Duration of lactation and incidence of type 2 diabetes. WIC-Based Interventions to Promote Breastfeeding Among African-American Women in Baltimore: Effects on Breastfeeding Initiation and Continuation A Clinic-Based Breastfeeding Peer Counselor Intervention in an Urban, Low-Income Population Antenatal training to improve breast feeding: a randomised trial. Integrating group counseling, cell phone messaging, and participant-generated songs and dramas into a microcredit program increases Nigerian women's adherence to international breastfeeding recommendations. Lactation counseling increases exclusive breast-feeding rates in Ghana. Use of stable-isotope techniques to validate infant feeding practices reported by Bangladeshi women receiving breastfeeding counseling. Breastfeeding training for health professionals and resultant changes in breastfeeding duration. 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CONTEXT Lactation is associated with improved glucose and insulin homeostasis , independent of weight change . OBJECTIVE To evaluate the association between lactation history and incidence of type 2 diabetes . DESIGN , SETTING , AND PARTICIPANTS Prospect i ve observational cohort study of 83,585 parous women in the Nurses ' Health Study ( NHS ) and retrospective observational cohort study of 73,418 parous women in the Nurses ' Health Study II ( NHS II ) . MAIN OUTCOME MEASURE Incident cases of type 2 diabetes mellitus . RESULTS In the NHS , 5145 cases of type 2 diabetes were diagnosed during 1,239,709 person-years of follow-up between 1986 and 2002 , and in the NHS II , 1132 cases were diagnosed during 778,876 person-years of follow-up between 1989 and 2001 . Among parous women , increasing duration of lactation was associated with a reduced risk of type 2 diabetes . For each additional year of lactation , women with a birth in the prior 15 years had a decrease in the risk of diabetes of 15 % ( 95 % confidence interval , 1%-27 % ) among NHS participants and of 14 % ( 95 % confidence interval , 7%-21 % ) among NHS II participants , controlling for current body mass index and other relevant risk factors for type 2 diabetes . CONCLUSIONS Longer duration of breastfeeding was associated with reduced incidence of type 2 diabetes in 2 large US cohorts of women . Lactation may reduce risk of type 2 diabetes in young and middle-aged women by improving glucose homeostasis We evaluated the single and combined effects of introducing a motivational video and peer counseling into four matched WIC clinics on breastfeeding initiation and continuation at 7 - 10 days among African-American WIC participants . Of the 242 women with complete data , 48 % initiated breastfeeding , but only 31 % were still breastfeeding at 7 - 10 days . Initiation was associated with cesarean delivery , infant feeding instruction , no artificial milk discharge pack , attending the peer counselor only-intervention site , and intention to breastfeed . Continuation was influenced by infant feeding instruction , no artificial milk discharge pack , and intention to breastfeed . Overall , trends toward a positive impact of the breastfeeding promotion activities were evident but weak , and largely gone by 7 - 10 days postpartum Background : Whereas breastfeeding initiation rates have risen in all groups throughout the country , rates of breastfeeding duration have changed more slowly . Peer counseling has had some success in sustaining breastfeeding , but with intensive programs and variable effects . Objectives : We aim ed to improve rates of any and exclusive breastfeeding at 1 and 6 months using a low-intensity peer counseling intervention beginning prenatally . We also planned to study the interaction of breastfeeding attitude and self-efficacy with the intervention . Methods : One hundred twenty prenatal women underwent stratified r and omization based on breastfeeding attitude , measured by the Iowa Infant Feeding Attitude Scale ( IIFAS ) . The peer counselor contacted the intervention group by telephone or in clinic up to 4 months postdelivery . Study groups were compared on breastfeeding outcomes , adjusting for IIFAS strata , and on interactions with self-efficacy . Results : One hundred three women were followed to at least 1 month . Women with positive attitudes had significantly higher rates of initiation ( 93 % vs 61 % ) and breastfeeding at 1 and 6 months ( 79 % vs 25 % and 12 % vs 0 % , respectively ) than those with negative attitudes , regardless of intervention . After adjusting for self-efficacy , women who received peer counseling had significantly higher breastfeeding rates at 1 month ( odds ratio = 3.2 ; 95 % confidence interval , 1.02 - 9.8 ) . The intervention group was marginally more likely to achieve their breastfeeding goal ( 43 % vs 22 % , P = .073 ) . Conclusion : Breastfeeding rates in all women improved during the study period . Breastfeeding attitude was more strongly associated with breastfeeding behavior than peer support . Peer counseling supported women with low self-efficacy and helped women achieve their breastfeeding goals OBJECTIVE to assess the effect of an antenatal training programme on knowledge , self-efficacy and problems related to breast feeding and on breast-feeding duration . DESIGN a r and omised controlled trial . SETTING the Aarhus Midwifery Clinic , a large clinic connected to a Danish university hospital in an urban area of Denmark . PARTICIPANTS a total of 1193 nulliparous women were recruited before week 21 + 6 days of gestation , 603 were r and omised to the intervention group , and 590 to the reference group . INTERVENTION we compared a structured antenatal training programme attended in mid-pregnancy with usual practice . MEASUREMENTS data were collected through self-reported question naires sent to the women 's e-mail addresses and analysed according to the intention to treat principle . The primary outcomes were duration of full and any breast feeding collected 6 weeks post partum ( any ) and 1 year post partum ( full and any ) . FINDINGS no differences were found between groups according to duration of breast feeding , self-efficacy score , or breast-feeding problems , but after participation in the course in week 36 of gestation women in the intervention group reported a higher level of confidence ( p=0.05 ) , and 6 weeks after birth they reported to have obtained sufficient knowledge about breast feeding ( p=0.02 ) . Supplemental analysis in the intervention group revealed that women with sufficient knowledge breast fed significantly longer than women without sufficient knowledge ( HR=0.74 CI : 0.58 - 0.97 ) . This association was not found in the reference group ( HR=1.12 CI : 0.89 - 1.41 ) . KEY CONCLUSIONS AND IMPLICATION S FOR PRACTICE antenatal training can increase confidence of breast feeding in pregnancy and provide women with sufficient knowledge about breast feeding after birth . Antenatal training may therefore be an important low-technology health promotion tool that can be provided at low costs in most setting s. The antenatal training programme needs to be followed by postnatal breast-feeding support as it is not sufficient in itself to increase the duration of breast feeding or reduce breast-feeding problems In northern Nigeria , interventions are urgently needed to narrow the large gap between international breastfeeding recommendations and actual breastfeeding practice s. Studies of integrated microcredit and community health interventions documented success in modifying health behaviors but typically had uncontrolled design s. We conducted a cluster-r and omized controlled trial in Bauchi State , Nigeria , with the aim of increasing early breastfeeding initiation and exclusive breastfeeding among female microcredit clients . The intervention had 3 components . Trained credit officers led monthly breastfeeding learning sessions during regularly scheduled microcredit meetings for 10 mo . Text and voice messages were sent out weekly to a cell phone provided to small groups of microcredit clients ( 5 - 7 women ) . The small groups prepared songs or dramas about the messages and presented them at the monthly microcredit meetings . The control arm continued with the regular microcredit program . R and omization occurred at the level of the monthly meeting groups . Pregnant clients were recruited at baseline and interviewed again when their infants were aged ≥6 mo . Logistic regression models accounting for clustering were used to estimate the odds of performing recommended behaviors . Among the clients who completed the final survey ( n = 390 ) , the odds of exclusive breastfeeding to 6 mo ( OR : 2.4 ; 95 % CI : 1.4 , 4.0 ) and timely breastfeeding initiation ( OR : 2.6 ; 95 % CI : 1.6 , 4.1 ) were increased in the intervention vs. control arm . Delayed introduction of water explained most of the increase in exclusive breastfeeding among clients receiving the intervention . In conclusion , a breastfeeding promotion intervention integrated into microcredit increased the likelihood that women adopted recommended breastfeeding practice s. This intervention could be scaled up in Nigeria , where local organizations provide microcredit to > 500,000 clients . Furthermore , the intervention could be adopted more widely given that > 150 million women , many of childbearing age , are involved in microfinance globally Exclusive breast-feeding ( EBF ) rates remain low despite numerous health benefits associated with this behavior . We conducted a r and omized trial on the effect of lactation counseling on EBF , which controlled for the Hawthorne effect while also varying the timing of the intervention . Pregnant women attending prenatal clinics in Tema were r and omly assigned to 1 of 2 intervention groups ( IG ) or to a control group ( C ) , as follows : 1 ) EBF support given pre- , peri- , and postnatally ( IG1 ; n = 43 ) ; 2 ) EBF support given only peri- and postnatally ( IG2 ; n = 44 ) ; or 3 ) nonbreast-feeding health educational support ( C ; n = 49 ) that had an equal amount of contact with lactation counselors . Two educational sessions were provided prenatally , and 9 home follow-up visits were provided in the 6-mo postpartum period . Infant feeding data were collected monthly at the participant 's home . The 3 groups did not differ in sociodemographic characteristics . At 6 mo postpartum , 90.0 % in IG1 and 74.4 % in IG2 had exclusively breast-fed during the previous month . By contrast , only 47.7 % in C were doing so ( P = 0.008 ) . Similarly , the percentage of EBF during the 6 mo was significantly higher ( P = 0.02 ) among IG1 and IG2 ( 39.5 % ) than among C ( 19.6 % ) . The 100 % increase in EBF rates can be attributed to the lactation counseling provided . Additional prenatal EBF support may not be needed within a context of strong routine prenatal EBF education BACKGROUND The World Health Organization recommends exclusive breastfeeding until age 6 mo . Studies relying on mothers ' self-reported behaviors have shown that lactation counseling increases both the rate and duration of exclusive breastfeeding . OBJECTIVE We aim ed to vali date reported infant feeding practice s in rural Bangladesh ; intakes of breast milk and nonbreast-milk water were measured by the dose-given-to-the mother deuterium dilution technique . DESIGN Subjects were drawn from the large-scale Maternal and Infant Nutrition Interventions , Matlab , study of combined interventions to improve maternal and infant health , in which women were r and omly assigned to receive either exclusive breastfeeding counseling or st and ard health care messages . Data on infant feeding practice s were collected by question naire at monthly visits . Intakes of breast milk and nonbreast-milk water were measured in a sub sample of 98 mother-infant pairs ( mean infant age : 14.3 wk ) and compared with question naire data reporting feeding practice s. RESULTS Seventy-five of the 98 subjects reported exclusive breastfeeding .  