Breastfeeding initiation in a rural sample: predictive factors and the role of smoking

states had an average initiation rate of 55%.1 This dis-crepancy exists even after controlling for sociodemo-graphic factors (adjusted odds of not being breastfed, 2.50 to 5.15 times greater).2 Additionally, when states were grouped on the basis of a number of indicators of friendliness toward breastfeeding—including presence of La Leche League groups, breastfeeding coalitions, and state legislation regarding breastfeeding in public places—these 7 states were in the lowest quartile.1 The benefits of breastfeeding for maternal and child health have been well documented,3-12 and the American Academy of Pediatrics, the American College of Obstetricians and Gynecologists, and the World Health Organization all recommend exclusive breastfeeding for the first 6 months of life.13-15 Researchers have dis-covered a number of factors related to breastfeeding initiation, which indicate those women who are most likely to breastfeed. Actual initiation of breastfeeding, regardless of intent during prenatal care, is consistently related to many background factors. For example, it is well documented that as maternal age16,17and years of education18-21 increase, so does the likelihood of breast-feeding. Findings regarding other associated factors are somewhat less consistent across studies. Being married2,18-20 and higher socioeconomic class2,21 are bot