Food Desert Residence and the Effect on Breastfeeding Initiation

INTRODUCTION: A myriad of social determinants of health (SDH) impact breastfeeding initiation (BFI). Prior research by this group using ecological data demonstrated that food desert residence (FDR) is associated with lower rates of BFI. This study uses individual level data to examine the effect of FDR on BFI. METHODS: Florida Department of Health birth data from 2019 were linked to the 2019 United States Department of Agriculture (USDA) Food Access Research Atlas. Food desert census tracts were defined per the USDA definition. Adjusted risk ratios (aRR) and 95% CIs were calculated using modified Poisson regression models. Models were adjusted for known SDH. RESULTS: Of 209,087 live singleton births, 16% resided in a food desert. FDR birthers had decreased BFI compared to non-FDR birthers (aRR, 1.23). Risk of decreased BFI was highest among Black birthers (aRR, 1.26) and lowest among Hispanic (aRR, 0.58) and Asian/Pacific Islander birthers (aRR, 0.74). Lower education level was associated with decreased BFI compared to college-educated birthers (aRR, middle school, 5.42; high school, 3.46; some college education, 1.95). History of diabetes and preterm or low-birth-weight infants (aRR, 1.14, 1.47, and 1.38, respectively) were also associated with reduced BFI. CONCLUSION: After adjustment for known SDH impacting BFI, FDR remains an important risk factor for decreased BFI. Level of education was the SDH most strongly associated with decreased BFI. Understanding how FDR impacts BFI allows better tailoring of interventions to increase BFI.