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Predictors of Optimal Breastfeeding among Hispanic Women in a Local WIC Program

This study explores factors influencing optimal breastfeeding among predominantly Hispanic women in a WIC program and provides strategies for recruitment and retention in breastfeeding programs.

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Predictors of Optimal Breastfeeding among Hispanic Women in a Local WIC Program

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  1. Predictors of Optimal Breastfeeding among Predominately Hispanic Women Participating in a Local WIC Program National WIC Association Conference, April 2017 Janine Rethy MD,MPH1 Amara Channell Doig, MPH2 Jennifer Brady, BS1 David Goodfriend, MD, MPH1 Sina Gallo, RD, PhD2 1Loudoun County Health Department, Leesburg, VA; 2Nutrition & Food Studies, George Mason University, Fairfax, VA J

  2. Loudoun County Health DepartmentObesity & Chronic Disease Prevention Division Community based prevention model to create a culture of health in Loudoun County • David Goodfriend, MD, MPH - Health Director • Janine Rethy, MD, MPH, FAAP, FABM - Physician Advisor • Jennifer Brady, BSc - Health Educator • Internship/Practicum students • Collaboration with George Mason University since 2014 • Sina Gallo, RD-PhD - Assistant Professor • Amara Channel Doig, MPH - Research Associate

  3. Funding 1. Community Partnerships for Healthy Mothers & Children National WIC Association & Centers for Disease Control To develop and implement community-driven plans to reduce and prevent chronic disease in high-risk areas 2. Preventive Health and Health Services Program Virginia Department of Health Preventing and Controlling Obesity and Chronic Disease Through Evidence Based Programming

  4. Objectives By the end of the session, participants will be able to: • Describe factors differentiating positive deviants from other women in the study of barriers and facilitators to infant feeding among African American women and the implications for WIC practice • Define optimal breastfeeding and list two predictors of optimal breastfeeding among low-income Hispanic women • List at least two strategies public health professionals can use to recruit and retain hard-to-reach mothers in community breastfeeding programs   

  5. Optimal Breastfeeding “The American Academy of Pediatrics reaffirms its recommendation of exclusive breastfeeding for about 6 months, followed by continued breastfeeding as complementary foods are introduced, with continuation of breastfeeding for 1 year or longer as mutually desired by mother and infant.” Pediatrics, 2012.

  6. Costs Associated with Suboptimal Breastfeeding in US $ 4.7 x 109 $ 1.8 x 109 $ 2.6 x 109 If 90% infants exclusively breastfed for 6 months US would save $17 billion / year, prevent an excess of 3,340 deaths Bartick & Reinhold. Pediatrics, 2010. Bartick et al. Maternal & Child Nutrition 2017

  7. Disparities in Breastfeeding Reported as % Breastfeeding Acculturation • Decreases initiation, duration and exclusivity in Hispanic women • Each additional year in the US decreases breastfeeding rates by 4% 1CDC Breastfeeding Report Card, 2016 (NIS); 2Ahluwalia et al. J Hum Lact, 2012 (PRAMS)

  8. Excessive Burden of Suboptimal Breastfeeding Among Ethnic Minorities Reported as Excess Disease per 100,000 / Relative Difference (95% CI) Bartick et al. J Pediatr, 2017.

  9. Loudoun County, Virginia • 20% born outside the United States • Increasingly diverse • 17% Asian • 14% Hispanic • ~40% increase in a decade • 7% Black • 4% living below federal poverty line • 12% Hispanic / Latinos Individuals living below the Federal Poverty Line

  10. WIC Breastfeeding Assessment Aims: Among women participating in a local WIC program, • Determine current infant feeding practices. • Describe breastfeeding intention and goals. • Describe timing and reasons for introduction of formula. • Identify the predictors for reaching optimal breastfeeding at 3 and 6 months.

  11. Methods • Self-administered online survey using tablets (via Qualtrics) at both Loudoun County WIC clinics • Available in English and Spanish • 5 sections, 58 questions • ~25 min. to complete • Anonymous and de-identified, 18 years + • IRB approval from George Mason University and VDH • Completed between July - August 2016

  12. Maternal Demographics Race / Ethnicity • 74% Latino / Hispanic • 90% Spanish speaking • 14% Black / African American • 5% Asian Primary Language • 68% Spanish Education • 45% did not complete high school

  13. Family Income & Assistance • 66% earned less than the federal poverty line • WIC income criteria <185% of federal poverty line • 71% of mothers are uninsured or unable to afford healthcare • 51% worried about running out of food in the last year • 26% ran out of food and unable to purchase more

  14. Specific Aim 1 To determine current infant feeding practices.

  15. Infant Feeding - 3 Months

  16. Infant Feeding - 6 Months Previous Mixed Feeding

  17. Breastfeeding Rates 32

  18. Specific Aim 2 To describe breastfeeding intention and goals.

  19. Breastfeeding Intention & Reaching Goals • Reaching Goals • 50% reached their breastfeeding duration goal • Exclusivity • 49% planned to breastfeed exclusively • 34% planned to exclusively breastfed for at least 6 months

  20. SpecificAim 3 Describe timing and reasons for introduction of formula.

  21. Introduction of Formula

  22. Introduction of Formula • 91% gave some formula

  23. Introduction of Formula • 91% gave some formula • 60% gave formula within the first few days

  24. Introduction of Formula • 91% gave some formula • 60% gave formula within the first few days • 43% gave formula before leaving the hospital • 18% at the first feeding

  25. Survival of Never Introducing Formula

  26. Reasonsfor Introduction of Formula

  27. Specific Aim 4 Identify the predictors for reaching optimal breastfeeding at 3 and 6 months.

  28. Logistic Regression Model: Optimal Breastfeeding 3 months (n=117)

  29. Logistic Regression Model: Optimal Breastfeeding 6 months (n=94)

  30. Conclusions & Recommendations • High percentage of WIC infants receiving formula within the first few days of life. • Improve prenatal education about normal volumes of early feeds as well as the risks of any non-human milk in first few days. • Setting breastfeeding goals is associated with increased duration and exclusivity of breastfeeding. • Prenatal counseling imperative with culturally adapted messaging. • WIC breastfeeding package may influence breastfeeding exclusivity. • Consider educating on WIC food packages earlier in care. • Consider not offering formula for first month, except in special circumstances.

  31. Acknowledgments Funding Centers for Disease Control and Prevention (CDC) National WIC Association (NWA) WIC Staff Graduate & Undergraduate Trainees Julizza Canales Study Participants

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