1 00:00:06,240 --> 00:00:10,960 Okay let's go ahead and get started welcome we are so pleased that you all joined us this afternoon 2 00:00:11,600 --> 00:00:16,960 for a Division of Nutrition Physical Activity and Obesity Seminar Series that focuses on community 3 00:00:16,960 --> 00:00:22,240 actions to improve breastfeeding rates CDC's Division of Nutrition Physical Activity and 4 00:00:22,240 --> 00:00:29,840 Obesity DNPAO our seminar series showcases the science and practice of our work um 5 00:00:30,800 --> 00:00:34,640 I hope sorry my screen just shifted and the seminar 6 00:00:34,640 --> 00:00:38,240 series is intended for partners for practitioners in the field for 7 00:00:38,240 --> 00:00:43,840 everyone to kind of get a better sense of what's going on and opportunities in the future. 8 00:00:46,400 --> 00:00:51,440 I'm Janelle Gunn. I serve as Associate Director for Policy Partnerships and Communication in CDC's 9 00:00:51,440 --> 00:00:55,760 Division of Nutrition Physical Activity Obesity and I'll be your moderator today 10 00:00:55,760 --> 00:00:59,760 today's seminar will highlight community actions to improve breastfeeding rates 11 00:00:59,760 --> 00:01:04,400 increasing breastfeeding rates and supporting optimal breastfeeding practices 12 00:01:04,400 --> 00:01:10,560 is a priority for DNPAO we've seen improvements in breastfeeding initiation about 84 of infants 13 00:01:10,560 --> 00:01:16,000 in 2018 have received breast milk at some point but there's still work to be done most 14 00:01:16,000 --> 00:01:20,800 infants are not exclusively breastfeeding or continuing to breastfeed as long as recommended 15 00:01:20,800 --> 00:01:26,160 only 26 of infants are breastfeeding exclusively at six months as recommended 16 00:01:26,160 --> 00:01:32,000 frustrating initiation rates vary geographically with large racial ethnic disparities nationally 17 00:01:32,000 --> 00:01:37,040 and at state and territorial levels focusing on communities with lower breastfeeding rates 18 00:01:37,040 --> 00:01:41,840 can reduce this barriers and improve infant nutrition and health so we have some really 19 00:01:41,840 --> 00:01:45,600 wonderful panelists today I think you all will really enjoy today's presentation 20 00:01:45,600 --> 00:01:52,400 they'll describe their work to support community breastfeeding at the community level. Just a few 21 00:01:52,400 --> 00:01:58,080 quick housekeeping reminders for our time today this zoom seminar call is being recorded so if 22 00:01:58,080 --> 00:02:02,480 you're not comfortable with being on a recorded call we ask that you disconnect at this time 23 00:02:03,120 --> 00:02:08,240 to have the best experience we encourage you to use the zoom webinar app to view 24 00:02:08,240 --> 00:02:13,920 slides and to participate in today's meetings all participants will be muted following our 25 00:02:14,640 --> 00:02:22,080 three presentations we will have a question and answer session so the q a box is open at any time 26 00:02:22,080 --> 00:02:27,040 throughout the talk today if you have a question go ahead and load it into the box 27 00:02:27,040 --> 00:02:34,400 and we'll do our best to get to as many questions as we can with the time that we have. I am super 28 00:02:34,400 --> 00:02:37,760 excited about our panelists today so I want to do a quick introduction 29 00:02:38,400 --> 00:02:45,600 of of all of them to you so our first um is one of the DNPAO's own Jasmine Nakayama. She's an 30 00:02:46,880 --> 00:02:50,320 epidemic intelligence officer or what we call at CDC an EIS 31 00:02:50,320 --> 00:02:56,640 officer in CDC's National Center for Chronic Disease Prevention and Health Promotion in DNPAO 32 00:02:57,200 --> 00:03:02,800 in her role on the maternal infant and toddler nutrition team Jasmine leads CDC's first analysis 33 00:03:02,800 --> 00:03:08,480 of county-level breastfeeding rates she received her PhD in nursing from Emory University's 34 00:03:08,480 --> 00:03:14,320 Nell Hodgson Woodruff School of Nursing and has a clinical experience in inpatient outpatient and 35 00:03:14,320 --> 00:03:19,920 emergency care settings and research experience using large electronic health record data sets. 36 00:03:20,960 --> 00:03:26,640 Harumi Reis Riley is a public health professional nutritionist and international board certified 37 00:03:26,640 --> 00:03:31,840 lactation consultant. She is a lead program analyst at the National Association of County 38 00:03:31,840 --> 00:03:37,120 and City Health Officials or NACCHO and where she oversees the reducing breastfeeding disparities 39 00:03:37,120 --> 00:03:43,840 through county continuity of care project this project aims to improve public health 40 00:03:43,840 --> 00:03:50,320 breastfeeding systems next we have a team of presenters so Cindy Young is co-founder 41 00:03:50,320 --> 00:03:55,520 of the Asian American and Native Hawaiian Pacific Islander Lactation Collaborative of California 42 00:03:55,520 --> 00:04:00,800 and the Asian Pacific Islander breastfeeding task force she is a program manager with Breastfeed 43 00:04:00,800 --> 00:04:05,440 LA an organization dedicated to improving the health and well-being of infants and families 44 00:04:05,440 --> 00:04:12,560 through education outreach and advocacy and her co-presenter is Tanya Lang also a co-founder of 45 00:04:12,560 --> 00:04:17,840 the Asian American and Native Hawaiian Pacific Islander Lactation Collaborative of California 46 00:04:17,840 --> 00:04:23,520 and a member of the steering committee of the Alameda County Breastfeeding Coalition. 47 00:04:23,520 --> 00:04:28,880 She is an international board certified lactation consultant a certified health education specialist 48 00:04:28,880 --> 00:04:34,960 and has supported chest breastfeeding and human milk feeding families for about 16 years. 49 00:04:37,520 --> 00:04:44,480 So first for our agenda today Dr Nakayama will discuss why breastfeeding is important how CDC 50 00:04:44,480 --> 00:04:49,200 monitors breastfeeding rates new efforts to monitor county level breastfeeding initiation 51 00:04:49,200 --> 00:04:55,760 rates using birth certificate data and uses and uses for county level breastfeeding data. 52 00:04:55,760 --> 00:05:00,000 Harumi will discuss the recently released continuity of care and breastfeeding support 53 00:05:00,000 --> 00:05:05,280 blueprint for communities focusing on specific recommendations strategies and examples for 54 00:05:05,280 --> 00:05:10,000 communities to strengthen local infant feeding data and then our final presenters 55 00:05:10,000 --> 00:05:14,720 Cindy and Tanya will discuss the diversity within the Asian American Native Hawaiian 56 00:05:14,720 --> 00:05:20,080 Pacific Islander communities review current breastfeeding and chest feeding data and their 57 00:05:20,080 --> 00:05:27,120 limitations and share current efforts to include and promote AANHPI voices in lactation 58 00:05:28,080 --> 00:05:34,400 so without further ado I would love to hand it over to my colleague Dr Nakayama Jasmine. 59 00:05:36,400 --> 00:05:40,000 Thank you good afternoon I'm excited to see everyone here it looks like there's a 60 00:05:40,000 --> 00:05:43,840 very lively audience I can see everyone in the chat chiming in so thank you um 61 00:05:45,520 --> 00:05:52,160 this presentation will review why breastfeeding is important why breastfeeding is important 62 00:05:52,160 --> 00:05:56,960 it will also summarize how CDC monitors breastfeeding rates share new efforts to 63 00:05:56,960 --> 00:06:03,520 monitor local level breastfeeding initiation rates and discuss uses of these local data I want to 64 00:06:03,520 --> 00:06:08,560 provide a quick reminder of the importance of this work breastfeeding is the optimal nutrition for 65 00:06:08,560 --> 00:06:14,640 most infants and protects against many illnesses and infections such as asthma and ear infections 66 00:06:16,400 --> 00:06:21,360 in addition to promoting bonding between mother and infant breastfeeding also provides health 67 00:06:21,360 --> 00:06:26,240 benefits for the mother including decreased risk for some chronic diseases such as high 68 00:06:26,240 --> 00:06:32,720 blood pressure and type 2 diabetes one of our data sources for national breastfeeding surveillance 69 00:06:32,720 --> 00:06:39,440 is the National Immunization Survey or NIS. NIS are the data that CDC reports on 70 00:06:39,440 --> 00:06:46,240 our website every August on the Breastfeeding Report Card and for healthy people indicators NIS 71 00:06:46,240 --> 00:06:51,520 is an annual nationally representative survey that is conducted by CDC 72 00:06:51,520 --> 00:06:58,000 using random digit dialing its primary objective is to assess vaccine coverage among children 73 00:06:58,000 --> 00:07:03,360 and since 2001 questions on