# Presentation: 459759

## Amy Gagliardi, MA, IBCLC, RLC
Community Health Center, Inc
Middletown, CT

December 8, 2006

**Community 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.

## History Timeline – Helping Out Neighboring Communities

**Old Saybrook****	****	****1980**
**Meriden****	****	****1990**
**New London****	****	****1992**
**Groton****	****	****1994**
**New Britain****	****	****1995**
**Clinton****	****   2001**
**Westbrook****	****	****2002 **
**Norwalk****	****	****2005**
**Mobile dentistry****	****   2005**
**Stamford****	****	****2005**

**History Timeline – Helping Out Neighboring Communities**

## What The Eye Sees...

## 2005 In Review

**2005 In Review**

## A Statewide Organization

## Services Provided

## 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 | 231
695 | 145 (68%)
512 (74%) | 1.66**
(1.21-2.28) |
| Living Arrangement
     Not with partner
     With partner | 161
206 | 116 (72%)
163 (79%) | 1.47 
(.91-2.38) |
| Smoker
     Yes
     No | 253
552 | 154 (61%)
411 (75%) | 1.87**
(1.37-2.57) |
| Hx of Substance Use
     Yes
     No | 221
584 | 147 (67%)
418 (72%) | 1.27
(.91-1.77) |
| Hx of Sexual Abuse
     Yes
     No | 106
699 | 77 (73%)
488 (70%) | .87 
(.55-1.38) |
| Hx of Violence
     Yes
     No | 147
658 | 99 (67%)
466 (71%) | 1.18
(.80-1.73) |
| Hx of Psychiatric Diagnosis
     Yes
     No | 61
748 | 44 (72%)
523 (70%) | .90
(.50-1.20) |

- **p<.01

## Figure 1: Differences In Initiation and Duration By Race/Ethnicity

## Figure 3: Initiation and Duration Based on Living Arrangements

## 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](mailto:gagliardi@chc1.com)__, __[gagliardia@sbcglobal.net](mailto:gagliardia@sbcglobal.net)_
- (860) 347-6971 x3308