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  1. Predictive Factors of Breast Feeding Attitudes and Breast Feeding Initiation Candice Allen-Jara, MD; Beth A. Auslander, PhDThe University of Texas Medical Branch at Galveston, Galveston, Texas,PGY 3 Results Introduction • BACKGROUND • Breastfeeding is very beneficial to the health and development of infants and is therefore highly recommended by all major institutions. • Many factors are known to contribute to maternal breast feeding intention and initiation. Four of these major factors include maternal body image, maternal mental health, social influences, and breast feeding attitudes. • Little research has been done on how these four factors are related to each other and, in turn, related to maternal breast feeding intention and initiation. • OBJECTIVES: • Assess predictive factors for each of the four breast feeding attitudes included in this study. • Determine how these individual breast feeding attitudes are associated with social influences, maternal body image and maternal mental health. • Using multivariate logistic regression models, determine which factors are predictive of breast feeding intention and initiation as outcomes. • Breast Feeding Attitudes: • The individual models for each breastfeeding attitude found the following factors to be predictive: • - benefits to infant: maternal influence (0.097 sig) • - social inconvenience: age (0.035 sig), minority race (0.033 sig), • anxiety (0.075 sig), physician influence (0.068 sig), body image • (0.014 sig) • - personal inconvenience: physician influence, minority race • (0.003 sig), body image (0.021 sig), anxiety (0.075 sig) • - physical inconvenience: age (0.065 sig), body image (0.015 sig), • significant other influence (0.08 sig) • In the full model for individual breast feeding attitudes the following remained as significant predictors: • - Benefits to infant: none • - Social inconvenience: physician influence, body image, age • - Personal inconvenience: physician influence, minority race • - Physical inconvenience: body image • Intention to breast feed as an outcome: • Intention to breastfeed was found to have significant predictors including social inconvenience (0.028 sig) personal inconvenience (0.0 sig)and benefits to infant (0.0 sig). Physical inconvenience, body image and social influences of any kind were not found to be predictive. • Initiation of breast feeding as an outcome: • In the individual model for initiation of breast feeding: benefits to infant (0.0 sig), personal inconvenience (0.098 sig), depression (0.015 sig), and anxiety (0.047 sig) were found to be predictive factors. • In the full model for initiation of breast feeding: only benefits to infant remained as a predictive factor. Demographic factors, maternal body image, maternal BMI, social influence and all other breast feeding attitudes were not found to be predictive of this outcome. Abstract Breast-feeding has been found to be very beneficial to the health and development of children as it lowers both morbidity and mortality. Though highly recommended by all major institutions like the CDC, AAP and WHO, initiation and duration rates remain far below where they should be. Previous research has found that both maternal body satisfaction and maternal breast feeding attitudes are related to breastfeeding intention and initiation but limited knowledge exists about the relationship between these two and how this relationship may affect breast feeding intention and initiation. This information is important for the development of strategic interventions that would promote breast feeding. In this study we will assess for factors that are predictive of four individual breast feeding attitudes. We will then assess the relationship between body satisfaction and these 4 individual breast feeding attitudes to determine predictive factors for breastfeeding intention and initiation as outcomes. Description of intervention/study Conclusions • METHODS • Sample: • Included 97 women between ages 18-45y/o who had recently delivered a baby at UTMB. • Procedure: • Participants were asked to complete a brief questionnaire that included demographic items, self reported weight & height, parity, as well as questions relating to : • - Breastfeeding Influence: assess relationship between various social • influences and maternal breast feeding attitudes and breast feeding • initiation. • - Breast feeding attitudes: (23 items) with 4 subscales: • 1. Benefits to Infant • 2. Social Inconvenience • 3. Personal Inconvenience • 4. Physical Inconvenience • - BSI- Anxiety and BSI-Depression : (6 