Journal of Obesity / 2016 / Article / Tab 1

Review Article

Breastfeeding Practices among Native Hawaiians and Pacific Islanders

Table 1

Description of selected studies.

Authors, yearType of studySample by location/region and demographics Measures (breastfeeding initiation, duration, and exclusive)Results (main outcomes and/or effect sizes)

Brown and Adelson, 1969 [36]Cross-sectional studyHonolulu, Hawaii (mothers and children)
Ethnically and socioeconomically diverse Caucasian, Hawaiian, Japanese, and other populations;
Low and middle income;
Age (mean): children = 2-3 years; Low income mothers = 28.4 years; Middle income mothers = 29 years;
children = 281
mothers = 249
Indicators: initiation and duration
Initiation: ever breastfed
Duration: breast fed for at least 6 months
Approximately one-quarter of the women breastfed their infant. More middle than low income mothers breastfed
Ever breastfed: 25.0% of all infants (26.0% Caucasians; 50.0% Japanese; 29.0% Hawaiian; 32.0% other populations)
Breastfed at 6 months: 80.0% all infants

Jansen, 1979 [37]Cross-sectional studyHoniara and Nggela-Sandfly, Solomon Islands, Pacific Islands (mothers)
Ethnicity: Pacific Islanders
Age (mean): Honiara = 28.3 years; Ngella-Sandfly = 30.7 years 
(Honiara = 100, Ngella-Sandfly = 89)
Indicators: initiation and duration
Initiation: ever breastfed
Duration: breastfed for at least 6 months; breastfed for at least 12 months
All mothers from Honiara and Nggela-Sandfly breastfed their infant on the first day after delivery. Early weaning before 6 months was uncommon
Ever breastfed: 99.5%
Breastfed for at least 6 months: Honiara = 85.7%; Nggela-Sandfly = 93.3%
Breastfed for at least 12 months: Honiara = 78.6%; Nggela-Sandfly = 92.3%

Franks and Jurgensen, 1985 [38]Cohort studyKiribati, Abemama Atoll Village Clinic (children)
Ethnicity: Pacific Islanders 
Indicators: exclusive breastfeeding and duration
Exclusive breastfeeding: exclusive breastfeeding for 4 months
Duration: breastfed for 12 months
Most children were breastfed for the whole of their first 4 months of life. Just under half were still being breastfed at 12 months
Exclusive breastfeeding for 4 months = 92.0%
Breastfed for 12 months = 45.7%

Suganuma et al., 1988 [39]Cross-sectional studyOahu, Hawaii (mothers)
Ethnically diverse: Caucasian = 37.9%; Hawaiian = 20.3%; Filipino = 10.1%; Japanese = 13.2%; other populations = 18.3%
Age = not reported
Indicator: exclusive breastfeeding
Breastfed only at hospital discharge
Over half of the total sample reported exclusively breastfeeding their infant at hospital discharge. Infant feeding pattern varied considerably by ethnic group. The incidence of exclusive breastfeeding at hospital discharge was the highest among Caucasians and lowest among Filipinos. Just over half of Hawaiians breastfed
Breastfed only at hospital discharge: total = 57.5%; Caucasian = 70.4%; Hawaiian = 52.6%; Filipino = 33.3%; Japanese = 55.4%; other populations = 51.5%

Lambert and Yee, 1981 [40]Panel studySuva, Fiji (infants)
Ethnically diverse: Fijian, Indian, and other populations 
Age = 0–18 months
= varied depending on year of study
Indicator: exclusive breastfeeding
Breastfed only for at least 0–3 months; breastfed only for at least 4–6 months
The extent of breastfeeding declined over the period 1977–1980 among Fijians as well as other ethnic groups
Breastfed only for at least 0–3 months: Fijian 68.5%; Indian 33.8%; other populations 43.7%
Breastfed only for at 4–6 months: Fijian 48.4%; Indian 26.2%; other populations 19.3%

Kieffer et al., 1997 [41]Cross-sectional study (utilizing The Nutrition Survey)Hawaii (mothers)
Ethnically diverse: Filipinos US born (2.8%); Filipinos Philippines born (3.8%); Hawaiian (18.4%); Japanese (14.4%); Other/mixed populations (19.2%); White (41.3%).
Age = 27–30 years 
Indicator: exclusive breastfeeding
Breastfeeding only at hospital discharge
Mothers who breastfed were more likely to be white, older, married, and educated, have chosen their feeding method prior to pregnancy, and were primarily concerned with the health of their infant as a reason to breastfeed
Exclusive breastfeeding among Hawaiians = 18.4%
Data not disaggregated by ethnicity

Dodgson et al., 2007 [27]Cross-sectional study utilizing WIC dataOahu, Hawaii
Ethnicity: Native Hawaiians
Age (mean) = 26.71 years
Indicator: exclusive breastfeeding and duration
Exclusive breastfeeding: any breastfeeding at 1 month; any breastfeeding at 6 months
Duration: exclusively breastfed for at least 3 months; exclusive breastfeeding for at least 6 months
A small amount of women breastfed their infant exclusively for 6 months. Mothers who breastfed exclusively at initiation were significantly more likely to breastfeed for 6 months than women who partially breastfed at initiation. Most Native Hawaiian women combined exclusive breastfeeding and partial breastfeeding. More multiparous than primiparous women exclusively breastfed at initiation
Any breastfeeding at 1 month = 91.0%;
any breastfeeding at 6 months = 52.0%;
exclusively breastfed at least 3 months = 29.0%;
exclusive breastfeeding at least 6 months = 18.0%

Novotny et al., 2007 [42]Univariate descriptive studyCommonwealth of the Northern Mariana Islands (children)
Ethnicity: Pacific Islanders
Age = 6 months to 10 years
Indicators: exclusive breastfeeding and duration
Exclusive breastfeeding: Exclusive breastfeeding for 0–2; 2–4; 4–6; and 6 or more months
Duration of breastfeeding: breastfed for 9 to 12 months; received breastmilk for 12 or more months
Over three-quarters of the children were breastfed, while just over half were breastfed at 6 months. A smaller percentage was still being breastfed at one year
Exclusively breastfed: 46.0% were exclusively breastfed for 0–2 months; 23.0% were exclusively breastfed for 2–4 months; 21.0% were exclusively breastfed for 4–6 months; 9.0% were exclusively breastfed for 6 or more months; 15.0% were breastfed for 9–12 months; 22.0% received breastmilk for 12 or more months

Hayes et al., 2014 [26]Cross-sectional study by PRAMS dataHawaii (mothers)
Ethnically diverse: Caucasian = 21.3%; Native Hawaiian = 27.6%; Samoan = 2.9%; Filipino = 18.3%; Japanese = 12.2%; Chinese = 3.6%; Korean = 1.6%; Black = 2.4%; other populations = 10.2%
Age = 20–35 years
Indicator: exclusive breastfeeding
Exclusive breastfeeding at 8 weeks
There was a difference in the rates of exclusive breastfeeding by ethnic group. White mothers had the highest estimate followed by Korean and Black mothers. Disparity in exclusive breastfeeding rates was observed among NHPI subgroups
36.3% of all mothers exclusively breastfed for at least 8 weeks (Caucasian = 51.9%; Native Hawaiian = 31.8%; Samoan = 24.2%; Filipino = 28.9%; Japanese = 29.4%; Chinese = 33.8%; Korean = 38.0%; Black = 37.0%; Other = 41.7%)

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