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Deborah L. Dee, MPH* Ziya Gizlice, PhD^ Marcia S. Roth, MPH*

Healthcare Provider Support and Breastfeeding Practices in North Carolina Between 1993-2005: Preliminary Results from the New NC CHAMP Surveillance System. Deborah L. Dee, MPH* Ziya Gizlice, PhD^ Marcia S. Roth, MPH* *Dept. of Maternal and Child Health, School of Public Health

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Deborah L. Dee, MPH* Ziya Gizlice, PhD^ Marcia S. Roth, MPH*

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  1. Healthcare Provider Support and Breastfeeding Practices in North Carolina Between 1993-2005: Preliminary Results from the New NC CHAMP Surveillance System Deborah L. Dee, MPH* Ziya Gizlice, PhD^ Marcia S. Roth, MPH* *Dept. of Maternal and Child Health, School of Public Health ^Center for Health Promotion and Disease Prevention University of North Carolina at Chapel Hill 11th Annual Maternal and Child Health Epidemiology Conference December 9, 2005

  2. Background • Human milk provides optimal nutrition for infants and young children • Breastfeeding confers many maternal, child health benefits • Healthy People 2010 breastfeeding goals not being met • Breastfeeding rates lowest among women living in Southeast (incl. North Carolina) • Healthcare provider support may influence woman’s feeding decisions & behaviors

  3. Study Aim: Examine BF Patterns in 1993-2005 North Carolina Birth Cohorts using CHAMP • Healthcare providers’ (HCPs’) help and encouragement with breastfeeding • Women’s breastfeeding practices • Initiation • Duration • Assess usefulness of NC CHAMP as source of breastfeeding-related data

  4. Data Source: NC CHAMP(Child Health Assessment and Monitoring Program) • Statewide surveillance system • Monitors health, risk behaviors for ALL children <18 yrs • Follow-back to NC BRFSS • Jan-Sept 2005 CHAMP: Eligible: 4,209 Participated: 3,747 (89% participation rate) Completed: 3,126 (83.4% completion rate)

  5. NC CHAMP Breastfeeding Sample • Breastfeeding questions asked only of households with child(ren) 0-12 yrs old • One child 0-12 randomly selected from household • Person “most knowledgeable” about child’s health asked to be respondent (usually child’s mother)

  6. Preliminary ResultsJanuary – September 2005

  7. Demographic Characteristics of Study Sample (Children ≤12 yrs of age)

  8. Healthcare Provider Encouragement of BF, BF Initiation, & 6 Month BF Duration 1993-2005 NC Birth Cohorts 83% 65% 72% 61% 27% 22% *Trend tests: P<.0001; ^Trend test: P=.0013

  9. Provider Support and Breastfeeding Practicesamong Non-Hispanic African Americans 1993-2005 NC Birth Cohorts 84% 58% 51% 39% 12% 5% Trend tests: *P<.0001; ^P=.0434; P-value for 6 mo duration=.1029 (NS)

  10. Provider Support and BF Practicesamong Non-Hispanic Whites1993-2005 NC Birth Cohorts 82% 75% 66% 64% 27% 25% Trend tests: *P<.0001; ^P=.0006; #P=.0286

  11. Breastfeeding Initiation According to Highest Level of Parent Education1993-2005 NC Birth Cohorts 84% 81% 63% 50% 50% 36% Trend tests: *P=<.0781 (NS); ^P=.0087; #P=.0159

  12. Provider Encouragement of Breastfeeding Among Families with and without CSHCN 1993-2005 NC Birth Cohorts 85% 68% 57% 57% Trend tests: *P=<.0001; ^P=.2643 (NS)

  13. Summary • NC families appear to be receiving more help and encouragement for breastfeeding from their healthcare providers • Prevalences of breastfeeding initiation in NC mirror those related to HCP encouragement of breastfeeding, but for most groups, rates are still below the HP 2010 goal of 75% • Prevalence of breastfeeding at 6 months seems to be on the rise, except among African Americans

  14. Limitations of NC CHAMP • Reminder: results are preliminary • 2005 data collection ends Dec. 31 • Retrospective collection of breastfeeding data • But studies indicate maternal recall valid, reliable • No information on other influences on BF • Only obtain data for one child in the family

  15. Strengths of NC CHAMP • Efficient way for states to conduct health-related surveillance • Can quickly identify and examine current practices and/or longer-term patterns or prevalence of various health behaviors • Rich dataset - potentially could be used to inform and guide various public health interventions • BF data for ALL children aged 0-12 y, not just a specific group • Can subset by certain characteristics if desired

  16. Future NC CHAMP Research • Complete 2005 CHAMP data collection • Examine • CHAMP BF data compared to other sources (PRAMS, NIS, etc.) • Predictors of breastfeeding behaviors • Associations between BF and various outcomes • Try to determine why breastfeeding practices vary among subgroups in order to tailor interventions • Consider adding questions regarding barriers to initiation, duration (e.g., family, workplace support, societal norms)

  17. Breastfeeding Confers Health Benefits to Mothers & Children, but… • CHAMP shows BF practices in NC still not meeting Healthy People 2010 goals • CHAMP suggests HCP support positively associated with BF initiation but not duration

  18. Public Health Implications • To increase BF duration, HCPs’ support efforts may need to be enhanced to ensure duration is addressed • HCPs can’t do it all • Time to develop additional strategies, including worksite support, policy development (maternity leave), changing social norms

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