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Full text release has been delayed at the author's request until August 04, 2029

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You Are Where You Eat: An Analysis of the Effects of Social Determinants of Health and Social Needs on Human Milk Feeding Behaviors

Tyson, Danielle Pleshette
http://orcid.org/0000-0003-3820-5426
http://rave.ohiolink.edu/etdc/view?acc_num=osu1721316686737494

Abstract Details

2024, Doctor of Philosophy, Ohio State University, Public Health.
Introduction: Human milk is the recommended infant food for the first six months of life. Despite recommendations and known health benefits for infants and lactating parents, only a quarter of the infants in the United States meet the recommended human milk feeding goals. While human milk feeding is often a personal decision, engaging in this health behavior may be shaped by neighborhood- and systemic-level factors. Aims: This dissertation aimed to evaluate the association between human milk feeding behaviors and three factors: (1) neighborhood-level social determinants of health, (2) caregiver-reported social needs, and (3) neighborhood-level food access. Methods: I performed secondary analyses of electronic health record data from infants born from April 2019 through July 2022 who attended a well-child visit at Nationwide Children’s Hospital (NCH) primary care clinics during the neonatal period. Infant records were linked to Ohio birth certificate data to obtain maternal demographic information and hospital breastfeeding data. During well-child visits at NCH, caregivers are asked about infant food intake. At each visit where feeding data was recorded in the first two years of life, I categorized an infant’s human milk consumption as exclusive, mixed, or none. In Aim 1, neighborhood-level social determinants of health were measured using the Child Opportunity Index (COI) 2.0 and the Area Deprivation Index (ADI). In Aim 2, caregiver-reported social needs were assessed using data from routinely administered social needs screenings performed at NCH. In Aim 3, neighborhood-level food access was assessed using the Food Access Research Atlas. Multivariable interval-censored accelerated failure time modeling was used to evaluate the time to cessation of (1) exclusive human milk feeding and (2) any human milk feeding. In secondary analyses, multivariable logistic regression modeling was used to evaluate the odds of (1) breastfeeding initiation and (2) exclusive breastfeeding at hospital discharge. Results: Most infants in these studies were born during the COVID-19 pandemic, received Medicaid, and had mothers who identified as non-Hispanic Black. The COI 2.0 was a significant predictor of the odds of initiating breastfeeding (p-value=0.025) and the time to cessation of any human milk feeding (p-value=0.013). Compared to very-low-opportunity neighborhoods, higher neighborhood opportunity levels were associated with increased odds of breastfeeding initiation and increased time to cessation of any human milk feeding. The ADI was a significant predictor of time to cessation of any human milk feeding (p-value=0.047). The length of exposure to any human milk increased as the quintile of neighborhood disadvantage decreased. Screening positive for any social needs was not associated with any outcomes assessed. Living in a neighborhood without low food access was associated with 21% higher odds of initiating breastfeeding and 24% longer time to cessation of any human milk feeding compared to living in a low-food-access neighborhood. Conclusions: Neighborhood-level social determinants of health and food access are associated with human milk feeding behaviors. These findings can be used to identify patients who may need additional human milk feeding education and support and to guide future research and policy decisions.
Maria Gallo (Committee Chair)
Fernanda Schumacher (Committee Member)
Sarah Keim (Committee Member)
Deena Chisolm (Advisor)
164 p.
Epidemiology; Public Health
human milk feeding; breastfeeding; pediatrics; maternal health; social needs; social determinants of health; primary care; food desert; screening; infant health; formula feeding; chestfeeding; birth certificate; vital statistics; electronic health record

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Citations

  • Tyson, D. P. (2024). You Are Where You Eat: An Analysis of the Effects of Social Determinants of Health and Social Needs on Human Milk Feeding Behaviors [Doctoral dissertation, Ohio State University]. OhioLINK Electronic Theses and Dissertations Center. http://rave.ohiolink.edu/etdc/view?acc_num=osu1721316686737494

    APA Style (7th edition)

  • Tyson, Danielle. You Are Where You Eat: An Analysis of the Effects of Social Determinants of Health and Social Needs on Human Milk Feeding Behaviors. 2024. Ohio State University, Doctoral dissertation. OhioLINK Electronic Theses and Dissertations Center, http://rave.ohiolink.edu/etdc/view?acc_num=osu1721316686737494.

    MLA Style (8th edition)

  • Tyson, Danielle. "You Are Where You Eat: An Analysis of the Effects of Social Determinants of Health and Social Needs on Human Milk Feeding Behaviors." Doctoral dissertation, Ohio State University, 2024. http://rave.ohiolink.edu/etdc/view?acc_num=osu1721316686737494

    Chicago Manual of Style (17th edition)

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This open access ETD is published by The Ohio State University and OhioLINK.