Multivariate analysis of state variation in breastfeeding rates in the United States.
OBJECTIVE
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.
Kogan
Michael D
MD
Health Resources and Services Administration, Maternal and Child Health Bureau, 5600 Fishers Lane, Room 18-41, Rockville, MD 20857, USA. mkogan@hrsa.gov
Singh
Gopal K
GK
Dee
Deborah L
DL
Belanoff
Candice
C
Grummer-Strawn
Laurence M
LM
D001294:Attitude to Health; D001942:Breast Feeding / Q000453:epidemiology / Q000523:psychology; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005260:Female; D015438:Health Behavior; D007722:Health Knowledge, Attitudes, Practice; D006293:Health Promotion / Q000331:legislation & jurisprudence* / Q000379:methods; D006301:Health Services Needs and Demand; D006306:Health Surveys; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D016015:Logistic Models; D009035:Mothers / Q000193:education / Q000331:legislation & jurisprudence / Q000523:psychology / Q000706:statistics & numerical data; D015999:Multivariate Analysis; D011203:Poverty; D012111:Residence Characteristics; D012945:Social Values; D012959:Socioeconomic Factors; D013219:State Government; D013997:Time Factors; D014481:United States