title: Racial and Ethnic Differences in Breastfeeding.
abstract: Breastfeeding rates differ among racial/ethnic groups in the United States. Our aim was to test whether racial/ethnic disparities in demographic characteristics, hospital use of infant formula, and family history of breastfeeding mediated racial/ethnic gaps in breastfeeding outcomes.
  
  
  
  We analyzed data from the Community and Child Health Network study (N = 1636). Breastfeeding initiation, postnatal intent to breastfeed, and breastfeeding duration were assessed postpartum. Hierarchical linear modeling was used to estimate relative odds of breastfeeding initiation, postnatal intent, and duration among racial/ethnic groups and to test the candidate mediators of maternal age, income, household composition, employment, marital status, postpartum depression, preterm birth, smoking, belief that "breast is best," family history of breastfeeding, in-hospital formula introduction, and WIC participation.
  
  
  
  Spanish-speaking Hispanic mothers were most likely to initiate (91%), intend (92%), and maintain (mean duration, 17.1 weeks) breastfeeding, followed by English-speaking Hispanic mothers (initiation 90%, intent 88%; mean duration, 10.4 weeks) and white mothers (initiation 78%, intent 77%; mean duration, 16.5 weeks); black mothers were least likely to initiate (61%), intend (57%), and maintain breastfeeding (mean duration, 6.4 weeks). Demographic variables fully mediated disparities between black and white mothers in intent and initiation, whereas demographic characteristics and in-hospital formula feeding fully mediated breastfeeding duration. Family breastfeeding history and demographic characteristics helped explain the higher breastfeeding rates of Hispanic mothers relative to white and black mothers.
  
  
  
  Hospitals and policy makers should limit in-hospital formula feeding and consider family history of breastfeeding and demographic characteristics to reduce racial/ethnic breastfeeding disparities.
authors.affiliation: NorthShore University HealthSystem Department of Pediatrics and Research Institute, Evanston, Illinois; chelseaomckinney@gmail.com.
authors.forename: Chelsea O
authors.initials: CO
authors.lastname: McKinney
authors.affiliation: Crean College of Health and Behavioral Sciences, Chapman University, Orange, California;
authors.forename: Jennifer
authors.initials: J
authors.lastname: Hahn-Holbrook
authors.affiliation: Institute for Policy Research, Northwestern University, Evanston, Illinois;
authors.forename: P Lindsay
authors.initials: PL
authors.lastname: Chase-Lansdale
authors.affiliation: Virginia Tech Carilion Research Institute, Virginia Tech, Roanoke, Virginia;
authors.forename: Sharon L
authors.initials: SL
authors.lastname: Ramey
authors.affiliation: Lake County Health Department and Community Health Center, Waukegan, Illinois;
authors.forename: Julie
authors.initials: J
authors.lastname: Krohn
authors.affiliation: Baltimore Healthy Start, Inc, Baltimore, Maryland;
authors.forename: Maxine
authors.initials: M
authors.lastname: Reed-Vance
authors.affiliation: Pregnancy and Perinatology Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Rockville, Maryland; and.
authors.forename: Tonse N K
authors.initials: TN
authors.lastname: Raju
authors.affiliation: NorthShore University HealthSystem Department of Pediatrics and Research Institute, Evanston, Illinois; Department of Pediatrics, University of Chicago, Pritzker School of Medicine, Chicago, Illinois.
authors.forename: Madeleine U
authors.initials: MU
authors.lastname: Shalowitz
mesh_terms: D000328:Adult; D001741:Black or African American / Q000523:psychology* / Q000706:statistics & numerical data; D001942:Breast Feeding / Q000208:ethnology* / Q000523:psychology / Q000706:statistics & numerical data; D005260:Female; D063105:Food Assistance; D006630:Hispanic or Latino / Q000523:psychology* / Q000706:statistics & numerical data; D006761:Hospitals; D006801:Humans; D007223:Infant; D041943:Infant Formula / Q000706:statistics & numerical data; D007231:Infant, Newborn; D033182:Intention; D016014:Linear Models; D012959:Socioeconomic Factors; D013997:Time Factors; D014481:United States; D044465:White People / Q000523:psychology* / Q000706:statistics & numerical data