Breastfeeding and health outcomes among citizen infants of immigrant mothers.
OBJECTIVE
To examine the associations between breastfeeding and child health outcomes among citizen infants of mothers immigrant to the United States.


METHODS
From September 1998 through June 2004, as part of the Children's Sentinel Nutrition Assessment Program, a sentinel sample of 3,592 immigrant mothers with infants aged 0 to 12 months were interviewed in emergency departments or pediatric clinics in six sites. Mothers reported breastfeeding history, child health history, household demographics, government assistance program participation, and household food security. Infants' weight and length were recorded at the time of visit. Bivariate analyses identified confounders associated with breastfeeding and outcomes, which were controlled in logistic regression. Additional logistic regressions examined whether food insecurity modified the relationship between breastfeeding and child outcomes.


RESULTS
Eighty-three percent of infants of immigrants initiated breastfeeding. Thirty-six percent of immigrant households reported household food insecurity. After controlling for potential confounding variables, breastfed infants of immigrant mothers were less likely to be reported in fair/poor health (adjusted odds ratio [AOR] 0.65, 95% confidence interval [CI] 0.50 to 0.85; P=0.001) and less likely to have a history of hospitalizations (AOR 0.72, CI 0.56 to 0.93, P=0.01), compared to nonbreastfed infants of immigrant mothers. Compared to nonbreastfed infants, the breastfed infants had significantly greater weight-for-age z scores (0.185 vs 0.024; P=0.006) and length-for-age z scores (0.144 vs -0.164; P<0.0001), but there was no significant difference in risk of overweight (weight-for-age >95th percentile or weight-for-length >90th percentile) between the two groups (AOR 0.94, CI 0.73 to 1.21; P=0.63). Household food insecurity modified the association between breastfeeding and child health status, such that the associations between breastfeeding and child health were strongest among food-insecure households.


CONCLUSIONS
Breastfeeding is associated with improved health outcomes for infants of immigrant mothers. Breastfeeding is an optimal strategy in the first year of life to improve all infants' health and growth, especially for children of immigrants who are at greater risk for experiencing food insecurity.
Johns Hopkins School of Public Health, Center for American Indian Health, Albuquerque, NM 87102, USA. nneault@jsph.edu
Nicole B
NB
Neault
Deborah A
DA
Frank
Anne
A
Merewood
Barbara
B
Philipp
Suzette
S
Levenson
John T
JT
Cook
Alan F
AF
Meyers
Patrick H
PH
Casey
Diana B
DB
Cutts
Maureen M
MM
Black
Timothy
T
Heeren
Carol
C
Berkowitz
D001835:Body Weight / Q000502:physiology; D001942:Breast Feeding / Q000208:ethnology*; D002657:Child Development / Q000502:physiology*; D054242:Emigrants and Immigrants; D005260:Female; D006801:Humans; D007223:Infant; D007227:Infant Nutritional Physiological Phenomena; D007231:Infant, Newborn; D015999:Multivariate Analysis; D012044:Regression Analysis; D014481:United States; D014505:Urban Population