Mean ( + /-SD ) breast milk intake was 884 + /- 163 mL/d in that group and 791 + /- 180 mL/d in the group reported as nonexclusively breastfed ( P = 0.0267 ) . Intakes of nonbreast-milk water were 40 + /- 80.6 and 166 + /- 214 mL/d ( P < 0.0001 ) , respectively . Objective cross-validation using deuterium dilution data showed good accuracy in reporting of feeding practice s , although apparent misreporting was widely present in both groups . CONCLUSIONS The dose-given-to-the-mother deuterium dilution technique can be applied to vali date reported feeding behaviors . Whereas this technique shows that the reports of feeding practice s were accurate at the group level , it is not adequate to distinguish between feeding practice s in individual infants CONTEXT Promotion of breastfeeding in Brazilian maternity hospitals . OBJECTIVE To quantify changes in the breastfeeding duration among mothers served by hospitals exposed to the Wellstart-SLC course  , comparing them with changes among mothers attended by institutions not exposed to this course . DESIGN R and omized Institutional Trial . SETTING The effects of training on breastfeeding duration was assessed in eight Brazilian hospitals assigned at r and om to either an exposed group ( staff attending the Wellstart-SLC course ) or a  control group .  SAMPLE For each of the eight study hospitals , two cohorts of about 50 children were visited at home at one and six months after birth . The first cohort ( n = 494 ) was composed of babies born in the month prior to exposure to the Wellstart-SLC course , and the second cohort ( n = 476 ) was composed of babies born six months subsequent to this exposure . MAIN MEASUREMENTS Kaplan-Meier curves were plotted to describe the weaning process and log-rank tests were used to assess statistical differences among survival curves . Hazard ratio ( HR ) estimates were calculated by fitting Cox proportional hazard regression models to the data . RESULTS The increases in estimated , adjusted rates for children born in hospitals with trained personnel were 29 % ( HR = 0.71 ) and 20 % ( HR = 0.80 ) for exclusive and full breastfeeding , respectively . No changes were identified for total breastfeeding . CONCLUSION This r and omized trial supports a growing body of evidence that training hospital health professionals in breastfeeding promotion and protection results in an increase in breastfeeding duration The effect of prenatal breastfeeding education on breastfeeding incidence and duration was determined among 31 prenatal WIC participants . The subjects , assigned to a control group  ( n= 17 ) or experimental group  ( n= 14 ) , received prenatal nutrition education through the WIC program . The experimental group received at least one breastfeeding education class . There was no significant difference in breastfeeding incidence between the groups , however , there was a significant difference in breastfeeding incidence by parity ( p<0.05 ) . There was a significantly higher percentage of women still breastfeeding at 3 and 4 months postpartum in the experimental versus the control group ( p<0.05 ) . The control group breastfed for 29.5 + 43.6 days , while the experimental group breastfed for 76 days + 104.3 ( p=.05 ) . Multiparous women who had bottle-fed previous children breastfed for a shorter duration ( 18 + 22 days ) than primiparous women ( 60 87 days ) ( p<.07 ) Objective To assess the effectiveness of an antenatal service using community based breastfeeding peer support workers on initiation of breast feeding . Design Cluster r and omised controlled trial . Setting Community antenatal clinics in one primary care trust in a multiethnic , deprived population . Participants 66 antenatal clinics with 2511 pregnant women : 33 clinics including 1140 women were r and omised to receive the peer support worker service and 33 clinics including 1371 women were r and omised to receive st and ard care . Intervention An antenatal peer support worker service planned to comprise a minimum of two contacts with women to provide advice , information , and support from approximately 24 weeks ’ gestation within the antenatal clinic or at home . The trained peer support workers were of similar ethnic and sociodemographic background s to their clinic population . Main outcome measure Initiation of breast feeding obtained from computerised maternity records of the hospitals where women from the primary care trust delivered . Results The sample was multiethnic , with only 9.4 % of women being white British , and 70 % were in the lowest 10th for deprivation . Most of the contacts with peer support workers took place in the antenatal clinics . Data on initiation of breast feeding were obtained for 2398 of 2511 ( 95.5 % ) women ( 1083/1140 intervention and 1315/1371 controls ) . The groups did not differ for initiation of breast feeding : 69.0 % ( 747/1083 ) in the intervention group and 68.1 % ( 896/1315 ) in the control groups ; cluster adjusted odds ratio 1.11 ( 95 % confidence interval 0.87 to 1.43 ) . Ethnicity , parity , and mode of delivery independently predicted initiation of breast feeding , but r and omisation to the peer support worker service did not . Conclusion A universal service for initiation of breast feeding using peer support workers provided within antenatal clinics serving a multiethnic , deprived population was ineffective in increasing initiation rates . Trial registration Current Controlled Trials IS RCT N16126175 Background It has proven difficult to reach World Health Organization ( WHO ) recommendations that infants be exclusively breastfed from birth to six months of age [ 1 , 2 ] , yet there is limited knowledge about interventions that are effective in increasing breastfeeding initiation and duration . Particularly lacking is evidence about how to maintain breastfeeding rates in countries which already have a high initiation of breastfeeding . This study aims to determine whether mid-pregnancy breastfeeding education  , with a focus on either attitudes to breastfeeding or on technical aspects of breastfeeding , has an effect on rates of breastfeeding initiation and duration . Secondary aims of the study are to : explore what factors might affect the duration of breastfeeding and evaluate the interventions from the participant and childbirth facilitator perspectives . Methods / Design A r and omised controlled trial ( RCT ) design will be used . Women having their first baby , and planning to give birth as public patients at the Royal Women 's Hospital ( RWH ) , Melbourne , will be approached at 18–20 weeks of pregnancy and invited to participate in the study . Participants will be r and omly allocated to a control group or one of two group interventions : a previously design ed and trialled tool to teach practical aspects of breastfeeding or an exploration of family attitudes to breastfeeding . The latter was developed and piloted by the investigators in conjunction with the group facilitators , prior to trial commencement . The interventions are planned to take place at 20–25 weeks . Data will be collected by question naire at recruitment , at interview in hospital after the birth and by telephone interview six months later . Medical/obstetric outcomes will be obtained from the medical record . The sample size ( 972 ) was calculated to identify an increase in breastfeeding initiation from 75 to 85 % and an increase from 40 to 50 % in breastfeeding at six months OBJECTIVE : To evaluate a specialized breastfeeding peer counseling ( SBFPC ) intervention promoting exclusive breastfeeding ( EBF ) among overweight/obese , low-income women . METHODS : We recruited 206 pregnant , overweight/obese , low-income women and r and omly assigned them to receive SBFPC or st and ard care ( controls )  at a Baby-Friendly hospital . SBFPC included 3 prenatal visits , daily in-hospital support , and up to 11 postpartum home visits promoting EBF and addressing potential obesity-related breastfeeding barriers . St and ard care involved routine access to breastfeeding support from hospital personnel , including staff peer counselors . Data collection included an in-hospital interview , medical record review , and monthly telephone calls through 6 months postpartum to assess infant feeding practice s , demographics , and health outcomes . Bivariate and logistic regression analyses were conducted . RESULTS : The intervention had no impact on EBF or breastfeeding continuation at 1 , 3 , or 6 months postpartum . In adjusted posthoc analyses , at 2 weeks postpartum the intervention group had significantly greater odds of continuing any breastfeeding ( adjusted odds ratio [ aOR ] : 3.76 [ 95 % confidence interval ( CI ) : 1.07–13.22 ] ) , and giving at least 50 % of feedings as breast milk ( aOR : 4.47 [ 95 % CI : 1.38–14.5 ] ) , compared with controls . Infants in the intervention group had significantly lower odds of hospitalization during the first 6 months after birth ( aOR : 0.24 [ 95 % CI : 0.07–0.86 ] ) . CONCLUSIONS : In a Baby-Friendly hospital setting , SBFPC targeting overweight/obese women did not impact EBF practice s but was associated with increased rates of any breastfeeding and breastfeeding intensity at 2 weeks postpartum and decreased rates of infant hospitalization in the first 6 months after birth OBJECTIVE To determine the effects of a prenatal breastfeeding workshop on  maternal breastfeeding self-efficacy and breastfeeding duration . DESIGN R and omized controlled trial . SETTING Large tertiary hospital in Ontario , Canada . PARTICIPANTS 110 primiparous women expecting a single child , an uncomplicated birth , and planning to breastfeed . INTERVENTION 2.5-hour prenatal breastfeeding workshop based on adult learning principles and self-efficacy theory . MAIN OUTCOME MEASURE Maternal breastfeeding self-efficacy and the numbers of days and amount of breastfeeding were measured at four and eight weeks postpartum . RESULTS / DATA ANALYSIS : Over time , maternal breastfeeding self-efficacy scores increased in both groups . Women who attended the workshop had higher self-efficacy scores and a higher proportion were exclusively breastfeeding compared to women who did not attend the workshop . There was little difference in the average number of days of breastfeeding , but the intervention group had less weaning . CONCLUSIONS The workshop increased maternal breastfeeding self-efficacy and exclusive breastfeeding OBJECTIVES : Despite recent efforts to increase breastfeeding , young African American mothers continue to breastfeed at low rates , and commonly introduce complementary foods earlier than recommended . This study examines the effects of a community doula home visiting intervention on infant feeding practice s among young mothers . METHODS : Low-income , African American mothers ( n = 248 ) under age 22 years participated in a r and omized trial of a community doula intervention . Intervention-group mothers received services from paraprofessional doulas : specialized