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Motherhood meets epidemiology: measuring risk factors for breast–feeding cessation

Published online by Cambridge University Press:  02 January 2007

Jennifer K Peat*
Affiliation:
Clinical Epidemiology Unit, The Children's Hospital at Westmead, Locked Bag 4001, Westmead, New South Wales 2145, Australia
Jane Allen
Affiliation:
James Fairfax Institute of Paediatric Nutrition, The Children's Hospital at Westmead, Westmead, Australia
Nguyen Nguyen
Affiliation:
Garvan Institute of Medical Research, St Vincent Hospital, Sydney, Australia
Andrew Hayen
Affiliation:
NSW Department of Health, Sydney, Australia
Wendy H Oddy
Affiliation:
School of Public Health, Curtin University of Technology, Telethon Institute for Child Health Research, Perth, Australia
Seema Mihrshahi
Affiliation:
Clinical Epidemiology Unit, The Children's Hospital at Westmead, Locked Bag 4001, Westmead, New South Wales 2145, Australia
*
*Corresponding author: Email jennifp2@chw.edu.au
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Abstract

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Objective:

To examine statistical models that have been used to predict the cessation of breast–feeding.

Setting:

In nutritional epidemiology, a knowledge of risk factors that lead to breast-feeding cessation is essential to promote optimal infant health by increasing or sustaining breast–feeding rates. However, a number of methodological issues complicate the measurement of such risk factors. It is important when building multivariate models that variables entered into the model are not intervening variables, factors on the causal pathway or surrogate outcomes. Inclusion of these types of variable can lead to inaccurate models and biased results. A factor often cited to predict breast–feeding is ‘intention to breast–feed’ prior to the birth of the infant, although this factor is directly on the causal decision–making pathway. Another factor often cited is the age of introduction of formula feeding, which is actually part of the outcome variable because formula feeding defines the difference between full, complementary and no breast-feeding. Rather than include these as risk factors in multivariate models, factors removed from the causal pathway such as influences of educational practices, including advice to complementary feed, and beliefs and attitudes of families and health-care practitioners should be measured.

Conclusions:

The accurate quantification of modifiable risk factors is essential for designing public health education campaigns that are effective in sustaining or increasing breast–feeding duration.

