title: Predictive Models for Characterizing Disparities in Exclusive Breastfeeding Performance in a Multi-ethnic Population in the US.
abstract: OBJECTIVE
  Maternal lactation performance varies across populations, yet the relative impact of maternal sociodemographics, perinatal factors, and birth outcomes on disparities in exclusive breastfeeding (XBR) outcomes is not well known. We aimed to develop predictive models and compare the relative contribution of predictors for XBR initiation and XBR ≥ 6 months.
  
  
  METHODS
  Infant feeding data were obtained from women with children aged 0-6 years (n = 1471) in a multi-ethnic cross-sectional study in the US (2011-2012). We compared discriminant ability of predictors for ever XBR and XBR ≥ 6 months using discriminant function analysis, respectively. We also calculated adjusted ORs for factors associated with XBR outcomes and breast-bottle feeding (BrBot) subgroups.
  
  
  RESULTS
  Maternal sociodemographics (education level, marital status, nativity, and age at childbirth) had greater discriminating abilities in predicting ever XBR and XBR ≥ 6 months than birth outcomes and perinatal factors. Foreign-born women were two-fold more likely to initiate XBR but not necessarily continue to 6 months compared to their US-born counterparts. Factors associated with BrBot subgroups differed from those associated with XBR outcomes, whereas maternal age was the only predictor consistently associated with ever XBR, XBR ≥ 6 months, and BrBot subgroups. The areas under the receiver operating characteristic curves for models predicting ever XBR and XBR ≥ 6 months were 0.88 (95 % CI 0.85, 0.91) and 0.90 (95 % CI 0.88, 0.93), respectively.
  
  
  CONCLUSIONS
  Findings underscore the importance of educational, clinical, and social support to promote XBR in mothers with sociodemographic factors predictive of none or poor XBR outcomes.
authors.affiliation: Department of Nutritional Sciences, University of Texas at Austin, Austin, TX, 78703, USA. yeyi.zhu@nih.gov.|Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, USA. yeyi.zhu@nih.gov.|Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, 20852, USA. yeyi.zhu@nih.gov.
authors.forename: Yeyi
authors.initials: Y
authors.lastname: Zhu
authors.affiliation: Department of Nutritional Sciences, University of Texas at Austin, Austin, TX, 78703, USA.
authors.forename: Ladia M
authors.initials: LM
authors.lastname: Hernandez
authors.affiliation: Department of Mathematics, University of Texas at Austin, Austin, TX, USA.
authors.forename: Peter
authors.initials: P
authors.lastname: Mueller
authors.affiliation: Department of Nutritional Sciences, University of Texas at Austin, Austin, TX, 78703, USA.
authors.forename: Yongquan
authors.initials: Y
authors.lastname: Dong
authors.affiliation: Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, USA.
authors.forename: Steven
authors.initials: S
authors.lastname: Hirschfeld
authors.affiliation: Department of Nutritional Sciences, University of Texas at Austin, Austin, TX, 78703, USA.|School of Human Ecology, University of Texas at Austin, Austin, TX, USA.
authors.forename: Michele R
authors.initials: MR
authors.lastname: Forman
mesh_terms: D000328:Adult; D001903:Bottle Feeding / Q000706:statistics & numerical data*; D001942:Breast Feeding / Q000208:ethnology*; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D004522:Educational Status; D005006:Ethnicity / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008423:Maternal Age; D009035:Mothers / Q000706:statistics & numerical data*; D011237:Predictive Value of Tests; D011247:Pregnancy; D012944:Social Support; D012959:Socioeconomic Factors
keywords: Breast-bottle feeding; Breastfeeding disparity; Breastfeeding promotion; Exclusive breastfeeding; Multi-ethnic population