breastfeeding have been asked to caregivers of children 74 00:07:03,360 --> 00:07:09,600 aged 19 to 35 months to assess breastfeeding rates at national and state levels by birth year 75 00:07:09,600 --> 00:07:13,360 the responses to these questions allow us to track breastfeeding 76 00:07:13,360 --> 00:07:18,880 initiation breastfeeding duration formula supplementation and exclusive breastfeeding 77 00:07:20,880 --> 00:07:25,280 next I want to describe another breastfeeding surveillance system that our team has recently 78 00:07:25,280 --> 00:07:31,120 started using which is birth certificate data the National Center for Health Statistics 79 00:07:31,120 --> 00:07:36,400 National Vital Statistics system is the federal compilation of birth certificate data which 80 00:07:36,400 --> 00:07:42,000 are collected between the time of delivery of an infant and the time of discharge from the facility 81 00:07:42,000 --> 00:07:46,800 or for infants that had home births the time of the completion of the birth certificate form 82 00:07:48,000 --> 00:07:52,560 the U.S. standard certificate of live birth collects data on many variables 83 00:07:52,560 --> 00:07:57,840 one of the questions asks whether an infant is being breastfed or discharged which is defined 84 00:07:57,840 --> 00:08:03,360 as receiving any breast milk or colostrum during the period between delivery and discharge from 85 00:08:03,360 --> 00:08:09,680 the birth facility or completion of the birth certificate form for home births our team has 86 00:08:09,680 --> 00:08:16,560 used birth certificate data for a couple different analyses a publication in may 2021 reported on 87 00:08:16,560 --> 00:08:21,920 racial and ethnic disparities in breastfeeding initiation using 2019 birth certificate data 88 00:08:22,640 --> 00:08:28,000 the figure on this slide shows the largest disparity in breastfeeding initiation between 89 00:08:28,000 --> 00:08:34,080 maternal racial and ethnic groups by percentage point differences in 48 states and in the District 90 00:08:34,080 --> 00:08:40,240 of Columbia the magnitude of disparity varied across the nation these data also indicated that 91 00:08:40,240 --> 00:08:45,200 the specific racial and ethnic group with the highest and lowest rates varied between states 92 00:08:46,400 --> 00:08:50,160 that analysis also indicated that states with higher breastfeeding 93 00:08:50,160 --> 00:08:56,800 initiation rates have the lowest disparity between racial and ethnic groups here the light blue bars 94 00:08:56,800 --> 00:09:01,600 show the overall breastfeeding initiation rates within a state and the dark blue bars 95 00:09:01,600 --> 00:09:06,000 show the disparity within the state which is defined here as the difference in breastfeeding 96 00:09:06,000 --> 00:09:10,960 initiation rates between ethnic and racial groups with the highest and lowest rates 97 00:09:11,840 --> 00:09:17,600 for example Oregon is the first state on the left Oregon has the highest breastfeeding rate and low 98 00:09:17,600 --> 00:09:22,720 disparity West Virginia on the far right has the lowest breastfeeding rate and higher disparity 99 00:09:23,760 --> 00:09:29,600 another publication in June 2019 described the receipt of breast milk by gestational age in 100 00:09:29,600 --> 00:09:34,720 the United States using 2017 birth certificate data this was one of the first times that we 101 00:09:34,720 --> 00:09:39,760 were able to look at breastfeeding initiation by gestational age and we were able to focus on 102 00:09:39,760 --> 00:09:46,480 some of our nation's most vulnerable infants this report indicated that the prevalence of infants 103 00:09:46,480 --> 00:09:53,040 receiving any breast milk was 48 overall and this number varied by gestational age 104 00:09:53,040 --> 00:09:58,720 disparities and receipt of breast milk by several socio-demographic factors including maternal race 105 00:09:58,720 --> 00:10:05,360 and ethnicity were noted across gestational age groups this slide highlights differences between 106 00:10:05,360 --> 00:10:10,080 NIS which are the data that we release every year on our website and the Breastfeeding Report Card 107 00:10:10,080 --> 00:10:17,120 and birth certificate data when looking at breastfeeding rates NIS on the left provides 108 00:10:17,120 --> 00:10:22,080 data on breastfeeding initiation duration and exclusivity whereas first certificate data on 109 00:10:22,080 --> 00:10:27,920 the right only include breastfeeding initiation data the most recent NIS data are for births 110 00:10:27,920 --> 00:10:34,880 occurring in 2018 whereas the most recent birth certificate data are for 2020 births. NIS provides 111 00:10:34,880 --> 00:10:40,240 data at the national and state level whereas birth certificate data have data at the county level 112 00:10:40,960 --> 00:10:47,360 birth certificate data do not include California. California did not report this variable to CDC 113 00:10:47,360 --> 00:10:51,680 and birth certificate data also do not include Michigan which asked the question a little 114 00:10:51,680 --> 00:10:57,200 differently and resulted in data that were not comparable breastfeeding initiation data for 115 00:10:57,200 --> 00:11:05,360 California and Michigan will be available for 2021 data and finally birth certificate data can allow 116 00:11:05,360 --> 00:11:10,640 analyses for gestational age and disparities due to the larger sample size within this data set. 117 00:11:12,960 --> 00:11:17,280 This slide shows you a resource for county breastfeeding initiation data this was 118 00:11:17,280 --> 00:11:21,120 recently published on our website last fall the link is on the slide 119 00:11:21,760 --> 00:11:27,120 the darkest blue on this map indicates the category of lowest breastfeeding initiation 120 00:11:27,120 --> 00:11:32,320 rates and the lightest blue indicates the category of the highest breastfeeding initiation rates 121 00:11:32,320 --> 00:11:36,400 the hashed lines indicate states or territories where data were not 122 00:11:36,400 --> 00:11:41,840 available and gray areas indicate data that were not shown for confidentiality reasons. 123 00:11:44,240 --> 00:11:50,320 Overall birth certificate breastfeeding initiation rates ranged from 22 percent to 100 percent 124 00:11:50,320 --> 00:11:57,120 across 3001 counties and county equivalents in 48 states in the District of Columbia we also 125 00:11:57,120 --> 00:12:02,320 presented rates for the territories of Guam and the commonwealth of the northern Mary islands 126 00:12:02,960 --> 00:12:06,000 and for 78 county equivalents in Puerto Rico. 127 00:12:06,640 --> 00:12:09,840 these rates demonstrate wide variation within states and across the nation. 128 00:12:12,160 --> 00:12:16,720 You can also select a state or territory to get more detailed information. 129 00:12:16,720 --> 00:12:21,040 This is an example of the map and the first few rows of a table presented for a state 130 00:12:21,920 --> 00:12:27,520 the breastfeeding initiation rate is presented for the state overall and for each county in a table. 131 00:12:28,240 --> 00:12:34,080 These tables of breastfeeding initiation rates by counties are available for download as a csv file. 132 00:12:34,080 --> 00:12:40,240 you can also sort the table here by location name number of infants or breastfeeding initiation rate. 133 00:12:41,440 --> 00:12:47,120 Note that data for some counties are not shown or the actual rate is not displayed 134 00:12:47,120 --> 00:12:52,720 to prevent identification of individuals these data can be used by many people 135 00:12:52,720 --> 00:12:57,920 and organizations to identify local rates of breastfeeding initiation to reveal disparities 136 00:12:57,920 --> 00:13:03,600 by location to inform programmatic efforts and to tailor local interventions more effectively. 137 00:13:04,560 --> 00:13:08,320 This concludes my presentation next I'll pass it over to Harumi Reis Riley. 