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Predicting Intentions to Continue Exclusive Breastfeeding for 6 Months: a Comparison Among Racial/Ethnic Groups

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Abstract

The purpose of this study was to explore how mothers of different races/ethnicities make decisions to continue exclusive breastfeeding (EBF) for 6 months under the Theory of Planned Behavior. Participants were recruited from hospitals and WIC clinics in Central Indiana and Southern New Jersey from 2008 to 2009. Mothers (N = 236: 93 non-Hispanic African American, 72 non-Hispanic white, 71 Hispanic/Latina) completed a self-administered questionnaire that measured theoretical constructs and beliefs related to their intention to practice EBF for 6 months. Intentions to continue EBF for 6 months were similar (P = 0.15) across racial/ethnic groups. Significant proportions of the intention (P < 0.001) were explained by the three theoretical constructs (attitude, subjective norm, and perceived behavioral control). The relative importance of each construct in predicting the intention varied by group. The most influential predictors (P < 0.001) were attitude for white mothers, subjective norm for African American mothers, and perceived behavioral control for Latina mothers. Latent beliefs strongly associated with attitude in white mothers were ‘bonding with the baby’ and ‘easy feeding.’ Beliefs held by family members and the general public contributed to the subjective norm of African American mothers. Perceived behavioral control in Latina mothers was highly correlated with ‘pumping breast milk’. Development of policy and intervention programs that focus on shaping strong predictors and beliefs within racial/ethnic groups could reduce disparities in EBF rates and establish EBF for 6 months as a cultural norm.

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References

  1. Lawrence, P. B. (1994). Breast milk: Best source of nutrition for term and preterm infants. Pediatric Clinics of North America, 41, 925–941.

    PubMed  CAS  Google Scholar 

  2. Uvnas-Moberg, K. (1998). Oxytocin may mediate the benefits of positive social interaction and emotions. Psychoneuroendocrinology, 23, 819–835.

    Article  PubMed  CAS  Google Scholar 

  3. Thome, M., Alder, E. M., & Alfons, R. (2006). A population-based study of exclusive breastfeeding in Icelandic women: Is there a relationship with depressive symptoms and parenting stress? International Journal of Nursing Studies, 43, 11–20.

    Article  PubMed  Google Scholar 

  4. James, D. C., & Lessen, R. (2009). The position of American Dietetic Association: Promoting and supporting breastfeeding. Journal of the American Dietetic Association, 109, 1926–1942.

    Article  PubMed  Google Scholar 

  5. Tryggvadottir, L., Tulinius, H., Jorunn, E. E., & Sigurvinsson, T. (2001). Breastfeeding and reduced risk of breast cancer in an Icelandic cohort study. American Journal of Epidemiology, 154, 37–42.

    Article  PubMed  CAS  Google Scholar 

  6. Collaborative Group on Hormonal Factors in Breast Cancer. (2002). Breast cancer and breastfeeding: Collaborative reanalysis of individual data from 47 epidemiological studies in 30 countries, including 50, 302 women with breast cancer and 96, 973 women without the disease. Lancet, 360, 187–195.

    Article  Google Scholar 

  7. Weimer, J. P. (2001). The economic benefits of breastfeeding: A review and analysis. U.S. Department of Agriculture Food Review, 24, 23–26. Retrieved January 4, 2010 from http://www.breastfeedingworks.org/econ-review-bf2002.pdf.

  8. Centers for Disease Control and Prevention. (2008). Pediatric Nutrition Surveillance, National summary of trends in breastfeeding indicators by race/ethnicity. Retrieved January 4, 2010, from http://www.cdc.gov/PEDNSS/pednss_tables/pdf/national_table19.pdf.

  9. Hurley, K. M., Black, M. M., Papas, M. A., & Quigg, A. M. (2008). Variation in breastfeeding behaviors, perceptions, and experiences by race/ethnicity among a low-income statewide sample of Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) participants in the United States. Maternal & Child Nutrition, 4, 95–105.

    Article  Google Scholar 

  10. Lee, H., Rubio, M., Elo, I., Mccollum, K., Chung, E., & Culhane, J. (2005). Factors associated with intention to breastfeed among low-income, inner-city pregnant women. Maternal and Child Health Journal, 9, 161–253.

