Lorena Garza Gonzalez, PhD Vice President Urban Strategies

Lorena Garza Gonzalez, PhD Vice President Urban Strategies

LATINO BEST START OVERVIEW

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Cost of Suboptimal Breastfeeding Medical Costs Non-Medical Costs Death Costs Total Significant Deaths United States $3,048,640,752 $1,254,061,824 $14,216,498,022 3,340 New Mexico Latinas $17,762,486 $7,843,861 $81,906,965 4 Children If 90% of New Mexican Latinas could comply with the medical recommendations to breastfeed exclusively for 6 months, New Mexico could save over $107 million/year and prevent 4 excess child deaths annually 4

Goals of Latino Best Start Collect information on breastfeeding practices and beliefs Provide information and tools that promote breastfeeding Move towards breastfeeding initiation, duration and exclusivity goals in Healthy People 2020 Create models that address barriers to breastfeeding in Latino communities Share lessons learned that can improve breastfeeding and other areas of well-being in the Latino community 5

LATINO BEST START PROJECT 1. Focus Groups 2. Community Survey 3. Develop a Curriculum 4. Program Evaluation 6

Our LBS Partners Creciendo Unidos Waukegan, IL Neighborhood Ministries Los Angeles Phoenix Columbia, SC San Antonio Homestead, FL Salinas, Puerto Rico 7

1. Latino Best Start Focus Groups Community Conversations

Focus Groups Participants 54% of responding mothers were born abroad 61% were from Mexico 55% Spoke only Spanish 14% Spoke only English 31% Spoke both languages 9

What We Learned from our Focus Groups The Health Care System Participants reported unjust treatment with Health Care personnel Health Care Workers believed they understood Latino community but used subtle words such as calling Latino group them/us 10

What We Learned from our Focus Groups Culture and Identity Food was central to defining culture Family gatherings Participants agreed that people are connected to their country of origin strong for new immigrants but remained a value of 2nd and 3rd generation participants La familia as a significant strength even if not blood 11

What We Learned from our Focus Groups Culture and Identity, cont. Participants reported loss of language meant loss of culture Participants identified generosity, loyalty, and respect as strengths in their culture. Communication skills between parents and children a problem 12

What We Learned from our Focus Groups Community and Work Reasons for not breastfeeding Unsupportive immediate family members School/Work Felt that formula was pushed on them from every direction 13

In summary: These are the Obstacles

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2. Latino Best Start Community Survey

Survey Data Mothers with Children age 5 or younger, N=786 M (SD) Age of Respondent 30.26 (7.36) Number of Children 2.69 (1.67) Place of Birth N (%) US - Born 199 (25.3) Foreign-Born 546 (69.5) What language do you speak MOST at home? N (%) Spanish 443 (56.4) English 93 (11.8) Both 194 (24.7) 17

Survey Data page 2 Which breastfeeding method did you use? N (%) Exclusive Breastfeeding 266 (29.9) Mixed Breastfeeding/Formula 338 (46.5) Formula Only 189 (23.6) Length of breastfeeding, in months M (SD) 11.88 (9.19) 18

Survey Data page 3 If you breastfed, what helped you decide to do so? I believe breastfeeding is a healthier choice N (%) 476 (60.6) Family supported the decision 361 (45.9) Prior positive experience 306 (38.9) Health providers supported decision Health providers gave information 299 (38.0) 252 (32.1) Flexible schedule 233 (29.6) Could not afford formula 78 (9.9) Employer supported the decision 65 (8.3) 19

Survey Data page 4 If you did not breastfeed what were some reasons? N (%) Had easy access to formula 91 (11.6) Thought formula was a healthier choice 67 (8.5) Prior negative experience 58 (7.4) Schedule was too complicated 46 (5.9) Family did not support decision 37 (4.7) Health providers did not support decision Health providers did not give information 33 (4.2) 23 (2.9) Employer did not support decision 10 (1.7) 20

