Retention and the Intersection of Structural Inequities in a Breastfeeding Intervention Study

Helen Wilde LaPlant, Confidence Francis-Edoziuno, Zhe Guan, Tumilara Aderibigbe, Xiaolin Chang, Ashwag Alhabodal, Kristen Delaney, Dana Scott, Mary Marshall-Crim, Idelisa Freytes, Wendy A Henderson, Stephen Walsh, Ruth F Lucas
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Abstract

Abstract Introduction: Women below the poverty threshold have lower representation and retention in breastfeeding studies. Methods: A secondary analysis of a longitudinal randomized controlled self-management for breast and nipple pain during breastfeeding study. Participants completed online surveys at discharge, weeks 1, 2, 3, 6, 9, 12, 18, and 24, with face-to-face interviews at 6 and 24 weeks. Text messages were sent to participants when modules and surveys were due. Retention was assessed in R with descriptive statistics, Mann-Whitney, Pearsons chi-square, and Cox Proportional Hazard Regression. Results: Two hundred and forty-four women (89 ≤$50,000 and 155 >$50,000) were recruited. Retention rates at 1 (93%), 2 (87%), 6 (82%), 9 (77%) and 24 (72%) weeks. For women of low income compared to those of high income there was a hazard ratio (HR) of 2.5 (p=0.0001) for retention. For non-Hispanic Black and Hispanic women compared to the combined non-Hispanic White and Other group, HRs for retention were 3.3 and 2.6 respectively (p=0.0001). Adjustment for age in the final hazard regression model of income, age, race and ethnicity decreased the HR for women of low income to 1.6 and HRs for non-Hispanic Black and Hispanic women to 2.1 and 1.9, respectively (p=.0001). However, none of the individual factors in the model achieved statistical significance. Discussion: Retention in breastfeeding studies impacts breastfeeding duration, a key lifelong preventative health behavior. Despite accessible study design, retention of women desiring to breastfeed was adversely affected by the intersection of income, race and ethnicity, and age.
母乳喂养干预研究中的保留率与结构性不平等的交集
摘要导言:贫困线以下的妇女在母乳喂养研究中的代表性和保留率较低。研究方法对一项针对母乳喂养期间乳房和乳头疼痛的纵向随机对照自我管理研究进行二次分析。参与者在出院、第 1、2、3、6、9、12、18 和 24 周时完成了在线调查,并在第 6 和 24 周时进行了面对面访谈。在模块和调查到期时向参与者发送短信。保留率的评估采用 R 语言,包括描述性统计、Mann-Whitney、Pearsons chi-square 和 Cox 比例危险回归:共招募了 244 名女性(89 人的收入低于 50,000 美元,155 人的收入为 50,000 美元)。1周(93%)、2周(87%)、6周(82%)、9周(77%)和24周(72%)的保留率。低收入妇女与高收入妇女相比,保留率的危险比(HR)为 2.5(P=0.0001)。对于非西班牙裔黑人和西班牙裔妇女,与非西班牙裔白人和其他群体相比,保留率分别为 3.3 和 2.6(p=0.0001)。在收入、年龄、种族和民族的最终危险回归模型中对年龄进行调整后,低收入妇女的 HR 降至 1.6,非西班牙裔黑人妇女和西班牙裔妇女的 HR 分别降至 2.1 和 1.9(p=0.0001)。然而,模型中的各个因素均未达到统计学意义:讨论:母乳喂养研究中的保留率会影响母乳喂养的持续时间,而母乳喂养是一种关键的终身预防性健康行为。尽管研究设计简单易行,但收入、种族和民族以及年龄的交叉影响对希望进行母乳喂养的妇女的保留率产生了不利影响。
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