    Article  Google Scholar 

  11. Centers for Disease Control and Prevention. (2010). Racial and ethnic differences in breastfeeding initiation and duration, by state-National Immunization Survey, United States, 2004–2008. Morbidity and Mortality Weekly Report, 59, 327–334. Retrieved March 26, 2010 from http://www.cdc.gov/mmwr/pdf/wk/mm5911.pdf.

  12. Gill, S. (2009). Breastfeeding by Hispanic women. Journal of Obstetric, Gynecologic, and Neonatal Nursing, 38, 244–252.

    Article  PubMed  Google Scholar 

  13. Li, R., Darling, N., Maurice, E., Barker, L., & Grummer-Strawn, L. M. (2005). Breastfeeding rates in the United States by characteristics of the child, mother, or family: The 2002 National Immunization Survey. Pediatrics, 115, e31–e37.

    Article  PubMed  Google Scholar 

  14. Wiemann, C. M., DuBois, J. C., & Berenson, A. B. (1998). Racial/ethnic differences in the decision to breastfeed among adolescent mothers. Pediatrics, 101(6), e11.

    Article  PubMed  CAS  Google Scholar 

  15. Timbo, B., Alterkruse, S., Headrick, M., & Klontz, K. (1996). Breastfeeding among black mothers: Evidence supporting the need for prenatal intervention. Journal for Specialists in Pediatric Nursing, 1(1), 35–40.

    Article  CAS  Google Scholar 

  16. Rassin, D. K., Richardson, D. J., Baranowski, T., et al. (1984). Incidence of breastfeeding in a low socioeconomic group of mothers in the United States: Ethnic patterns. Pediatrics, 73, 132–137.

    PubMed  CAS  Google Scholar 

  17. Ajzen, I. (1991). The theory of planned behavior. Organizational Behavior and Human Decision Processes, 50(2), 179–211.

    Article  Google Scholar 

  18. Montano, D. E., Kasprzyk, D., & Fishbein, M. (2001). Toward an understanding of condom use behaviors: A theoretical and methodological overview of project SAFER. Psychology, Health & Medicine, 6(2), 139–150.

    Article  Google Scholar 

  19. Ajzen, I., & Fishbein, M. (1980). Understanding attitudes and prediction social behavior. Upper Saddle River, NJ: Prentice-Hall, Inc.

    Google Scholar 

  20. Manstead, A., Proffitt, C., & Smart, J. (1983). Predicting and understanding mother’s infant-feeding intentions and behavior: Testing the theory of reasoned action. Journal of Personality and Social Psychology, 44, 657–671.

    Article  PubMed  CAS  Google Scholar 

  21. Faden, R. R. (1988). Determinants of infant feeding: Breast vs. bottle. Baltimore: The Johns Hopkins University. (NTIS No. MCH/CCS-88/01).

    Google Scholar 

  22. Coreil, J., & Murphy, J. E. (1988). Maternal commitment, lactation practices, and breastfeeding duration. Journal of Obstetric, Gynecologic, and Neonatal Nursing, 17, 273–278.

    Article  Google Scholar 

  23. Kaufman, K. J., & Hall, L. A. (1989). Influence of the social network on choice and duration of breastfeeding in mothers of preterm infants. Research in Nursing and Health, 12, 149–159.

    Article  PubMed  CAS  Google Scholar 

  24. Wambach, K. A. (1997). Breastfeeding intention and outcome: A test of the theory of planned behavior. Research in Nursing and Health, 20(1), 51–59.

    Article  PubMed  CAS  Google Scholar 

  25. Duckett, L., Henly, S., Avery, M., Potter, S., Hills-Bonczyk, S., Hulden, R., et al. (1998). A theory of planned behavior-based structural model for breastfeeding. Nursing Research, 47(6), 325–336.

    Article  PubMed  CAS  Google Scholar 

  26. Bai, Y., Middlestadt, S. E., Peng, C. Y., & Fly, A. D. (2010). Predictors of continuation of exclusive breastfeeding for the first six months of life. J Hum Lact, 26, 26–34.

    Article  PubMed  Google Scholar 

  27. Tabachnik, B., & Fidell, L. (2001). Using multivariate statistics (4th ed.). Boston: Allyn and Bacon.

    Google Scholar 

  28. Sawyer, R. (1982). Sample size and the accuracy of predictions made from multiple regression equations. Journal of Educational Statistics, 7(2), 91–104.