138 00:13:10,320 --> 00:13:16,160 Thank you Jasmine and thanks for having me here to share a bit about the blueprint and what it 139 00:13:16,160 --> 00:13:22,240 says about local level breastfeeding data. So here are my acknowledgements. Uh the blueprint 140 00:13:22,240 --> 00:13:28,400 project is funded by CDC DNPAO so thank you but the views within the blueprint does not 141 00:13:28,400 --> 00:13:33,200 necessarily represent those of CDC. I also want to acknowledge that the content of the 142 00:13:33,200 --> 00:13:38,800 in the blueprint is a result of at least 100 professionals in the field here's a bit about 143 00:13:38,800 --> 00:13:43,920 us. NACCHO is the National Association of County and City Health Officials. Within NACCHO the chest 144 00:13:43,920 --> 00:13:48,800 breastfeeding program falls under the maternal child and adolescent health portfolio and exists 145 00:13:48,800 --> 00:13:54,560 since 2014. We have tons of resources developed through these past eight years and most recently 146 00:13:54,560 --> 00:14:00,080 we launched the Continuity of Care Breastfeeding Support Blueprint that I'll talk about today. I 147 00:14:00,080 --> 00:14:05,200 also wanted to add a plug here for the NACCHO's Public Health Informatics team. I'm going to talk 148 00:14:05,200 --> 00:14:09,840 about gaps on local level breastfeeding data but through their work I understand these gaps 149 00:14:09,840 --> 00:14:16,400 exist across many local public health programs so local professionals rely on data systems to 150 00:14:16,400 --> 00:14:22,320 assess community health identify population needs and create effective policy and programs 151 00:14:22,880 --> 00:14:27,920 and although most data collection happens at the local level this data is not easily 152 00:14:27,920 --> 00:14:33,600 accessible by local agencies. Usually the health data is fed from local to state to federal level 153 00:14:33,600 --> 00:14:39,520 so NACCHO informatics work to identify solutions within local health IT infrastructure to ensure 154 00:14:39,520 --> 00:14:44,720 that the data collect is collected and can be disseminated at the local level by looking at uh 155 00:14:44,720 --> 00:14:52,240 interoperability of systems and security of data sharing. So next slide you'll see a snapshot of 156 00:14:52,240 --> 00:14:58,320 the blueprint the blueprint goal is to ensure that lactation services are accessible coordinated and 157 00:14:58,320 --> 00:15:02,880 that all community spaces are consistently supportive. The blueprint was developed in 158 00:15:02,880 --> 00:15:08,400 partnership with the U.S. Breastfeeding Committee and their Continuity of Care Constellation. The 159 00:15:08,400 --> 00:15:13,120 blueprint includes seven recommendations divided in two themes. Uh improvements in community 160 00:15:13,120 --> 00:15:19,040 infrastructure structure and capacity building of the local lactation workforce. Uh the blueprint 161 00:15:19,040 --> 00:15:24,640 focuses only on actions that can be taken at the local level we launched the blueprint last August 162 00:15:24,640 --> 00:15:29,360 and you can download the blueprint from the continuity of care resource repository website 163 00:15:29,360 --> 00:15:35,600 and you see the link there in the slide. And next slide you see the blueprint recommendations. Today 164 00:15:35,600 --> 00:15:40,160 we'll focus only on recommendation one and four because there are the specific ones that discuss 165 00:15:40,160 --> 00:15:45,520 local breastfeeding data and the rationale for those recommendations is that community data 166 00:15:45,520 --> 00:15:54,000 can tell the story of where continuity of care gaps exist and equitably support specifically 167 00:15:54,000 --> 00:15:59,200 specific continuity of care models that uh enable families to meet their infant feeding goals. 168 00:16:00,000 --> 00:16:04,640 But as you're going to see the availability of communal level breastfeeding data especially 169 00:16:04,640 --> 00:16:10,320 data that is stratified by race and ethnicity and income is very limited. And through the blueprint 170 00:16:10,320 --> 00:16:16,160 meetings we heard many challenges in accessing local level data. The frustration was even more 171 00:16:16,160 --> 00:16:20,560 evident when we divided two subgroups and then the postpartum subgroups like the three-month 172 00:16:20,560 --> 00:16:26,720 milestone in babe babies over six months because continuation data is almost inexistent by then. 173 00:16:26,720 --> 00:16:32,320 So without this local disaggregated data it's really hard to even state that sub-optimal 174 00:16:32,320 --> 00:16:36,800 breastfeeding is actually an issue in the community. How we're going to say that there's 175 00:16:36,800 --> 00:16:42,560 a problem if there's no data to tell the story and how is anyone going to show impact of lactation 176 00:16:42,560 --> 00:16:47,520 support implementations if there is no data to show increasing rates and decreasing disparities. 177 00:16:48,160 --> 00:16:54,480 So in that slide the recommendation four states to develop a community driven database to track 178 00:16:54,480 --> 00:17:01,680 infant feeding consistently. Uh strategy 4.1 talks about assessing existing local data. 179 00:17:01,680 --> 00:17:06,800 One of the most known breastfeeding data that is consistently collected in communities is through 180 00:17:06,800 --> 00:17:12,240 the local WIC agency. However we've heard over and over and over again that this data is not easily 181 00:17:12,240 --> 00:17:19,120 accessible by other community agencies and also WIC data reflects only a subset of the community. 182 00:17:19,120 --> 00:17:25,440 But anyways other breastfeeding data that is being potentially collected at the local level are those 183 00:17:25,440 --> 00:17:30,800 through the home visiting programs like Healthy Start Nurse Family Partnership, Early Head Start 184 00:17:31,440 --> 00:17:37,440 data from Baby Cafes and also probably by some of some federal quite qualified health 185 00:17:37,440 --> 00:17:43,200 centers and other individual providers probably through their electronic health records systems. 186 00:17:43,200 --> 00:17:49,200 But the type of data collected by each may not align with each other and usually systems do not 187 00:17:49,200 --> 00:17:55,600 talk to each other which makes very difficult to safely share data. So this recommendation speaks 188 00:17:55,600 --> 00:18:01,040 to the need to improve into interoperability across health systems to allow exchange of 189 00:18:01,040 --> 00:18:09,520 information effectively. In the next slide you see we're going to start talking about um strategies 190 00:18:10,640 --> 00:18:14,640 for this recommendation to establish a streamlined community database. 191 00:18:15,200 --> 00:18:20,800 You see that in this recommendation a lot of the language is borrowed by the collective 192 00:18:20,800 --> 00:18:26,720 impact framework and public health informatics but this recommendation is really the shortest in all 193 00:18:26,720 --> 00:18:32,160 the blueprints and because currently there's not a whole lot of examples best practices 194 00:18:32,160 --> 00:18:36,960 or useful tools in the field but we are hopeful that there will be more communities addressing 195 00:18:36,960 --> 00:18:41,840 this critical gap in continuity of care. And also if you are doing some work on this area please 196 00:18:43,040 --> 00:18:48,480 let us know. I'll show briefly some of the few community examples that we know. I know some of 197 00:18:48,480 --> 00:18:55,360 them are here in this call today so please help me out. Tell your story in the chat box. But hopefully 198 00:18:55,360 --> 00:19:01,600 we can get everybody to come back and present on our recommendation for webinar later on this fall. 199 00:19:03,600 --> 00:19:08,560 We have REACH recipient in Nebraska. They have been using the collective 200 00:19:08,560 --> 00:19:13,040 impact framework and they use the shared measurement systems concept 201 00:19:13,040 --> 00:19:17,680 which means that partners are consistently collecting data and measuring results. And then 202 00:19:17,680 --> 00:19:22,400 the Partnership for Health Lincoln serves as a backbone organization to manage this data. 203 00:19:22,400 --> 00:19:26,480 so they collect and compile different sources of breastfeeding data that includes both of 204 00:19:26,480 --> 00:19:32,320 their local hospitals vital records data for breastfeeding intention and data from both of 205 00:19:32,320 --> 00:19:37,680 their local WIC offices. And they use those to identify trends in breastfeeding duration. They 206 00:19:37,680 --> 00:19:44,240 do even more in other program areas where there is an actual standardized indicator. For example they 207 00:19:44,240 --> 00:19:50,560 collect a lot of A1C data which is the indicator that measure average blood glucose and informs 208 00:19:50,560 --> 00:19:56,400 diabetes management. So this data is pulled from their three largest safety net clinics in Lincoln 209 00:19:56,400 --> 00:20:01,040 so they have a very good idea on how diabetes control is progressing in their county and they 210 00:20:01,040 --> 00:20:06,800 can tell if diabetes prevention activities are in fact being affected. And then the next example 211 00:20:07,680 --> 00:20:14,800 comes from Erie county in New York. This data is a bit old they plan to develop this county-wide data 212 00:20:14,800 --> 00:20:20,400 dashboard and repository to track their county breastfeeding rates. So first they establish the 213 00:20:20,400 --> 00:20:25,280 core set of data of breastfeeding data and the data format for each partner to collect 214 