home visitors trained as childbirth educators and lactation counselors . Doulas provided home visits from pregnancy through 3 months postpartum , and support during childbirth . Control-group mothers received usual prenatal care . Data were obtained from medical records and maternal interviews at birth and 4 months postpartum . RESULTS : Intent-to-treat analyses showed that doula-group mothers attempted breastfeeding at a higher rate than control-group mothers ( 64 % vs 50 % ; P = .02 ) and were more likely to breastfeed longer than 6 weeks ( 29 % vs 17 % ; P = .04 ) , although few mothers still breastfed at 4 months . The intervention also impacted mothers ’ cereal/solid food introduction ( P = .008 ) : fewer doula-group mothers introduced complementary foods before 6 weeks of age ( 6 % vs 18 % ) , while more waited until at least 4 months ( 21 % vs 13 % ) compared with control-group mothers . CONCLUSIONS : Community doulas may be effective in helping young mothers meet breastfeeding and healthy feeding guidelines . The intervention ’s success may lie in the relationship that develops between doula and mother based on shared cultural background and months of prenatal home visiting , and the doula ’s presence at the birth , where she supports early breastfeeding experiences Background Despite high levels of breastfeeding initiation in Australia , only 47 percent of women are breastfeeding ( exclusively or partially ) six months later , with marked differences between social groups . It is important to identify women who are at increased risk of early cessation of breastfeeding . Methods Data from the three arms of a r and omised controlled trial were pooled and analysed as a cohort using logistic regression to identify which factors predicted women continuing to feed any breast milk at six months postpartum . The original trial included 981 primiparous women attending a public , tertiary , women 's hospital in Melbourne , Australia in 1999–2001 . The trial evaluated the effect of two mid-pregnancy educational interventions on breastfeeding initiation and duration . In the 889 women with six month outcomes available , neither intervention increased breastfeeding initiation nor duration compared to st and ard care . Independent variables were included in the predictive model based on the literature and discussion with peers and were each tested individually against the dependent variable ( any breastfeeding at six months ) . Results Thirty-three independent variables of interest were identified , of which 25 qualified for inclusion in the preliminary regression model ; 764 observations had complete data available . Factors remaining in the final model that were positively associated with breastfeeding any breast milk at six months were : a very strong desire to breastfeed ; having been breastfed oneself as a baby ; being born in an Asian country ; and older maternal age . There was an increasing association with increasing age . Factors negatively associated with feeding any breast milk at six months were : a woman having no intention to breastfeed six months or more ; smoking 20 or more cigarettes per day pre-pregnancy ; not attending childbirth education ; maternal obesity ; having self-reported depression in the six months after birth ; and the baby receiving infant formula while in hospital . Conclusion In addition to the factors commonly reported as being associated with breastfeeding in previous work , this study found a negative association between breastfeeding outcomes and giving babies infant formula in hospital , a high maternal body mass index , and self-reported maternal depression or anxiety in the six months after the baby was born . Interventions that seek to increase breastfeeding should consider focusing on women who wish to breastfeed but are at high risk of early discontinuation Background Interventions promoting optimal infant and young child nutrition could prevent a fifth of under-5 deaths in countries with high mortality . Poor infant and young child feeding practice s are widely documented in Kenya , with potential detrimental effects on child growth , health and survival . Effective strategies to improve these practice s are needed . This study aims to pilot implementation of the Baby Friendly Community Initiative ( BFCI ) , a global initiative aim ed at promoting optimal infant and young child feeding practice s , to determine its feasibility and effectiveness with regards to infant feeding practice s , nutrition and health outcomes in a rural setting in Kenya . Methods The study , employing a cluster-r and omized trial design , will be conducted in rural Kenya . A total of 12 clusters , constituting community units within the government ’s Community Health Strategy , will be r and omized , with half allocated to the intervention and the other half to the control arm . A total of 812 pregnant women and their respective children will be recruited into the study . The mother-child pairs will be followed up until the child is 6 months old . Recruitment will last approximately 1 year from January 2015 , and the study will run for 3 years , from 2014 to 2016 . The intervention will involve regular counseling and support of mothers by trained community health workers and health professionals on maternal , infant and young child nutrition . Regular assessment of  knowledge , attitudes  and practice s on maternal , infant and young child nutrition will be done , coupled with assessment of nutritional status of the mother-child pairs and morbidity for the children . Statistical methods will include analysis of covariance , multinomial logistic regression and multilevel modeling . The study is funded by the NIH and USAID through the Program for Enhanced Research ( PEER ) Health . Discussion Findings from the study outlined in this protocol will inform potential feasibility and effectiveness of a community-based intervention aim ed at promoting optimal breastfeeding and other infant feeding practice s. The intervention , if proved feasible and effective , will inform policy and practice in Kenya and similar setting s , particularly regarding implementation of the baby friendly community initiative . Trial registration IS RCT N03467700 ; Date of Registration : 24 September OBJECTIVE To evaluate the efficacy of a paraprofessional-delivered , home-visiting intervention among young , reservation-based American Indian ( AI ) mothers on parenting knowledge , involvement , and maternal and infant outcomes . METHOD From 2002 to 2004 , expectant AI women aged 12 to 22 years ( n = 167 ) were r and omized ( 1:1 ) to one of two paraprofessional-delivered , home-visiting interventions : the 25-visit " Family Spirit " intervention addressing prenatal and newborn care and maternal life skills ( treatment ) or a 23-visit breast-feeding/nutrition education intervention ( active control ) . The interventions began during pregnancy and continued to 6 months postpartum . Mothers and children were evaluated at baseline and 2 , 6 , and 12 months postpartum . Primary outcomes included changes in mothers ' parenting knowledge and involvement . Secondary outcomes included infants ' social and emotional behavior ; the home environment ; and mothers ' stress , social support , depression , and substance use . RESULTS Participants were mostly teenaged , first-time , unmarried mothers living in reservation communities . At 6 and 12 months postpartum , treatment mothers compared with control mothers had greater parenting knowledge gains , 13.5 ( p < .0001 ) and 13.9 ( p < .0001 ) points higher , respectively ( 100-point scale ) . At 12 months postpartum , treatment mothers reported their infants to have significantly lower scores on the externalizing domain ( beta = -.17 , p < .05 ) and less separation distress in the internalizing domain ( beta = -.17 , p < .05 ) . No between-group differences were found for maternal involvement , home environment , or mothers ' stress , social support , depression , or substance use . CONCLUSIONS This study supports the efficacy of the paraprofessional-delivered Family Spirit home-visiting intervention for young AI mothers on maternal knowledge and infant behavior outcomes . A longer , larger study is needed to replicate results and evaluate the durability of child behavior outcomes OBJECTIVE We followed a cohort ( N = 306 ) of infants at well-baby visits in two suburban pediatric practice s to assess the relation of exclusive breastfeeding , and other environmental exposures , to episodes of acute otitis media ( AOM ) and otitis media with effusion ( OME ) .  METHODS Detailed prospect i ve information about the exclusiveness of breastfeeding , parental smoking , day care attendance , and family history was obtained at scheduled clinic visits .  Tympanometric and otoscopic examinations  were used in the diagnosis of otitis media ( OM ) . Nasopharyngeal cultures  were performed at 1 - 6 months , and at 8 , 10 , 12 , 15 , 18 , and 24 months of age to detect colonization with middle-ear pathogens . RESULTS Between 6 and 12 months of age , cumulative incidence of first OM episodes increased from 25 % to 51 % in infants exclusively breastfed and from 54 % to 76 % in infants formula-fed from birth . Peak incidence of AOM and OME episodes was inversely related to rates of breastfeeding beyond 3 months of age . A twofold elevated risk of first episodes of AOM or OME was observed in exclusively formula-fed infants compared with infants exclusively breast-fed for 6 months . In the logistic regression analysis , formula-feeding was the most significant predictor of AOM and OME episodes , although age at colonization with middle-ear pathogens and day care ( outside the home ) were significant competing risk factors . A hazard health model suggested additionally that breastfeeding , even for short duration s ( 3 months ) , reduced onset of OM episodes in infancy . CONCLUSIONS Modifiable factors in the onset of AOM and OME episodes during the first 2 years of life include early age at colonization ( < /=3 months of age ) , day care outside the home , and not being breastfed We sought to assess the relationship between acculturative type and breastfeeding outcomes among low-income Latinas , utilising a multidimensional assessment of acculturation . We analysed data derived from a breastfeeding peer counselling r and omised trial . Acculturation was assessed during pregnancy using a modified Acculturation Rating Scale for Mexican Americans scale . Analyses were restricted to Latinas who completed the acculturation scale and had post-partum breastfeeding data ( n = 114 ) .  