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Breast-feeding initiation in low-income women: Role of attitudes, support, and perceived control

      Despite the documented health and emotional benefits of breast-feeding to women and children, breast-feeding rates are low among subgroups of women. In this study, we examine factors associated with breast-feeding initiation in low-income women, including Theory of Planned Behavior measures of attitude, support, and perceived control, as well as sociodemographic characteristics. A mail survey, with telephone follow-up, of 733 postpartum Medicaid beneficiaries in Mississippi was conducted in 2000. The breast-feeding initiation rate in this population was 38%. Women who were older, white, non-Hispanic, college-educated, married, not certified for the Supplemental Nutrition Program for Women, Infants, and Children, and not working full-time were more likely to breast-feed than formula-feed at hospital discharge. Attitudes regarding benefits and barriers to breast-feeding, as well as health care system and social support, were associated with breast-feeding initiation at the multivariate level. Adding the health care system support variables to the regression model, and specifically support from lactation specialists and hospital nurses, explained the association between breast-feeding initiation and women’s perceived control over the time and social constraints barriers to breast-feeding. The findings support the need for health care system interventions, family interventions, and public health education campaigns to promote breast-feeding in low-income women.
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      References

        • Abbott Laboratories Ross Products Division
        Mothers survey.
        Author, Del Rio, TX2003
        • Ajzen I.
        The theory of planned behavior.
        Organizational Behavior and Human Decision Processes. 1991; 50: 179-211
        • Alexy B.
        • Martin A.C.
        Breastfeeding.
        Public Health Nursing. 1994; 11: 214-218
        • American Academy of Family Physicians (AAFP)
        Breastfeeding and infant nutrition. 1998–1999 AAFP reference manual. Author, Washington, DC1994
        • American Academy of Pediatrics (AAP)
        Policy statement.
        Pediatrics. 1997; 100: 1035-1039
        • American College of Nurse-Midwives (ACNM)
        Clinical practices statement on breastfeeding. Author, Washington, DC1992 (http://www.acnm.org/prof/breast.html)
        • American College of Obstetricians and Gynecologists (ACOG)
        Breastfeeding. Author, Washington, DC2000 (http://www.aafp.org/policy/75.html)
        • American Dietetic Association (ADA)
        Position of the ADA. Author, Washington, DC1997 (http://www.eatright.org/adap0697.html)
        • American Public Health Association (APHA)
        Breastfeeding. Author, Washington, DC1982 (Public Policy Statement no. 8226)
        • Armstrong J.
        • Reilly J.J.
        • Child Health Information Team
        Breastfeeding and lowering the risk of childhood obesity.
        Lancet. 2002; 359: 2003-2004
        • Arora S.
        • McJunkin C.
        • Wehrer J.
        • Kuhn P.
        Major factors influencing breastfeeding rates.
        Pediatrics. 2000; 106: E67
        • Avery M.
        • Duckett L.
        • Dodgson J.
        • Savik K.
        • Henly S.J.
        Factors associated with very early weaning among primiparas intending to breastfeed.
        Maternal and Child Health Journal. 1998; 2: 167-179
        • Ball T.M.
        • Wright A.L.
        Health care costs of formula feeding in the first year of life.
        Pediatrics. 1999; 103: 870-876
        • Bar-Yam N.B.
        • Darby L.
        Fathers and breastfeeding.
        Journal of Human Lactation. 1997; 13: 45-50
        • Beaudry M.
        • Dufour R.
        • Marcoux S.
        Relation between infant feeding and infections during the first six months of life.
        Journal of Pediatrics. 1995; 126: 191-197
        • Bernaix L.W.
        Nurses’ attitudes, subjective norms, and behavioral intentions toward support of breastfeeding mothers.
        Journal of Human Lactation. 2000; 16: 201-209
        • Best Start Social Marketing
        Research brief. Author, Tampa, FL1996
        • Bronner Y.L.
        • Bentley M.
        • Caulfield L.