00:20:25,280 --> 00:20:31,680 and report among hospitals pediatricians family physicians WIC offices so each partner would have 215 00:20:31,680 --> 00:20:37,760 the ability to query in real-time aggregated rates among all reporting entities. They also wanted to 216 00:20:37,760 --> 00:20:44,560 have a storage of data for future research and evaluation purposes but I've heard they were not 217 00:20:44,560 --> 00:20:50,240 yet successful in engaging and encouraging their medical practices to use existing resources within 218 00:20:50,240 --> 00:20:56,240 their electronic health records to track rates. But their plan is pretty cool right. But of course 219 00:20:56,240 --> 00:21:02,320 this idea for a local breastfeeding dashboard did not come overnight out of the blue right. This was 220 00:21:02,320 --> 00:21:07,280 just one more step within the comprehensive breastfeeding program that you see here. Next 221 00:21:08,480 --> 00:21:14,640 uh here you see that they had previously formally incorporated breastfeeding measures and services 222 00:21:14,640 --> 00:21:19,520 into their community health improvement plan and through that they had their own strategic plan for 223 00:21:19,520 --> 00:21:25,280 breastfeeding and a comprehensive process map for the county as you see here. So this is to say that 224 00:21:25,840 --> 00:21:30,800 data related activities requires intentional planning to strategically like identify 225 00:21:30,800 --> 00:21:37,920 what when who to collect this data. And then in the next slide we're going to move on to uh 226 00:21:37,920 --> 00:21:46,160 recommendation one and Erie county is the perfect segue because of strategy 1.2 uh to integrate 227 00:21:46,160 --> 00:21:50,800 breastfeeding indicators and goals into community health improvement plans like here he did 228 00:21:51,520 --> 00:21:56,160 uh we did a whole 90-minute webinar recently just on that recommendation. So you can see 229 00:21:56,160 --> 00:22:00,880 the recording link there we're going to change the chat box too. There's a lot of strategies 230 00:22:00,880 --> 00:22:05,120 under this recommendation but today I really just wanted to talk about the data related 231 00:22:05,120 --> 00:22:12,320 strategy 1.1 of conducting a local lactation landscape assessment which is a little different 232 00:22:12,320 --> 00:22:16,560 from the recommendation four that I just talked because it involves more than collecting just 233 00:22:16,560 --> 00:22:24,560 the quantitative data. So next for this strategy I'll share a bit of our identifying care gaps 234 00:22:24,560 --> 00:22:31,680 uh project. So this was a grand project focusing solely understanding the community. So we funded 235 00:22:31,680 --> 00:22:37,840 eight community partnerships to conduct communal lactation assessments. So next you can see that 236 00:22:37,840 --> 00:22:44,000 we based their assessment framework on CHA CHIPs Mobilizing Action through Planning and Partnership 237 00:22:44,000 --> 00:22:49,120 or MAPP that has been used for decades to develop community health assessments and improvement plans. 238 00:22:49,680 --> 00:22:55,040 So we tailored MAPP best practices to include those three-part assessments. First you can you 239 00:22:55,040 --> 00:22:59,920 see their community status assessments that quantitatively describe the community and you 240 00:22:59,920 --> 00:23:04,960 see some of the samples of data that could be collected here. The second part is the community 241 00:23:04,960 --> 00:23:10,080 partners assessment to understand the individual and collective capacity of partners to address the 242 00:23:10,080 --> 00:23:16,000 root causes of breastfeeding inequities by looking critically within their own systems and processes. 243 00:23:16,000 --> 00:23:21,120 And finally third and critical part is the community context assessment to learn through 244 00:23:21,120 --> 00:23:26,640 the lens of those with lived experience and dig further into historical and structural routes of 245 00:23:26,640 --> 00:23:32,160 inequities within the community and of course also learn the community strengths desires 246 00:23:32,160 --> 00:23:36,800 and because we know that the solutions should disparities lies within communities members 247 00:23:37,360 --> 00:23:44,560 wisdom right. So in the next slide you're going to see all of eight grantees. They all did a great job. 248 00:23:44,560 --> 00:23:48,960 Um I'll just highlight the four here the pictures because of some 249 00:23:48,960 --> 00:23:53,120 something very unique they shared with us and we don't have a lot of time. So first here you see 250 00:23:53,120 --> 00:23:58,400 the Center for African American Health in the green box. One of their focus was understanding barriers 251 00:23:58,400 --> 00:24:03,840 to career advancements for Black lactation support providers and Black families experience navigating 252 00:24:04,480 --> 00:24:10,880 lactation support. So their results show the families experience modern medical racism and very 253 00:24:10,880 --> 00:24:16,720 limited opportunities for newly Black lactation support providers across the Denver region. 254 00:24:17,600 --> 00:24:22,720 Second here you see the east Saint Louis Health Department. One cool thing that they did was 255 00:24:22,720 --> 00:24:28,560 collect data from over 150 local businesses about their breastfeeding friendly practices and with 256 00:24:28,560 --> 00:24:34,640 these results they know exactly where to focus future efforts right. Third we have Coahoma Diaper 257 00:24:34,640 --> 00:24:40,080 Bank in the Mississippi Delta and they partnered with the Center for Health Equity Education 258 00:24:40,080 --> 00:24:45,200 and Research here. So they did a comprehensive assessment of existing community breastfeeding 259 00:24:45,200 --> 00:24:50,880 data and then they found a large data gap in breastfeeding durations and exclusivity 260 00:24:50,880 --> 00:24:55,040 and many difficulties accessing existing breastfeeding data from the state. 261 00:24:55,040 --> 00:25:00,000 They also identified other data sources from Baby Cafe and the CHAMPS hospital 262 00:25:00,000 --> 00:25:06,800 initiative but only CHAMPS gathered data by race and ethnicity which is crucial for understanding 263 00:25:06,800 --> 00:25:11,920 current community disparities and advancing health equity. And finally here last you see the 264 00:25:13,360 --> 00:25:18,560 breastfeeding coalition that by the way this coalition was created because of the availability 265 00:25:18,560 --> 00:25:24,480 of incredibly disaggregated data that is made available by the Minnesota Department of Health. 266 00:25:24,480 --> 00:25:28,960 Through this data they were able to identify that Hmong families had the lowest breastfeeding rates 267 00:25:28,960 --> 00:25:33,280 in many different counties so they formed the Hmong Breastfeeding Coalition and through this 268 00:25:33,280 --> 00:25:38,640 project they were able to understand some of their continuity of care gaps and found the 269 00:25:38,640 --> 00:25:44,320 Hmong driven organizations offered no lactation services or referrals and the most organizations 270 00:25:44,320 --> 00:25:49,920 providing lactation support do not offer any culturally responsive services for Hmong families. 271 00:25:49,920 --> 00:25:56,240 They also did a very cool um culturally attuned community contacts assessment which was a video 272 00:25:56,240 --> 00:26:02,720 storytelling collection initiative since the Hmong culture is rooted in oral storytelling to preserve 273 00:26:03,280 --> 00:26:10,080 language and traditions. So you can find all their recommendations under recommendation one on the 274 00:26:10,080 --> 00:26:16,480 blueprint website. And then next I just wanted to conclude these examples with a beautiful sample of 275 00:26:16,480 --> 00:26:22,320 disaggregated county level data from the Minnesota Department of Health that I just talked about. They 276 00:26:22,320 --> 00:26:28,800 do such a great job compiling data from WIC from birth certificates and hospitals and make the data 277 00:26:28,800 --> 00:26:35,120 very accessible to anyone that requests it. I was very impressed uh impressed with the how much 278 00:26:35,120 --> 00:26:41,280 they were able to disaggregate their WIC data by cultural identity like you see in this table here. 279 00:26:41,280 --> 00:26:47,200 Uh you see Black families from at least six culturally cultural identities instead of 280 00:26:47,200 --> 00:26:52,640 lumping all Black infants together as if they were one monolithic group. Very impressive right. 281 00:26:53,760 --> 00:26:59,040 And on the smaller screenshot you see another graphic of county level breastfeeding data 282 00:26:59,040 --> 00:27:04,640 duration data. So this only reflects WIC participants but still I think this is one of the 283 00:27:04,640 --> 00:27:12,320 most uh most disaggregated duration that we have seen through the past year um and very accessible. 