Cox survival analyses were conducted to evaluate differences in breastfeeding continuation and exclusivity by acculturative type . Participants were classified as integrated-high ( 23.7 % , n = 27 ) , traditional Hispanic ( 36.8 % , n = 42 ) , integrated-low ( 12.3 % , n = 14 ) and assimilated ( 27.2 % , n = 31 ) . The integrated-low group was significantly more likely to continue breastfeeding than the traditional Hispanic , assimilated , and integrated-high groups ( P < 0.05 , P < 0.05 , and P < 0.01 , respectively ) . The traditional Hispanic group was marginally more likely to continue breastfeeding than the integrated-high group ( P = 0.06 ) . Breastfeeding continuation rates vary significantly between acculturative types in this multinational , low-income Latina sample . Multidimensional assessment s of acculturation may prove useful in better tailoring future breastfeeding promotion interventions Background Very few Australian infants are exclusively breastfed to 6 months as recommended by the World Health Organization . There is strong empirical evidence that fathers have a major impact on their partner ’s decision to breastfeed and continuation of breastfeeding . Fathers want to participate in the breastfeeding decision making process and to know how they can support their partner to achieve their breastfeeding goals . The aim of the Parent Infant Feeding Initiative ( PIFI ) is to evaluate the effect on duration of any and exclusive breastfeeding of three breastfeeding promotion interventions of differing intensity and duration , targeted at couples but channelled through the male partner . The study will also undertake a cost-effectiveness evaluation of the interventions . Methods / design The PIFI study is a factorial r and omised controlled trial . Participants will be mothers and their male partners attending antenatal classes at selected public and private hospitals with maternity departments in Perth , Western Australia . Fathers will be r and omly allocated to either the usual care control group ( CG ) , one of two medium intensity ( MI1 and MI2 ) interventions , or a high intensity ( HI ) intervention . MI1 will include a specialised antenatal breastfeeding education session for fathers with supporting print material s. MI2 will involve the delivery of an antenatal and postnatal social support intervention delivered via a smartphone application and HI will include both the specialised antenatal class and the social support intervention . Outcome data will be collected from couples at baseline and at six and 26 weeks postnatally . A total of 1600 couples will be recruited . This takes into account a 25 % attrition rate , and will detect at least a 10 % difference in the proportion of mothers breastfeeding between any two of the groups at 26 weeks at 80 % power and 5 % level of significance , using a Log-rank survival test . Multivariable survival and logistic regression analyses will be used to assess the effect of the treatment groups on the outcomes after adjusting for covariates . Discussion The PIFI study will be the first Australian study to provide Level II evidence of the impact on breastfeeding duration of a comprehensive , multi-level , male-partner-focused breastfeeding intervention . Unique features of the intervention include its large sample size , delivery of two of the interventions by mobile device technology , a rigorous assessment of intervention fidelity and a cost-effectiveness evaluation . Trial registration Australian New Zeal and Clinical Trials Registry ACTRN12614000605695 . Registered 6 June This study was undertaken to determine the effects of a partner-support , incentive-baed educational program on breast feeding knowledge , attitudes and support and to examine the relationship between feeding intentions and feeding behavior among low-income women . Women who expressed a willingness to participate in the intervention were r and omly assigned to “ intervention ” and “ usual breast feeding ” ( control ) groups . Sixty-eight primipara women , with expected due date s between May and December , 1992 , volunteered to participate in the study . Of these , 34 were r and omly assigned to each of the two groups . Approximately 81 percent of the women completed the study , leaving n=29 in the control group and n-26 in the intervention group . The intervention consisted of special incentives ( prizes ) for women and their partners to participate in several breast feeding education and promotion activities . Intervention group women and their partners experienced positive changes in breast feeding knowledge and attitudes . Furthermore , the intervention seemed to have influenced more women in the treatment group to breast feed despite their prenatal feeding intentions . In addition , the partners of intervention group women were perceived to be more supportive of , breast feeding than control group partners . These findings suggest that incentives , such as donated prizes , can be used to attract lower socioeconomic group women and their partners to breast feeding promotion interventions . Participation in such interventions can produce positive changes in breast feeding knowledge , attitudes , and support , and can have a dramatic effect in promoting breast feeding Background Nutrition in the first 1,000 days of life ( during pregnancy and the first two years ) is critical for child growth and survival . Poor maternal , infant and young child nutrition ( MIYCN ) practice s are widely documented in Kenya , with potential detrimental effects on child growth and survival . This is particularly a problem in slums , where most urban residents live . For example , exclusive breastfeeding for the first six months is only about two per cent . Innovative strategies to reach slum residents are therefore needed . Strategies like the Baby Friendly Hospital Initiative have proven effective in some setting s but their effectiveness in re source -limited setting s , including slums where many women do not deliver in hospital , is question able . We propose to test the effectiveness of a home-based intervention on infant feeding practice s , nutrition and health outcomes of infants born in two slums in Nairobi , Kenya . Methods / Design The study , employing a cluster-r and omised study design , will be conducted in two slums in Nairobi : Korogocho and Viw and ani where 14 community units ( defined by the Government ’s health care system ) will form the unit of r and omization . A total of 780 pregnant women and their respective child will be recruited into the study . The mother-child pair will be followed up until the child is one year old . Recruitment will last approximately one year and three months from September 2012 to December 2013 . The mothers will receive regular , personalised , home-based counselling by trained Community Health Workers on MIYCN . Regular assessment of knowledge , attitudes and practice s on MIYCN will be done , coupled with assessment s of nutritional status of the mother-child pairs and diarrhea morbidity for the children . Statistical methods will include analysis of covariance and multinomial logistic regression . Additionally , cost-effectiveness analysis will be done . The study is funded by the Wellcome Trust and will run from March 2012 to February 2015 . Discussion Interventions aim ed at promoting optimal breastfeeding and complementary feeding practice s are considered to have high impact and could prevent a fifth of the under-five deaths in countries with high mortality rates . This study will inform policy and practice in Kenya and similar setting s regarding delivery mechanisms for such high-impact interventions , particularly among urban poor population s . Trial registration IS RCT Abstract Objective To investigate whether offering volunteer support from counsellors in breast feeding would result in more women breast feeding .  Design R and omised controlled trial . Setting 32 general practice s in London and south Essex . Participants 720 women considering breast feeding . Main outcome measures Primary outcome was prevalence of any breast feeding at six weeks . Secondary outcomes were the proportion of women giving any breast feeds , or bottle feeds at four months , duration of any breast feeding , time to introduction of bottle feeds , and satisfaction with breast feeding . Results Offering support in breast feeding did not significantly increase the prevalence of any breast feeding to six weeks ( 65 % ( 218/336 ) in the intervention group and 63 % ( 213/336 ) in the control group ; relative risk 1.02 , 95 % confidence interval 0.84 to 1.24 ) . Survival analysis up to four months confirmed that neither duration of breast feeding nor time to introduction of formula feeds differed significantly between control and intervention groups . Not all women in the intervention group contacted counsellors postnatally , but 73 % ( 123/179 ) of those who did rated them as very helpful . More women in the intervention group than in the control group said that their most helpful advice came from counsellors rather than from other sources . Conclusions Women valued the support of a counsellor in breast feeding , but the intervention did not significantly increase breastfeeding rates , perhaps because some women did not ask for help OBJECTIVE To assess the impact of a paraprofessional-delivered home-visiting intervention to promote child care knowledge , skills , and involvement among pregnant American Indian adolescents . DESIGN R and omized controlled trial comparing a family-strengthening intervention with a breastfeeding education program . SETTING One Apache and 3 Navajo communities . PARTICIPANTS Fifty-three pregnant American Indian adolescents were r and omly assigned to intervention ( n = 28 ) or control ( n = 25 ) groups . Follow-up data were available for 19 intervention and 22 control participants . Intervention Paraprofessionals delivered 41 prenatal and infant care lessons in participants ' homes from 28 weeks ' gestation to 6 months post partum . MAIN OUTCOME MEASURES Child care knowledge , skills , and involvement . RESULTS Mothers in the intervention compared with the control group had significantly higher parent knowledge scores at 2 months ( adjusted mean difference [ AMD ] , + 14.9 [ 95 % confidence interval ( CI ) , + 7.5 to + 22.4 ] ) and 6 months post partum ( AMD , + 15.3 [ 95 % CI , + 5.9 to + 24.7 ] ) . Intervention group mothers scored significantly higher on maternal involvement scales at 2 months post partum ( AMD , + 1.5 [ 95 % CI , -0.02 to + 3.02 ] ) , and scores approached significance at 6 months post partum ( AMD , + 1.1 [ 95 % CI , -0.06 to + 2.2 ] ) . No between-group differences were found for child care skills . CONCLUSIONS A paraprofessional-delivered , family-strengthening home-visiting program significantly increased mothers ' child care knowledge and involvement . A longer and larger trial is needed to underst and the intervention 's potential to improve adolescent parenting and related child outcomes in American Indian communities OBJECTIVE To determine the impact of facility-based semi-intensive and home-based intensive counselling in improving exclusive breast-feeding ( EBF )  in a low-re source urban setting in Kenya . DESIGN A cluster r and omized controlled trial in which nine villages were assigned on a 1:1:1 ratio , by computer , to two intervention groups and a control group . The home-based intensive counselling group ( HBICG ) received seven counselling sessions at home by trained peers , one prenatally and six postnatally . The facility-based semi-intensive counselling group ( FBSICG ) received only one counselling session prenatally . The control group ( CG ) received no counselling from the research team . Information on infant feeding practice s was collected monthly for 6 months after delivery . The data -gathering team was blinded to the intervention allocation . The outcome was EBF prevalence at 6 months . SETTING Kibera slum , Nairobi . SUBJECTS A total of 360 HIV-negative women , 34 - 36 weeks pregnant , were selected from an antenatal clinic in Kibera ; 120 per study group . RESULTS Of the 360 women enrolled , 265 completed the study and were included in the analysis ( CG n 89 ; FBSICG n 87 ; HBICG n 89 ) . Analysis was by intention to treat . The prevalence of EBF at 6 months