Breastfeeding rates among African American women lag far behind those of white and Hispanic women, and nationally, the lowest rates of breastfeeding among all women, are among African American women under 20 years of age. In addition to the evidence of health benefits to mothers and infants from breastfeeding, recent research results show that lactation is inversely associated with aggressive triple negative breast cancer (TNBC) that disproportionately affects young African American women. These results clearly confirmed that parity-- formerly considered a risk reduction factor?is actually increasing risk of TNBC in African American women.1 Moreover, these results demonstrated that these risks can be totally ameliorated in African American women if they breastfeed.1 Research and health behavior theories show that perceived risk for health problems can be a motivating factor for behavior change. Thus, the breastfeeding and breast cancer risk results, combined with the known role of perceived risk as a motivator of behavior change, provides a compelling basis for developing and testing an intervention strategy centered around Peer Counselors educating young African American mothers about these links. The goal of the proposed study is to develop and evaluate a risk reduction intervention using multi-level cognitive and affective strategies through Women, Infants and Children (WIC) Peer Counselors (PCs) to increase breastfeeding by high risk African American mothers who are least likely to breastfeed.
The Specific Aims are:
Aim 1. Develop intervention strategies with WIC PCs to disseminate to African American mothers through community-engaged approach;
Aim 2. Assess the comparative cognitive, affective, sociocultural measures, and breastfeeding intent and outcomes with mothers exposed to the new strategies compared to mothers served by the existing WIC PC program. This study will not only assess the impact of the intervention on breastfeeding outcomes, but will also allow us to examine cognitive and affective factors related to decision making for breastfeeding behaviors in familial and sociocultural context, providing important insights into the role and relative importance of feelings, knowledge and beliefs, economics, behavioral and social barriers related to disparities in breastfeeding. Expected outcomes: Results will provide crucial information to determine if risk perceptions can be transformative in creating a shift from formula-as-an-equivalent-feeding-practice to ?Breast is Best? among African American women within their social context-- basically creating a culture-change model.
The proposed study is relevant to public health because it studies the behavioral impact of disseminating new scientific findings about reducing breast cancer risk for African American women by breastfeeding. In addition to assessing if this information will increase breastfeeding practices, the study will also assess the factors which influence African American mothers decisions about breastfeeding and the potential effectiveness of a community-based WIC Peer Counselor intervention to impact these decisions. The proposed study is relevant to the NIH mission pertaining to support of knowledge and research that will help improve maternal and child health and ultimately reduce breast cancer health disparities.