amy gagliardi, ma, ibclc, rlc community health center, inc middletown, ct december 8, 2006...
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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
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• [email protected],
[email protected]• (860) 347-6971 x3308