    Article  Google Scholar 

  29. Bai, Y. K., Middlestadt, S. E., Peng, C.Y., & Fly, A. D. (2008). Measures of reliability and validity of three constructs of the theory of planned behavior applied to exclusive breastfeeding continuation behavior. The FASEB Journal, 22, 1080.5.

    Google Scholar 

  30. Bai, Y. K., Middlestadt, S. E., Peng, C. Y., & Fly, A. D. (2009). Psychosocial factors underlying mother’s decision to continue exclusive breastfeeding for 6 months: An elicitation study. Journal of Human Nutrition and Dietetics, 22, 134–140.

    Article  PubMed  CAS  Google Scholar 

  31. Ajzen, I. (2006). Constructing a TpB Questionnaire: Conceptual and methodological considerations. Retrieved Sep 28, 2010 from http://people.umass.edu/aizen/pdf/tpb.measurement.pdf.

  32. Dodgson, J. E., Henly, S. J., Duckett, L., & Tarrant, M. (2003). Theory of planned behavior-based models for breastfeeding duration among Hong Kong Mothers. Nursing Research, 52(3), 148–158.

    Article  PubMed  Google Scholar 

  33. Rempel, L. A. (2004). Factors influencing the breastfeeding decisions of long term breastfeeders. Journal of Human Lactation, 20(3), 306–318.

    Article  PubMed  Google Scholar 

  34. Lovera, D., Sanderson, M., Bogle, M. L., & Acosta Vela, M. (2007). Duration of breastfeeding associated with the breastfeeding peer support program for husbands and fathers of Brownsville, Texas WIC participants. Journal of the American Dietetic Association, 107, A-111.

  35. Shealy, K., Li, R., Benton-Davis, S., Grummer-Strawn, L. (2005). The CDC guide to breastfeeding interventions. Atlanta: US Department of Health and Human Services, Center for Disease Control and Prevention. Retrieved Sep 7, 2010 from http://www.cdc.gov/breastfeeding/pdf/breastfeeding_interventions.pdf.

  36. The Sloan work and family research network, Boston University. (2009). Statues related to breastfeeding and the workplace to date (August 2009). Retrieved November 20, 2009 from http://wfnetwork.bc.edu/pdfs/SBT_Breastfeeding.pdf.

  37. Cohen, R., & Mrtek, M. B. (1994). The impact of two corporate lactation programs on the incidence and duration of breastfeeding by employed mothers. American Journal of Health Promotion, 8(6), 436–441.

    PubMed  CAS  Google Scholar 

  38. Dodgson, J. E., & Duckett, L. (1997). Breastfeeding in the workplace. Building a support program for nursing mothers. AAOHN Journal, 45(6), 290–298.

    PubMed  CAS  Google Scholar 

  39. Rogers, B., & Banchy, P. (1994). Establishing an employee breast pumping facility. Journal of Human Lactation, 10, 119–120.

    Article  PubMed  CAS  Google Scholar 

  40. U.S. Department of Health and Human Services. (2009). Healthy People 2020 Public Meetings, 2009 Draft Objectives. Retrieved March 25, 2010 from http://www.healthypeople.gov/hp2020/Objectives/files/Draft2009Objectives.pdf.

  41. Vance, M. R. (2005, June–July). Breastfeeding legislation in the United States: A general overview and implications for helping mothers, Leaven, 41 (3), 51–54. Retrieved Sep 7, 2010 from http://www.llli.org/llleaderweb/LV/LVJunJul05p51.html.

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Acknowledgments

This study was supported in part by an internal research grant from Montclair State University.

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Authors and Affiliations

  1. Department of Health and Nutrition Sciences, Montclair State University, 1 Normal Ave, Montclair, NJ, 07043, USA

    Yeon Bai & Shahla M. Wunderlich

  2. Department of Applied Health Science, Nutrition and Dietetics Program, Indiana University, 1025 E. 7th Street, Bloomington, IN, 47405, USA

    Alyce D. Fly

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  1. Yeon Bai
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  2. Shahla M. Wunderlich
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  3. Alyce D. Fly
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Correspondence to Yeon Bai.

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Bai, Y., Wunderlich, S.M. & Fly, A.D. Predicting Intentions to Continue Exclusive Breastfeeding for 6 Months: a Comparison Among Racial/Ethnic Groups. Matern Child Health J 15, 1257–1264 (2011). https://doi.org/10.1007/s10995-010-0703-7

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  • DOI: https://doi.org/10.1007/s10995-010-0703-7

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