1. Developing Worksite Wellness Programs: The Lactation Support Model Katherine Shealy, MPH, IBCLC, RLC Nutrition Branch Carol MacGowan, MPH, RD, LD Program Development and Evaluation Branch Division of Nutrition, Physical Activity, and Obesity

2. 2 Worksite Health Promotion Definition: A combination of educational, organization, and environmental activities & programs designed to motivate & support healthy lifestyles among a company’s employees and their families. Source: Chenoweth, 2007

3. 3 Worksites as Environments for Health Behavior Change ● Employees spend at least 50% of waking hours at worksite ● Employer reasons: Decrease costs Attract and retain good employees Reduce health care spending Improve morale ● Examples from other areas: Physical activity, tobacco cessation, stress management, etc. Source: Chenoweth, 2007

4. 4 Breastfeeding as a Public Health Issue for the United States Infants in the US who are not breastfed face significantly increased risk of: ● Chronic diseases (eg.: Type 1 & type 2 diabetes, obesity) ● Infectious diseases (eg.: Atopic dermatitis, otitis media, lower respiratory tract infections, gastrointestinal illness) ● Rare events (eg.: Childhood leukemia, SIDS, necrotizing enterocolitis) Mothers in the US who do not breastfeed face significantly increased risk of: ● Breast cancer ● Ovarian cancer ● Type 2 diabetes Sources: Chen & Rogan, Pediatrics – 2004 Agency for Healthcare Research and Quality, USDHHS – 2007

5. Healthy People 2010 Goals Breastfeeding Rates Among 2004 Births Data from CDC National Immunization Survey Percent 25% 75% 50% 40% 17%

6. 6 Breastfeeding Worksite Interventions: Why? ● Women make up 46% of the total US labor force 67 million women (60% of all women) are employed Most mothers work full-time (78%) Most mothers of young children work (55%) Mothers are the fastest growing workforce (80% growth over past 20 yr) Source: US Department of Labor – 2006

7. Employment Rates Among Mothers Data from US Department of Labor – 2006 Source: US Department of Labor – 2006

8. 8 Breastfeeding Worksite Interventions: Why? ● Postpartum return to work is an identified barrier to breastfeeding Lower rates of initiation, exclusivity & duration Cited by mothers as a reason for weaning ● Postpartum return to work overlaps critical period for exclusive breastfeeding ⅓ return within 3 months ⅔ return within 6 months Low-income women return to work earlier Sources: CDC Guide to Breastfeeding Interventions – 2005 Fein & Roe Am J Pub Health – 1998 Fein et al. Pediatrics – forthcoming

9. 9 Identified Issues in Worksite Lactation Support ● Concerns with ad-hoc programs Instability Lack of active management support Self-selecting ● Concerns with work settings Cube vs. office Factory line, service industry Hospitals, schools

10. 10 ● Better meets employers’ needs than ad hoc programs ● Provides active protection and support for employees who are breastfeeding ● Can be used as template for additional areas of wellness promotion ● Can be integrated into larger wellness programs Formal Breastfeeding Worksite Interventions

11. 11 Workplace Lactation Support Increases: Breastfeeding duration Staff productivity and loyalty Public image of employers Decreases: Absenteeism Employer health care costs Employee turnover

12. 12 Basic Needs of Breastfeeding Employees ● Time and space to express milk regularly ● Support from supervisors and colleagues ● Information on how to successfully combine breastfeeding with employment ● Access to health professionals who can assist with breastfeeding questions and concerns

13. 13 Worksite Lactation Programs Resources ● CDC – Healthier Worksite Initiative Lactation Support Toolkit ● MCHB – The Business Case for Breastfeeding ● US Breastfeeding Committee – Checklist for Accommodations for Breastfeeding in the Workplace

14. 14 The CDC Guide to Breastfeeding Interventions ● Maternity Care Practices ● Workplace Support ● Peer Support ● Educating Mothers ● Professional Support ● Media and Social Marketing

15. 15 Origins of the CDC Healthier Worksite Initiative (HWI) ● October 2002 Tasked with developing a WHP initiative to complement CDC’s Lifestyle Program ● Spring 2003 Program staffed

16. 16 HWI Scope ● Based on HealthierUS “pillars” Nutritious eating Physical activity Preventive health screenings Healthy choices ● All CDC employees nationwide ● Share lessons learned

17. 17 HWI Vision and Mission Vision…. A worksite where healthful choices are easy choices. Mission… The Healthier Worksite Initiative will develop, evaluate, and disseminate science-based programs that promote worksite health for all CDC/ATSDR employees, and serve as a model and resource for other [federal and state] worksites.

18. 18 LSP Toolkit: Introduction ● Toolkit scope How to create a comprehensive worksite LSP ● Health challenge Win-win-win situation: benefits employers new moms infants ● Toolkit components What?Why?How?