was 23.6 % in HBICG , 9.2 % in FBSICG and 5.6 % in CG . HBICG mothers had four times increased likelihood to practise EBF compared with those in the CG ( adjusted relative risk = 4.01 ; 95 % CI 2.30 , 7.01 ; P=0.001 ) . There was no significant difference between EBF rates in FBSICG and CG . CONCLUSIONS EBF can be promoted in low socio-economic conditions using home-based intensive counselling . One session of facility-based counselling is not sufficient to sustain EBF Assessed is a breast-feeding training course that was attended by health professionals at the Santos Lactation Center ( SLC ) , Santos , São Paulo , Brazil , as well as its impact on the implementation of breast-feeding programmes in maternity hospitals . Eight maternity hospitals were studied -- four were r and omly allocated to the experimental group and sent three health professionals to attend an 18-day course at SLC ; the remaining four institutions constituted the  control group . The compliance of all eight hospitals with WHO/UNICEF 's " Ten steps for successful breast-feeding " was determined using scores obtained before and 6 months after the training course . Institutions in the experimental group had an improved score , but those in the control group did not . The SLC training course was efficient since it enabled the participants to promote breast-feeding practice s. However , in order to succeed in implementing breast-feeding programmes , health professionals require also to develop skills to apply the knowledge they acquire in the course , as well as to involve the whole maternity unit team in the activities OBJECTIVE To assess the efficacy of peer counseling to promote exclusive breastfeeding ( EBF ) among low-income inner-city women in Hartford , Conn. DESIGN Participants recruited prenatally were r and omly assigned to either receive support for EBF from a peer counselor plus conventional breastfeeding support ( peer counseling group [ PC ] ) or only conventional breastfeeding support ( control group [ CG ] ) and followed through 3 months post partum . SETTING Low-income predominantly Latina community . PARTICIPANTS Expectant mothers , less than 32 weeks gestation and considering breastfeeding ( N = 162 ) . Intervention Exclusive breastfeeding peer counseling support offering 3 prenatal home visits , daily perinatal visits , 9 postpartum home visits , and telephone counseling as needed . MAIN OUTCOME MEASURES Exclusive breastfeeding rates at hospital discharge , 1 , 2 , and 3 months post partum ( n = 135 ) . RESULTS At hospital discharge , 24 % in the CG compared with 9 % in the PC had not initiated breastfeeding , with 56 % and 41 % , respectively , nonexclusively breastfeeding . At 3 months , 97 % in the CG and 73 % in the PC had not exclusively breastfed ( relative risk [ RR ] = 1.33 ; 95 % CI , 1.14 - 1.56 ) during the previous 24 hours . The likelihood of nonexclusive breastfeeding throughout the first 3 months was significantly higher for the CG than the PC ( 99 % vs 79 % ; RR = 1.24 ; 95 % CI , 1.09 - 1.41 ) . Mothers in the CG were less likely than their PC counterparts to remain amenorrheic at 3 months ( 33 % vs 52 % ; RR = 0.64 ; 95 % CI , 0.43 - 0.95 ) . The likelihood of having 1 or more diarrheal episode in infants was cut in half in the PC ( 18 % vs 38 % ; RR = 2.15 ; 95 % CI , 1.16 - 3.97 ) . CONCLUSION Well-structured , intensive breastfeeding support provided by hospital and community-based peer counselors is effective in improving exclusive breastfeeding rates among low-income , inner-city women in the United States OBJECTIVE : To evaluate the effectiveness of a professional one-to-one antenatal breastfeeding support and education intervention on the exclusivity and duration of breastfeeding . METHODS : A total of 469 primiparous women who attended the antenatal clinics of two geographically distributed public hospitals in Hong Kong were r and omized to receive either  st and ard antenatal care or a one-to-one antenatal breastfeeding support and education session . The primary outcome was the prevalence of exclusive breastfeeding at 6 weeks postpartum . Secondary outcomes were the prevalence of exclusive breastfeeding at 3 and 6 months postpartum as well as the overall duration of any and exclusive breastfeeding across the first 6 months postpartum . RESULTS : The exclusive breastfeeding rate in the intervention group was 37.8 % at 6 weeks postpartum compared with 36.4 % in the st and ard care group ( P=.77 ; 95 % confidence interval [ CI ] −0.08 to 0.11 ) . There were no significant differences between the two treatment groups in exclusive breastfeeding rates at 3 and 6 months or in the overall duration of any ( hazard ratio [ HR ] 1.11 , 95 % CI 0.88–1.40 ] or exclusive breastfeeding ( HR 0.96 , 95 % CI 0.79–1.17 ) . The study had a least 80 % power to detect a 50 % increase in the rate of exclusive breastfeeding at 6 weeks postpartum . CONCLUSION : In a setting with a high breastfeeding initiation rate , one-to-one antenatal breastfeeding support and education did not increase the exclusivity or duration of breastfeeding . CLINICAL TRIAL REGISTRATION : Clinical Trials.gov , www . clinical trials.gov , NCT01648114 . LEVEL OF EVIDENCE : Objective To evaluate the affect of an antenatal educational breastfeeding intervention on women 's breastfeeding duration BACKGROUND Breastfeeding peer counseling has improved breastfeeding rates in developing countries ; however , its impact in this country has not been adequately evaluated . OBJECTIVE To evaluate the effectiveness of an existing , breastfeeding peer counseling program within the United States . DESIGN R and omized , prospect i ve , controlled trial in which participants were recruited prenatally and r and omly assigned to receive either routine breastfeeding education or routine breastfeeding education plus peer counseling . SETTING An urban hospital serving a large population of low-income Latinas . PARTICIPANTS Pregnant women ( < or = 26 weeks ' gestation ) were recruited from the hospital 's prenatal clinic . Inclusion criteria specified that participants be low income , be considering breastfeeding , have delivered a healthy , full-term singleton , and have access to a telephone . Intervention Breastfeeding peer counseling services included 1 prenatal home visit , daily perinatal visits , 3 postpartum home visits , and telephone contact as needed . MAIN OUTCOME MEASURES Breastfeeding rates at birth and 1 , 3 , and 6 months postpartum . RESULTS The proportion not initiating breastfeeding was significantly lower in the intervention group than among controls ( 8/90 [ 9 % ] vs 17/75 [ 23 % ] ; relative risk , 0.39 ; 95 % confidence interval , 0.18 - 0.86 ) . The probability of stopping breastfeeding also tended to be lower in the intervention group at both 1 month ( 36 % vs 49 % ; relative risk , 0.72 ; 95 % confidence interval , 0.50 - 1.05 ) and 3 months ( 56 % vs 71 % ; relative risk , 0.78 ; 95 % confidence interval , 0.61 - 1.00 ) . CONCLUSION These findings demonstrate that , in the United States , peer counselors can significantly improve breastfeeding initiation rates and have an impact on breastfeeding rates at 1 and 3 months post partum Mothers need consistent , sustained information and support to develop and meet personal breastfeeding goals , but often receive insufficient assistance and conflicting and incorrect advice . The use of technology may be helpful in supplementing existing health care professional breastfeeding education and support efforts . We developed and evaluated a computer-based animated , interactive agent design ed to provide breastfeeding information and support to mothers interested in breastfeeding . A r and omized controlled study of a first-generation system was conducted to determine the feasibility of ( 1 ) use of the Computer Agent ; ( 2 ) the recruitment plan ; and ( 3 ) the planned outcome evaluation ( assessing the impact of the intervention on intent to breastfeed , attitudes towards breastfeeding , and breastfeeding self-efficacy ) . The pilot study ( N = 15 ) showed that the use of the Computer Agent , the recruitment plan , and the planned outcome evaluation were all feasible . Mothers who used the Computer Agent  had greater intentions to exclusively breastfeed after exposure to the Agent ( intent to exclusively breastfeed for 6 months 1–7 scale score of 6.14 ( post ) vs. 5.14 ( pre ) ; p < 0.05 ) . Non-statistically significant trends in improvement with use of the Computer Agent breastfeeding support system were also seen in the between subjects analyses of intent to breastfeed and breastfeeding self-efficacy . The pilot study demonstrated the feasibility of using a Computer Agent to support breastfeeding mothers and informed the design of a larger r and omized clinical trial . An interactive Computer Agent may be helpful in improving rates of exclusive breastfeeding , particularly when there is not adequate health care professional support OBJECTIVE The purpose of this study was to compare breastfeeding duration in mothers after delivery who were assigned r and omly to a behavioral educational intervention vs enhanced usual care . STUDY DESIGN We conducted a r and omized trial . Self-identified black and Latina mothers early after delivery were assigned r and omly to receive a behavioral educational intervention or enhanced usual care . The 2-step intervention aim ed to prepare and educate mothers about postpartum symptoms and experiences ( including tips on breastfeeding and breast/nipple pain ) and to bolster social support and self-management skills . Enhanced usual care participants received a list of community re sources and received a 2-week control call . Intention-to-treat analyses examined breastfeeding duration ( measured in weeks ) for up to 6 months of observation . This study was registered with clinical trial.gov ( NCT01312883 ) . RESULTS Five hundred forty mothers were assigned r and omly to the intervention ( n = 270 ) vs control subjects ( n = 270 ) . Mean age was 28 years ( range , 18 - 46 years ) ; 62 % of the women were Latina , and 38 % were black .  