        Influence of work or school on breastfeeding among urban WIC participants. Abstracts of the 124th Annual Meeting of the American Public Health Association.
        APHA, New York1996
        • Burglehaus M.J.
        • Smith L.A.
        • Sheps S.B.
        • Green L.W.
        Physicians and breastfeeding.
        Canadian Journal of Public Health. 1997; 88: 383-387
        • Burr M.L.
        • Limb E.S.
        • Maguire M.J.
        • Amarah L.
        • Eldridge B.A.
        • Layzell J.C.
        • Merrett T.G.
        Infant feeding, wheezing, and allergy.
        Archives of Disease in Childhood. 1993; 68: 724-728
        • Caulfield L.E.
        • Gross S.M.
        • Bentley M.E.
        • Bronner Y.
        • Kessler L.
        • Jensen J.
        • et al.
        WIC-based interventions to promote breastfeeding among African American women in Baltimore.
        Journal of Human Lactation. 1998; 14: 15-22
        • Centers for Disease Control and Prevention
        Pediatric nutrition surveillance, 1997 full report. United States Department of Health and Human Services, Atlanta, GA1998
        • Cohen R.
        • Mrtek M.B.
        • Mrtek R.G.
        Comparison of maternal absenteeism and infant illness rates among breastfeeding and formula-feeding women in two corporations.
        American Journal of Heath Promotion. 1995; 10: 148-153
        • Collaborative Group on Hormonal Factors in Breast Cancer
        Breast cancer and breastfeeding.
        Lancet. 2002; 360: 187-195
        • Cumming R.G.
        • Klineberg R.J.
        Breastfeeding and other reproductive factors and the risk of hip fractures in elderly women.
        International Journal of Epidemiology. 1993; 22: 684-691
        • Cushing A.H.
        • Samet J.M.
        • Lambert W.E.
        • Skipper B.J.
        • Hunt W.C.
        • Young S.A.
        • McLaren L.C.
        Breastfeeding reduces risk of respiratory illness in infants.
        American Journal of Epidemiology. 1998; 147: 863-870
        • Davis M.K.
        Review of the evidence for an association between infant feeding and childhood cancer.
        International Journal of Cancer. 1998; 11: 29-33
        • Dennis C.L.
        Breastfeeding initiation and duration.
        Journal of ObstetricsGynecologyand Neonatal Nursing. 2002; 31: 12-32
        • Dermer A.
        Overcoming medical and social barriers to breastfeeding.
        American Family Physician. 1995; 51: 755-763
        • Dewey K.G.
        Growth characteristics of breastfed compared to formula-fed infants.
        Biology of the Neonate. 1998; 74: 94-105
        • Dewey K.G.
        • Heinig M.J.
        • Nommwen L.A.
        Maternal weight loss patterns during prolonged lactation.
        American Journal of Clinical Nutrition. 1993; 58: 162-166
        • Dewey K.G.
        • Heinig M.J.
        • Nommsen-Rivers L.A.
        Differences in morbidity between breastfed and formula-fed infants.
        Journal of Pediatrics. 1995; 126: 696-702
        • Dick M.J.
        • Evans M.L.
        • Arthurs J.B.
        • Barnes J.K.
        • Caldwell R.S.
        • Hutchins S.S.
        • Johnson L.K.
        Predicting early breastfeeding attrition.
        Journal of Human Lactation. 2002; 1: 21-28
        • Dietz W.H.
        Breastfeeding may help prevent childhood overweight.
        Journal of the American Medical Association. 2001; 285: 2506-2507
        • Duncan B.
        • Ey J.
        • Holberg C.J.
        • Wright A.L.
        • Martinez F.D.
        • Taussig L.M.
        Exclusive breastfeeding for at least 4 months protects against otitis media.
        Pediatrics. 1993; 91: 867-872
        • Fein B.
        • Roe B.
        The effect of work status on initiation and duration of breastfeeding.
        American Journal of Public Health. 1998; 88: 1042-1046
      1. Fishbein M. Readings in attitude theory and measurement. Wiley, New York1967
        • Freed G.L.
        • Clark S.J.
        • Harris B.G.
        • Lowdermilk D.L.
        Methods and outcomes of breastfeeding instruction for nursing students.
        Journal of Human Lactation. 1996; 12: 105-110
        • Freed G.L.
        • Clark S.J.
        • Sorenson J.R.
        • Lohr J.A.
        • Cefalo R.C.
        • Curtis P.
        National assessment of physicians’ breastfeeding knowledge, attitudes, training, and experience.
