This R01 renewal application extends our Community Based Participatory Research (CBPR) project that represents community efforts coupled with multi-institution, multi-disciplinary efforts across the perinatal period involving hospitals, WIC, prenatal and infant care providers to increase adoption of evidence-based approaches to improve breastfeeding (BF). Despite the proliferation of guidelines, recommendations and policies advising otherwise infants born to low income mothers (LIM) have higher rates of infant formula use and premature introduction of complementary food (CF), unsafe sleep conditions and second hand smoke (SHS) exposure compared to non-LIM. These rates represent significant current and future health care expenditures and are chronic and preventable and persistent. Our focus will expand beyond BF to include the concomitant issues of infant feeding practices (timing of CF), sleep safety and SHS exposure. These early infancy factors, while distinct, are inter-related, typically addressed to the same person (mother), in the same period of time (prenatal/early postpartum), are multifactorial, influenced by factors across levels of the social ecological (SE) model. Despite these commonalities, interventions promoting optimal infant feeding practices, safe sleep and SHS typically focus on a single issue at a single level (e.g. individual) and upon dissemination often fail to reach their original efficacy. Through this renewal we will continue to focus on two components of the SE model: Institutional level: address LIMs'lack of continuity, information and support across perinatal providers;Community level: CBPR and community messaging. While multi-level, multi-message coordinated interventions are considered essential to assure sustained impact, research testing their aggregate impact and across the SE model is lacking. Our long-term goal is to understand how key components of SE model, (intra/interpersonal, community and institutional) interact to learn how to maximally impact infant feeding practices and other infant health and safety practices. Our overarching hypothesis is that mothers will be more likely to follow guideline based infant feeding (and other health and safety practices) when all SE levels support these actions. Our CBPR approach and infrastructure uniquely positions us to pursue these aims: Increase community-wide adoption of evidence-based BF interventions across hospitals, WIC and prenatal and infant care providers to improve BF rates, delay introduction of CF and, secondarily increase adherence to SHS and safe sleep guidelines;test if a modified BFPC model to enhance continuity further improves these outcomes and;develop statistical models that account for the SE model's different levels (intra/interpersonal, community and institutional) investigating how these levels are associated with outcomes (BF, CF, SHS and safe sleep practices). Our results will: demonstrate how interventions across the SE model work synergistically (or do not) to increase adherence to feeding and safety guidelines and generate statistical models testing the SE model.

Public Health Relevance

Our Community Based Participatory Research project seeks to further improve infant health across a community by increasing low-income parents'adherence to infant feeding guidelines, safe sleep practices and second hand smoke exposure. We will achieve this by working with our community's hospitals, health care providers, other organizations and residents to increase adoption of methods that promote and support parent's guideline adherence.

Agency
National Institute of Health (NIH)
Institute
Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD)
Type
Research Project (R01)
Project #
5R01HD055191-07
Application #
8696873
Study Section
Community-Level Health Promotion Study Section (CLHP)
Program Officer
Raiten, Daniel J
Project Start
2007-09-28
Project End
2018-06-30
Budget Start
2014-07-01
Budget End
2015-06-30
Support Year
7
Fiscal Year
2014
Total Cost
Indirect Cost
Name
University of Rochester
Department
Public Health & Prev Medicine
Type
School of Medicine & Dentistry
DUNS #
City
Rochester
State
NY
Country
United States
Zip Code
14627
Dozier, Ann M; Brownell, Elizabeth; Guido, Joseph et al. (2014) Adapting the pregnancy risk assessment monitoring survey to enhance locally available data: methods. Matern Child Health J 18:1196-204
Korfmacher, Katrina Smith; Suter, Barbara J; Cai, Xueya et al. (2014) Environmental risks and children's health: what can PRAMS tell us? Matern Child Health J 18:1155-68
Dozier, Ann M; Nelson, Alice; Brownell, Elizabeth A et al. (2014) Patterns of postpartum depot medroxyprogesterone administration among low-income mothers. J Womens Health (Larchmt) 23:224-30
Dozier, Ann M; Howard, Cynthia R; Brownell, Elizabeth A et al. (2013) Labor epidural anesthesia, obstetric factors and breastfeeding cessation. Matern Child Health J 17:689-98
Brownell, Elizabeth A; Fernandez, I Diana; Fisher, Susan G et al. (2013) The effect of immediate postpartum depot medroxyprogesterone on early breastfeeding cessation. Contraception 87:836-43
Chin, Nancy P; Cuculick, Jessica; Starr, Matthew et al. (2013) Deaf mothers and breastfeeding: do unique features of deaf culture and language support breastfeeding success? J Hum Lact 29:564-71
Brownell, Elizabeth A; Fernandez, I Diana; Howard, Cynthia R et al. (2012) A systematic review of early postpartum medroxyprogesterone receipt and early breastfeeding cessation: evaluating the methodological rigor of the evidence. Breastfeed Med 7:10-8
Brownell, Elizabeth; Howard, Cynthia R; Lawrence, Ruth A et al. (2012) Delayed onset lactogenesis II predicts the cessation of any or exclusive breastfeeding. J Pediatr 161:608-14
Dozier, Ann M; Nelson, Alice; Brownell, Elizabeth (2012) The Relationship between Life Stress and Breastfeeding Outcomes among Low-Income Mothers. Adv Prev Med 2012:902487
Dozier, Ann M (2012) Quick reference breastfeeding guide available for medical students and residents. Breastfeed Med 7:320

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