Type
Research Article
Copyright
Copyright © The Authors 2004

References

1Scott, JA, Binns, CW. Factors associated with the initiation and duration of breastfeeding: a review of the literature. Australian Journal of Nutrition and Dietetics 1998; 55: 5161.Google Scholar
2Rothman, KJ. Modern Epidemiology. Boston, MA: Little, Brown and Company, 1986; 125–30.Google Scholar
3Hennekens, CH, Buring, JE. Analysis of epidemiologic studies: evaluating the role of confounding. In: Mayrent, SL, ed. Epidemiology in Medicine. Boston, MA: Little, Brown and Company, 1987; 287321.Google Scholar
4World Health Organization (WHO). Evidence for the Ten Steps to Successful Breastfeeding. WHO/CHD/98.9. Geneva: WHO, 1998.Google Scholar
5WHO Collaborative Study Team on the Role of Breastfeed–ing on the Prevention of Infant Mortality. Effect of breastfeeding on infant and child mortality due to infectious diseases in less developed countries. Lancet 2000; 355: 451–5.CrossRefGoogle Scholar
6Leon-Cava, N, Lutter, C, Ross, J, Martin, L. Quantifying the Benefits of Breastfeeding: A Summary of the Evidence. The Linkages Project. Washington, DC: Pan American Health Organization, 2002.Google Scholar
7Brandtzaeg, P. Mucosal immunity integration between mother and the breast–fed infant. Vaccine 2003; 21: 3382–8.CrossRefGoogle ScholarPubMed
8Oddy, W. Breastfeeding protects against illness and infection in infants and children: a review of the evidence. Breastfeeding Review 2001; 9: 11–8.Google ScholarPubMed
9American Academy of Pediatrics. Breastfeeding and the use of human milk. Pediatrics 1997; 100: 1035–9.CrossRefGoogle Scholar
10Michaelsen, KF, Weaver, L, Branca, F, Robertson, A. Feeding and Nutrition of Infants and Young Children: Guidelines for the WHO European Region, with Emphasis on the Former Soviet Countries. Copenhagen: World Health Organization Regional Office for Europe, 2000.Google Scholar
11World Health Organization (WHO). The Optimal Duration of Exclusive Breastfeeding. Geneva: WHO, 2001.Google Scholar
12National Health and Medical Research Council. Dietary Guidelines for Children and Adolescents in Australia. Canberra: Commonwealth of Australia, 2003.Google Scholar
13Wright, AL. The rise of breastfeeding in the United States. Pediatric Clinics of North America 2001; 48: 112.CrossRefGoogle ScholarPubMed
14Donath, S, Amir, LH. Rates of breastfeeding in Australia by state and socio–economic status: evidence from the 1995 National Health Survey. Journal of Paediatric and Child Health 2000; 36: 164–8.CrossRefGoogle ScholarPubMed
16Loughlin, HH, Clapp-Channing, NE, Gehlbach, SH, Pollard, JC, McCutchenr', TM. Early termination of breast feeding; indentifying those at risk. Pediatrics 1985; 75: 508–13.CrossRefGoogle Scholar
17Cronenwett, L, Stukel, T, Kearney, M, Barrett, J, Covington, A, Del Monte, K, et al. Single daily bottle use in the early weeks postpartum and breast feeding outcomes. Pediatrics 1992; 90: 760–6.CrossRefGoogle ScholarPubMed
18Lawson, K, Tulloch, MI. Breast feeding duration: prenatal intentions and postnatal practices. Journal of Advanced Nursing 1995; 22: 841–9.CrossRefGoogle ScholarPubMed
19Quarles, A, Williams, PD, Hoyle, DA, Brimeyer, M, Williams, AR. Mothers' intention, age, education and the duration and management of breast feeding. Maternal–Child Nursing Journal 1994; 22: 102–8.Google Scholar
20Hornell, A, Hofvander, Y, Kylberg, E. Solids and formula: association with pattern and duration of breastfeeding. Pediatrics 2001; 107: 31–7.CrossRefGoogle ScholarPubMed
21Dulon, M, Kersting, M, Schach, S. Duration of breastfeeding and associated factors in Western and Eastern Germany. Acta Paediatrica 2001; 90: 931–5.CrossRefGoogle ScholarPubMed
22Hall, RT, Mercer, AM, Teasley, SL, McPherson, DM, Simon, SD, Santos, SR, et al. A breastfeeding assessment score to evaluate the risk for cessation of breastfeeding by 7 to 10 days of age. Journal of Pediatrics 2002; 141: 659–64.CrossRefGoogle ScholarPubMed
23Henderson, L, Kitzinger, J, Green, J. Representing infant feeding: content analysis of British media portrayals of bottle feeding and breast feeding. British Medical Journal 2000; 321: 1196–8.CrossRefGoogle ScholarPubMed
24Kramer, K. Breastfeeding and child health, growth, and survival [Commentary]. International Journal of Epidemiology 2003; 32: 96–8.CrossRefGoogle ScholarPubMed
25Rutishauser, IHE, Carlin, JB. Body mass index and duration of breastfeeding: a survival analysis during the first six months of life. Journal of Epidemiology and Community Health 1992; 46: 559–65.CrossRefGoogle ScholarPubMed
26Oddy, WH, Peat, JK. Breastfeeding, asthma and atopic disease: an epidemiological review of the literature. Journal of Human Lactation 2003; 19: 250–61.CrossRefGoogle ScholarPubMed
27Diong, S, Johnson, M, Langdon, R. Breastfeeding and Chinese mothers living in Australia. Breastfeeding Review 2000; 8: 1723.Google ScholarPubMed
28Scott, JA, Landers, MCG, Hughes, RM, Binns, CW. Factors associated with breastfeeding at discharge and duration of breastfeeding. Journal of Paediatrics and Child Health 2001; 37: 254–61.CrossRefGoogle ScholarPubMed
29Kramer, MS, Chalmers, B, Hodnett, ED, Sevkovskaya, Z, Dzikovich, I, Shapiro, S, et al. Promotion of breastfeeding intervention trial (PROBIT). A randomized trial in the Republic of Belarus. Journal of the American Medical Association 2001; 285: 413–20.CrossRefGoogle ScholarPubMed
30Kramer, MS, Kakuma, R. Optimal duration of exclusive breastfeeding. Cochrane Database of Systematic Reviews 2002: CD003517.CrossRefGoogle Scholar