284 00:27:13,360 --> 00:27:19,280 And then just to conclude I wanted to tell you about the current happenings within the blueprint. 285 00:27:19,280 --> 00:27:24,560 We're currently funding 10 organizations to implement the blueprint recommendations 286 00:27:24,560 --> 00:27:29,680 and we are also running our blueprint webinar series and I would like to invite you all here 287 00:27:29,680 --> 00:27:36,720 to the recommendation 3 webinar on May 24. And then in the fall we hope to bring all these 288 00:27:36,720 --> 00:27:42,800 organizations highlighted here today to discuss their project more in depth for webinar and 289 00:27:42,800 --> 00:27:48,960 data so stay tuned. Thank you so much and thank you CDC for all the technical support provided 290 00:27:48,960 --> 00:27:54,960 during this webinar. It's my pleasure now to turn it over to Tanya Lang and Cindy Young who 291 00:27:54,960 --> 00:28:02,240 have been doing great work in this field. Tanya. Thank you Harumi and thank you so much for the 292 00:28:02,240 --> 00:28:06,080 opportunity to present today again I'm Tanya Lang and I'm one of the co-founders of the 293 00:28:06,080 --> 00:28:11,920 collaborative. Um I identify as Chinese-American and I was born in the U.S. and I also speak two 294 00:28:11,920 --> 00:28:17,680 dialects of Chinese. And I'm going to hand it over to Cindy. Hi everyone I'm Cindy Young 295 00:28:17,680 --> 00:28:23,200 and I'm also a co-founder of the collaborative and I identify as Japanese and Korean-American 296 00:28:24,320 --> 00:28:30,400 and I also speak a little bit of Japanese as well. Today I wanted to go over quickly our or overview 297 00:28:30,400 --> 00:28:34,240 of what we're going to talk about. We're going to be talking about the diversity of our Asian 298 00:28:34,240 --> 00:28:39,120 American Native Hawaiian and Pacific Islander communities we're going to be talking a little bit 299 00:28:39,120 --> 00:28:44,480 about the current AANHPI chest and breastfeeding data and limitations. We're going to be talking 300 00:28:44,480 --> 00:28:50,720 about the model minority myth and the framing of our data. And finally we're going to be talking a 301 00:28:50,720 --> 00:28:56,080 little bit about the lactation landscape analysis that we're doing within the collaborative. 302 00:28:57,840 --> 00:29:02,160 Finally we're going to be talking about the formation of the collaborative and how we 303 00:29:02,160 --> 00:29:08,160 came together. So let's start by defining our population. Uh what do we mean when we say 304 00:29:08,160 --> 00:29:14,320 Asian American Native Hawaiian and Pacific Islander. So AANHPI is an umbrella term used 305 00:29:14,320 --> 00:29:19,280 to describe many different cultures and distinct languages that represent almost half the globe. 306 00:29:19,280 --> 00:29:24,800 The continent of Asia alone has over 48 countries and the Pacific Islands cover a 307 00:29:24,800 --> 00:29:29,600 geographic region that spans a distance broader than the United States and includes dozens of 308 00:29:29,600 --> 00:29:35,600 distinct cultures. So with this incredible ethnic diversity comes also a vast number of languages 309 00:29:35,600 --> 00:29:42,160 spoken. Uh let's take a closer look at the Pacific Islands or Pasifika which is what I'm told is the 310 00:29:42,160 --> 00:29:48,000 preferred term. So Pasifika is further divided into Micronesia Melanesia and Polynesia and 311 00:29:48,000 --> 00:29:52,880 here are some of the islands listed within each. I just want to note that the immigration 312 00:29:52,880 --> 00:29:57,920 and political status is different for residents of each island which determines whether one can 313 00:29:57,920 --> 00:30:04,080 live or work in the U.S. and access services and you may even see differences within each family. 314 00:30:04,960 --> 00:30:10,480 So where do most AANHPI people live in the United States. California actually has the highest number 315 00:30:10,480 --> 00:30:15,280 of people who identify as Asian and the second highest number identifying as native Hawaiian 316 00:30:15,280 --> 00:30:20,480 or Pacific Islander. AANHPIs are a large part of the population California and that's why 317 00:30:20,480 --> 00:30:26,160 it's so important to understand the needs of our communities. Okay so let's talk a little bit about 318 00:30:26,160 --> 00:30:33,680 data. Dr Nakayama already discussed the May 2021 CDC MMWR report on racial and ethnic disparities 319 00:30:33,680 --> 00:30:39,040 in breastfeeding initiation and that report found pretty high initiation rates for Asian mothers. 320 00:30:39,680 --> 00:30:44,400 In fact the prevalence of breastfeeding initiation was highest among Asians in 36 states 321 00:30:45,440 --> 00:30:49,520 nationally the largest racial ethnic disparity in breastfeeding initiation 322 00:30:49,520 --> 00:30:54,000 was 16.7 percentage points so what that meant was that it was a higher 323 00:30:54,000 --> 00:31:00,320 it was um higher for Asian mothers than for Black mothers um and as she mentioned uh California did 324 00:31:00,320 --> 00:31:05,840 not report its data. And remember I always said that California is a state where 30 percent 325 00:31:05,840 --> 00:31:12,320 of the US AANHPI population resides and that's the largest in the nation so making broad statements 326 00:31:12,320 --> 00:31:17,600 about high initiation rates in Asian and Native Hawaiian or other Pacific Islander communities 327 00:31:17,600 --> 00:31:23,440 without data from California really misses a large proportion of AANHPIs and their experiences 328 00:31:24,240 --> 00:31:28,240 and doesn't really present a full picture of breastfeeding in our communities. 329 00:31:29,040 --> 00:31:33,520 Also the data in the report only captures any breastfeeding rather than exclusive rates and 330 00:31:33,520 --> 00:31:39,760 again any breastfeeding can represent as little as one feeding so um just want to put out there that 331 00:31:39,760 --> 00:31:47,040 we really need to be careful about how we frame our data. So let's take a closer look at California. 332 00:31:47,040 --> 00:31:51,040 Um so the in-hospital breastfeeding data are taken from the newborn screening program 333 00:31:51,040 --> 00:31:56,000 and the exclusive breastfeeding data at one month and five or three months are taken from the 334 00:31:56,000 --> 00:32:01,920 Maternal Infant Health Assessment or MIHA so data from the newborn screen show high initiation rates 335 00:32:01,920 --> 00:32:08,480 for Asians and Pacific Islanders. But when we look at exclusive breastfeeding we see much lower rates 336 00:32:08,480 --> 00:32:14,640 for AANHPIs which are both of which are lower than the California average and by 337 00:32:14,640 --> 00:32:20,800 one month you see exclusivity drops. The one month exclusive rate for Asians and Pacific Islanders 338 00:32:20,800 --> 00:32:25,440 is the lowest among all ethnic groups and the three month exclusive rate is the second lowest. 339 00:32:26,160 --> 00:32:31,120 So just wanted to note also that the newborn screening data are broken out into Asian and 340 00:32:31,120 --> 00:32:36,640 Pacific Islander into two categories and you see a difference between the Asian and Pacific Islander 341 00:32:37,760 --> 00:32:44,880 groups in initiation but the MIHA data combine Asian and Pacific Islander into one category. So 342 00:32:44,880 --> 00:32:49,760 are there differences in duration between Asian and Pacific Islanders that are being masked by 343 00:32:49,760 --> 00:32:55,840 aggregated data. We don't really know. Um also MIHA is administered only in English and Spanish. 344 00:32:56,960 --> 00:33:02,080 Almost half of those identified as linguistically isolated in California are AANHPI 345 00:33:02,720 --> 00:33:07,680 meaning they self-identify as speaking English less than well and as we know language barriers 346 00:33:07,680 --> 00:33:11,280 can negatively impact the quality of care in hospital and clinic settings 347 00:33:11,840 --> 00:33:15,520 we're probably missing a significant portion of the AANHPIs in this survey. 348 00:33:17,280 --> 00:33:21,840 So let's take a look at my home in Alameda county which is in the San Francisco bay area in 349 00:33:21,840 --> 00:33:28,960 California. Here we see high initiation rates and lower rates for initial exclusive breastfeeding. 