McKinney Chelsea O, Hahn-Holbrook Jennifer, Chase-Lansdale P Lindsay, Ramey Sharon L, Krohn Julie, Reed-Vance Maxine, Raju Tonse N K, Shalowitz Madeleine U
NorthShore University HealthSystem Department of Pediatrics and Research Institute, Evanston, Illinois;
Crean College of Health and Behavioral Sciences, Chapman University, Orange, California;
Pediatrics. 2016 Aug;138(2). doi: 10.1542/peds.2015-2388. Epub 2016 Jul 12.
Breastfeeding rates differ among racial/ethnic groups in the United States. Our aim was to test whether racial/ethnic disparities in demographic characteristics, hospital use of infant formula, and family history of breastfeeding mediated racial/ethnic gaps in breastfeeding outcomes.
We analyzed data from the Community and Child Health Network study (N = 1636). Breastfeeding initiation, postnatal intent to breastfeed, and breastfeeding duration were assessed postpartum. Hierarchical linear modeling was used to estimate relative odds of breastfeeding initiation, postnatal intent, and duration among racial/ethnic groups and to test the candidate mediators of maternal age, income, household composition, employment, marital status, postpartum depression, preterm birth, smoking, belief that "breast is best," family history of breastfeeding, in-hospital formula introduction, and WIC participation.
Spanish-speaking Hispanic mothers were most likely to initiate (91%), intend (92%), and maintain (mean duration, 17.1 weeks) breastfeeding, followed by English-speaking Hispanic mothers (initiation 90%, intent 88%; mean duration, 10.4 weeks) and white mothers (initiation 78%, intent 77%; mean duration, 16.5 weeks); black mothers were least likely to initiate (61%), intend (57%), and maintain breastfeeding (mean duration, 6.4 weeks). Demographic variables fully mediated disparities between black and white mothers in intent and initiation, whereas demographic characteristics and in-hospital formula feeding fully mediated breastfeeding duration. Family breastfeeding history and demographic characteristics helped explain the higher breastfeeding rates of Hispanic mothers relative to white and black mothers.
Hospitals and policy makers should limit in-hospital formula feeding and consider family history of breastfeeding and demographic characteristics to reduce racial/ethnic breastfeeding disparities.
美国不同种族/族裔群体的母乳喂养率存在差异。我们的目的是检验人口统计学特征、医院婴儿配方奶粉的使用情况以及母乳喂养家族史方面的种族/族裔差异是否介导了母乳喂养结果方面的种族/族裔差距。
我们分析了社区与儿童健康网络研究的数据（N = 1636）。产后评估母乳喂养开始情况、产后母乳喂养意愿以及母乳喂养持续时间。采用分层线性模型来估计不同种族/族裔群体中母乳喂养开始、产后意愿和持续时间的相对比值，并检验产妇年龄、收入、家庭构成、就业情况、婚姻状况、产后抑郁、早产、吸烟、“母乳是最好的”信念、母乳喂养家族史、住院期间配方奶粉的使用以及妇女、婴儿与儿童营养补充计划（WIC）参与情况等候选中介因素。
讲西班牙语的西班牙裔母亲最有可能开始母乳喂养（91%）、有母乳喂养意愿（92%）并维持母乳喂养（平均持续时间为17.1周），其次是讲英语的西班牙裔母亲（开始母乳喂养率90%，意愿率88%；平均持续时间为10.4周）和白人母亲（开始母乳喂养率78%，意愿率77%；平均持续时间为16.5周）；黑人母亲开始母乳喂养（61%）、有母乳喂养意愿（57%）并维持母乳喂养（平均持续时间为6.4周）的可能性最小。人口统计学变量完全介导了黑人和白人母亲在母乳喂养意愿和开始母乳喂养方面的差异，而人口统计学特征和住院期间配方奶粉喂养完全介导了母乳喂养持续时间。母乳喂养家族史和人口统计学特征有助于解释西班牙裔母亲相对于白人和黑人母亲更高的母乳喂养率。
医院和政策制定者应限制住院期间配方奶粉的喂养，并考虑母乳喂养家族史和人口统计学特征，以减少种族/族裔在母乳喂养方面的差异。
