Holland Margaret L, Thevenent-Morrison Kelly, Mittal Mona, Nelson Alice, Dozier Ann M
Yale University School of Nursing, 400 West Campus Drive, Orange, CT, 06477, USA.
Department of Public Health Sciences, University of Rochester, 265 Crittenden Blvd, Rochester, NY, 14642, USA.
Matern Child Health J. 2018 Jan;22(1):82-91. doi: 10.1007/s10995-017-2357-1.
Objectives Breastfeeding has short- and long-term health benefits for children and mothers, but US breastfeeding rates are suboptimal. Exposure to violence may contribute to these low rates, which vary by race/ethnicity. We studied: (1) whether patterns of violence exposure differ by race/ethnicity and (2) whether these patterns are associated with breastfeeding outcomes. Methods We conducted a secondary analysis of data drawn from self-report surveys completed by a convenience sample of low-income postpartum women (n = 760) in upstate New York. Latent class analysis was used to identify groups of women with similar responses to seven violence measures, including childhood physical and/or sexual violence, experience of partner violence during or just after pregnancy (physical, emotional, verbal), and neighborhood violence (perceived or by ZIP code). Logistic regression and survival analysis were utilized to determine if classes were associated with breastfeeding initiation, duration, and exclusivity, controlling for demographics. Results Exposure to at least one form of violence was high in this sample (87%). We identified 4 classes defined by violence exposure (combining current and historical exposures). Violence exposure patterns differed between racial/ethnic groups, but patterns were inconsistently associated with breastfeeding plans or outcomes. For White women, history of violence exposure increased the likelihood of earlier breastfeeding cessation. By contrast, among Black women, history of violence exposure increased the likelihood of having a breastfeeding plan and initiating breastfeeding. Conclusions for Practice Some differences between violence exposure classes are likely due to the correlation between race/ethnicity and socioeconomic status in the community studied. Additional studies are warranted to better understand how exposure to violence is related to breastfeeding and how best to support women making decisions about intention, initiation, and duration of breastfeeding.
目标 母乳喂养对儿童和母亲有短期和长期的健康益处，但美国的母乳喂养率并不理想。遭受暴力可能导致这些低比率，且因种族/族裔而异。我们研究了：（1）暴力暴露模式是否因种族/族裔而异，以及（2）这些模式是否与母乳喂养结果相关。方法 我们对纽约州北部低收入产后妇女（n = 760）的便利样本完成的自我报告调查数据进行了二次分析。潜在类别分析用于识别对七种暴力测量有相似反应的女性群体，包括童年身体和/或性暴力、孕期或产后不久的伴侣暴力经历（身体、情感、言语）以及邻里暴力（感知到的或按邮政编码）。使用逻辑回归和生存分析来确定类别是否与母乳喂养开始、持续时间和排他性相关，并控制人口统计学因素。结果 该样本中至少遭受一种暴力形式的比例很高（87%）。我们根据暴力暴露（结合当前和历史暴露）确定了4个类别。暴力暴露模式在种族/族裔群体之间存在差异，但模式与母乳喂养计划或结果的关联并不一致。对于白人女性，暴力暴露史增加了更早停止母乳喂养 的可能性。相比之下，在黑人女性中，暴力暴露史增加了制定母乳喂养计划和开始母乳喂养的可能性。实践结论 暴力暴露类别之间的一些差异可能是由于所研究社区中种族/族裔与社会经济地位之间的相关性。有必要进行更多研究以更好地了解暴力暴露与母乳喂养之间的关系以及如何最好地支持女性做出关于母乳喂养意图、开始和持续时间的决定。
