203182 Variations in amount and timing of prenatal peer counseling and breastfeeding among low income women: An ecological perspective

Wednesday, November 11, 2009

Susan M. Gross, PhD, MPH, RD , Food Supplement Nutrition Education, University of Maryland Cooperative Extension, Columbia, MD
Dr. Joy P. Nanda, DSc, MS, MHS, MBA , Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
Amy Resnik, MS, RD, CSP, LDN , Maryland WIC Program, Maryland State Department of Health and Mental Hygiene, Balitmore, MD
Marycatherine Augustyn, PhD , Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
Caitlin Cross-Barnet , Department of Population, Family and Reprodutive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
David M. Paige, MD MPH , Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
Breastfeeding peer counseling (BFPC) positively impacts on breastfeeding initiation rates (BFIR) among low income women. However, the timing and quantity of BFPC during pregnancy on breastfeeding initiation is not clear. We utilized an ecological approach to explore whether variations in breastfeeding initiation rates (BFIR) were correlated with the timing and amount of BFPC contacts during pregnancy. Our population included 17,083 mother-infant dyads enrolled in 10 local WIC agencies offering BFPC during 2007. At certification, BFIR in these agencies was 60.6%.

In 2007, 31.5% of participants received at least one prenatal BFPC contact. Timing and number of contacts varied between agencies. On average, 11.7% of participants received just one prenatal contact, 7.2% received just 2 prenatal contacts and 12.6% received 3 or more prenatal contacts. The percentage of participants who received >=3 contacts by trimester of entry was 11.7% 1st trimester, 13.5% 2nd trimester, and 12.3% 3rd trimester.

Overall, >=3 prenatal BFPC contacts was significantly correlated with BFIR (r=0.72, p<0.05) with similar results obtained when analyzed by trimester of entry to WIC program (r=0.74, 0.69 & 0.71 for participants with >=3 contacts PC's for 1st, 2nd and 3rd trimester, respectively). After adjusting for variations in BFIR by local WIC agency, the patterns of BFIR for overall BFPC and by trimester of program entry remained the same.

Greater amount of BFPC prenatal exposure appears to have an association with increased BFIR among low-income participants. Early trimester of program entry and frequent BFPC contact may have a modest association with breastfeeding initiation rates.

Learning Objectives:
1. Provide an ecological framework to study breastfeeding initiation rates and peer counseling. 2. Describe the timing and amount of prenatal breastfeeding peer counseling contacts which may influence breastfeeding among low income women 3. Measure ecological correlation between prenatal breastfeeding peer counseling contacts and breastfeeding initiation and exclusivity

Keywords: Breast Feeding, Peer Counselors

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: Dr. Susan M. Gross is a specialist in maternal and child nutrition. Dr. Gross received her B.S in Nutrition Sciences and Clinical Dietetics from University of California, Berkeley, California and her Master’s in Public Health from San Diego State University. She earned her Doctorate of Philosophy degree in Maternal and Child Health from the Johns Hopkins School of Public Health and Hygiene. She completed an NIH Post-doctoral fellowship in disability research at the Kennedy Krieger Institute in Baltimore, Maryland. She has been a registered dietitian since 1987 and has been licensed in Maryland since June 2008. Most of Dr. Susan M. Gross’s career has been dedicated to research related to the Special Supplemental Nutrition Program for Women, Infants and Children (WIC). Dr. Susan M. Gross has been a part of the evaluation team for the Evaluation of the Maryland WIC Breastfeeding Peer Counselor Program at the Johns Hopkins Bloomberg School of Public Health. She served as co-investigator for numerous research initiatives related to WIC, including the Breastfeeding Promotion among Low-income Urban WIC Participants and a Literature Review of the Effectiveness of Nutrition Education for Pregnant Women, Breastfeeding Women and Caretakers of Infants. Dr. Gross is also a faculty member of the Department of Population and Family Health Sciences Winter Institute at Johns Hopkins Bloomberg School of Public Health. She teaches with Dr. David Paige an intensive one week course on Nutrition and Growth in Maternal and Child Health. Her research interests include: Maternal and Child Nutrition (specifically breastfeeding promotion and introduction of solid foods in the WIC program as well as childhood obesity and school-based initiatives to promote fruit and vegetable consumption). Dr. Gross was also instrumental in the creation of the Maryland “Right to Breastfeed” law in 2003. This law protects a woman’s right to breastfeed in public places.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.