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Risk of Breastfeeding Cessation Among Low-Income Women, Infants, and Children: A Discrete Time Survival Analysis

Tenfelde, Sandi M.; Finnegan, Lorna; Miller, Arlene Michaels; Hill, Pamela D.

doi: 10.1097/NNR.0b013e3182456b0a

Background: Women who receive services from the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) often stop breastfeeding earlier than recommended. Little is known about maternal background and intrapersonal variables that predict the timing of breastfeeding cessation over the 12-month postpartum period.

Objectives: The aim of this study was to identify the maternal background and intrapersonal predictors associated with the timing of breastfeeding cessation in WIC participants over the course of the 12-month postpartum period.

Method: Existing longitudinal survey and administrative data from low-income breastfeeding WIC recipients (n = 309) were analyzed using discrete time survival analysis. Risk of breastfeeding cessation was the outcome, and self-reported items were used to derive predictor variables that corresponded to the background and intrapersonal variables of the Interaction Model of Client Health Behavior.

Results: Rates of breastfeeding were low (31% at 6 months and 6% at 12 months). In the best fitting discrete time survival analysis model, women who were older and of Mexican ethnicity, who had previous breastfeeding experience, and who had breastfeeding support from family or friends were at lowest risk for breastfeeding cessation at each monthly interval.

Discussion: Breastfeeding duration rates were lower than Healthy People 2020 benchmarks of 61% at 6 months and 34% at 12 months. Clinicians and researchers can use the findings from this study to develop interventions that are targeted to periods of greatest risk of premature breastfeeding cessation to prolong breastfeeding duration in this vulnerable population.

Sandi M. Tenfelde, PhD, APN, WHNP-BC, is Assistant Professor, School of Nursing, Loyola University Marcella Niehoff, Maywood, Illinois.

Lorna Finnegan, PhD, FNP-BC, is Associate Professor, College of Nursing, University of Illinois at Chicago.

Arlene Michaels Miller, PhD, RN, is Professor, College of Nursing, Rush University, Chicago, Illinois.

Pamela D. Hill, PhD, RN, FAAN, is Professor and Clinical Nurse Researcher, Trinity College of Nursing and Health Sciences, Rock Island, Illinois.

Accepted for publication November 8, 2011.

Thank you to Dr. Richard Campbell, Professor Emeritus, Epidemiology and Biostatistics, Sociology, and Institute for Health Research and Policy, University of Illinois at Chicago, and Dr. Lucy Marion, Dean, Professor, and Kellett Endowed Chair in Nursing, College of Nursing, Georgia Health Sciences University, for their help with the study designand analysis. Thank you also to Tina Layer, Data Coordinator from the State of Illinois Department of Human Services; the staff at Near North Health Services Corporation; and Dr. Sarah Forrestal, Survey Researcher at Mathematica Policy Research, for assistance with data cleaning and analysis.

The administrative data were provided by the State of Illinois Department of Human Services, and the published material does not necessarily reflect the views of the State of Illinois.

The authors have no funding or conflicts of interest to disclose.

Corresponding author: Sandi M. Tenfelde, PhD, APN, WHNP-BC, School of Nursing, Loyola University Marcella Niehoff, 2160 South First Avenue, 105-2840, Maywood, IL 60153 (e-mail:

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