Housing Insecurity, Housing Conditions, and Breastfeeding Behaviors for Medicaid-Eligible Families in Urban Settings.
Housing Insecurity, Housing Conditions, and Breastfeeding Behaviors for Medicaid-Eligible Families in Urban Settings.
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DOI：
10.1177/08903344221108073
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发表时间：
2022-11
期刊：
影响因子：
--
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为了确定母乳喂养障碍，需要进行研究，探索暴露于健康的社会决定因素与母乳喂养之间的联系。住房不安全和家庭条件(混乱和拥挤)可能会增加母亲的压力和不适，减少可用于母乳喂养的时间，从而影响母乳喂养。我们的目的是调查住房不安全感、产后早期的纯母乳喂养意向和产后6个月纯母乳喂养之间的关系，以确定是否存在低于最佳母乳喂养率的风险。本研究是对两个时间段的纵向研究的二次数据分析。数据收集自纽约市和匹兹堡说英语和西班牙语、符合医疗补助条件的母婴双胞胎(N=361)，在临近出生时和6个月大的孩子。结构方程模型被用来检验住房不安全感对6个月大婴儿母乳喂养排他性的直接和间接影响。PATH模型显示，经历更多的住房不安全标志(即丧失抵押品赎回权/驱逐威胁、无家可归史、迟租)预示着6个月时母乳喂养排他性显著降低。这在一定程度上是通过出生后早期较少的纯母乳喂养意图来调节的。更大的家庭拥挤与6个月的母乳喂养排他性相关，在意图的中介下。家庭拥挤的影响因研究地点和参与者种族/民族而异。将住房不安全作为一种多维结构加以完善，可导致开发标准化的数据收集工具，为今后处理健康的社会决定因素的研究中的方法学决定提供信息，并可为制定响应性的个人和结构一级干预措施提供信息。这项研究中使用的数据是作为Smart Beginings随机对照试验(在ClinicalTrials.gov上注册的NCT02459327)的一部分收集的。
Research exploring associations between exposure to social determinants of health and breastfeeding is needed to identify breastfeeding barriers. Housing insecurity and household conditions (chaos and crowding) may affect breastfeeding by increasing maternal stress and discomfort and decreasing time available to breastfeed. We aimed to examine the relationships between housing insecurity, breastfeeding exclusivity intention during the early postnatal period, and breastfeeding exclusivity at 6 months postpartum among a sample “at risk” for suboptimal breastfeeding rates. This study is a secondary data analysis of a longitudinal study at two time periods. Data were collected from English- and Spanish-speaking, Medicaid-eligible mother-infant dyads (N = 361) at near-birth and child aged 6 months, in New York City and Pittsburgh. Structural equation modeling was used to examine direct and indirect effects of housing insecurity on breastfeeding exclusivity at child aged 6 months. The path model showed that experiencing more markers of housing insecurity (i.e., foreclosure/eviction threat, history of homelessness, late rent) was predictive of significantly lower breastfeeding exclusivity at 6 months. This was partially mediated through less exclusive breastfeeding intention during the early postnatal period. Greater household crowding was associated with 6-month breastfeeding exclusivity when mediated by intention. Household crowding had differential effects by study site and participant race/ethnicity. Refinement of housing insecurity as a multi-dimensional construct can lead to the development of standardized data collection instruments, inform future methodological decisions in research addressing social determinants of health, and can inform the development of responsive individual- and structural-level interventions. The data used in this study were collected as part of the SMART Beginnings Randomized Controlled Trial (NCT02459327 registered at ClinicalTrials.gov).
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作者：
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