Baseline sociodemographic , clinical , psychosocial , and breastfeeding characteristics were similar among intervention vs control subjects . Mothers in the intervention arm breastfed for a longer duration than did the control subjects ( median , 12.0 vs 6.5 weeks , respectively ; P = .02 ) Mothers in the intervention arm were less likely to quit breastfeeding over the first 6 months after delivery ( hazard ratio , 0.79 ; 95 % confidence interval , 0.65 - 0.97 ) . CONCLUSION A behavioral educational intervention increased breastfeeding duration  among low-income , self-identified black and Latina mothers during the 6-month postpartum period The factors that influence the actual initiation and duration of breastfeeding were studied among low-income women followed by the Canada Prenatal Nutrition Program ( CPNP ) . A group of 196 pregnant women were selected at r and om from a sample of 6223 pregnant women who registered with the CPNP . Two 24-hour recalls and information regarding lifestyle habits , peer support , and infant-feeding practice s were obtained between 26 and 34 weeks of gestation and 21 days and 6 months after birth . Women who received a  university education ( completed or not completed ) versus women with [ .lessequal ] high school education ( odds ratio [ OR ] , 8.40 ; 95 % confidence interval [ CI ] , 1.02 - 69.50 ) , women born outside Canada ( OR,8.81 ; 95 % CI , 3.34 - 23.19 ) , and women of low birth weight infants ( OR , 0.39 ; 95 % CI , 0.16 - 0.96 ) were more likely to initiate breastfeeding . Late introduction of solid foods ( P = .004 ) , nonsmoking ( P = .005 ) , multiparity ( P = .012 ) , and a higher level of education ( P = .049 ) were positively associated with the duration of breastfeeding among initiators . Underst and ing factors associated with initiation and duration of breastfeeding among low-income women is critical to better target breastfeeding promotion Background : Guidelines recommend prenatal education to improve breastfeeding rates ; however , effective educational interventions targeted at low-income , minority population s are needed as they remain less likely to breastfeed . Objective : To determine whether a low-cost prenatal education video improves hospital rates of breastfeeding initiation and exclusivity in a low-income population . Methods : A total of 522 low-income women were r and omized during a prenatal care visit occurring in the third trimester to view an educational video on either breastfeeding or prenatal nutrition and exercise . Using multivariable analyses , breastfeeding initiation rates and exclusivity during the hospital stay were compared . Results : Exposure to the intervention did not affect breastfeeding initiation rates or duration during the hospital stay . The lack of an effect on breastfeeding initiation persisted even after controlling for partner , parent , or other living at home and infant complications ( adjusted odds ratio [ OR ] = 1.05 , 95 % CI , 0.70 - 1.56 ) . In addition , breastfeeding exclusivity rates during the hospital stay did not differ between the groups ( P = .87 ) . Conclusion : This study suggests that an educational breastfeeding video alone is ineffective in improving the hospital breastfeeding practice s of low-income women . Increasing breastfeeding rates in this at-risk population likely requires a multipronged effort begun early in pregnancy or preconception The objective of this study was to prospect ively explore the influence ofwomen ’s experiences in preparing for and establishing breastfeeding on the duration of breastfeeding .  A cohort of 490 women was surveyed at intervals during pregnancy and after giving birth . Data were collected on breastfeeding outcomes and experiences and analyzed using multiple logistic regression . After controlling for sociodemographic variables , women were less likely to be still fully breastfeeding at 6 to 10 weeks postpartum if they believed they needed more breastfeeding information prior to delivery or had experienced breastfeeding problems . Women were less likely to be fully breastfeeding at 4 months postpartum if they had experienced breastfeeding problems . This prospect i ve study demonstrated the influence ofwomen ’s preparedness for breastfeeding and their experiences in establishing breastfeeding  on breastfeeding duration . Improvements in prenatal education about breastfeeding and management of breastfeeding problems are likely to increase breastfeeding duration BACKGROUND Despite high levels of breastfeeding initiation in Australia , only 46 percent of women are still breastfeeding ( exclusively or partially ) 6 months later , with marked differences between social groups . This study aim ed to determine the influence of mid-pregnancy breastfeeding education on the proportions of women breastfeeding at hospital discharge , and on the duration of breastfeeding . METHODS A r and omized controlled trial to compare two strategies for increasing the initiation and duration of breastfeeding was conducted , in which 981 primiparas who attended a public , tertiary women 's hospital in Melbourne , Australia , were r and omized to one of two interventions or to st and ard care ( 327 in each group ) . The interventions were a 1.5-hour class on practical aspects of breastfeeding using a previously tested tool ( Practical Skills ) , and two 1-hour classes exploring family and community attitudes toward , and experiences of , breastfeeding ( Attitudes ) . Both interventions took place in interactive small groups when women were in mid-pregnancy . Breastfeeding initiation was ascertained by interview 2 to 4 days after birth , and breastfeeding duration was assessed by telephone interview 6 months after birth . RESULTS Neither intervention increased breastfeeding initiation or duration compared with st and ard care . Rates at initiation were 97 percent ( 296/306 ) for the Practical Skills intervention , 95 percent ( 291/308 ) for the Attitudes intervention , and 96 percent ( 297/310 ) for st and ard care . Rates at 6 months were , respectively , 55 percent ( 162/297 ) , 50 percent ( 146/293 ) , and 54 percent ( 162/299 ) . CONCLUSIONS In setting s where breastfeeding initiation is already high , neither study intervention could be recommended as an effective strategy to increase breastfeeding initiation or duration OBJECTIVE To determine the effects of a partner-supported , incentive-based educational program on rates and duration of breast-feeding among low-income women . DESIGN Women who expressed a willingness to participate in the breast-feeding educational program  were r and omly assigned to one of two groups : an intervention group and a control group who received usual breast-feeding education . SETTING Clinics of the Special Supplemental Food Program for Women , Infants , and Children in Flagstaff , Ariz. SUBJECTS Sixty-eight primiparous pregnant women with expected due date s between May 1992 and December 1992 were willing to participate in the study . Of these , 34 were r and omly assigned to the intervention group and 34 to the control group . Approximately 81 % of the women completed the study : 29 in the control group and 26 in the intervention group . INTERVENTION The intervention consisted of special incentives ( prizes ) for women and their partners to participate in a breast-feeding class for expectant couples and an educational series on childbirth . Women were also encouraged to use a breast-feeding support program in which peers serve as role models . MAIN OUTCOME MEASURES The primary outcome measure was infant feeding method . Data were collected from mothers in both groups at the time of discharge from the hospital and at 2 weeks , 6 weeks , and 3 months postpartum . STATISTICAL ANALYSES PERFORMED Binomial proportional analyses of the feeding data were performed . RESULTS Women in the intervention group reported a higher percentage of breast-feeding at all measurement times . APPLICATIONS These findings suggest that incentives , such as donated prizes , can be used to attract primiparous women from lower socioeconomic groups , along with their partners , to participate in educational interventions design ed to promote breast-feeding . Participation by couples in breast-feeding promotion activities can dramatically increase the rate and duration of breast-feeding Breast feeding rates in Irel and have stagnated at around 33 % over the past 10 years . We aim ed to assess the effect of a simple intervention in late pregnancy on breast feeding rates . The study was r and omised and prospect i ve . In the intervention group a sheet illustrating eight positive aspects of breast feeding was presented to mothers at their 36 week antenatal visit . This information was reinforced with a question naire on the topic of breast feeding . The control group received a routine antenatal care . There were 98 mothers in the intervention group and 95 controls . A similar percentage in each group had medical cards . On discharge from hospital 31.5 % of controls and 43.9 % of the test group were breast feeding . This difference just failed to reach statistical significance ( P = 0.07 ) . The intervention , which took just three minutes of a medical student 's time , appeared to result in an improved breast feeding rate . Though the difference did not reach statistical significance , this reflects , in part , the small numbers in the study . About half of the women in the study indicated that no doctor had offered any advice on the choice of feeding . Since this minor intervention produced a good response , it would seem appropriate to adopt a more positive attitude in the promotion of breast feeding BACKGROUND In the Netherl and s , the initiation rate of breast-feeding ( BF ) was 80 % in 2002 , but only 35 % of the mothers continued to breast-feed for 3 months . This study examined the effectiveness of a breast-feeding promotion program to increase the continuation of breast-feeding . METHODS A cluster-r and omized intervention trial was used . Ten child health care centers in three regions of the home health care were r and omly allocated to the program or usual care . Elements in the program were health counseling , measures to enhance cooperation , early signaling of breast-feeding problems and continuity of care , and lactation consultancy .  Pregnant mothers who applied for home health care in the intervention or usual care regions were enrolled and were followed up from pregnancy until 6 months postpartum ( n = 683 ) . The primary outcome measure was the continuation of breast-feeding until at least 3 months . RESULTS The 3-month breast-feeding rate was 32 % in the intervention and 38 % in the control groups ( OR = 0.79 , 95 % CI = 0.58 - 1.08 ) . CONCLUSION The program was not effective . We discuss possible explanations from the design and execution of the trial and give some points for improvement of our program , such as the categories of caregivers involved and the number and duration of contacts after parturition Many factors are associated with low breast-feeding rates among black low-income women . This study examines whether , despite such factors , health professionals ' prenatal education of black poor women is associated with increased breast-feeding rates .  Black women born in the United States who attended a midwives prenatal clinic ( N = 159 ) were r and omly assigned to two types of prenatal education or were followed up in a control group . All women were interviewed on entry into the study and after delivery of their infants . Women assigned to group classes attended at least one session discussing myths , problems , and benefits of breast-feeding .  