Design and pilot testing of a culturally tailored breastfeeding promotion intervention for non-Hispanic black women

Project Summary/Abstract Breastfeeding confers numerous health benefits for both mother and child; however, despite improvements on a national level of breastfeeding rates (initiation, exclusivity, and duration), disparities have widened for certain racial and ethnic groups. The gap between white and non-Hispanic black (NHB) women has worsened, with only 73.6% of NHB women-initiated breastfeeding compared to 85.5% of white women in 2019. The breastfeeding peer counselor (PC) model is breastfeeding promotion and social support program that has demonstrated positive effects on breastfeeding outcomes and is perceived favorably, mainly among lower- income NHB women. However, there is a need for breastfeeding PC programs that are specifically tailored to the needs of NHB women, intended for NHB women of all socioeconomic backgrounds, and can be feasibly implemented in the community. In addition, the vast majority of breastfeeding research focuses on assessing exclusivity of breastfeeding and far less attention is paid to partial breastfeeding; this measurement approach may underestimate breastfeeding and obscure positive findings. During the K99 phase, Aim 1 will entail a qualitative examination into the factors that influence the decision-making process of whether to breastfeed among NHB women. During the R00 phase, Aim 2 will utilize the findings of Aim 1 to design a breastfeeding PC intervention, using an intervention mapping process, tailoring to the needs and preferences of NHB women and the capacity of potential program implementers. Also during the R00 phase, Aim 3 will consist of the design and validation of a breastfeeding intensity instrument to better capture partial breastfeeding; Aim 4 will involve piloting the tailored BPC program using a randomized controlled design to evaluate the impact on breastfeeding outcomes. Collectively, this research will further our understanding of factors that impact breastfeeding decisions among NHB women and potentially improve breastfeeding outcomes through the design of a breastfeeding PC program tailored specifically for NHB women. These research efforts would support the emergence of a dedicated early career researcher (PI Kasprzak) with expertise in qualitative methods, community-based interventions, lactation education and support, and implementation research. The mentorship team offers expertise in behavioral interventions (Dr. Leone) and breastfeeding research (Dr. Cadwell, Dr. Racine), with collaboration support on community-engaged research, intervention design and tailoring for vulnerable populations (Dr. Cadzow, Dr. Singleton, Dr. Racine), and quantitative methods and study design (Dr. Singleton, Dr. Racine, Dr. Simms, Mr. Paluch). Dr. Kasprzak’s career development will occur within the Department of Community Health and Health Behavior at the University at Buffalo, which is comprised of a network of productive and interdisciplinary researchers. If awarded, this K99/R00 will facilitate Dr. Kasprzak’s advancement to independent community-based interventionist with the skills necessary to maintain an impactful research program aimed at narrowing health disparities among vulnerable populations.