A long-standing programmatic tension within the Supplemental Nutrition Program for Women, Infants and Children (WIC) has been the promotion of breastfeeding coupled with the availability of free infant formula. Breastfeeding initiation and duration is substantially lower among WIC participants than their eligible non-participants. Peer counseling has been viewed as a potentially cost-effective means of increasing breastfeeding without removing the safety net of free formula. In fact, the recent Surgeon General's Call to Action on Breastfeeding recommends that peer counseling become a core service in all WIC agencies. The proposed study will evaluate the effectiveness of a telephone-based peer counseling program to improve breastfeeding among WIC recipients. The study leverages already collected data from the largest randomized control trial (RCT) of peer counseling for breastfeeding ever undertaken among WIC clients by contrasting results from the RCT conducted in four counties in Oregon to those from a non-randomized peer counseling intervention of the same design that was implemented at the same time in two different counties in the state. As a third contrast, we will analyze changes in breastfeeding among WIC clients in the same state over the same study period but in counties that had no peer counseling intervention. Data from the last two sources will be extracted from Oregon's WIC administrative data system. We will compare estimates of the intention-to-treat as well the effect of treatment on the treated in the RCT to those obtained from a non-randomized design. This will provide the first estimates of selection bias associated with a peer counseling intervention based on observational data. In addition, we can estimate the potential external validity of results from th RCT by contrasting the characteristics and breastfeeding outcomes of WIC participants in the control arm of the RCT to those of WIC participants in counties with no peer counseling. By exploiting data in three distinct settings, (RCT of peer counseling, non-RCT of peer counseling and no peer counseling), we will provide a comprehensive examination of the potential of peer counseling to enhance the initiation, duration and exclusivity of breastfeeding among WIC participants.

Public Health Relevance

Breastfeeding improves infant and maternal health and yet a long-standing tension within the Supplemental Nutrition Program for Women, Infants and Children (WIC) has been the promotion of breastfeeding coupled with the availability of free infant formula. Peer counseling has been viewed as a potentially cost-effective means of increasing breastfeeding without removing the safety net of free formula. This study will evaluate the effectiveness of a peer counseling program to enhance breastfeeding with data from randomized, and non- randomized intervention conduction simultaneously in the same state.

Agency
National Institute of Health (NIH)
Institute
Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD)
Type
Small Research Grants (R03)
Project #
1R03HD072991-01
Application #
8337555
Study Section
Pediatrics Subcommittee (CHHD)
Program Officer
Raiten, Daniel J
Project Start
2012-08-06
Project End
2014-07-31
Budget Start
2012-08-06
Budget End
2013-07-31
Support Year
1
Fiscal Year
2012
Total Cost
$78,773
Indirect Cost
$28,773
Name
Bernard M. Baruch College
Department
Miscellaneous
Type
Other Domestic Higher Education
DUNS #
620127493
City
New York
State
NY
Country
United States
Zip Code
10010
Reeder, Julie A; Joyce, Ted; Sibley, Kelly et al. (2014) Telephone peer counseling of breastfeeding among WIC participants: a randomized controlled trial. Pediatrics 134:e700-9