Date

February 2007

Document Type

Thesis

Degree Name

M.P.H.

Department

Dept. of Public Health and Preventive Medicine

Institution

Oregon Health & Science University

Abstract

Background Human breast milk provides health benefits to breastfed babies, mothers who breastfeed, and society in general. However, breastfeeding rates in the United States are in need of improvement. While Hispanic women overall have high breastfeeding rates compared to other minority groups, it has been hypothesized that acculturation among Hispanic women can impact breastfeeding behavior. Acculturation is a process by which immigrants acquire the cultural norms, attitudes, beliefs, and behaviors of a dominant society? Many risk factors and adverse health outcomes among Hispanic women have been associated with increased acculturation, particularly outcomes surrounding the perinatal period. This study tests the hypothesis that more acculturated Hispanic women are less likely to breastfeed at ten weeks than less-acculturated Hispanic women. Methods The 2000-2001 Oregon Pregnancy Risk Assessment Monitoring System (PRAMS) dataset was used to study the relationship between acculturation and any breastfeeding at ten weeks postpartum. Acculturation was defined by two measures, maternal nativity and survey language, and women were grouped into three categories of acculturation (low, intermediate, and high). Simple logistic regression analyses identified associations between breastfeeding and each independent variable, and a backward elimination approach to variable selection eliminated statistically non-significant variables from the model. All analyses conducted account for the sampling weights due to the complex sampling design. Results Acculturation was significantly associated with any breastfeeding at ten weeks in univariable analysis (p < 0.001). After adjusting for other variables, highly acculturated women were less likely to breastfeed than low-acculturation women (OR 0.34; 95% CI 0.23 - 0.50). The relationship between acculturation and breastfeeding was modified by WIC enrollment and parity. For highly acculturated women, those not enrolled in WIC were more likely to breastfeed at ten weeks than women who were in WIC (OR 3.34; 95% CI 1.86- 6.00). Similarly, among the highly-acculturated women, primiparous women were more likely to breastfeed than multiparous women (OR 2.25; 95% CI 1.24-4.11 ). However, for women with intermediate or low levels of acculturation, WIC enrollment and parity had no effect on breastfeeding. Although several factors were associated with breastfeeding at ten weeks, acculturation remained the strongest predictor of breastfeeding throughout all analyses. Discussion This study found a significant association between increased acculturation and any breastfeeding at ten weeks. Highly acculturated Hispanic women may benefit from targeted breastfeeding promotion programs or culturally appropriate advice on breastfeeding from health care providers. Because acculturation is a complex process by nature, further research is needed to help clarify reasons why breastfeeding practices decline as women acculturate. Such research would aid in developing breastfeeding promotion programs to encourage breastfeeding among highly acculturated Hispanic women. Because the Hispanic population in Oregon is growing and will continue to make up an increasing segment of the population, it is important that Hispanic women receive adequate breastfeeding advice and interventions. This study provides information that can be used to improve breastfeeding promotion programs and health care practices related to breastfeeding.

Identifier

doi:10.6083/M4C53HWZ

School

School of Medicine

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