 546–555 (2018). https://doi.org/10.1007/s10995-017-2423-8
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DOI: https://doi.org/10.1007/s10995-017-2423-8