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Influence of neighbourhood purchasing power on breastfeeding at four months of age: a Swedish population-based cohort study
Child Health Care Unit, Region Halland, Kungsbacka, Sweden & Department of Paediatrics, Institute for Clinical Sciences at the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Research and Development Department, Halland, Halmstad, Sweden.
Research and Development Department, Halland, Halmstad, Sweden.
Child Health Care Unit, Region Halland, Kungsbacka, Sweden & Department of Paediatrics, Institute for Clinical Sciences at the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
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2013 (English)In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 13, no 1, article id 1077Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Parental socioeconomic status (SES) is an important determinant in child health, influencing beneficial factors such as breastfeeding. A better understanding of the influence of neighbourhood-level SES measures, relating to spatial determinants, might lead to targeted actions to promote breastfeeding during infancy.

METHODS: A cross-sectional study analysis the association between breastfeeding at four months of age and neighbourhood purchasing power, taking account of individual-level variables including maternal age, smoking and parental level of education. Data were obtained from a prospective population- based cohort study recruited from birth in 2007-2008 in the Halland region, southwestern Sweden. Questionnaire data on the individual-level variables and the outcome variable of breastfeeding at four months (yes/no) were used (n=2,407). Each mother was geo-coded with respect to her residential parish (there are 61 parishes in the region) and then stratified by parish-level household purchasing power. It emerged that four neighbourhood characteristics were reasonable to use, viz. <10%, 10-19%, 20-29% and ≥ 30% of the resident families with low purchasing power.

RESULTS: The proportion of mothers not breastfeeding at four months of age showed a highly significant trend across the neighbourhood strata (p=0.00004): from 16.3% (< 10% with low purchasing power) to 29.4% (≥ 30% with low purchasing power), yielding an OR of 2.24 (95% confidence interval: 1.45-3.16). After adjusting for the individual-level variables, the corresponding OR=1.63 (1.07-2.56) was significant and the trend across the strata was still evident (p=0.05). A multi-level analysis estimated that, in the neighbourhoods with ≥ 30% of the families with low purchasing power, 20% more mothers than expected, taking account of the individual-level factors, reported no breastfeeding at four months of age (≥ 95% posterior probability of an elevated observed-to-expected ratio).

CONCLUSION: The neighbourhood purchasing power provided a spatial determinant of low numbers of mothers breastfeeding at four months of age, which could be relevant to consider for targeted actions. The elevated observed-to-expected ratio in the neighbourhoods with the lowest purchasing power points toward a possible contextual influence. © 2013 Almquist-Tangen et al.; licensee BioMed Central Ltd.

Place, publisher, year, edition, pages
London: BioMed Central, 2013. Vol. 13, no 1, article id 1077
Keyword [en]
Breastfeeding, Child health, Neighbourhood purchasing power, Prevention, Spatial determinant
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
URN: urn:nbn:se:hh:diva-25088DOI: 10.1186/1471-2458-13-1077ISI: 000329498300001PubMedID: 24237634Scopus ID: 2-s2.0-84887561306OAI: oai:DiVA.org:hh-25088DiVA: diva2:712834
Note

This study was supported by a grant from the Research and Development Department, Halland, Sweden.

Available from: 2014-04-16 Created: 2014-04-16 Last updated: 2017-12-05Bibliographically approved

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