Psychosocial factors associated with racial disparities in exclusive breastfeedingIsiguzo, Chinwoke (2022) Psychosocial factors associated with racial disparities in exclusive breastfeeding. Doctoral Dissertation, University of Pittsburgh. (Unpublished)
AbstractDespite the well-documented benefits of exclusive breastfeeding, many child-bearing people wean their infants before the recommended six months. Black child-bearing people exclusively breastfeed for a shorter time than people of other racial and ethnic groups. The reasons for these continued breastfeeding disparities are unclear; therefore, it is crucial to examine how psychosocial factors contribute to this disparity. This dissertation compared exclusive breastfeeding rates obtained from the 24-hour recall and the since birth methods and estimated the magnitude of difference between both across race and demographic characteristics. I examined the influence of psychosocial factors such as perceived stress, perceived and received social support, racial and gender discrimination, and microaggressions on exclusive breastfeeding. Data were derived from a National Heart, Lung, and Blood Institute (NHLBI) funded study (Postpartum Mobile Mothers Study -PMOMS) collected using ecological momentary assessment (EMA) for 12 months postpartum. The analyses included: 1) Mixed-effects logistic regression model with random intercepts to establish the relationship between perceived stress, social support, and exclusive breastfeeding; 2) Generalized structural equation modeling to test the hypothesized pathway through which racial and gender discrimination and microaggression would directly or indirectly influence exclusive breastfeeding through perceived stress. The 24-hour recall exclusive breastfeeding rates were higher across the first six months postpartum than the since birth exclusive breastfeeding rates. Participants who reported higher perceived stress were less likely to breastfeed exclusively for six months. Perception of social support moderated the relationship between perceived stress and breastfeeding. In contrast, receiving social support did not moderate the relationship between perceived stress and exclusive breastfeeding but directly increased the likelihood of exclusive breastfeeding. Black participants were less likely to exclusively breastfeed in the study. Perceived stress mediated the relationship between microaggressions and exclusive breastfeeding such that microaggressions increased stress, which in turn reduced the likelihood of exclusive breastfeeding. This study shows that racial differences, stress, social support, and microaggressions influence exclusive breastfeeding and may contribute to the racial disparities observed in exclusive breastfeeding rates. Addressing these factors would improve exclusive breastfeeding rates among child-bearing people and bridge the racial gap. Share
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