Amy Gagliardi, MA, IBCLC, RLCCommunity Health Center, Inc

Middletown, CT

December 8, 2006

Psychosocial Risk Factors for Breastfeeding

Initiation and Duration in a High-Risk,

Low-Income Population

Mission Statement

Community Health Center is a private, non-profit agency

providing primary health care and social services.

Its’ quality health care services are available to all, and

particularly to those who cannot gain access to

such services elsewhere. The Community Health Center takes

leadership in promoting interagency cooperation.

It is based on consumer control and is committed to ensuring human rights and respecting

human dignity; as such, it strives to be a voice and vehicle for social change.

Middletown1972

Old Saybrook1980

Meriden1990

New London1992

Groton1994

New Britain1995

Clinton 2001

Westbrook2002

Norwalk2005

Mobile dentistry 2005

Stamford2005

History Timeline – Helping Out Neighboring Communities

What The Eye Sees…

2005 In Review

A Statewide Organization

Services Provided• Medical

– Pediatrics– Internal medicine– Family practice– Family planning– Breast and Cervical Cancer

Early Detection Program– Asthma management

program– Prenatal program– Maternal-Infant program

• Dental– Preventative– Restorative– Emergency

• Behavioral Health– Child Guidance Clinic– Intensive Family

Preservation– Homeless Case

Management

• Community Based Services– AIDS/HIV Services– Medical Social Work– Parent Aides

• School Based Health Centers– Medical– Behavioral Health

• Women & Family Services– Family Resource Center– Homeroom After School

Program– Domestic Violence

Services– Battered Women’s Shelter

• Eligibility Assistance• Vinnie’s Jump & Jive dance

hall

What Is An IBCLC?

• Board certified and registered allied health care professional

• Certification exam = standardized independent assessment of knowledge and competency

• Exam disciplines include: anatomy, physiology, endocrinology, nutrition, biochemistry, immunology, infectious disease, pathology, pharmacology, toxicology, psychology, sociology, anthropology, growth parameters, developmental milestones, interpretation of research, ethical and legal issues, breastfeeding equipment and technology, techniques and public health

Why Promote Breastfeeding?

• Healthy People 2000/2010: Breastfeeding initiation 75%, breastfeeding at 6 mths 50%, breastfeeding 12 mths 25%

• AAP recommendations: Exclusive breastfeeding for 6 mths with continued breastfeeding during the 1st year and beyond

• Health Benefits Associated with Breastfeeding

• Disparity between general population and Low-Income groups

Epidemiological Research Suggests

• Human milk superior and species specific

• Reduced risk/incidence of acute and chronic diseases

• Infant: diarrhea, lower respiratory infection, otitis media, bacteremia, bacterial meningitis, botulism, UTI, necritizing enterocolitis, enhanced cognitive development, SIDS, chronic digestive diseases

Epidemiological Research Suggests

• Mother: decreased postpartal bleeding, rapid uterine involution, weight loss, increased bone density, reduced risk of certain forms of cancer including breast, ovarian, endometrial/uterine (Enger et.al, 1998, Newcomb and Dietz, 2000, National Cancer Institute), enhanced attachment (Sinusas, Gagliardi, 2001)

• Economic: Decreased health care costs, reduced employee absenteeism, cost saving (AAP, Breastfeeding and the Use of Human Milk, 1997)

Diabetes/Obesity• Breastfeeding protective effect

against type 2 diabetes in women (Stuebe et.al, 2005, Taylor et.al, 2005).

• Breastfeeding protective against obesity in children (Bogen et.al, 2004, Bergmann et.al, 2006, Grummer-Strawn, Mei, 2004)

Disparity in low-Income Populations

• 2001: In USA 70.1% initiated breastfeeding among all groups (Ross Labs, 2002)

• 2001: 47.5% initiated breastfeeding among low income groups, 20.6% at 6 mths, 12.3% at 12 mths (CDC Pediatric Nutrition Surveillance System (PedNss), 2005)

Maternal-Infant Program

• Provides prenatal and postpartum care for uninsured and for income < 185% poverty leval

• Serve women throughout Middlesex County• Middletown and Clinton CHC• Medical care in collaboration with Family

Practice Residency Program of Middlesex Hospital

• Healthy Start services including case management, care coordination and linkages, childbirth education

Breastfeeding Promotion Project

• October 1994 Federal Community Nutrition Grant

• Prommotion of breastfeeding to low income pregnant women through the use of trained, supervised and certified peer counselors

• Community outreach including provider training, community news letters, advisory committee comprised of professional and target population members

• Services include breastfeeding promotion within prenatal clinic, hospital and home visits, phone consultation, breastpumps and supplies

Pre-Intervention Breastfeeding Rates

• Chart review revealed 29% breastfeeding initiation rate

• Duration data unavailable• Agency places high value on

breastfeeding• Challenges associated with the

integration of a lactation professional and peer counselors within the medical setting

Continuation of Project• 1 year funding• CHC commitment to

continuation of services• Combination of reimbursement

and grants• 9 year research project

Service Delivery

• Prenatal physicians/Primary Care Physicians

• Maternal-Infant Program co-ordinator

• Board Certified Lactation Consultant• Medical assistants• Nurse Case Manager• Peer Counselor

Data Collection and Analysis

• Work Study students• Collaboration with University of

Connecticut Department of Psychology

• Reasearch Team: Peter A Gagliardi, BA Stephanie Milan, PhD

Results• T = 931• 661 (71%) initiated breastfeeding• 361 Still breastfeeding at 6 weeks• 39% of Total number and 55% of those

who initiated breastfeeding continued at 6 weeks

• Rates of initiation and duration differ significantly by race/ethnicity/age/smoking and living arrangement

Table 1:Factors Associated With Breastfeeding Initiation

Factor: N % Initiate Breastfeeding Odds Ratio(95% CI)

Age Under 20 at birth Over 20 at birth

231695

145 (68%)512 (74%)

1.66**(1.21-2.28)

Living Arrangement Not with partner With partner

161206

116 (72%)163 (79%)

1.47 (.91-2.38)

Smoker Yes No

253552

154 (61%)411 (75%)

1.87**(1.37-2.57)

Hx of Substance Use Yes No

221584

147 (67%)418 (72%)

1.27(.91-1.77)

Hx of Sexual Abuse Yes No

106699

77 (73%)488 (70%)

.87 (.55-1.38)

Hx of Violence Yes No

147658

99 (67%)466 (71%)

1.18(.80-1.73)

Hx of Psychiatric Diagnosis Yes No

61748

44 (72%)523 (70%)

.90(.50-1.20)

**p<.01

Figure 1: Differences In Initiation and Duration By

Race/Ethnicity

OtherAsianAfrican-American

LatinaWhite

Race/Ethnicity

100.00

80.00

60.00

40.00

20.00

0.00

% >

0

42%

62%

30%38%40%

92%84%

57%

80%

71%

% Maintaining at 6weeks

% Initiating

Figure 3: Initiation and Duration Based on Living

Arrangements

72

33

79

50

0

10

20

30

40

50

60

70

80

90

Initiation 6 weekspostpartum

Time

Perc

ent

Not livingwith partnerLiving withpartner

Conclusion

• Breastfeeding Promotion is an effective intervention towards increasing breastfeeding initiation and duration rates among high risk populations

• Recommendation for targeted interventions for specific sub-populations

Contact Informatiom

• Amy Gagliardi, MA, IBCLC,RLC• gagliardi@chc1.com,

gagliardia@sbcglobal.net• (860) 347-6971 x3308