Addressing Racial Inequities in Breastfeeding in the Southern United States
Addressing Racial Inequities in Breastfeeding in the Southern United States
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DOI：
10.1542/peds.2018-1897
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发表时间：
2019-02-01
期刊：
影响因子：
8
通讯作者：
Feldman-Winter, Lori
中科院分区：
文献类型：
--
作者：
Merewood, Anne;Bugg, Kimarie;Feldman-Winter, Lori
背景：种族是美国母乳喂养率的一个预测因素，非洲裔美国婴儿的母乳喂养率最低。很少有研究评估了实施成功母乳喂养十个步骤（以下简称为十个步骤）后不同种族的母乳喂养率的变化，也没有研究评估了实施与母乳喂养率种族差异变化之间的关系。我们的目标是确定在美国南部的医院和社区为基础的倡议是否可以提高遵守十个步骤，导致婴儿友好的指定，并减少母乳喂养的种族差异。方法：2014年至2017年，密西西比、路易斯安那、田纳西和得克萨斯州的医院参加了“社区和医院推进孕产实践”倡议，并接受了密集的质量改进和技术援助干预，以提高对“十个步骤”的遵守情况。社区合作伙伴和全州组织提供了平行支持。医院提交了按种族分层的每月汇总数据，包括母乳喂养、皮肤护理和病房护理。研究结果：在31个月的过程中，非裔美国人和白色婴儿之间母乳喂养开始的差异下降了9.6个百分点（95%置信区间1.6-19.5）。所有种族的母乳喂养起始率从66%增加到75%，排他性从34%增加到39%。非洲裔美国婴儿的初始母乳喂养和纯母乳喂养分别从46%增加到63%（P <0.05）和从19%增加到31%（P <0.05）。在所有种族中，剖腹产后的皮肤护理与母乳喂养的开始和排他性显著相关;仅在非洲裔美国婴儿中，母婴同室与纯母乳喂养的增加显著相关。结论：对十个步骤的依从性增加与母乳喂养中种族差异的减少有关。
BACKGROUND: Race is a predictor of breastfeeding rates in the United States, and rates are lowest among African American infants. Few studies have assessed changes in breastfeeding rates by race after implementing the Ten Steps to Successful Breastfeeding (hereafter referred to as the Ten Steps), and none have assessed the association between implementation and changes in racial disparities in breastfeeding rates. Our goal was to determine if a hospital- and community-based initiative in the Southern United States could increase compliance with the Ten Steps, lead to Baby-Friendly designation, and decrease racial disparities in breastfeeding. METHODS: Hospitals in Mississippi, Louisiana, Tennessee, and Texas were enrolled into the Communities and Hospitals Advancing Maternity Practices initiative from 2014 to 2017 and received an intensive quality improvement and technical assistance intervention to improve compliance with the Ten Steps. Community partners and statewide organizations provided parallel support. Hospitals submitted monthly aggregate data stratified by race on breastfeeding, skin-to-skin care, and rooming in practices. RESULTS: The disparity in breastfeeding initiation between African American and white infants decreased by 9.6 percentage points (95% confidence interval 1.6-19.5) over the course of 31 months. Breastfeeding initiation increased from 66% to 75% for all races combined, and exclusivity increased from 34% to 39%. Initiation and exclusive breastfeeding among African American infants increased from 46% to 63% (P < .05) and from 19% to 31% (P < .05), respectively. Skin-to-skin care after cesarean delivery was significantly associated with increased breastfeeding initiation and exclusivity in all races; rooming in was significantly associated with increased exclusive breastfeeding in African American infants only. CONCLUSIONS: Increased compliance with the Ten Steps was associated with a decrease in racial disparities in breastfeeding.