Examining Relationships Between Multiple Adverse Social Determinants of Health, Maternal Depressive Symptoms, Timing of Solid Food Introduction, and Breastfeeding Duration Among Black or African American Women

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BACKGROUND: Breastfeeding has been shown to reduce the risk of several diseases-including those that disproportionately affect Black or African American women and children. Adverse social determinants of health (SDOH) have been associated with a higher prevalence of postpartum depressive symptoms and are negatively associated with breastfeeding outcomes and the timing of solid food introduction. Prior research has focused on each individual SDOH in isolation and has not, to the best of our knowledge, examined the mediating role of depressive symptoms and timing of introduction to solid foods. OBJECTIVE: This study aimed to examine (1) the association between multiple adverse SDOH and timing of breastfeeding cessation and (2) if this relationship is mediated by maternal depressive symptoms and the timing of introduction to solid food. MATERIALS AND METHODS: = 242). Multivariable logistic regression and regression-based causal mediation analyses were used to address the objectives of this study. RESULTS: Findings showed multiple adverse SDOH were associated with increased odds of stopping breastfeeding at 4 and 6 months of age (4 months: odds ratio [OR] = 3.49, 95% confidence interval [CI]: 1.11, 10.97; 6 months: OR = 5.03, 95% CI: 1.54, 16.47). This relationship was partially mediated by the introduction of solid foods at 4 months of age (indirect effect: OR = 1.53, 95% CI = 1.18, 2.34) but not mediated by maternal depressive symptoms. CONCLUSIONS: Multiple adverse SDOH demonstrated relationships with the timing of both breastfeeding cessation and introduction to solid foods.

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