title: Changes in Breastfeeding Attitudes in a Metropolitan Community in Tennessee.
abstract: BACKGROUND
  The Southern United States has low breastfeeding rates, particularly among African Americans. Breastfeeding rates are influenced by community attitudes and norms.
  
  
  OBJECTIVE
  This study aimed to examine changes in breastfeeding attitudes and demographic factors related to these attitudes.
  
  
  METHODS
  Cross-sectional data from a community-based survey, repeated annually from 2004 to 2008, were analyzed. Univariable analysis examined trends over time and log binomial regression estimated the strength of the association between year of the survey, demographic factors, and outcome responses related to the survey questions.
  
  
  RESULTS
  After adjusting for sex, race, marital status, age, and education, compared to 2004, 2008 respondents were 26% more likely to rate breastfeeding as extremely important compared to formula feeding (prevalence ratio [PR] = 1.26; 95% confidence interval [CI], 1.10-1.43). Similarly, 2008 respondents were 29% more likely to rate the importance of breastfeeding for long-term health as extremely important (PR = 1.29; 95% CI, 1.14-1.46). Comfort levels with breastfeeding outside the home also increased. Respondents to the 2008 survey were more likely to report that they were comfortable with a mother breastfeeding in their workplace (PR = 1.20; 95% CI, 1.11-1.31) and in a mall or restaurant (PR = 1.15; 95% CI, 1.06-1.26). After controlling for demographic factors, there were no significant differences in responses between African Americans and other races.
  
  
  CONCLUSIONS
  Despite significantly lower breastfeeding rates among African Americans, this analysis revealed significant positive changes in attitudes regarding breastfeeding between 2004 and 2008, regardless of race. These changes in attitude coincided with increased breastfeeding initiation rates, suggesting that federal, state, and local breastfeeding promotion efforts had an effect.
authors.affiliation: Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN, USA.
authors.forename: Simonne S
authors.initials: SS
authors.lastname: Nouer
authors.affiliation: All Better Pediatrics, Memphis, TN, USA Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN, USA.
authors.forename: Julie L
authors.initials: JL
authors.lastname: Ware
authors.affiliation: The Urban Child Institute, Memphis, TN, USA.
authors.forename: Katherine M
authors.initials: KM
authors.lastname: Baldwin
authors.affiliation: Departments of Preventive Medicine and Pediatrics, University of Tennessee Health Science Center, Memphis, TN, USA mhare@uthsc.edu.
authors.forename: Marion E
authors.initials: ME
authors.lastname: Hare
mesh_terms: D000328:Adult; D001741:Black or African American / Q000523:psychology*; D001942:Breast Feeding / Q000208:ethnology / Q000523:psychology* / Q000639:trends; D003430:Cross-Sectional Studies; D005260:Female; D007722:Health Knowledge, Attitudes, Practice / Q000208:ethnology*; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D013714:Tennessee; D014504:Urban Health / Q000208:ethnology* / Q000639:trends
keywords: breastfeeding; breastfeeding attitudes; breastfeeding promotion; epidemiology