        Journal of the American Medical Association. 1995; 273: 472-476
        • Garofalo R.P.
        • Goldman A.S.
        Expression of functional immunomodulatory and anti-inflammatory factors in human milk.
        Clinical Perinatology. 1999; 26: 361-377
        • Gielen A.C.
        • Faden R.R.
        • O’Campo P.
        • Brown H.
        • Paige D.M.
        Maternal employment during the early postpartum period.
        Pediatrics. 1991; 87: 298-305
        • Goksen F.
        Normative vs. attitudinal considerations in breastfeeding behavior.
        Social Science and Medicine. 2002; 54: 1743-1753
        • Goldman A.S.
        The immune system of human milk.
        Pediatric Infectious Diseases Journal. 1993; 12: 664-672
        • Greco L.
        • Auricchio S.
        • Mayer M.
        • Grimaldi M.
        Case control study on nutritional risk factors in celiac disease.
        Journal of Pediatric Gastroenterology and Nutrition. 1997; 7: 395-399
        • Grummer-Strawn L.M.
        • Rice S.P.
        • Dugas K.
        • Clark L.D.
        • Benton-Davis S.
        An evaluation of breastfeeding promotion through peer counseling in Mississippi WIC clinics.
        Maternal and Child Health Journal. 1997; 1: 35-42
        • Guttman N.
        • Zimmerman D.R.
        Low-income mothers’ views on breastfeeding.
        Social Science and Medicine. 2000; 50: 1457-1473
        • Health Resources and Services Administration (HRSA) Maternal and Child Health Bureau (MCHB)
        Breastfeeding—abstracts and products of MCHB-funded projects.
        Author, Rockville, MD1996
        • Heinig M.J.
        • Dewey K.G.
        Health effects of breastfeeding for mothers.
        Nutrition Research Reviews. 1997; 10: 35-56
        • Hellings P.
        • Howe C.
        Assessment of breastfeeding knowledge of nurse practitioners and nurse midwives.
        Journal of Midwifery and Women’s Health. 2000; 45: 264-270
        • Hernell O.
        • Blackberg L.
        Human milk bile salt-stimulated lipase.
        Journal of Pediatrics. 1994; 125 (5 Pt 2): S56-S61
        • Hills-Bonczyk S.G.
        • Avery M.D.
        • Savik K.
        • Potter S.
        • Duckett L.J.
        Women’s experiences with combining breastfeeding and employment.
        Journal of Nurse-Midwifery. 1993; 38: 257-266
        • Hoey C.
        • Ware J.L.
        Economic advantages of breastfeeding in an HMO setting.
        American Journal of Managed Care. 1997; 3: 861-865
        • Hong T.M.
        • Callister L.C.
        • Schwartz R.
        First time mothers’ views of breastfeeding support from nurses.
        American Journal of Maternal Child Nursing. 2003; 8: 10-15
        • Howie P.W.
        • Forsyth J.S.
        • Ogston S.A.
        • Clark A.
        • Florey C.
        Protective effect of breastfeeding against infection.
        British Medical Journal. 1990; 300: 11-16
        • Humenick S.S.
        • Hill P.D.
        • Spiegelberg P.L.
        Breastfeeding and health professional encouragement.
        Journal of Human Lactation. 1998; 14: 305-310
        • Humphreys A.S.
        • Thompson N.J.
        • Miner K.R.
        Intention to breastfeed in low-income pregnant women.
        Birth. 1998; 25: 169-174
        • Ivarsson A.
        • Hernell O.
        • Stenlund H.
        • Persson L.A.
        Breastfeeding protects against celiac disease.
        American Journal of Clinical Nutrition. 2002; 75: 914-921
        • Izatt S.D.
        Breastfeeding counseling by health care providers.
        Journal of Human Lactation. 1997; 13: 109-113
        • Janke J.R.
        Development of the breastfeeding attrition prediction tool.
        Nursing Research. 1994; 43: 100-104
        • Kalwart H.J.
        • Specker B.L.
        Bone mineral loss during lactation and recovery after weaning.
        Obstetrics and Gynecology. 1995; 86: 26-32
        • Karipis T.A.
        • Spicer M.
        A survey of pediatric nurses’ knowledge about breastfeeding.
        Journal of Pediatric Nursing. 1999; 14: 193-200
      2. Khoury, A. J., Bryant, C. A., Carothers, C., Hinton, A., Graham-Kresge, S., Moazzem, S. W., & Foretich, C. The National Loving Support Makes Breastfeeding Work Campaign in Mississippi. Maternal and Child Health Journal (forthcoming).