Women assigned to individual prenatal counseling spoke with a pediatrician or nurse practitioner , who discussed breast-feeding topics similar to those covered in the classes . Women in the control group received no additional prenatal education . The three study groups had significantly different percentages of women who breast-fed ( controls 22 % , classes 46 % , individual sessions 53 % ) . Higher percentages of women in the study groups carried out their prenatal plans to breast-feed ( controls 50 % , classes 86 % , individual sessions 62 % ) or breast-fed despite prenatal plans to bottle-feed ( controls 10 % , classes 26 % , individual sessions 48 % ) . After multivariable analysis controlling for age , prenatal plans to breast-feed , prior breast-feeding experience , perceived support for breast-feeding , education , gravidity , and employment plans , women in intervention groups had a higher likelihood of breast-feeding than control subjects . These findings suggest that an increase in relatively simple , not-too-time-consuming educational efforts in institutions and offices serving black low-income women might yield significant narrowing of the gap in breast-feeding rates between white affluent women and black low-income women BACKGROUND Breastfeeding conveys many benefits , but women often encounter difficulties in the first few weeks . The objective of this study was to examine women 's perspectives on the information , advice , and support they receive with breastfeeding . METHODS A qualitative analysis was conducted of women 's responses to open questions about their experiences of breastfeeding support . Participants were recruited as part of a r and omized controlled trial of additional support from volunteer breastfeeding counselors , and they completed question naires when their babies were 6 weeks old . RESULTS Of the 720 women recruited to the trial , 654 began breastfeeding and completed postnatal question naires ; 492 ( 75 % ) participants were first-time mothers and 200 ( 31 % ) were of minority ethnic origin . At 6 weeks , 249 ( 38 % ) women were exclusively breastfeeding , 183 ( 28 % ) were both breastfeeding and bottle-feeding , whereas 222 ( 34 % ) were exclusively bottle-feeding . Although many women commented positively on their experiences , others thought they did not receive the information and support they needed . Thematic analysis of women 's responses to open questions identified five components of the support that women wanted : information about breastfeeding and what to expect , practical help with positioning the baby to breastfeed , effective advice and suggestions , acknowledgment of mothers ' experiences and feelings , and reassurance and encouragement . CONCLUSIONS Maternity services should address the components identified by the study findings as constituting good breastfeeding support . Guidance and information for family members and training for those involved in peer or professional initiatives should take into account women 's views on what support they want , together with when and how they want it provided BACKGROUND Exclusive breastfeeding is recommended worldwide but not commonly practised . We undertook a r and omised controlled study of the efficacy of home-based peer counselling to increase the proportion of exclusive breastfeeding among mothers and infants residing in periurban Mexico City . METHODS Two intervention groups with different counselling frequencies , six visits ( 44 ) and three visits ( 52 ) , were compared with a control group ( 34 ) that had no intervention .  From March , 1995 , to September , 1996 , 170 pregnant women were identified by census and invited to participate in the study . Home visits were made during pregnancy and early post partum by peer counsellors recruited from the same community and trained by La Leche League . Data were collected by independent interview . Exclusive breastfeeding was defined by WHO criteria . FINDINGS 130 women participated in the study . Only 12 women refused participation . Study groups did not differ in baseline factors . At 3 months post partum , exclusive breastfeeding was practised by 67 % of six-visit , 50 % of three-visit , and 12 % of control mothers ( intervention groups vs controls , p<0.001 ; six-visit vs three-visit , p=0.02 ) . Duration of breastfeeding was significantly ( p=0.02 ) longer in intervention groups than in controls , and fewer intervention than control infants had an episode of diarrhoea ( 12 % vs 26 % , p=0.03 ) . INTERPRETATION This is the first reported community-based r and omised trial of breastfeeding promotion . Early and repeated contact with peer counsellors was associated with a significant increase in breastfeeding exclusivity and duration . The two-fold decrease in diarrhoea demonstrates the importance of breastfeeding promotion to infant health OBJECTIVE To assess the impact of experiential learning method ologies in primiparous women on their choice and maintenance of an infant feeding method . STUDY DESIGN A prospect i ve controlled study into experiential learning methods applied to patients with four months ' follow up . Seventy-three primiparous women attending the antenatal clinic at the West Suffolk Hospital for their 32 weeks check were allocated to two groups on the basis of date of attendance . Multiple pregnancy and serious illness were excluded . Thirty-three women attended a two hour seminar on breast feeding using experiential techniques .  Forty had routine antenatal care and acted as controls .  Breast feeding rates of the two groups were recorded at various stages . Assessment also included comments from question naires . RESULTS The two groups did not differ significantly in the number of women proposing to breast feed their infants ( Z = -0.0490 , P = 0.9609 ) nor in the numbers of women breast feeding on day one ( Z = -0.6203 , P = 0.5350 ) . There were proportionally more women breast feeding their infants at two weeks ( Z = -1.4944 , P = 0.1351 ) in the subject group , but this was not statistically significant . However , the difference at four months was significant , ( Z = -2.5784 , P = 0.0099 ) , more than double the percentage of controls maintaining some breast feeding to four months in the subject group . CONCLUSIONS Experiential learning was associated with increased rates of prolonged breast feeding , possibly due to increased patient confidence in their choice . This learning approach could be applied to other areas of patient health education Objective . To determine whether an individualized , prenatal and postnatal , lactation consultant intervention result ed in increased cumulative intensity of breastfeeding up to 52 weeks . Design . The r and omized , nonblinded , controlled trial recruited women from prenatal care . Baseline prenatal interviews covered demographic data and breastfeeding experience , intention , and knowledge . Interviews at 1 , 2 , 3 , 4 , 6 , 8 , 10 , and 12 months after birth collected data on weekly feeding patterns , infant illness , and infant health care use . Setting . Two community health centers serving low-income , primarily Hispanic and /or black women . Participants . The analytic sample included 304 women ( intervention : n = 145 ; control : n = 159 ) with ≥1 postnatal interview . Intervention . Study lactation consultants attempted 2 prenatal meetings , a postpartum hospital visit , and /or home visits and telephone calls . Control subjects received the st and ard of care .  Outcome Measures . Cumulative breastfeeding intensity at 13 and 52 weeks , based on self-reports of weekly feeding , on a 7-level scale . Results . The intervention group was more likely to breastfeed through week 20 ( 53.0 % vs 39.3 % ) . Exclusive breastfeeding rates were low and did not differ according to group . In multivariate analyses , control subjects had lower breastfeeding intensity at 13 weeks ( odds ratio [ OR ] : 1.90 ; 95 % confidence interval [ CI ] : 1.13–3.20 ) and 52 weeks ( OR : 2.50 ; 95 % CI : 1.48–4.21 ) . US-born control subjects had lowest breastfeeding intensity at 13 weeks ( OR : 5.22 ; 95 % CI : 2.43–11.22 ) and 52 weeks ( OR : 5.25 ; 95 % CI : 2.44–11.29 ) . There were no significant differences in breastfeeding intensity among the US-born intervention , foreign-born intervention , and foreign-born control groups . Conclusions . This “ best- practice s ” intervention was effective in increasing breastfeeding duration and intensity . Breastfeeding promotion should focus on US-born women and exclusive breastfeeding OBJECTIVE Recognizing that an expectant father may influence a mother 's decision to breast- or formula-feed , we tested the effectiveness of a simple , educational intervention that was design ed to encourage fathers to advocate for breastfeeding and to assist his partner if she chooses to breastfeed . STUDY DESIGN We conducted a r and omized controlled trial in which expectant fathers ( n = 59 ) were assigned r and omly to attend either a 2-hour intervention class on infant care and breastfeeding promotion ( intervention ) or a class on infant care only ( control group ) . The classes , which were led by a peer-educator , were interactive and informal and utilized different media to create an accessible environment for participants . Couples were recruited during the second trimester from a university obstetrics practice . RESULTS Overall , breastfeeding was initiated by 74 % of women whose partners attended the intervention class , as compared with 41 % of women whose partners attended the control class ( P = .02 ) . CONCLUSION Expectant fathers can be influential advocates for breastfeeding , playing a critical role in encouraging a woman to breastfeed her newborn infant BACKGROUND The study documented Australian primigravidas ' perceptions about breastfeeding . OBJECTIVES To examine women 's perspectives of their breastfeeding experiences during the first 12 weeks postpartum . DESIGN A Journal was introduced to an  intervention group ( n=149 ) attending prenatal classes at a private hospital at 36 antenatal weeks . Using quantitative data at two days and 12 weeks postpartum , the intervention group was compared with a control group  ( n=154 ) that delivered at the same hospital . Qualitative data were also collected about the women 's perceptions about breastfeeding to further illuminate their experience . Qualitative data from 203 women at two days postpartum and 252 women at 12 weeks postpartum represented the combined comments from the intervention and control groups . PARTICIPANTS Participants were recruited as part of a r and omised controlled trial of the effects of a Breastfeeding Journal on breastfeeding prevalence , self-efficacy , support , and influence from conflicting advice . The convenience sample of middle class , well-educated primiparous women from a Western Australian hospital had given birth to a singleton infant that was greater than 34 weeks gestation . METHODS An open-ended question on a question naire sought mothers ' comments about their breastfeeding experiences . Data were analysed using inductive content analysis . FINDINGS These mothers described trying to ' get breastfeeding right ' . Getting it right included enhancing factors , factors with mixed effect , and negative factors . CONCLUSIONS Middle class mothers share breastfeeding perceptions with women in more vulnerable groups , including encountering conflicting and unhelpful advice and feeding pressures from health care professionals , family , and community members OBJECTIVE To evaluate the effectiveness of a breastfeeding promotion program in the Women , Infant and Children ( WIC ) Supplemental Nutrition Program participants . STUDY DESIGN This r and omized clinical trial included 52 women in the intervention group who received one-to-one pre- and postnatal breastfeeding education and support from a lactation consultant . Women ( n = 52 ) r and omized to controls received  st and ard breastfeeding services . Data regarding their infants ' feeding ( classified as exclusive , partial , and bottle ) during the first 7 days , 1 , 2 , and 3 months of age were compared . Additionally , the mothers were surveyed to assess their knowledge , attitude , and beliefs regarding breastfeeding . RESULTS Among the 104 enrolled women , 91 ( 87.5 % ) were Hispanic . Almost all the pregnant women had planned to breastfeed their infants . Although the majority of women reported breastfeeding their infants , 45.6 % in the intervention group and 28.9 % of controls practice d exclusive breastfeeding during the first 7 days . By 3 months , the rate of exclusive breastfeeding in the intervention and control groups