Breastfeeding disparities and recommended strategies to end them in New York.

Objective: The objective of this study was to identify strategies to address breastfeeding disparities across New York in the United States.

Methods: Data were collected from August-December 2021 using a qualitative research design that included 45 key informant interviews and 253 online questionnaires.

Results: Ninety-six percent of participants lived in or represented New York, and four percent were national experts.

New York State's Paid Family Leave Program is Associated with More Equitable and Increased Use of Paid Leave Following Childbirth.

Objectives: This study aimed to assess changes in paid maternity leave before and after New York's (NY) Paid Family Leave (PFL) law went into effect (1/1/2018) and changes in disparities by maternal characteristics.

Methods: We used specific data collected on maternity leaves by women who gave birth in 2016-2018 in NY State (outside NY City) participating in the Pregnancy Risk Assessment Monitoring System survey. Multiple logistic regressions were conducted to evaluate the effect of the PFL law on prevalence of paid leave taken by women after childbirth.

Effects of New York state paid family leave on early immunizations.

Objective: To test whether introduction of New York Paid Family Leave (NY PFL) in 2018 is associated with the timeliness of immunizations among infants whose mothers reside in NY in one of the 57 counties outside of New York City (NYC).

Methods: We use difference-in-difference methods, comparing immunization outcomes before and after NY PFL went into effect among infants born to mothers who were employed during pregnancy, and thus likely to be affected by NY PFL, vs. mothers who were not employed during pregnancy and thus unlikely to be affected.

First-Year Enrollment and Utilization of New York State Paid Family Leave: 2018.

Context: The New York Paid Family Leave (NYPFL) law was passed in April 2016 and took effect January 1, 2018. Expanding paid family leave (PFL) coverage has been proposed as a public health strategy to improve population health and reduce disparities.

Objective: To describe first-year enrollment in NYPFL and to evaluate utilization of NYPFL benefits.

New York State Paid Family Leave Law Associated with Increased Breastfeeding Among Black Women.

While breastfeeding has increased during the past 50 years, disparities continue, with Black women having the lowest rates. Use of paid leave has been associated with longer breastfeeding duration. Evaluate the impact of New York (NY)'s Paid Family Leave (PFL) law on breastfeeding, after it became effective on January 1, 2018.

Variation in Formula Supplementation of Breastfed Newborn Infants in New York Hospitals.

Objectives: We examined the variation between 126 New York hospitals in formula supplementation among breastfed infants after adjusting for socioeconomic, maternal, and infant factors and stratifying by level of perinatal care.

Methods: We used 2014 birth certificate data for 160 911 breastfed infants to calculate hospital-specific formula supplementation percentages by using multivariable hierarchical logistic regression models.

Results: Formula supplementation percentages varied widely among hospitals, from 2.

Impact of State Legislation on Hospital Breastfeeding Support in New York.

Objective: The purpose of this study was to evaluate whether 2 state mandates, both implemented in 2010, had an impact on NY hospitals providing maternity care. Specifically, we measured changes in hospital staff's awareness, attitudes, and promotion of breastfeeding (BF), maternity care practices, and hospital breastfeeding policies and tested whether they were related to implementation of the Breastfeeding Mothers' Bill of Rights or the mandate for public reporting of hospital-specific BF measures.

Design: In 2009 and 2011, written hospital BF policies were collected and evaluated using a 28-item review tool and hospital BF surveys were conducted.

The Impact of Hospital Resources and Availability of Professional Lactation Support on Maternity Care: Results of Breastfeeding Surveys 2009-2014.

Background: Breastfeeding provides maternal and infant health benefits. Maternity care practices encompassed in the 10 Steps to Successful Breastfeeding are positively associated with improved breastfeeding outcomes. This study assessed changes in maternity care practices and lactation support.

Public Reporting of Hospital-Specific Breastfeeding Measures.

