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AJPH First Look, published online ahead of print Aug 13, 2008
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AJPH.2007.127118v1
98/10/1872    most recent
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October 2008, Vol 98, No. 10 | American Journal of Public Health 1872-1880
© 2008 American Public Health Association
DOI: 10.2105/AJPH.2007.127118

RESEARCH AND PRACTICE

Multivariate Analysis of State Variation in Breastfeeding Rates in the United States

Michael D. Kogan, PhD, Gopal K. Singh, PhD, Deborah L. Dee, PhD, Candice Belanoff, MPH and Laurence M. Grummer-Strawn, PhD

Michael D. Kogan and Gopal K. Singh are with the Health Resources and Services Administration's Maternal and Child Health Bureau, Rockville, MD. Deborah L. Dee and Laurence M. Grummer-Strawn are with the Centers for Disease Control and Prevention, Atlanta, GA. Candice Belanoff is with Harvard University's School of Public Health, Boston, MA.

Correspondence: Requests for reprints should be sent to Michael D. Kogan, PhD, Health Resources and Services Administration, Maternal and Child Health Bureau, 5600 Fishers Lane, Room 18-41, Rockville, MD 20857 (e-mail: mkogan{at}hrsa.gov).

Objectives. We sought to determine the impact of sociodemographic and behavioral factors and state legislation on breastfeeding initiation (child ever fed breastmilk) and duration.

Methods. We used data from a nationally representative study of children aged 6 to 71 months (N = 33 121); we calculated unadjusted and adjusted state estimates for breastfeeding initiation and duration. We used logistic regression models to examine factors associated with never breastfeeding or breastfeeding less than 6 months. We conducted a multilevel analysis of state legislation's role.

Results. There were wide state variations in breastfeeding initiation and duration. The western and northwestern states had the highest rates. Covariate adjustment accounted for 25% to 30% of the disparity. Multivariate analysis showed that the adjusted odds of not being breastfed were 2.5- to 5.15-times greater in southern states compared with Oregon (reference). Children in states without breastfeeding legislation had higher odds of not being breastfed.

Conclusions. Sociodemographic and maternal factors do not account for most breastfeeding rate variation. The association with breastfeeding legislation should be explored and may reflect cultural norms.






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