350 00:33:29,600 --> 00:33:34,480 Pacific Islanders have the lowest in-hospital exclusive breastfeeding rates as you can see 351 00:33:35,120 --> 00:33:41,440 but by one month exclusivity drops to 37 percent for Asian and Pacific Islanders and continues to 352 00:33:41,440 --> 00:33:47,360 decrease at three months to 32.7 percent. Again the one-month exclusive breastfeeding rate 353 00:33:47,360 --> 00:33:52,560 for Asians and Pacific Islanders is lowest among all ethnic groups and the three-month exclusive 354 00:33:52,560 --> 00:33:58,880 rate is the second lowest. In Los Angeles county we see slightly lower initiation rates but the 355 00:33:58,880 --> 00:34:04,000 initial exclusive breastfeeding rate is much lower than what we saw for Alameda county and California 356 00:34:04,000 --> 00:34:10,400 overall. Here we see that Asians have the lowest in-hospital exclusivity rates of all groups 357 00:34:10,400 --> 00:34:17,200 and it gets even worse by one month exclusivity drops to 31.6 for Asians and Pacific Islanders 358 00:34:17,200 --> 00:34:23,920 and continues to decrease to 18.2 percent by three months. So Asians and Pacific Islanders have the 359 00:34:23,920 --> 00:34:30,480 lowest exclusive breastfeeding rates of all ethnic groups at one month and three months. And I don't 360 00:34:30,480 --> 00:34:35,840 know about you but I find these numbers to be alarming and again why are we focusing so much on 361 00:34:35,840 --> 00:34:41,840 supplementation and exclusivity rates. Uh remember any breastfeeding can represent as little as one 362 00:34:41,840 --> 00:34:47,200 feeding and while any amount of human milk feeding is of course good and should be celebrated we know 363 00:34:47,200 --> 00:34:52,560 that the greatest health benefits for both mom and baby come from exclusive breast or chest feeding 364 00:34:52,560 --> 00:34:58,480 and that is why it's important to focus not just on the initiation rates. So to sum up AANHPI is an 365 00:34:58,480 --> 00:35:04,960 umbrella term used to refer to many heterogeneous groups that differ in culture language ancestry 366 00:35:04,960 --> 00:35:10,560 and religion however this is not how AANHPI are necessarily perceived. In our country 367 00:35:11,200 --> 00:35:17,840 Asian Americans are often stereotyped as a model minority. So a polite you know law abiding group 368 00:35:17,840 --> 00:35:22,320 who's successful due to inborn talent and kind of pull yourselves up by your bootstraps 369 00:35:22,320 --> 00:35:27,440 immigrant mentality. Asians as a group are thought to succeed just as well as whites 370 00:35:27,440 --> 00:35:33,920 but at the same time Asians are also viewed as perpetual foreigners. So however the myth ignores 371 00:35:33,920 --> 00:35:39,440 the diversity of our communities and considers Asian Americans as a monolith that is generally 372 00:35:39,440 --> 00:35:45,040 invisible in our society while also masking racism against our communities. Um the rampant racism 373 00:35:45,040 --> 00:35:51,680 against AANHPIs during the COVID-19 pandemic is just one example and more recently on March 374 00:35:51,680 --> 00:35:57,120 uh March 16th we acknowledged the one-year anniversary of the murders of eight people 375 00:35:57,120 --> 00:36:03,280 including eight Asian women massage workers at spas in metro Atlanta. Um the model minority 376 00:36:03,280 --> 00:36:08,720 myth also completely ignores Pasifika peoples. Uh the perceived success of Asians is often used to 377 00:36:08,720 --> 00:36:12,880 divide communities of color which ultimately harms the goal of achieving racial justice 378 00:36:12,880 --> 00:36:18,000 in our community. So from the current data we see high initiation rates to breastfeed 379 00:36:18,000 --> 00:36:24,000 um and high intention. We also see high rates of formula supplementation. So why is that is that 380 00:36:24,000 --> 00:36:31,040 related to racism or unfair or harsh treatment or linguistic isolation. When we look at national data 381 00:36:31,040 --> 00:36:36,400 it appears that we're doing great but that's not necessarily reflected in the local data 382 00:36:37,680 --> 00:36:43,840 for all health indicators are not regularly collected for our communities and even if we have 383 00:36:43,840 --> 00:36:48,960 data for Asians often data for Pacific Islanders is not available and we're often told that there 384 00:36:48,960 --> 00:36:53,840 are too few numbers and we're too few in numbers to break out the data in its own category. 385 00:36:54,560 --> 00:36:59,520 um but that's um that's a problem with data collection can be solved by things 386 00:36:59,520 --> 00:37:05,440 like over sampling of certain populations. Um unfortunately what little data we have on Asian 387 00:37:05,440 --> 00:37:10,880 Pacific Islanders are often combined together into one category and do not paint an accurate picture 388 00:37:10,880 --> 00:37:17,280 of the health of our communities. The model minority myth combined with the aggregated data 389 00:37:17,280 --> 00:37:21,840 paints a much more positive picture of the health and well-being of our communities and what we know 390 00:37:21,840 --> 00:37:29,600 is true. Um and as we saw in the MMWR report the problematic data framing of data has implications. 391 00:37:30,560 --> 00:37:34,640 Um data often drives programmatic priorities and funding opportunities so what little data 392 00:37:34,640 --> 00:37:39,680 we have suggest that our communities are doing well when looking at most health indicators. 393 00:37:39,680 --> 00:37:44,320 Um so that leads to a vicious cycle of fewer allocation of attention and resources to 394 00:37:44,320 --> 00:37:49,200 our communities and then not seeking out more data because there's no apparent need to do so 395 00:37:49,200 --> 00:37:51,520 and then not having the data to show any community needs. 396 00:37:53,760 --> 00:37:58,240 I'm going to hand it over to Cindy. All right now I'm going to talk a little bit about some 397 00:37:58,240 --> 00:38:03,280 of the work that we've been doing within the collaborative. So we've been doing our lactation 398 00:38:03,280 --> 00:38:09,920 landscape analysis and our landscape analysis began back in June of 2021 and it's the largest 399 00:38:09,920 --> 00:38:16,000 AANHPI lactation community needs assessment in the nation and we wanted to really add to the body 400 00:38:16,000 --> 00:38:20,000 of knowledge about chest and breastfeeding and human milk feeding in our communities 401 00:38:20,000 --> 00:38:25,680 and the resources available or the lack thereof to support our communities. So our landscape analysis 402 00:38:25,680 --> 00:38:31,040 has been divided into three parts. We have our national resource mapping survey which I'll 403 00:38:31,040 --> 00:38:36,080 talk about in a second. We have our community context assessment which includes a provider 404 00:38:36,080 --> 00:38:41,120 survey and a parent survey and Tanya is going to be talking about that. And then also we really 405 00:38:41,120 --> 00:38:47,120 wanted to focus on advocating for disaggregated data. That was a really important piece for us 406 00:38:47,680 --> 00:38:53,040 because it illustrates the diversity within the AANHPI umbrella and presents a more accurate 407 00:38:53,040 --> 00:38:57,440 picture of chest and breastfeeding with our within our communities. As Tanya mentioned 408 00:38:58,400 --> 00:39:04,160 data for all health indicators are not always collected for AANHPI and furthermore most data 409 00:39:04,160 --> 00:39:10,000 are aggregated under the general Asian American and Pacific Islander umbrella and so that's um 410 00:39:10,000 --> 00:39:14,960 the main reason why we wanted to really advocate for disaggregating it. And I also wanted to mention 411 00:39:14,960 --> 00:39:19,280 that this project that we were working on as a collaborative was not funded 412 00:39:19,280 --> 00:39:23,600 and we all decided that we wanted to do this work and we volunteered to do it. Um 413 00:39:23,600 --> 00:39:27,840 Breastfeed LA shout out to them. They were able to provide some in-kind support through their staff 414 00:39:29,520 --> 00:39:35,040 and others all volunteered their time for the work that we were doing so we're really grateful 415 00:39:35,040 --> 00:39:39,440 for all of the folks who worked on it so thank you to the collaborative members who couldn't 416 00:39:39,440 --> 00:39:46,320 be here with us today our extended family. We consider them our family members. Um so 417 00:39:46,320 --> 00:39:51,280 first let's talk a little bit about the National Resource Mapping Survey. The goal of that was to 418 00:39:51,280 --> 00:39:57,200 really create a national list of AANHPI lactation support professionals and educational resources 419 00:39:57,200 --> 00:40:04,720 for AANHPI families and this piece was led by one of our students Danielle Tropea and was who 420 00:40:04,720 --> 00:40:10,480 developed a landscape assessment tool to gather resources nationwide. We launched the survey back 421 00:40:10,480 --> 00:40:17,920 in October of 2021 and kept it open from October to December and we sought input from lactation 422 00:40:17,920 --> 00:40:24,000 support people who either identified as AANHPI or worked with predominantly AANHPI communities. 