Survey Data page 5 What would help you decide to use exclusive breastfeeding with your next newborn? N (%) I believe breastfeeding is a healthier choice 525 (66.8) Prior positive experience 401 (51.0) Family supports decision 374 (47.6) Health providers support decision 289 (36.8) Health providers gave information 276 (35.1) Schedule is flexible enough 237 (30.2) 21

Mothers Beliefs and Breastfeeding Behaviors Latinas (N=745) ages 15-50 with a child 5 years old or younger Breastfeeding behaviors and factors that impacted their decision to exclusively breastfeed A Mother s belief that breastfeeding was a healthier choice was the most influential factor on breastfeeding decision for both groups 22

3. One Solution: Latino Best Start Curriculum

Latino Best Start Rationale Latino Best Start Grounded in values Based on the premise that WE can create the change we need Designed to create champions in neighborhoods to promote the healthily lifestyles beginning at breastfeeding Culturally relevant Flexible Designed to be highly participatory Teaching participants how to discover and develop leadership skills, they not only change themselves and their families, but their communities 24

LBS LESSON TOPICS Values A Healthy Start, A Healthy Life Leadership Advocacy Making Things Happen Developing a Plan Part 1 & 2 25

LBS ACTIVITY EXAMPLE #1 LOTERÍA 26

LBS ACTIVITY EXAMPLE #2 DEVELOPING Planning a Quinceañera A PLAN Or any other scenario that fits your community. The point here is to have the groups practice making a plan. It could be creating a soccer team and planning for the first game, or anything relevant to your community. At this point, go through the quinceañera plan. Ask people to answer each question and facilitate a large group discussion. Why? To celebrate our daughter s 15 years of life with our family and friends. What? To host a celebration for 300 family members on my daughter s birthday. How? Choose a date, make an invitation list, set a budget, send out invitations, arrange for food, reserve a location, select music, buy the dress, select the court, select a church for the reception, order a cake, attend the quinceañeras, clean up. Who? Immediate family, tíos, tías, friends By when? Each step will need a date assigned to it. How will we know that we have succeeded? These are the clues that tell us we have arrived at our goal. We want to know that we are successful when we implement our plans. What clues would you look for to see that the 27

4. Latino Best Start Program Evaluation

Was the LBS Curriculum Effective? Latinas (N=786) Purpose: increase health advocacy and breastfeeding knowledge and behaviors through workshops delivered by LBS partner agencies. Pre/Post tests Movement in the desired or correct direction from pre- to posttest was observed for every single item Clinically significant and statistically significant 29

RECOMMENDATIONS

Recommendations Workplace Paid Family Leave Pumps, places and time to pump, and space to store breast milk Educating Healthcare Workers Integrate a Cultural Humility model Collective family approach Language Culture Start talking about breastfeeding early Support and visit once home and return to work 31

Recommendations Hospital Policies Integrate a Cultural Humility model Multilingual lactation support Multicultural lactation support Baby Friendly Hospitals WIC Integrate a Cultural Humility model Day Care/Head Start Provide breastfeeding support to moms Training and education for staff on handling breast milk 32

Research Recommendations Training Community Based Organizations on Data Collection Meet every organization where they are at Tailoring TA Have designated data collectors Latino Based Researchers Research team must reflect the community Importance of Quantitative Data Can t just tell our stories Incorporate both methods Need More Research on Latino Communities 33

QUESTIONS?

CONTACT INFORMATION Lorena Garza Gonzalez - LGonzalez@urbanstrategies.us Vice President, Urban Strategies Diana N. Derige - DDerige@urbanstrategies.us Program Director, Latino Best Start Director of Health Initiatives, Urban Strategies Nara Hojvat-Gallin - Nara@urbanstrategies.us Project Analyst, Urban Strategies Latino Best Start Website http://latinobeststart.org/ Urban Strategies Website www.urbanstrategies.us