title: Pacifier Use and Exclusive Breastfeeding in Brazil.
abstract: BACKGROUND
  Exclusive breastfeeding (EBF) rates for infants younger than 6 months have increased in Brazil, although at the current pace of improvement it would take 6 years to reach an EBF rate of 50%. Thus, it is important to identify relevant modifiable key risk factors for the premature interruption of EBF.
  
  
  OBJECTIVE
  This study aimed to find out if pacifier use is an independent risk factor for the interruption of EBF among Brazilian infants.
  
  
  METHODS
  We conducted secondary cross-sectional data analyses of 2 waves of infant feeding surveys conducted in 1999 and in 2008 in the Brazilian state capitals and Federal District (N = 42 395 children < 6 months). Multivariate logistic regression was used to test the association between pacifier use and the risk of interruption of EBF in a pooled sample and within each survey wave, adjusting for socioeconomic, demographic, and biomedical confounders.
  
  
  RESULTS
  In the pooled sample, a third of the infants were exclusively breastfed (32.7%) and almost 50% had used a pacifier. Whereas EBF prevalence among infants increased from 25.1% in 1999 to 40.3% in 2008, pacifier use prevalence decreased from 58.5% to 41.6% in the same time period. Pacifier use was strongly associated with the risk of interruption of EBF in 1999 (adjusted odds ratio [AOR] = 2.65; 95% confidence interval [CI], 2.38-2.94), in 2008 (AOR = 3.18; 95% CI, 2.81-3.60), and in the pooled sample (AOR = 2.77; 95% CI, 2.63-2.91) after adjusting for key confounders.
  
  
  CONCLUSIONS
  Pacifier use was the strongest risk factor for EBF interruption. Effective strategies to reduce pacifier use among infants younger than 6 months may further improve EBF rates in Brazil.
authors.affiliation: Program of Nutrition in Public Health, School of Public Health, University of São Paulo, São Paulo, Brazil gabibuccini@usp.br.
authors.forename: Gabriela Dos Santos
authors.initials: Gdos S
authors.lastname: Buccini
authors.affiliation: Yale School of Public Health, New Haven, CT, USA.
authors.forename: Rafael
authors.initials: R
authors.lastname: Pérez-Escamilla
authors.affiliation: Instituto de Saúde, Secretaria Estadual da Saúde de São Paulo, São Paulo, Brazil.
authors.forename: Sonia Isoyama
authors.initials: SI
authors.lastname: Venancio
mesh_terms: D000328:Adult; D001938:Brazil; D001942:Breast Feeding / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D005260:Female; D006306:Health Surveys; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D016015:Logistic Models; D008297:Male; D016017:Odds Ratio; D041361:Pacifiers / Q000706:statistics & numerical data*; D012307:Risk Factors
keywords: Brazil; breastfeeding; exclusive breastfeeding; pacifiers; risk factors