        • Khoury A.J.
        • Hinton A.
        • Mitra A.K.
        • Carothers C.
        • Foretich C.
        Improving breastfeeding knowledge, attitudes, and practices of WIC clinic staff.
        Public Health Reports. 2002; 117: 453-462
        • Khoury A.J.
        • Mitra A.K.
        • Hinton A.
        • Carothers C.
        • Sheil H.
        An innovative video succeeds in addressing barriers to breastfeeding among low-income women.
        Journal of Human Lactation. 2002; 18: 125-131
        • Kramer F.
        Breastfeeding reduces maternal lower body fat.
        Journal of the American Dietetic Association. 1993; 93: 429-433
        • Kuzela A.L.
        • Stifter C.A.
        • Worobey J.
        Breastfeeding and mother-infant interactions.
        Journal of Reproductive and Infant Psychology. 1990; 8: 185-194
        • Levine O.S.
        • Farley M.
        • Harrison L.H.
        • Lefkowitz L.
        • McGeer A.
        • Schwartz B.
        Risk factors for invasive pneumococcal disease in children.
        Pediatrics. 1999; 103: 28
        • Lucas A.
        • Cole T.J.
        Breast milk and neonatal necrotizing enterocolitis.
        Lancet. 1990; 336: 1519-1523
        • Mahoney M.C.
        • James D.M.
        Predictors of anticipated breastfeeding in an urban, low-income setting.
        Journal of Family Practice. 2000; 49: 529-533
        • McIntyre E.
        • Hiller J.E.
        • Turnbull D.
        Attitudes towards infant feeding among adults in a low socioeconomic community.
        Breastfeeding Review. 2001; 9: 13-24
        • McNeilly A.S.
        Lactational amenorrhea.
        Endocrinology and Metabolism Clinics of North America. 1993; 22: 59-73
        • Meier P.P.
        • Brown L.P.
        • Hurst N.M.
        Breastfeeding the preterm infant.
        in: Auerback K. Riordan J. Breastfeeding. Aspen, Gaithersburg, MD1998: 449-480
        • Meyerink R.O.
        • Marquis G.S.
        Breastfeeding initiation and duration among low-income women in Alabama.
        Journal of Human Lactation. 2002; 18: 38-45
        • Montgomery D.L.
        • Splett P.L.
        Economic benefits of breastfeeding infants enrolled in WIC.
        Journal of the American Dietetic Association. 1997; 97: 379-385
        • National Medical Association (NMA)
        Pediatrics section of the NMA statement on breastfeeding. Author, Washington, DC2000
        • Norris J.M.
        • Scott F.W.
        A meta-analysis of infant diet and insulin-dependent diabetes mellitus.
        Epidemiology. 1996; 7: 87-92
        • Oddy W.H.
        Breastfeeding protects against illness and infection in infants and children.
        Breastfeeding Review. 2001; 9: 11-18
        • Oddy W.H.
        • Sherriff J.L.
        • de Klerk N.H.
        • Kendall G.E.
        • Sly P.D.
        • et al.
        The relation of breastfeeding and body mass index to asthma and atopy in children.
        American Journal of Public Health. 2004; 94: 1531-1537
        • Pabst H.F.
        Immunomodulation by breastfeeding.
        Pediatric Infectious Disease Journal. 1997; 16: 991-995
        • Patton C.B.
        • Beaman M.
        • Csar N.
        • Lewinski C.
        Nurses’ attitudes and behaviors that promote breastfeeding.
        Journal of Human Lactation. 1996; 12: 111-115
        • Perez-Escamilla R.
        • Pollitt E.
        • Lonnerdal B.
        • Dewey K.G.
        Infant feeding policies in maternity wards and their effect on breastfeeding success.
        American Journal of Public Health. 1994; 84: 89-97
        • Phillips V.
        Evaluation of a voluntary in-service on breastfeeding.
        Journal of Nursing Staff Development. 1991; 7: 246-247
        • Picciano M.F.
        Human milk.
        Biology of the Neonate. 1998; 74: 84-93
        • Pisacane A.
        • Graziano L.
        • Mazzarella G.
        • Scarpellino B.
        • Zona G.
        Breastfeeding and urinary tract infection.
        Journal of Pediatrics. 1992; 129: 87-89
        • Quarles A.
        • Williams P.D.
        • Hoyle D.A.
        • Brimeyer M.
        • Williams A.R.
        Mothers’ intention, age, education and the duration and management of breastfeeding.
        Maternal-Child Nursing Journal. 1994; 22: 102-108
        • Raisler J.
        Against the odds.
        Journal of Midwifery and Women’s Health. 2000; 45: 253-263
        • Raisler J.
        • Alexander C.
        • O’Campo P.
        Breastfeeding and infant illness.
        American Journal of Public Health. 1999; 89: 25-30
        • Raj V.K.
        • Plichta S.B.
        The role of social support in breastfeeding promotion.
