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MICH-23 Data Details

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MICH-23 Reduce the proportion of breastfed newborns who receive formula supplementation within the first 2 days of life

About the Data: National

Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

Data Source: 
National Immunization Survey
Changed Since the Healthy People 2020 Launch: 
Yes
Measure: 
percent
Baseline (Year): 
23.3 (2009)
Target: 
14.2
Target-Setting Method: 
Projection/trend analysis
Target-Setting Method Justification: 
The proportion of breastfed infants supplemented with infant formula within the first 2 days of life increased from 22.3 percent of infants born in 2003 to 24.2 percent of infants born in 2006. Supplementation of newborn breastfed infants with formula has an important influence on breastfeeding after hospital discharge. The Joint Commission, an organization that accredits hospitals, recently added a performance measure for which hospitals report the proportion of newborns who leave the hospital having had nothing but breast milk. This measure is expected to help drive hospitals to improve practices to decrease formula supplementation of breastfed newborns when not medically indicated. A target of 14.2 percent is proposed because current efforts are expected to result in an absolute 10-percentage point decrease over the next 10 years. Although ambitious, the target is reasonable.
Numerator: 

Number of caregivers of breastfed infants born in cohort year (for current baseline, year 2006) who indicate their infant received formula supplementation within the first 2 days of life

Denominator: 

Number of children aged 19-35 months born in one calendar year (e g , baseline refers to the 2006 birth cohort) who were breastfeeding at 2 days of life

Comparable Healthy People 2010 Objective: 
Not applicable
Questions Used to Obtain the National Baseline Data: 

    From the 2011 National Immunization Survey

    [NUMERATOR:]

    Was [child] ever breastfed or fed breast milk?

    1. Yes
    2. No

    How old was [child's name] when (he/she) was first fed formula?

    1. ≤ 2 days of age
    2. Other
Methodology Notes: 

    If the response to the first question (Was child ever breastfed or fed breast milk?) is No, the child is not considered a breastfed newborn and is not included in the denominator.

    The National Immunization Survey (NIS) is conducted annually and collects data on children through age 35 months, and enables CDC to calculate breastfeeding rates each year. Because children are 19-35 months of age at the time of the NIS interview, each cross-sectional survey includes children born in two different calendar years. Using a computer-generated list, the NIS identifies households across the United States with children aged 19–35 months and interviews the person who is most knowledgeable about the child’s immunization status (“caregiver”). Starting January 2003, all respondents to the household telephone survey were asked questions related to breastfeeding, with modification of breastfeeding questions in 2004 and 2006. Survey years are combined to calculate breastfeeding by year of child’s birth (cohort) instead of year in which the participant was surveyed. To calculate breastfeeding indicators by year of child birth, data are combined across all available survey years.

    In 2011, a cellular telephone sample of respondents was included in the National Immunization Survey (NIS) along with the landline telephone sampling frame used for all previous survey years (referred to as dual-frame sampling).In 2018, the NIS sampling frame was changed to include only a cell phone sample (referred to as single cell-frame sampling). While the inclusion of cell phones resulted in the need to revise the baselines and targets of many HP2020 objectives, the change from dual frame to single cell-frame sampling of respondents had a minimal effect on national estimates of all 6 breastfeeding indicators examined (ever breastfed, breastfed at 6 and 12 months, exclusive breastfeeding through 3 and 6 months, and formula supplementation before 2 days among breastfed infants); national prevalence estimates differed by 0.2 percentage points or less.

    The following webpage outlines all of the changes that were made for the NIS in 2011 and 2018.
    https://www.cdc.gov/breastfeeding/data/nis_data/methods.html.

About the Data: State

Description of the data source, numerator, denominator, survey questions, and other relevant details about the state-level data.

Data Source: 
National Immunization Survey
Measure: 
percent
Numerator: 

Number of caregivers of breastfed infants born in cohort year (for current baseline, year 2006) who indicate their infant received formula supplementation within the first 2 days of life

Denominator: 

Number of children aged 19-35 months born in one calendar year (e g , baseline refers to the 2006 birth cohort) who were breastfeeding at 2 days of life

Questions Used to Obtain the State Data: 

      From the 2011 National Immunization Survey

      [NUMERATOR:]

      Was [child] ever breastfed or fed breast milk?

      1. Yes
      2. No

      How old was [child's name] when (he/she) was first fed formula?

      1. ≤ 2 days of age
      2. Other
Methodology Notes: 

      If the response to the first question (Was child ever breastfed or fed breast milk?) is No, the child is not considered a breastfed newborn and is not included in the denominator.

      The National Immunization Survey (NIS) is conducted annually and collects data on children through age 35 months, and enables CDC to calculate breastfeeding rates each year. Because children are 19-35 months of age at the time of the NIS interview, each cross-sectional survey includes children born in two different calendar years. Using a computer-generated list, the NIS identifies households across the United States with children aged 19–35 months and interviews the person who is most knowledgeable about the child’s immunization status (“caregiver”). Starting January 2003, all respondents to the household telephone survey were asked questions related to breastfeeding, with modification of breastfeeding questions in 2004 and 2006. Survey years are combined to calculate breastfeeding by year of child’s birth (cohort) instead of year in which the participant was surveyed. To calculate breastfeeding indicators by year of child birth, data are combined across all available survey years.

      In 2011, a cellular telephone sample of respondents was included in the National Immunization Survey (NIS) along with the landline telephone sampling frame used for all previous survey years (referred to as dual-frame sampling).In 2018, the NIS sampling frame was changed to include only a cell phone sample (referred to as single cell-frame sampling). While the inclusion of cell phones resulted in the need to revise the baselines and targets of many HP2020 objectives, the change from dual frame to single cell-frame sampling of respondents had a minimal effect on national estimates of all 6 breastfeeding indicators examined (ever breastfed, breastfed at 6 and 12 months, exclusive breastfeeding through 3 and 6 months, and formula supplementation before 2 days among breastfed infants); national prevalence estimates differed by 0.2 percentage points or less.

      The following webpage outlines all of the changes that were made for the NIS in 2011 and 2018.
      https://www.cdc.gov/breastfeeding/data/nis_data/methods.html.

Revision History

Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

Description of Changes Since the Healthy People 2020 Launch: 
The baseline for this objective was revised in 2019 due to a change in the methodology used to track this measure. The baseline year was revised from 2006 to 2009. The baseline was revised from 24.2% to 23.3%. In keeping with the original target setting method (projection/trend analysis), the target remained 14.2%.

References

Additional resources about the objective

  1. Smith PJ, Zhao Z, Wolter KM, Singleton JA, Nuorti JP. Age-period-cohort analyses of public health data collected from independent serial cross-sectional complex probability sample surveys. Seattle, WA: Joint Statistical Meeting; 2006.