Background:

Research exploring associations between exposure to social determinants of health and breastfeeding is needed to identify breastfeeding barriers. Housing insecurity and household conditions (chaos and crowding) may affect breastfeeding by increasing maternal stress and discomfort and decreasing time available to breastfeed.

Research Aim:

We aimed to examine the relationships between housing insecurity, breastfeeding exclusivity intention during the early postnatal period, and breastfeeding exclusivity at 6 months postpartum among a sample “at risk” for suboptimal breastfeeding rates.

Methods:

This study is a secondary data analysis of a longitudinal study at two time periods. Data were collected from English- and Spanish-speaking, Medicaid-eligible mother-infant dyads (N = 361) at near-birth and child aged 6 months, in New York City and Pittsburgh. Structural equation modeling was used to examine direct and indirect effects of housing insecurity on breastfeeding exclusivity at child aged 6 months.

Results:

The path model showed that experiencing more markers of housing insecurity (i.e., foreclosure/eviction threat, history of homelessness, late rent) was predictive of significantly lower breastfeeding exclusivity at 6 months. This was partially mediated through less exclusive breastfeeding intention during the early postnatal period. Greater household crowding was associated with 6-month breastfeeding exclusivity when mediated by intention. Household crowding had differential effects by study site and participant race/ethnicity.

Conclusion:

Refinement of housing insecurity as a multi-dimensional construct can lead to the development of standardized data collection instruments, inform future methodological decisions in research addressing social determinants of health, and can inform the development of responsive individual- and structural-level interventions.

The data used in this study were collected as part of the SMART Beginnings Randomized Controlled Trial (NCT02459327 registered at ClinicalTrials.gov).

中文翻译：

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城市环境中符合医疗补助条件的家庭的住房不安全、住房条件和母乳喂养行为

背景：

需要研究探索暴露于健康的社会决定因素与母乳喂养之间的关联，以确定母乳喂养障碍。住房不安全和家庭条件（混乱和拥挤）可能会通过增加产妇压力和不适以及减少母乳喂养的时间来影响母乳喂养。

研究目的：

我们的目的是在一个母乳喂养率欠佳的“风险”样本中，检查住房不安全、产后早期纯母乳喂养意向和产后 6 个月纯母乳喂养之间的关系。

方法：

本研究是对两个时间段的纵向研究的二次数据分析。数据来自纽约市和匹兹堡的说英语和西班牙语、符合医疗补助条件的母婴（N = 361）和 6 个月大的婴儿。结构方程模型用于检查住房不安全对 6 个月大的儿童纯母乳喂养的直接和间接影响。

结果：

路径模型表明，经历更多的住房不安全标志（即丧失抵押品赎回权/驱逐威胁、无家可归史、迟租）预示着 6 个月时的纯母乳喂养率显着降低。这部分是通过产后早期较少的纯母乳喂养意图介导的。在意向介导的情况下，更大的家庭拥挤与 6 个月的纯母乳喂养有关。家庭拥挤对研究地点和参与者种族/民族有不同的影响。

结论：

将住房不安全作为一个多维结构进行改进可以导致标准化数据收集工具的开发，为未来解决健康问题社会决定因素的研究方法决策提供信息，并可以为制定响应性的个人和结构层面干预措施提供信息。

本研究中使用的数据是作为 SMART 开始随机对照试验（在 ClinicalTrials.gov 注册的 NCT02459327）的一部分收集的。