title: Impact of breastfeeding self-efficacy and sociocultural factors on early breastfeeding in an urban, predominantly Dominican community.
abstract: BACKGROUND
  Latinas have high breastfeeding initiation rates that decrease significantly in the first postpartum months. Little is known about the effects of self-efficacy and sociocultural factors on early breastfeeding among low-income Latinas. This study quantifies early breastfeeding rates and identifies factors associated with breastfeeding at 4-6 weeks postpartum in our community.
  
  
  METHODS
  Mothers were recruited from a newborn clinic (NBC) in the first postpartum week. Questionnaires in the NBC and 4-6 weeks later assessed feeding practices, breastfeeding self-efficacy, and sociocultural factors. Feeding practices in the well baby nursery (WBN) were obtained by chart review. A scale from "1" (exclusive formula feeding) to "5" (exclusive breastfeeding) characterized feeding practices. Paired-sample t tests assessed change in feeding practices, and regression analysis assessed the impact of factors on breastfeeding at 4-6 weeks.
  
  
  RESULTS
  We interviewed 209 women: 86.1% Latina, 47.3% foreign-born, and 94.2% Medicaid-recipients. Breastfeeding increased from WBN to NBC (2.6±1.2 to 2.9±1.4; p<0.05) and then decreased by 4-6 weeks (2.9±1.4 to 2.5±1.44; p<0.05), without significant change between WBN and 4-6 weeks. Higher levels of education [β=0.21 (0.08, 0.56)], breastfeeding a previous child for ≥6 months [β=0.35 (0.57, 1.8)], foreign birth [β=0.2 (0.06, 1.07)], and higher breastfeeding self-efficacy scores [β=0.38 (0.02, 0.05)] were associated with more breastfeeding. Higher breastfeeding self-efficacy scores were associated with exclusive breastfeeding [adjusted odds ratio=1.18 (1.05, 1.32)].
  
  
  CONCLUSIONS
  Breastfeeding self-efficacy was the sole, modifiable factor associated with exclusive breastfeeding. Efforts to improve breastfeeding self-efficacy may serve to support breastfeeding in this population.
authors.affiliation: 1 Division of Child and Adolescent Health, Columbia University , New York, New York.
authors.forename: Melissa E
authors.initials: ME
authors.lastname: Glassman
authors.forename: Karen
authors.initials: K
authors.lastname: McKearney
authors.forename: Minna
authors.initials: M
authors.lastname: Saslaw
authors.forename: Dana R
authors.initials: DR
authors.lastname: Sirota
mesh_terms: D000293:Adolescent; D000328:Adult; D001903:Bottle Feeding / Q000208:ethnology / Q000523:psychology; D001942:Breast Feeding / Q000208:ethnology / Q000523:psychology; D002755:Choice Behavior; D005247:Feeding Behavior; D005260:Female; D006630:Hispanic or Latino / Q000523:psychology / Q000706:statistics & numerical data; D006801:Humans; D007231:Infant, Newborn; D009035:Mothers / Q000523:psychology; D009519:New York City / Q000453:epidemiology; D011203:Poverty; D011247:Pregnancy; D020377:Self Efficacy; D011795:Surveys and Questionnaires