        Journal of Human Lactation. 1998; 14: 41-45
        • Riordan J.M.
        The cost of not breastfeeding.
        Journal of Human Lactation. 1997; 13: 93-97
        • Roe B.
        • Wittington L.A.
        • Fein S.B.
        • Teisl M.F.
        Is there competition between breastfeeding and maternal employment?.
        Demography. 1999; 36: 157-171
        • Rosenblatt K.A.
        • Thomas D.B.
        Prolonged lactation and endometrial cancer.
        International Journal of Epidemiology. 1995; 24: 499-503
        • Saarinen U.M.
        • Kajosaari M.
        Breastfeeding as prophylaxis against atopic disease.
        Lancet. 1995; 346: 1065-1069
        • Scariati P.D.
        • Grummer-Strawn L.M.
        • Fein S.B.
        A longitudinal analysis of infant morbidity and the extent of breastfeeding in the United States.
        Pediatrics. 1997; 99: 5
        • Schafer E.
        • Vogel M.K.
        • Viegas S.
        • Hausafus C.
        Volunteer peer counselors increase breastfeeding duration among rural low-income women.
        Birth. 1998; 25: 101-106
        • Schanler R.J.
        • O’Conner K.G.
        • Lawrence R.A.
        Pediatricians’ practices and attitudes regarding breastfeeding promotion.
        Pediatrics. 1999; 103: E35
        • Scott J.A.
        • Binns C.W.
        Factors associated with the initiation and duration of breastfeeding.
        Breastfeeding Review. 1999; 7: 5-16
        • Shu X.O.
        • Linet M.S.
        • Steinbuch M.
        • Wen W.Q.
        • Buckley J.D.
        • Neglia J.P.
        • et al.
        Breastfeeding and risk of childhood acute leukemia.
        Journal of the National Cancer Institute. 1999; 91: 1765-1772
        • Sikorski J.
        • Renfrew M.J.
        • Pindoria S.
        • Wade A.
        Support for breastfeeding mothers (Cochrane Review).
        The Cochrane Library. 2002; 1 (Oxford: Update Software)
        • Smulevich V.B.
        • Solionova L.G.
        • Belyakova S.V.
        Parental occupation and other factors and cancer risk in children.
        International Journal of Cancer. 1999; 83: 712-717
        • UNICEF/WHO
        The UNICEF/baby friendly hospital initiative. Author, New York1992
        • United States Department of Health and Human Services (DHHS)
        Healthy People 2010: Vol II. Objectives for Improving Health (part B). 2000 (www.health.gov/healthypeople/document/tableofcontents.htm#Volume2)
        • Uvnas-Moberg K.
        • Eriksson M.
        Breastfeeding.
        Acta Paediatrica. 1996; 85: 525-530
        • von Kries R.
        • Koletzko B.
        • Sauerwald T.
        • von Mutius E.
        • Barnert D.
        • Grunert V.
        • von Hoss H.
        Breastfeeding and obesity.
        British Medical Journal. 1999; 319: 147-150
        • Wambach K.A.
        Breastfeeding intention and outcome.
        Research in Nursing and Health. 1997; 20: 51-59
        • Whittemore A.S.
        • Harris R.
        • Itnyre J.
        • Collaborative Ovarian Cancer Group
        Characteristics relating to ovarian cancer risk.
        American Journal of Epidemiology. 1992; 136: 1184-1203
        • World Health Organization (WHO)
        Evidence for the ten steps to successful breastfeeding (Pub No. WHO/CHD 98.9). Author, Geneva1998
        • Wright A.L.
        • Holberg C.J.
        • Taussig L.M.
        • Martinez F.D.
        Relationship of infant feeding to recurrent wheezing at age 6 years.
        Archives of Pediatric and Adolescent Medicine. 1995; 149: 758-763

      Biography

      Amal Khoury is a health services researcher with interests in women’s health care and policy across the life span, and particularly in cancer control and access to care in vulnerable populations of women.

      Biography

      Syed Wakerul Moazzem is a public health physician with training in epidemiology and biostatistics and research interests in maternal and child health and communicable and chronic disease epidemiology.

      Biography

      Chad Jarjoura is a women’s health care physician with training in obstetrics and gynecology and research interests in the organization and delivery of preventive and primary care services to women.

      Biography

      Cathy Carotherss is an International Board Certified Lactation Consultant specializing in breastfeeding promotion and support, particularly with women in low-income populations.

      Biography

      Agnes Hinton is a public health researcher and teacher with interests in nutrition education and cancer control in underserved populations and health outreach through community health advisors.