US National Breastfeeding Surveillance: Current status and recommendations Donna J. Chapman, Ph. D, RD and Rafael Pérez-Escamilla, Ph. D University of Connecticut, Dept of Nutritional Sciences NIH EXPORT Center for Eliminating Health Disparities Among Latinos
Objectives: n Identify sources of nationally representative breastfeeding data n Assess quality of data collected n Make recommendations to improve national breastfeeding surveillance
Methods: Breastfeeding Surveillance Assessment National Surveys with Breastfeeding Data Standard Certificate of Live Birth (SCLB) (Was infant BF on discharge? ) • Federally Funded • Nation-wide data • BF initiation/duration • BF behavior of individuals CDC Website Contact CDC Emailed Registrars of Vital Statistics (8/2006) • Using SCLB/ documenting BF initiation? • If no, planning to use SCLB? Literature Review Follow-up contact 10 Relevant Surveys Downloaded & Evaluated • Non-responders • States planning SCLB use
Surveys Included: n Longitudinal Surveys (n=2) n n n Program-based Surveillance (n=2) n n n Infant Feeding Practices Survey II Early Childhood Longitudinal Survey, Birth Cohort Pregnancy Nutrition Surveillance System (PNSS) Pediatric Nutrition Surveillance System (Ped. NSS) Cross-sectional surveys (n=6) n n n National Immunization Survey, 2005 NHANES 2003/2004 National Survey of Family Growth, 2002 Pregnancy Risk Assessment Monitoring System (PRAMS) National Survey of Early Childhood Health, 2000 National Survey of Children’s Health, 2007
Variables of Interest n BF outcomes n n n Ethnic descriptors and related variables n n n BF initiation, duration of any/exclusive BF, current BF status Wording of BF questions Ethnicity categories Maternal birthplace Acculturation Conducted in Puerto Rico Confounders n Age, education, income, household size, BMI
Breastfeeding Initiation PNSS, Ped. NSS: Not specified NIS=National Immunization Survey, NSCH= National Survey of Children’s Health, NHANES=National Health and Nutrition Examination Survey, PRAMS=Pregnancy Risk Assessment Monitoring System, NSFG=National Survey of Family Growth, ECLS=Early Childhood Longitudinal Survey, NSECH=National Survey of Early Childhood Health, IFPSII=Infant Feeding Practice Survey II
BF Duration/Current Status Ped. NSS: Not specified; PNSS: Not collected NIS=National Immunization Survey, NSCH= National Survey of Children’s Health, NHANES=National Health and Nutrition Examination Survey, PRAMS=Pregnancy Risk Assessment Monitoring System, NSFG=National Survey of Family Growth, ECLS=Early Childhood Longitudinal Survey, NSECH=National Survey of Early Childhood Health, IFPSII=Infant Feeding Practice Survey II
Exclusive BF Duration /Current status PNSS, Ped. NSS, NSECH: Data not collected NIS=National Immunization Survey, NSCH= National Survey of Children’s Health, NHANES=National Health and Nutrition Examination Survey, PRAMS=Pregnancy Risk Assessment Monitoring System, NSFG=National Survey of Family Growth, ECLS=Early Childhood Longitudinal Survey; NSECH=National Survey of Early Childhood Health, IFPSII=Infant Feeding Practice Survey II
Racial / Ethnic Categories PRAMS: Linked to birth certificate NIS=National Immunization Survey, NSCH= National Survey of Children’s Health, NHANES=National Health and Nutrition Examination Survey, PRAMS=Pregnancy Risk Assessment Monitoring System, NSFG=National Survey of Family Growth, ECLS=Early Childhood Longitudinal Survey, NSECH=National Survey of Early Childhood Health, IFPSII=Infant Feeding Practice Survey II
Hispanic Ethnic Descriptors PRAMS: Linked to birth certificate for ethnic data NIS=National Immunization Survey, NSCH= National Survey of Children’s Health, NHANES=National Health and Nutrition Examination Survey, PRAMS=Pregnancy Risk Assessment Monitoring System, NSFG=National Survey of Family Growth, ECLS=Early Childhood Longitudinal Survey, NSECH=National Survey of Early Childhood Health, IFPSII=Infant Feeding Practice Survey II
Asian Ethnic Descriptors PRAMS: Linked to birth certificate for ethnic data NIS=National Immunization Survey, NSCH= National Survey of Children’s Health, NHANES=National Health and Nutrition Examination Survey, PRAMS=Pregnancy Risk Assessment Monitoring System, NSFG=National Survey of Family Growth, ECLS=Early Childhood Longitudinal Survey, NSECH=National Survey of Early Childhood Health, IFPSII=Infant Feeding Practice Survey II
Black Ethnic Descriptors PRAMS: Linked to birth certificate for ethnic data NIS=National Immunization Survey, NSCH= National Survey of Children’s Health, NHANES=National Health and Nutrition Examination Survey, PRAMS=Pregnancy Risk Assessment Monitoring System, NSFG=National Survey of Family Growth, ECLS=Early Childhood Longitudinal Survey, NSECH=National Survey of Early Childhood Health, IFPSII=Infant Feeding Practice Survey II
Confounding Variables NIS=National Immunization Survey, NSCH= National Survey of Children’s Health, NHANES=National Health and Nutrition Examination Survey, PRAMS=Pregnancy Risk Assessment Monitoring System, NSFG=National Survey of Family Growth, ECLS=Early Childhood Longitudinal Survey, NSECH=National Survey of Early Childhood Health, IFPSII=Infant Feeding Practice Survey II
US Standard Certificate of Live Birth (SCLB) n Model/template birth certificate n 2004: Latest revision Includes maternal worksheet n Includes section for MD to complete n n Documents breastfeeding at discharge
Standard Certificate of Live Birth
Results: Standard Certificate of Live Birth (SCLB) n 51/54 states/territories responded 24 are using the SCLB n 27 are not using SCLB n n 12/27 working toward SCLB implementation
Adoption of SCLB (10/2007)
Recommendations n Formally n n n establish BF surveillance system Adopt consistent wording for BF variables Use more detailed ethnic descriptors Routinely collect data in all US territories Consistently assess acculturation Add key variables associated with BF outcomes Encourage nationwide adoption of SCLB
Acknowledgment n CDC staff n n n Administrative Assistance n n Laurence Grummer-Strawn, Ph. D. Sara Fein, Ph. D. Lisa Phillips Ellen Meisterling Khara Leon Funding n NIH-NCMHD EXPORT grant P 20 MD 001765
Summary: Data Quality
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