Background: Establishing breastfeeding in the first days of an infant's life is important for longer term success in breastfeeding. In 2009, New York State (NYS) was the second state to require maternity care facilities to collect infant feeding information and to publicly disseminate hospital-specific infant feeding statistics. Public reporting of these statistics as performance measures is a strategy to prompt hospitals to improve breastfeeding support.

Adding Laboratory Data to Hospital Claims Data to Improve Risk Adjustment of Inpatient/30-Day Postdischarge Outcomes.

Numerical laboratory data at admission have been proposed for enhancement of inpatient predictive modeling from administrative claims. In this study, predictive models for inpatient/30-day postdischarge mortality and for risk-adjusted prolonged length of stay, as a surrogate for severe inpatient complications of care, were designed with administrative data only and with administrative data plus numerical laboratory variables. A comparison of resulting inpatient models for acute myocardial infarction, congestive heart failure, coronary artery bypass grafting, and percutaneous cardiac interventions demonstrated improved discrimination and calibration with administrative data plus laboratory values compared to administrative data only for both mortality and prolonged length of stay.

Admission Laboratory Results to Enhance Prediction Models of Postdischarge Outcomes in Cardiac Care.

Predictive modeling for postdischarge outcomes of inpatient care has been suboptimal. This study evaluated whether admission numerical laboratory data added to administrative models from New York and Minnesota hospitals would enhance the prediction accuracy for 90-day postdischarge deaths without readmission (PD-90) and 90-day readmissions (RA-90) following inpatient care for cardiac patients. Risk-adjustment models for the prediction of PD-90 and RA-90 were designed for acute myocardial infarction, percutaneous cardiac intervention, coronary artery bypass grafting, and congestive heart failure.

Breastfeeding-Friendly Erie County: Establishing a Baby Café Network.

Community-based lactation support groups help improve breastfeeding duration by offering practical peer and professional help and counseling through the sharing of information and experiences in a relaxed setting. The objective of this project, funded by the Centers for Disease Control and Prevention, was to establish at least 5 Baby Cafés in organizations that reach low-income women living in a high-need, racially/ethnically diverse, urban county with 1 of the lowest rates of breastfeeding initiation, exclusivity, and duration in New York. The New York State Department of Health partnered with the P(2) Collaborative of Western New York and United Way of Buffalo & Erie County's Healthy Start Healthy Future for All Coalition to facilitate the recruitment of 11 community-based agencies in Erie County, New York, to provide and/or enhance breastfeeding support.

Implementing Legislation to Improve Hospital Support of Breastfeeding, New York State, 2009-2013.

Introduction: Increasing breastfeeding is a public health priority supported by strong evidence. In 2009, New York passed Public Health Law § 2505-a, requiring that hospitals support the World Health Organization's (WHO's) recommended "Ten Steps for Successful Breastfeeding" (Ten Steps). This legislation strengthened and codified existing New York State's hospital perinatal regulations.

Breastfeeding-Friendly Erie County: Establishing the New York State Breastfeeding Friendly Practice Designation.

Background: Primary care providers play an important role in encouraging and counseling pregnant and postpartum women to successfully breastfeed.

Objective: One objective of this 1-year grant was to establish the Breastfeeding Friendly Practice Designation criteria and process to identify and designate at least 5 primary care practices as New York State Breastfeeding Friendly Practices in a high-need, racially/ethnically diverse, urban county in New York with very low prevalence of breastfeeding initiation, exclusivity, and duration.

Methods: A partnership between the New York State Department of Health and the P(2) Collaborative of Western New York and United Way of Buffalo & Erie County's Healthy Start Healthy Future for All Coalition facilitated the development of the New York State Ten Steps to a Breastfeeding Friendly Practice, accompanying implementation guide, designation criteria, and model office policies.

Can Adding Laboratory Values Improve Risk-Adjustment Mortality Models Using Clinical Percutaneous Cardiac Intervention Registry Data?