423 00:40:24,720 --> 00:40:30,960 We promoted the survey through many of our partner organizations including USBC NACCHO the California 424 00:40:30,960 --> 00:40:37,360 Breastfeeding Coalition California WIC National WIC and so far we've received 60 responses 425 00:40:37,360 --> 00:40:41,920 which tells us several things that either um there aren't very many resources out there 426 00:40:41,920 --> 00:40:48,320 which we suspect is probably true um or we're just not getting um it out to the um the right 427 00:40:48,320 --> 00:40:55,680 people. So we have decided to reopen our survey and we are continuing to gather um resources 428 00:40:55,680 --> 00:41:03,600 and we're hoping that we can further um add to the listings and make it as robust as possible. 429 00:41:03,600 --> 00:41:10,080 And we plan to share the list um when we have a good amount um on a website where people can 430 00:41:10,080 --> 00:41:16,240 access it for free. And so I want to share with all of you the link. Here there's a QR code. So if 431 00:41:16,240 --> 00:41:21,040 you'd like to take the survey or know of someone who can and is eligible to take the survey please 432 00:41:21,040 --> 00:41:26,000 share with um for with them and there's also a URL as well that you can share with folks. 433 00:41:29,840 --> 00:41:33,840 All right I'm going to turn it back to Tanya who's going to talk about the provider survey. 434 00:41:35,920 --> 00:41:41,520 Um so our community contacts assessment was led by another student Sophia Tan and included a survey 435 00:41:41,520 --> 00:41:48,480 and focus group of AANHPI healthcare providers and key informants who serve primarily AANHPI families 436 00:41:48,480 --> 00:41:55,520 and also a survey for AANHPI postpartum parents. So the survey for parents is currently in progress 437 00:41:57,040 --> 00:42:02,880 but for this provider survey and focus group we partnered with Asian Health Services which is 438 00:42:03,520 --> 00:42:11,040 which is an FQHC based in Oakland California. Um and that's the main side of our community context 439 00:42:11,040 --> 00:42:17,600 assessment. So uh providers and staff at AHS um completed a survey and participated in a focus 440 00:42:17,600 --> 00:42:23,120 group discussion. Um some of the findings that came out um from the survey and the focus group 441 00:42:23,680 --> 00:42:30,960 is that um there was definitely a need for more educational materials in AANHPI languages more 442 00:42:30,960 --> 00:42:35,600 staff training and lactation and also how to incorporate cultural practices in chest 443 00:42:35,600 --> 00:42:40,880 and breastfeeding support and also a resource directory of lactation support professionals 444 00:42:40,880 --> 00:42:46,480 which we are working on with that national um resource mapping survey and some of the important 445 00:42:46,480 --> 00:42:53,440 points that came out of that focus group is that um the family in the household extended family 446 00:42:53,440 --> 00:42:58,080 members in the household have a heavy influence on whether parents will breast or chest feed. 447 00:42:59,440 --> 00:43:04,560 They we had providers tell us straight up you know I can tell immediately who's going to breastfeed 448 00:43:04,560 --> 00:43:10,800 depending on how supportive other family members are in the house. They also wanted to know 449 00:43:10,800 --> 00:43:18,000 where to access in language educational materials and needed a defined referral process and where to 450 00:43:18,000 --> 00:43:24,320 send patients for more complex lactation support and also realize that the need to make some more 451 00:43:25,120 --> 00:43:32,880 workflow changes to improve communication um so minor things like um the comprehensive perinatal 452 00:43:32,880 --> 00:43:38,160 health workers now include their teaching notes in both the parent and the child's chart so that 453 00:43:38,160 --> 00:43:43,040 pediatricians actually know what happened and what kind of education the lactating parent received. 454 00:43:43,600 --> 00:43:49,200 and I'll hand it back over to Cindy to talk about how the collaborative formed. So many of 455 00:43:49,200 --> 00:43:54,960 you are probably wondering so how did you all come together. Um so it's kind of a nice a very uh 456 00:43:55,840 --> 00:44:01,040 great story I like to share. Um so the Lactation Collaborative of California 457 00:44:01,040 --> 00:44:06,320 AANHPI lactation collaborative um evolved from a joint effort between the Asian Pacific Islander 458 00:44:06,320 --> 00:44:12,400 Breastfeeding Task Force of Los Angeles. So that's an organization that I was working with 459 00:44:12,400 --> 00:44:17,040 and the Asian Southeast Asian and Pacific Islander Task Force of Alameda County and 460 00:44:17,040 --> 00:44:22,880 that's an organization that Tanya is affiliated with and we thought you know the north and the 461 00:44:22,880 --> 00:44:28,080 south of California we should all really be working together and so we decided to write for 462 00:44:28,080 --> 00:44:34,240 a grant um that NACCHO was offering um and it was the conducting communities assessment to improve 463 00:44:34,240 --> 00:44:38,400 the chest breastfeeding landscape in historically oppressed communities. And we heard about a lot of 464 00:44:38,400 --> 00:44:43,440 the grant recipients. They're really great and much deserving of the funding. We unfortunately didn't 465 00:44:43,440 --> 00:44:48,560 get the funding but we put together a really great work plan um that included the landscape 466 00:44:48,560 --> 00:44:53,200 analysis and the parent and provider surveys and the disaggregating of the data and we said 467 00:44:53,200 --> 00:44:57,760 we still want to do this is really great work. It's important work. It's not being done. 468 00:44:57,760 --> 00:45:02,960 Let's do it. And so we were able. It was just very fortuitous. The group came together we had some 469 00:45:02,960 --> 00:45:09,360 students that needed um to do some hours for their um master's degree um we had some elders 470 00:45:09,360 --> 00:45:14,720 um who were in the community who really wanted to give back to the community and had some time and 471 00:45:14,720 --> 00:45:19,600 said you know we can work on this as well. And we're like great let's do this. So we decided 472 00:45:19,600 --> 00:45:25,120 to put that work plan to work and we were able to accomplish a lot of that work plan unfunded. 473 00:45:26,320 --> 00:45:32,160 So one of the goals of the collaborative is to create a bridge between mainstream lactation 474 00:45:32,160 --> 00:45:38,320 public health organizations. And the AANHPI community the collaborative recognizes that many 475 00:45:38,320 --> 00:45:43,520 barriers to breast and chest feeding that exist in our AANHPI community which include limited 476 00:45:43,520 --> 00:45:49,280 breast and chest feeding data lack of culturally humble and language-appropriate lactation support 477 00:45:49,280 --> 00:45:55,440 systemic racism and healthcare and implicit bias among healthcare staff who continue to perpetuate 478 00:45:55,440 --> 00:46:00,720 myths such as AANHPI women don't breastfeed. And so we're here to dispel those myths and bring 479 00:46:00,720 --> 00:46:05,520 attention and resources to our community who are often left out of important health conversations. 480 00:46:07,120 --> 00:46:10,240 And our collaborative really fosters connections between 481 00:46:10,240 --> 00:46:16,320 our AANHPI individuals groups and organizations who provide lactation education and support. 482 00:46:16,320 --> 00:46:22,640 And like I said before we are really a north and south California statewide partnership that also 483 00:46:22,640 --> 00:46:28,080 conducts outreach to other AANHPI groups and to mainstream state and national organizations. 484 00:46:28,800 --> 00:46:33,760 One thing that really makes us special is that we really place a high priority on mentoring our 485 00:46:33,760 --> 00:46:39,920 AANHPI students and young professionals including supporting those who wish to become IBCLCs. 