639 - Neighborhood-Level Social Determinants of Health as a Predictor of Human Milk Feeding Behaviors in the First Two Years of Life

Publication Number: 639.6019

Danielle P. Tyson, Ohio State University College of Medicine, Columbus, OH, United States; Deena J. Chisolm, Nationwide Childrens Hospital, Columbus, OH, United States; Maria F. Gallo, Ohio State University, College of Public Health, Columbus, OH, United States

Background: Exclusive human milk feeding is recommended for infant feeding in the first six months of life. However, only a quarter of infants in the United States meet the recommended human milk feeding goals. A person’s social determinants of health, including neighborhood-level factors , strongly influence their ability to perform recommended health behaviors.

Objective: The goal of this study was to evaluate the association between neighborhood-level social determinants of health and human milk feeding behaviors among infants who received primary care at a large pediatric hospital system in the Midwest during the first 30 days of life.

Design/Methods: We conducted a secondary analysis of electronic health record data from infants born from April 2019 through July 2022, which were linked to state birth certificate data to obtain maternal demographic information and hospital breastfeeding data. Data on infant food intake was routinely recorded into the health record during well-child visits. For each visit in the first two years of life, we used this feeding data to categorize an infant’s human milk consumption as exclusive, mixed, or none. Neighborhood-level social determinants of health were measured at the census tract level using the Child Opportunity Index (COI) 2.0 corresponding to the infant’s first listed address. We used multivariable interval-censored accelerated failure time modeling to evaluate the time to cessation of (1) exclusive human milk feeding and (2) any human milk feeding. In secondary analyses, we used multivariable logistic regression modeling to evaluate the odds of (1) breastfeeding initiation and (2) exclusive breastfeeding at hospital discharge.

Results: This study included 12,761 infants representing 446 census tracts. The COI 2.0 was statistically significantly associated with initiating breastfeeding (p-value=0.025) and the time to cessation of any human milk feeding (p-value=0.013). Compared to very-low-opportunity neighborhoods, living in neighborhoods with higher opportunity levels was associated with increased odds of breastfeeding initiation and increased time to cessation of any human milk feeding. We did not observe a significant association between neighborhood opportunity level and exclusive human milk feeding.

Conclusion(s): Neighborhood-level social determinants of health were associated with odds of breastfeeding initiation and the time to cessation of any human milk feeding. These findings can be used to help identify patients and communities who may need additional human milk feeding education and support and to guide future research and policy decisions.