title: Community Rates of Breastfeeding Initiation.
abstract: BACKGROUND
  Breastfeeding initiation rates vary considerably across racial and ethnic groups, maternal age, and education level, yet there are limited data concerning the influence of geography on community rates of breastfeeding initiation.
  
  
  OBJECTIVE
  This study aimed to describe how community rates of breastfeeding initiation vary in geographic space, highlighting "hot spots" and "cool spots" of initiation and exploring the potential connections between race, socioeconomic status, and urbanization levels on these patterns.
  
  
  METHODS
  Birth certificate data from the Kentucky Department of Health for 2004-2010 were combined with county-level geographic base files, Census 2010 demographic and socioeconomic data, and Rural-Urban Continuum Codes to conduct a spatial statistical analysis of community rates of breastfeeding initiation.
  
  
  RESULTS
  Between 2004 and 2010, the average rate of breastfeeding initiation for Kentucky increased from 43.84% to 49.22%. Simultaneously, the number of counties identified as breastfeeding initiation hot spots also increased, displaying a systematic geographic pattern in doing so. Cool spots of breastfeeding initiation persisted in rural, Appalachian Kentucky. Spatial regression results suggested that unemployment, income, race, education, location, and the availability of International Board Certified Lactation Consultants are connected to breastfeeding initiation.
  
  
  CONCLUSIONS
  Not only do spatial analytics facilitate the identification of breastfeeding initiation hot spots and cool spots, but they can be used to better understand the landscape of breastfeeding initiation and help target breastfeeding education and/or support efforts.
authors: 1 Center for Spatial Reasoning & Policy Analytics, College of Public Service & Community Solutions, Arizona State University, Phoenix, AZ, USA.
authors: Tony H
authors: TH
authors: Grubesic
authors: 2 La Leche League International, Schaumburg, IL, USA.
authors: Kelly M
authors: KM
authors: Durbin
mesh_terms: D001942:Breast Feeding / Q000523:psychology* / Q000706:statistics & numerical data; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007629:Kentucky; D009035:Mothers / Q000523:psychology* / Q000706:statistics & numerical data; D011181:Postnatal Care / Q000379:methods / Q000523:psychology / Q000706:statistics & numerical data; D011247:Pregnancy; D011634:Public Health / Q000379:methods / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012424:Rural Population / Q000706:statistics & numerical data; D012959:Socioeconomic Factors; D062206:Spatial Analysis; D014505:Urban Population / Q000706:statistics & numerical data
keywords: Kentucky; breastfeeding; breastfeeding initiation; geography; spatial analysis