486 00:46:39,920 --> 00:46:45,120 And our collaborative recognizes that there are many um additional uh barriers to building 487 00:46:45,120 --> 00:46:49,760 capacity within our communities and we believe in providing additional support and uplifting 488 00:46:49,760 --> 00:46:56,160 our emerging leaders. And so we're always giving them opportunity to lead to speak at public um you 489 00:46:56,160 --> 00:47:01,040 know events and really put them in the spotlight because we feel that that's important. And another 490 00:47:01,040 --> 00:47:06,320 piece that we have included and that we care deeply about is that we incorporate the wisdom 491 00:47:06,320 --> 00:47:14,800 of our elders and ensuring that um their voice is heard as well. Um so it's a really great um sort of 492 00:47:14,800 --> 00:47:22,640 generational organization that encompasses all. Um the collaborative is also supported by allies from 493 00:47:23,200 --> 00:47:28,240 LA and the Alameda County Breastfeeding Coalition and we've also forged strong partnerships with 494 00:47:28,240 --> 00:47:34,640 other community organizations and stakeholders. And that pandemic has really allowed us to form 495 00:47:34,640 --> 00:47:40,880 a really close relationship. Um you know all these zoom meetings probably were not a thing until the 496 00:47:40,880 --> 00:47:46,160 pandemic. And so we're that maybe a silver lining that occurred uh from the pandemic is that we were 497 00:47:46,160 --> 00:47:53,200 able to really um connect and work together. And um we strongly believe that the successes that are 498 00:47:53,200 --> 00:47:58,560 you know within our collaborative are a result of our strong roots in our AANHPI communities. 499 00:47:58,560 --> 00:48:03,280 And our collaborative is also unique in that our efforts are completely organized and driven by 500 00:48:03,280 --> 00:48:11,600 our AANHPI community members with support from our allies within the lactation field. And our while 501 00:48:11,600 --> 00:48:17,760 our member um while one member may take the lead on a specific project our group norm is to include 502 00:48:17,760 --> 00:48:22,320 input from everyone in the group. And we strive to make sure everyone's voice is heard. So we always 503 00:48:22,320 --> 00:48:27,840 kind of joke around we bring our family with us when we when we do um you know presentations when 504 00:48:27,840 --> 00:48:33,840 we um we work on different projects because we feel that everyone's voice is really important. 505 00:48:34,640 --> 00:48:40,640 All right. Um so now you're wondering um what can we do you know. What how can we lift uplift 506 00:48:40,640 --> 00:48:48,240 the AANHPI community. How can we work with AANHPIs. Um so some of the things that we would um uh call 507 00:48:48,240 --> 00:48:54,480 you to do is to look at the data where you are. Get to know your communities and who your clients are. 508 00:48:54,480 --> 00:49:00,880 And if you don't know ask. Questions are great. Um reframing cultural traditions as assets versus 509 00:49:00,880 --> 00:49:07,760 something that you need to you know work around or work against. Uh support AANHPI organizations. 510 00:49:08,400 --> 00:49:15,680 Include us at the table. Um bring in young professionals and include the wisdom of our elders 511 00:49:15,680 --> 00:49:22,240 in all conversations. And ensure education provided to the community is culturally congruent not just 512 00:49:22,240 --> 00:49:26,640 regular information that's been translated into another language. It specifically needs to be 513 00:49:26,640 --> 00:49:33,200 tailored to the needs of our community. Um I know we're kind of coming up on time here so I want to 514 00:49:33,200 --> 00:49:38,960 thank all of you for letting us um share about the work that we've been doing and if you have 515 00:49:38,960 --> 00:49:44,320 any other questions about the AANHPI Lactation Collaborative of California welcome to reach 516 00:49:44,320 --> 00:49:51,680 out to Tanya or myself. Our contact information is listed here. And um like I said thank you so much 517 00:49:51,680 --> 00:49:56,720 and I turn the time back over to Janelle. Thank you. Thanks for all these wonderful presentations 518 00:49:56,720 --> 00:50:01,680 this afternoon. We have just a couple minutes for a few questions and answers. We want to remind our 519 00:50:01,680 --> 00:50:07,360 participants as well that the seminar is recorded and will be uploaded on the DNPAO 520 00:50:07,360 --> 00:50:12,880 webpage with some links so you can come back to there for some resources. So Jasmine if I could 521 00:50:12,880 --> 00:50:20,000 turn it back to you we've got some good questions about plans for repeating uh your analysis. Great. 522 00:50:20,000 --> 00:50:26,240 That's a question we get asked very often. We don't have any firm plans but we would like to 523 00:50:26,240 --> 00:50:30,720 repeat something like this in the future. We've received very positive feedback. It sounds like 524 00:50:31,280 --> 00:50:36,720 people really like having this data. They would like to have this done in the future to compare 525 00:50:36,720 --> 00:50:43,520 trends across time. We would like to include California and Michigan which means that we 526 00:50:43,520 --> 00:50:50,320 would need to wait for the 2021 data. And we also want 2022 data so that we can aggregate the 527 00:50:50,320 --> 00:50:55,040 two years and have enough of a sample size to look at county level initiation rates. 528 00:50:57,280 --> 00:51:03,200 Thank you. So we're halfway there. Um Harumi the next question is for you. The question is how 529 00:51:03,200 --> 00:51:11,920 can we access local WIC breastfeeding disparities data? Yeah as I mentioned uh local data is usually 530 00:51:12,800 --> 00:51:19,360 any local data is usually fed to state and then probably USDA here on a week so 531 00:51:19,360 --> 00:51:26,240 but we heard that I would start with your state health department but we heard across the country 532 00:51:26,240 --> 00:51:35,040 different levels of accessibility. Uh some make it very easy to access and some even I heard one 533 00:51:35,040 --> 00:51:40,960 require a fee um so it really depends on your state but I would start with the state. But then 534 00:51:40,960 --> 00:51:46,720 you know REACH Nebraska they compile the local WIC data at the local level and they 535 00:51:46,720 --> 00:51:50,800 make that accessible too. So I think it really depends on your state and your community. 536 00:51:53,200 --> 00:51:57,120 Thank you. And then Cindy and Tanya. I'll turn a question over to you. 537 00:51:57,120 --> 00:52:01,600 Given the diversity of Asian American Native Hawaiian Pacific Islander communities, 538 00:52:01,600 --> 00:52:04,800 how does language affect the ability to collect accurate data? 539 00:52:08,400 --> 00:52:15,040 Well as we had talked about earlier you know oftentimes surveys that are done to collect 540 00:52:15,040 --> 00:52:22,720 more data aren't necessarily translated into AANHPI languages. Um at best we see that um 541 00:52:22,720 --> 00:52:28,560 you know a survey um might be translated into Spanish or even a lot of educational materials 542 00:52:28,560 --> 00:52:33,120 you know that was something that we heard loud and clear from providers who were serving our 543 00:52:33,120 --> 00:52:40,960 communities. Um there just are not enough in language resources for our families and um 544 00:52:40,960 --> 00:52:45,600 it's and it's not a simple thing either because again given the diversity of our communities 545 00:52:45,600 --> 00:52:53,360 um think about how many languages that represents you know um even you know on Chinese. And even for 546 00:52:53,360 --> 00:52:57,760 Chinese there's not really you know just Chinese there's you know if you're translating materials 547 00:52:57,760 --> 00:53:03,520 is it in traditional Chinese or simplified Chinese or if there's anything um that need to 548 00:53:03,520 --> 00:53:08,160 be translated into another spoken language there are many dialects so that's just for Chinese. 549 00:53:10,240 --> 00:53:15,840 Yeah so just to add to what Tanya was saying so we are missing a big portion of our community 550 00:53:16,480 --> 00:53:21,360 by limiting the languages that the surveys are offered in and so that's something that 551 00:53:21,360 --> 00:53:27,120 we definitely are you know advocating for is to expand the number of languages that surveys 552 00:53:27,120 --> 00:53:32,960 are um offered in so that we can capture more of particularly the folks that are 553 00:53:32,960 --> 00:53:38,960 monolingual or you know um English is not their first language um communities so 554 00:53:39,840 --> 00:53:44,640 that's something we're hoping to work on as part of the advocacy work that we're doing. 555 00:53:46,720 --> 00:53:50,400 Thank you. Well we are coming to the end of our hour today. I really want to thank all 556 00:53:50,400 --> 00:53:55,520 our speakers for joining us. We had a great turnout which I'm so pleased really showing the interest 557 00:53:55,520 --> 00:54:00,080 across the country and how communities can better support breastfeeding. So thank you 558 00:54:00,080 --> 00:54:04,000 again to all of our speakers. Thank you to all of our participants for joining us for this 559 00:54:04,000 --> 00:54:09,840 first seminar series in 2022 and we look forward to seeing you at the next one. Thank you all.