UC Irvine

Multiple leading perinatal health organizations recommend the feeding of human milk (e.g., via breastfeeding) as the optimal form of infant feeding during at least the first 6 months of life. These recommendations are supported by extensive evidence of the health benefits for both the infant and the mother throughout the lifecourse, including reduced risk of chronic and infectious disease. However, racial disparities, marked by reduced breastfeeding initiation and duration rates, have persisted among Black/African-American mothers compared to other racial/ethnic groups in the United States. Even with documented historical and current lived experiences of racism specific to this group, there is a paucity of investigations examining the contribution of racism as a potential barrier towards breastfeeding goals among Black/African-American families. Current evidence also lacks examinations of spirituality, religiosity, and social network resources that may influence breastfeeding within this population. Further, even less is known about shared relationships between racism and supportive resources in mitigating breastfeeding outcomes.

This research addresses knowledge gaps through a secondary analysis of the Community and Child Health Network (CCHN) dataset focused on the sample of Black/African-American participants. This research ultimately advances the understanding of racism-related and resource-related mechanisms of breastfeeding initiation and duration among Black/African-American families.

Chapter 1 of this dissertation presents a review of the current literature of this topic by reviewing definitions presented throughout the document, reviewing racial disparities in infant feeding (e.g., specifically breastfeeding), and reviewing sociodemographic trends as it relates to breastfeeding. Lastly, Chapter 1 provides an overview of the theoretical framework informing this dissertation.

Chapter 2 examines the characterization of social networks among Black/African American mothers and further relates these typologies to breastfeeding outcomes. Results indicate heterogenous social networks among Black/African American mothers in the CCHN dataset. Further, these social networks relate to breastfeeding where mothers with networks characterized by high levels of influence and support for breastfeeding are significantly more likely to initiate breastfeeding and breastfeed for longer, compared to mothers with networks characterized by low/moderate levels of influence and low levels of support for breastfeeding.

Chapter 3 of this dissertation elucidates the contribution of interpersonal racial discrimination (e.g., youth, everyday, healthcare, job, education, police, housing) on breastfeeding initiation and duration among Black/African-American mothers. Contrary to the hypothesis,significantly higher likelihoods of breastfeeding initiation were observed among mothers who endorsed experiences of racial discrimination during youth, everyday adulthood, in police-related settings, and in healthcare-related settings, compared to mothers who denied these experiences. However, these relationships were observed to be partially moderated by social support networks (Chapter 2). Mothers reporting moderate-high levels of racial discrimination yet receiving support from diverse network members (high influence and high support), demonstrated a higher likelihood of breastfeeding initiation compared to mothers reporting low levels of discrimination.

Chapter 4 elucidates the contribution of individual and interpersonal resources (e.g., spirituality, religiosity, social support) on breastfeeding initiation and duration among Black/African-American mothers. Findings are generally in support of the hypothesis, where higher spirituality and religiosity scores were significantly associated with breastfeeding initiation and duration. However, when accounting for sociodemographic characteristics in fully-adjusted models, spirituality was consistently associated with higher likelihoods of breastfeeding initiation and longer durations. Religiosity remained associated with higher likelihoods of breastfeeding initiation, but relationships were attenuated for breastfeeding duration. Also, contrary to the hypothesis, domains of social support (emotional/informational, affectionate, tangible, positive social interactions) were not significantly related to breastfeeding initiation. Further contrary to the hypothesis, increasing scores of emotional/informational, tangible, and positive social interaction domains were related to lower likelihoods of breastfeeding initiation and shorter durations. In summary, Chapter 4 identifies novel spiritual and religious resources that can be leveraged in interventions to promote breastfeeding. There appears to be differential effects of individual and interpersonal resources on breastfeeding initiation versus duration. This implies that xiithe mechanism of supportive resources to start breastfeeding may de different than mechanisms to continue breastfeeding.

The significance of this research contributes to nuanced understanding of barriers and resiliency among Black/African American families. Additionally, this research identifies novel targets for infant feeding interventions among Black/African-American families by elucidating the relationship between racism (e.g., barriers) and resources with regard to breastfeeding.