Poster #167 - The Influence of Home Visiting Services on Breastfeeding and Bedsharing

• In Event: 2-110 - Poster Session 07
  In Poster Session: PS 07 Section - Prevention and Interventions

Integrative Statement

Background: In recent years, home visiting has attracted growing public support as a means of improving maternal and child health outcomes, particularly in low-income and high-risk populations. Research suggests that, by providing timely information and support, home visitors help to promote positive health behaviors in pregnant women and new mothers. This study examined whether two distinct home visiting programs influenced rates of breastfeeding and bedsharing—two salient and potentially interrelated health behaviors that impact child development.

Method: The Healthy Families Study is a prospective investigation of 239 low-income women with children who were referred to an urban health department for home visiting services. Participants were randomly assigned prenatally either to Healthy Families America (HFA), an evidence-based, long-term program, or to a less intensive, Medicaid-funded nurse home visiting program lasting up to 60 days postpartum. Using an intent-to-treat design, this study compares the two treatment groups to each other and to a third, quasi-experimental group of participants who were referred but did not enroll in services.
Breastfeeding was measured as a dichotomous indicator denoting if a mother initiated breastfeeding and as a continuous indicator denoting the duration of breastfeeding up to one year postpartum. Bedsharing was measured as a dichotomous outcome signifying whether a mother reported that her infant bedshared with a caregiver or another child by six months of age. Descriptive analyses were used to report the prevalence and distribution of study variables. We tested bivariate associations between breastfeeding and bedsharing. We then performed multivariate regressions with bootstrapping to test program effects on breastfeeding and bedsharing, controlling for maternal age, race/ethnicity, and education.

Results: Results showed that 84.2% of mothers initiated breastfeeding, and that the median duration of breastfeeding was 7.8 weeks. By age six months, 44.0% of infants had bedshared. Bivariate analyses showed that breastfeeding at 6 months was significantly correlated with bedsharing (r = 0.17, p = 0.02). Compared to women who did not enroll in services, women receiving HFA services were 3.3 times as likely to breastfeed (p = 0.03) and breastfed approximately six weeks longer on average (p = 0.04). Brief nurse home visiting services were associated with a smaller, non-significant effect on breastfeeding initiation (OR = 2.1, p = 0.16) and no apparent effect on breastfeeding duration (B = 0.66, p = 0.80). Compared to non-recipients, recipients of brief nurse home visiting services did not differ in their rates of bedsharing (OR = 0.8, p = 0.60), while HFA recipients reported significantly higher rates of bedsharing (OR = 2.5, p = 0.02).

Implications: Consistent with prior research, we found that HFA services were associated with increased breastfeeding. Brief nurse home visiting was not linked to reduced bedsharing, while HFA services provided by various human service professionals were associated with increased bedsharing. The potential reasons for this unexpected finding will be discussed, including the possibility that (a) increased breastfeeding is associated with increased bedsharing, and (b) some home visitors may communicate messages that are inconsistent with the American Academy of Pediatrics safe sleep recommendations against bedsharing.

Authors

• Colleen Emily Janczewski, University of Wisconsin-Milwaukee
  Presenting Author

• Joshua Patrick Mersky, University of Wisconsin-Milwaukee
  Non-Presenting Author

• Chien-Ti Lee, University of Wisconsin-Milwaukee
  Non-Presenting Author