items each) • - Body Shape Questionnaire : (8 items): assess body shape • satisfaction • Statistical Methods: • Hierarchical regression models were conducted to assess the relationship between breast feeding attitudes and: • - body satisfaction • - maternal depression, and anxiety • - social influence • Logistic regression models were then conducted to assess for predictors of:- individual breast feeding attitudes • - breast feeding intention and initiation • 1. The individual models for each breast feeding attitude • found multiple significant predictive factors. • 2. In the full model for each breast feeding attitude only a • handful of predictive factors remained for social • inconvenience, personal inconvenience and physical • inconvenience attitudes. Benefits to infant attitude did not • have any significant predictive factors. • 3. In addition: • Physician influence appears to be a predictive factor of both personal and social inconvenience attitudes. • Anxiety and depression were not found to be predictive of maternal body image. • Maternal body image is a predictive factor of personal, physical and social inconvenience. • Minority race was found to be a predictive factor of social and personal inconvenience • 4. Intention to breastfeed was found to have significant • predictors including social inconvenience, personal • inconvenience and benefits to infant. Physical • inconvenience, body image and social influences of any • kind were not found to be predictive. • 5. In the individual model for initiation of breast feeding • benefits to infant, personal inconvenience, depression, and • anxiety were found to be predictive factors. • 6. In the full model for initiation of breast feeding only benefits • to infant remained as a predictive factor. Demographic • factors, maternal body image, maternal BMI, social • influence and all other breast feeding attitudes were not • found to be predictive of this outcome. References Bivariate Linear Regression Models Predicting Breast Feeding Attitudes 1. L. Gartner, et al. “Breastfeeding and the Use of Human Milk.” Journal of AAP. Vol. 115 No. 2 February 2005, pp. 496-506 (doi:10.1542/peds.2004-2491). http://aappolicy.aappublications.org/cgi/content/full/pediatrics;115/2/496  2. D. Thulier, et al. “Variables associated with breastfeeding duration.” JOGNN In Review. 38, 259-268; 2009.  3. J. Barnes, et al. “Extreme attitudes to body shape, social, social and psychological factors and a reluctance to breast feed.” Journal of the Royal Society of Medicine. Volume 90. October 1997.  4. S.F. Foster, et al. “Body Image, Maternal Fetal Attachment, and Breast Feeding.” Journal of Psychosomatic Research. Vol. 41 No. 2 pp 181-184, 1996.  5. L. Amir et al. “A systematic review of maternal obesity and breastfeeding intention, initiation and duration.” BMC Pregnancy and Childbirth 2007, 7:9.  6. Baranowski, et al. “Attitudes towards breastfeeding.” Journal of Developmental and Behavioral Pediatrics. Vol 7, Number 6. December 1986.  7. Le Strat, et al. “Prevalence and correlates of major depressive episode in pregnant and postpartum women in the United States.” Journal of Affect Disorders. 2011 Jul 28. www.ncbi.nlm.nih.gov/pubmed/21802737. Accessed 10/3/11.  8. Forster D, et al: “Factors associated with continuing to feed any breast milk at six months postpartum in a group of Australian women.” Int Breastfeed J 2006, 1:18.  9. J. Pippins et al. “Association of Breastfeeding with Maternal Depressive Symptoms.” Journal of Women’s Health. Vol. 15. number 6, 2006. 10. M. Evans et al. “Modified Breastfeeding Attrition Prediction Tool: Prenatal and Postpartum Tests.” The Journal of Perinatal Education. Vol. 13, No.1. Winter 2004 11. Lang, A. J., Norman, S. B., Means-Christensen, A. and Stein, M. B. (2009), Abbreviated brief symptom inventory for use as an anxiety and depression screening instrument in primary care. Depression and Anxiety, 26: 537–543. doi: 10.1002/da.20471 12. T. Baranowski et al. “Social Support, Social Influence, Ethnicity and the Breastfeeding Decision.” Social Science Medicine. Vol 17. No. 21. pp 1599-1611, 1983.  13. D. Gjerdingen, et al. “Predictors of Mother’s Postpartum Body Dissatisfaction.” Women Health. 49(6): 491-504. Sept 2009.  14. Evans & Dolan. “Body Shape Questionnaire.” 1993. www.psyctc.org/tools/bsq/doc/bsq-8b.doc. Accessed 1/13/11. Multivariate Logistic Regression Analyses: Associations with individual Breast Feeding Attitudes Bivariate Logistic Regression Analyses: Associations with Initiation of Breast Feeding 2012 Texas Pediatric Society Electronic Poster Contest Insert Program or Hospital Logo