Mayo Clinic, Rochester, Minnesota, USA.
Breastfeed Med. 2020 Oct;15(10):646-654. doi: 10.1089/bfm.2020.0083. Epub 2020 Aug 26.
To explore, in a large, nationally representative U.S. sample of children, potential independent associations between social and community factors and breastfeeding outcomes, using the Social Ecological Model as a theoretical framework. A secondary data analysis of the 2011-2012 National Survey of Children's Health was conducted ( = 29,829). Multivariate logistic regression was performed to estimate associations between predictor variables (parental emotional support, neighborhood social support, neighborhood safety, neighborhood amenities, and medical home) and breastfeeding outcomes (breastfeeding initiation [BFI] and exclusive breastfeeding for 6 months [EBF6m]). For predictor variables reaching statistical significance in the adjusted models, we performed subgroup analyses by race-ethnicity. After adjusting for individual- and family-level sociodemographic and maternal-child health factors, living in a neighborhood with 4 amenities was associated with 1.54 (95% confidence interval [CI] 1.06-2.23) times the odds of BFI, compared to children living in neighborhoods with no amenities. There was a negative association (adjusted odds ratio [aOR] 0.83; 95% CI 0.70-0.99) between neighborhood social support and BFI, although living in a supportive neighborhood was associated with 1.37 (95% CI 1.11-1.69) times the odds of EBF6m. There was a negative association (aOR 0.71; 95% CI 0.54-0.93) between perceived neighborhood safety and EBF6m. The observed associations differed by race-ethnicity. Community-level structural and social support factors influence breastfeeding outcomes, independent of previously described individual level sociodemographic factors, and the observed associations differ by race-ethnicity. These findings have implications for the development of "breastfeeding-friendly" communities and public policies.
为了探索社会生态模型作为理论框架下，社会和社区因素与母乳喂养结果之间潜在的独立关联，我们在美国一个大型的具有代表性的儿童样本中进行了这项研究。我们对 2011-2012 年全国儿童健康调查（ = 29829）进行了二次数据分析。我们采用多变量逻辑回归来估计预测变量（父母情感支持、邻里社会支持、邻里安全、邻里便利设施和医疗之家）与母乳喂养结果（母乳喂养开始[BFI]和 6 个月纯母乳喂养[EBF6m]）之间的关联。对于在调整后的模型中达到统计学意义的预测变量，我们按种族和族裔进行了亚组分析。在调整了个体和家庭社会人口统计学和母婴健康因素后，与居住在没有便利设施的社区的儿童相比，居住在有 4 种便利设施的社区的儿童 BFI 的几率增加了 1.54 倍（95%置信区间[CI] 1.06-2.23）。邻里社会支持与 BFI 呈负相关（调整后的优势比[aOR] 0.83；95%CI 0.70-0.99），尽管生活在一个支持性的邻里社区与 EBF6m 的几率增加了 1.37 倍（95%CI 1.11-1.69）。邻里安全感与 EBF6m 呈负相关（aOR 0.71；95%CI 0.54-0.93）。观察到的关联因种族和族裔而异。社区层面的结构和社会支持因素独立于先前描述的个体社会人口统计学因素影响母乳喂养结果，且观察到的关联因种族和族裔而异。这些发现对“母乳喂养友好型”社区和公共政策的制定具有启示意义。