Background: Registry data for percutaneous coronary intervention (PCI) are being used in New York and Massachusetts and by the American College of Cardiology to risk-adjust provider mortality rates. These registries contain very few numerical laboratory data for risk adjustment.

Methods: For 20 hospitals, New York's PCI registry data from 2008-2010 were used to develop statistic models for predicting in-hospital/30-day mortality with and without appended laboratory data.

The value of adding laboratory data to coronary artery bypass grafting registry data to improve models for risk-adjusting provider mortality rates.

Background: Clinical databases are currently being used for calculating provider risk-adjusted mortality rates for coronary artery bypass grafting (CABG) in a few states and by the Society for Thoracic Surgeons. These databases contain very few laboratory data for purposes of risk adjustment.

Methods: For 15 hospitals, New York's CABG registry data from 2008 to 2010 were linked to laboratory data to develop statistical models comparing risk-adjusted mortality rates with and without supplementary laboratory data.

There Is More to Transparency than Meets the Eye: The Impact of Mandatory Disclosure Laws Aimed at Promoting Breastfeeding.

Requiring hospitals to inform patients of clinical best practices and to disclose performance data are two common regulatory strategies for improving healthcare. Proponents of such mandatory disclosure laws--sometimes referred to as "targeted transparency "--argue that they increase patient awareness and thereby create reputational incentives for hospitals to improve their performance. Evaluation of targeted transparency typically focuses on patient responses to information and changes in hospital behavior based on reputational concerns.

Association of prenatal participation in a public health nutrition program with healthy infant weight gain.

Objectives: We tested the hypothesis that early enrollment in the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) is associated with a reduced risk of rapid infant weight gain (RIWG).

Methods: We used a longitudinal cohort of mother-infant pairs (n = 157,590) enrolled in WIC in New York State from 2008 to 2009 and estimated the odds of RIWG, defined as a 12-month change in weight-for-age z score of more than .67, comparing infants of mothers enrolled during the first, second, or third trimester of pregnancy with those who delayed enrollment until the postpartum period.

Development of the breastfeeding quality improvement in hospitals learning collaborative in New York state.

Exclusive breastfeeding is a public health priority. A strong body of evidence links maternity care practices, based on the Ten Steps to Successful Breastfeeding, to increased breastfeeding initiation, duration and exclusivity. Despite having written breastfeeding policies, New York (NY) hospitals vary widely in reported maternity care practices and in prevalence rates of breastfeeding, especially exclusive breastfeeding, during the birth hospitalization.

Improving hospital breastfeeding policies in New York State: development of the model hospital breastfeeding policy.

The public health importance of breastfeeding, especially exclusive breastfeeding, is gaining increased recognition. Despite a strong evidence base that key hospital maternity practices (Ten Steps to Successful Breastfeeding) impact breastfeeding initiation and exclusivity in the hospital and breastfeeding duration post-discharge, they are not widely implemented. In 2009, written hospital breastfeeding policies were collected from all New York State (NYS) hospitals providing maternity care services (n=139).

Improving maternity care practices in New York: answering the Surgeon General's Call to Action.

Hospitals providing maternity care influence breastfeeding mothers and infants during the critical, early postnatal period. Despite concerted public health efforts, there are persistent, large variations across New York State (NYS) hospitals in breastfeeding policies, maternity care, and infant feeding practices and in rates of breastfeeding initiation and exclusivity. An initiative addressing this issue is the Breastfeeding Quality Improvement in Hospitals (BQIH) Learning Collaborative, which was designed and implemented by the NYS Department of Health (NYSDOH).

A meta-analysis of interventions that target children's screen time for reduction.

Background: Screen time, especially television viewing, is associated with risk of overweight and obesity in children. Although several interventions have been developed to reduce children's screen time, no systematic review of these interventions exists to date.

Objective: This is a systematic review and meta-analysis of interventions targeting a reduction in children's screen time.