title: Barriers to Human Milk Feeding at Discharge of Very Low-Birthweight Infants: Evaluation of Neighborhood Structural Factors.
abstract: Although 98% of mothers in our cohort initiated human milk (HM) provision for their very low-birthweight (VLBW) infants, fewer black infants received HM at neonatal intensive care unit (NICU) discharge than non-black infants. This study examined neighborhood structural factors associated with HM feeding at discharge to identify potential barriers.
  
  
  
  Sociodemographic and HM data were prospectively collected for 410 VLBW infants and mothers. Geocoded addresses were linked to neighborhood structural factors. Bivariate and multivariate logistic regression analyses were conducted for the entire cohort and racial/ethnic subgroups.
  
  
  
  HM feeding at discharge was positively correlated with further distance from Women, Infants, and Children (WIC) office, less violent crime, less poverty, greater maternal education, older maternal age, greater infant gestational age, and shorter NICU hospitalization. Multivariate analysis demonstrated that only maternal race/ethnicity, WIC eligibility, and length of NICU hospitalization predicted HM feeding at discharge for the entire cohort. The interaction between access to a car and race/ethnicity significantly differed between black and white/Asian mothers, although the predicted probability of HM feeding at discharge was not significantly affected by access to a car for any racial/ethnic subgroup.
  
  
  
  Neighborhood structural factors did not significantly impact HM feeding at discharge. However, lack of access to a car may be a factor for black mothers, potentially representing restricted HM delivery to the NICU or limited social support, and warrants further study.
authors.affiliation: 1 College of Nursing, Rush University Medical Center , Chicago, Illinois.
authors.forename: Brittany
authors.initials: B
authors.lastname: Riley
authors.affiliation: 1 College of Nursing, Rush University Medical Center , Chicago, Illinois.
authors.forename: Michael
authors.initials: M
authors.lastname: Schoeny
authors.affiliation: 2 Department of Pediatrics, Rush University Medical Center , Chicago, Illinois.
authors.forename: Laura
authors.initials: L
authors.lastname: Rogers
authors.affiliation: 3 College of Nursing, University of Illinois at Chicago , Chicago, Illinois.
authors.forename: Ifeyinwa V
authors.initials: IV
authors.lastname: Asiodu
authors.affiliation: 2 Department of Pediatrics, Rush University Medical Center , Chicago, Illinois.
authors.forename: Harold R
authors.initials: HR
authors.lastname: Bigger
authors.affiliation: 1 College of Nursing, Rush University Medical Center , Chicago, Illinois.|2 Department of Pediatrics, Rush University Medical Center , Chicago, Illinois.
authors.forename: Paula P
authors.initials: PP
authors.lastname: Meier
authors.affiliation: 1 College of Nursing, Rush University Medical Center , Chicago, Illinois.|2 Department of Pediatrics, Rush University Medical Center , Chicago, Illinois.
authors.forename: Aloka L
authors.initials: AL
authors.lastname: Patel
mesh_terms: D000328:Adult; D001903:Bottle Feeding / Q000208:ethnology / Q000523:psychology / Q000706:statistics & numerical data; D001942:Breast Feeding / Q000208:ethnology / Q000523:psychology / Q000706:statistics & numerical data*; D002641:Chicago / Q000453:epidemiology; D004522:Educational Status; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007227:Infant Nutritional Physiological Phenomena; D007231:Infant, Newborn; D007234:Infant, Premature; D019102:Infant, Very Low Birth Weight; D007363:Intensive Care Units, Neonatal; D009035:Mothers / Q000523:psychology*; D010351:Patient Discharge; D011247:Pregnancy; D011446:Prospective Studies; D044469:Racial Groups / Q000523:psychology / Q000706:statistics & numerical data; D012111:Residence Characteristics; D012959:Socioeconomic Factors