19. 19 HWI Web Resources Homepage URL: http://www.cdc.gov/nccdphp/dnpa/hwi/

20. 20 Lactation Support Program (LSP) Toolkit

21. 21 LSP Toolkit Example: Planning

22. 22 HRSA Maternal and Child Health Bureau (MCHB) Project The Business Case for Breastfeeding

23. 23 The Business Case for Breastfeeding (BCB) ● MCHB project to produce a resource kit on lactation support in the workplace ● Focuses on a business perspective ● Designed for: Employers Human Resource Managers Employees Lactation Consultants/Advocates

24. 24 Scope of BCB Resource Kit ● Increase awareness among employers of the economic benefits of breastfeeding ● Outline manageable, flexible, models for implementing or enhancing a worksite breastfeeding support program ● Increase number of U. S. employers that utilize a worksite breastfeeding support program

25. 25 Components of BCB Resource Kit Five Modules Brochure focused on cost savings, targeted to management staff Easy Steps to Support Breastfeeding Employees Tool Kit with templates that can be adapted for individual businesses Employees’ Guide to Breastfeeding and Working Outreach Marketing Guide and templates

26. 26 Implementation Training ● MCHB and HHS Office of Women’s Health have funded the development of a curriculum for implementing the Resource Kit ● Curriculum entitled: Implementing the Business Case for Breastfeeding in YOUR Community

27. 27 Status of BCB Resource Kit ● FY 2008-2010 Train-the-Trainer (TTT) Workshops for: State Breastfeeding Coalitions (SBC) Healthy Start Communities ● First TTT workshop held January 2008

28. 28 Pilot BCB Resource Kit TTT Sites

29. 29 MCHB Business Case for Breastfeeding ● Project Officer: Isadora Hare, MSW LCSW Division of Healthy Start and Perinatal Services Maternal and Child Health Bureau E-mail: ihare@hrsa.govihare@hrsa.gov ● Web release: Spring 2008

30. 30 US Breastfeeding Committee – Checklist for Accommodations for Breastfeeding in the Workplace ● Environment: Space Facility location Pumps Pump personal supplies Furnishings ● Policy: Leave Other accommodations Breaks for expressing milk Workplace education

31. 31 Potential Action Steps ● Be an example – establish a model lactation support program for all state employees ● Celebrate successes – recognize employers who support their breastfeeding employees ● Use resources wisely – find out about existing policies and legislation that support your work

32. 32 Resources ● CDC Breastfeeding Website http://www.cdc.gov/breastfeeding ● CDC Healthier Worksite Initiative http://www.cdc.gov/hwi ● HRSA Maternal Child Health Bureau http://www.mchb.hrsa.gov ● US Breastfeeding Committee http://www.usbreastfeeding.org

33. 33 References ● Agency for Health Care Research and Quality. Breastfeeding and Maternal and Infant Health Outcomes in Developed Countries 2007. Available Online at http://www.ahrq.gov/downloads/pub/evidence/pdf/brfout/brfout.pdf Accessed March 6, 2008 http://www.ahrq.gov/downloads/pub/evidence/pdf/brfout/brfout.pdf ● Chenoweth, DH. Worksite Health Promotion, 2 nd Ed. Champaign, IL: Human Kinetics Publishers, 2007. ● Chen A and Rogan WJ. Breastfeeding and the Risk of Postneonatal Death in the United States. Pediatrics 2004; 113: e435-e439 ● Fein SB, Roe B. The effect of work status on initiation and duration of breastfeeding. American Journal of Public health 1998; 88(7): 1042-6. ● Healthy Workforce 2010: An essential sourcebook for employers. Available online at http://www.acsworkplacesolutions.com/documents/Healthy_Workforce_2010.pdfhttp://www.acsworkplacesolutions.com/documents/Healthy_Workforce_2010.pdf. Accessed February 2007 ● U.S. Department of Labor Women’s Bureau. (2006). Statistics and Data: Quick Stats. Available online at http://www.dol.gov/wb/stats/main.htm. Accessed February 2007.http://www.dol.gov/wb/stats/main.htm ● U.S. Department of Labor Women’s Bureau. (2006). Employment status of women and men in 2005. Available online at http://www.dol.gov/wb/facthseets/Qf-ESWIM06.htm. Accessed February 2007. http://www.dol.gov/wb/facthseets/Qf-ESWIM06.htm. Accessed February 2007 ● Shealy K, Li R, Benton-Davis S, Grummer-Strawn L. The CDC guide to breastfeeding interventions. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, 2005.

34. 34 Thank You Contact information: Katherine Shealy: KShealy@cdc.govKShealy@cdc.gov Carol MacGowan: CMacGowan@cdc.govCMacGowan@cdc.gov