title: Rural and urban breastfeeding initiation trends in low-income women in North Carolina from 2003 to 2007.
abstract: Breastfeeding has extensive health benefits for both infants and mothers. Despite these benefits, a significant number of women, disproportionately low-income women, do not initiate breastfeeding. Previous research has also demonstrated that breastfeeding prevalence varies by urbanicity level. The objective was to examine race/ethnicity and urbanicity trends in breastfeeding initiation among low-income women in North Carolina from 2003 to 2007. Breastfeeding initiation data from the North Carolina Pregnancy Nutrition Surveillance System were utilized, with responses from 240,054 women over the 5-year period. Overall, 65.4% of women in mixed-urban counties and 62.1% of women in urban counties initiated breastfeeding compared to only 49.8% of women in rural counties. The disparity between rural and urban counties widened over time, with urban and mixed-urban counties making significantly greater gains in breastfeeding initiation than rural counties. Hispanic and non-Hispanic white women had 6.17 (95% confidence interval [CI], 5.99-6.36) and 1.4 (95% CI, 1.46-1.53) times the odds of initiating breastfeeding as non-Hispanic blacks, respectively. Finally, stratified multivariate regression models identified that the association between race/ethnicity and breastfeeding varied by urbanicity level. The current study provides a clearer picture of rural and urban breastfeeding trends within North Carolina and has implications for states with similar racial/ethnic and urbanicity levels. The research determined that women in rural areas, particularly non-Hispanic blacks, are less likely to initiate breastfeeding. Increased emphasis should be placed on developing breastfeeding interventions for rural communities, particularly targeting the non-Hispanic black population.
authors.affiliation: Department of Public Health, Brody School of Medicine, East Carolina University, Greenville, North Carolina, USA
authors.forename: Suzanne
authors.initials: S
authors.lastname: Lynch
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Bethel
authors.forename: Najmul
authors.initials: N
authors.lastname: Chowdhury
authors.forename: Justin B
authors.initials: JB
authors.lastname: Moore
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D001942:Breast Feeding / Q000208:ethnology / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D009657:North Carolina / Q000453:epidemiology; D009749:Nutrition Surveys; D011203:Poverty / Q000706:statistics & numerical data*; D012424:Rural Population / Q000706:statistics & numerical data*; D012959:Socioeconomic Factors; D014505:Urban Population / Q000706:statistics & numerical data*; D055815:Young Adult