had dropped to 13.9 % and 10.5 % , respectively . Parity , mode of delivery , previous experience with breastfeeding , rooming in , and return to work did not significantly affect the exclusive breastfeeding rate . Maternal knowledge , attitude , and beliefs regarding breastfeeding were comparable between the study groups at the baseline stage as well as 3 months postpartum . CONCLUSIONS Participation in the proposed breastfeeding promotion program by the low-income mothers was associated with an insignificant increase in the exclusive breastfeeding rate during the first 3 postpartum months Objective To investigate whether antenatal breast feeding education alone or postnatal lactation support alone improves rates of exclusive breast feeding compared with routine hospital care . Design R and omised controlled trial . Setting A tertiary hospital in Singapore . Participants 450 women with uncomplicated pregnancies . Main outcome measures Primary outcomes were rates of exclusive breast feeding at discharge from hospital and two weeks , six weeks , three months , and six months after delivery . Secondary outcomes were rates of any breast feeding . Results Compared with women who received routine care , women in the postnatal support group were more likely to breastfeed exclusively at two weeks ( relative risk 1.82 , 95 % confidence interval 1.14 to 2.90 ) , six weeks ( 1.85 , 1.11 to 3.09 ) , three months ( 1.87 , 1.03 to 3.41 ) , and six months ( 2.12 , 1.03 to 4.37 ) postnatally . Women receiving antenatal education were more likely to breast feed exclusively at six weeks ( 1.73 , 1.04 to 2.90 ) , three months ( 1.92 , 1.07 to 3.48 ) , and six months ( 2.16 , 1.05 to 4.43 ) postnatally . The numbers needed to treat to achieve one woman exclusively breast feeding at six months were 11 ( 6 to 80 ) for postnatal support and 10 ( 6 to 60 ) for antenatal education . Women who received postnatal support were more likely to exclusively or predominantly breast feed two weeks after delivery compared with women who received antenatal education ( 1.53 , 1.01 to 2.31 ) . The rate of any breastfeeding six weeks after delivery was also higher in the postnatal support group compared with women who received routine care ( 1.16 , 1.02 to 1.31 ) . Conclusions Antenatal breast feeding education and postnatal lactation support , as single interventions based in hospital both significantly improve rates of exclusive breast feeding up to six months after delivery . Postnatal support was marginally more effective than antenatal education . Trial registration Clinical Trials NCT00270920 BACKGROUND Peer support may improve  breastfeeding rates  but the evidence is inconclusive . Previous studies and review s recommend trials in different healthcare setting s. AIM To test if a specified programme of peer support affects the initiation and /or the duration of breastfeeding . DESIGN OF STUDY A two-group r and omised controlled trial of peer support for breastfeeding with evaluation of breastfeeding initiation and duration on an intention-to-treat basis . SETTING General practice in Ayrshire , Scotl and . METHOD Following informed consent , 225 women at 28 weeks gestation were allocated to control or peer support group by post-recruitment concealed allocation . All peer support and control group mothers received normal professional breastfeeding support . Additionally , those in the  peer support group still breastfeeding on return home from hospital had peer support until 16 weeks . RESULTS Thirty-five of the 112 ( 31 % ) women in the peer support group were breastfeeding at 6 weeks compared to 33/113 ( 29 % ) in the control group , a difference of 2 % ( 95 % confidence interval = -10 % to 14 % ) . The median breastfeeding duration for all women in the peer support group was 2 days compared to 1 day for the control group and the Kaplan-Meier survival plot shows the peer support group overall breastfeeding slightly longer than the control group , with no statistically significant difference by logrank test ( P = 0.5 ) . The median breastfeeding duration among primagravidae in the peer support group was 7 days , compared to 3 days for the control group . Among women who started to breastfeed the medians were 72 days in the peer support group and 56 days in the control group . These differences were not statistically significant . CONCLUSIONS Peer support did not increase breastfeeding in this population by a statistically significant amount This study compared breastfeeding attitudes , intention , and initiation among low-income women exposed or not exposed to the Best Start program .  A between- ( experimental vs control group ) and within-factor ( pretest vs posttest ) repeated measures design was employed . A nonprobability sample of 54 subjects was r and omly assigned to a control group ( n = 28 ) or an experimental group ( n = 26 ) . Using the Breastfeeding Attrition Prediction Tool , statistically significant group by time interaction effects were found for negative breastfeeding sentiment , positive breastfeeding sentiment , and breastfeeding control scales . Compared to the control group , the experimental group had significantly increased positive breastfeeding sentiment ( P < .01 ) , decreased negative breastfeeding sentiment ( P < .01 ) , and increased breastfeeding control ( P < .01 ) from pretest to posttest . Following exposure to the Best Start program , subjects in the experimental group showed statistically significantly higher breastfeeding intention and initiation than did those in the control group . Practical implication s are discussed . J Hum Lact . 20(3):300 - 305 We interviewed women who participated in a breast-feeding promotion intervention study about whether and how participation affected their infant feeding choices , and if they would recommend such an intervention to others . The larger study , a r and omized controlled trial ( RCT ) of an individualized , pre- and post-natal lactation consultant ( LC ) intervention , enrolled 382 low-income primarily Black and Hispanic women in New York City . Twenty-one women completed qualitative exit interviews  for this study ( 11 from the Intervention group and 10 Controls ) . Several of the Controls stated that the post-partum study interviews were a source of support , and made them more conscious of how they fed their infant . The Intervention Group was asked about contacts with the study ' Mother-Baby specialist ' ( i.e. LC ) , including what was and was n't helpful . The Intervention Group participants described the Mother-Baby Specialist as key in their decision to initiate and maintain breastfeeding . They credit her direct skills and positive reinforcement with their confidence and perseverance to breastfeed . The success of the intervention is attributed to technical assistance from a trained lactation consultant within the context of a relationship built on encouragement , guidance and support Despite the vast number of risk factors that apparently predispose to the development of osteoporosis ( OP ) , they have not been accurately identified and given relative priority . In order to analyse possible risk factors prospect ively in a local patient population with overt OP ( histomorphometrically confirmed and characterised ) and compare it with an appropriately matched non-OP control group ( with normal bone mass on dual-energy X-ray absorptiometry )  , a detailed general history , risk factor analysis , dietary history and anthropometric data  were obtained from 56 OP and 125 non-OP subjects . In females a positive family history of OP ( P = 0.002 ) , a fair complexion ( P = 0.009 ) , lower body mass ( P = 0.02 ) and height ( P = 0.03 ) , no breast-feeding of babies ( P = 0.006 ) , a history of smoking ( P = 0.001 ) and fat distribution around the waist ( P = 0.009 ) were identified as risk factors . In males lack of exercise ( P = 0.008 ) , a history of smoking ( P = 0.01 ) , lower body mass ( P = 0.04 ) and height ( P = 0.04 ) , a preference for salty food ( P = 0.02 ) and fat distribution around the waist ( P = 0.002 ) appeared to predispose .  Dietary calcium , phosphorus , protein and caffeine intakes were similar in OP and control subjects , but alcohol consumption was clearly higher in both OP males ( P = 0.001 ) and females ( P = 0.01 ) OBJECTIVE : To address the impact of simple antenatal educational interventions on breastfeeding practice . METHODS : A r and omized controlled trial was carried out in a tertiary referral center from May 2002 to December 2004 . A r and om sample of eligible low-risk antenatal patients was recruited from clinics in the National University Hospital , Singapore . Group A received breastfeeding educational material and individual coaching from a lactation counselor . Group B received breastfeeding educational material with no counseling . Group C received routine antenatal care only . RESULTS : A total of 401 women were recruited . Mothers receiving individual counseling and educational material  practice d exclusive and predominant breastfeeding more often than mothers receiving routine care alone at 3 months ( odds ratio [ OR ] 2.6 , 95 % confidence interval [ CI ] 1.2–5.4 ) and 6 months ( OR 2.4 , 95 % CI 1.0–5.7 ) postpartum . More mothers practice d exclusive and predominant breastfeeding at 6 months among women receiving individual counseling compared with women exposed to educational material alone ( OR 2.5 , 95 % CI 1.0–6.3 ) . CONCLUSION : Where breastfeeding practice s are suboptimal , simple one-encounter antenatal education and counseling significantly improve breastfeeding practice up to 3 months after delivery . Provision of printed or audiovisual educational material is not enough . Health care workers should make every effort to have one face-to-face encounter to discuss breastfeeding with expectant mothers before they deliver . CLINICAL TRIAL REGISTRATION : Clinical Trials.gov , www . clinical trials.gov , NCT002770192 LEVEL OF EVIDENCE : OBJECTIVE To evaluate the efficacy of an intervention program to increase breast-feeding in a low-income , inner-city population . DESIGN A r and omized , nonblinded clinical control trial . Patients were followed up through pregnancy , delivery , and the first year of the infant 's life or until the time of weaning from the breast , whichever came first . SETTING The ambulatory care center for prenatal and pediatric care and the inpatient maternity unit of a primary care center that serves a low-income , inner-city population . PATIENTS There were a total of 108 patients : 51 were r and omized to the intervention group that received prenatal and postnatal lactation instruction from a lactation consultant , and 57 were r and omized to the control group that  received the st and ard of care at the institution . Patients in the control group were not seen by the lactation consultant . The two groups were similar demographically . INTERVENTION This program consisted of individual prenatal lactation consultation , daily rounds by the lactation consultant on the postpartum unit , and outpatient follow-up at 48 hours after discharge , at the time that the infant was 1 week of age , and at all future health supervision visits for infants up to 1 year of age . MAIN OUTCOME MEASURES The incidence and duration of breast-feeding . RESULTS There was a markedly higher incidence of breast-feeding in the intervention group , as compared with that of the control group ( 61 % vs 32 % , respectively ; P = .002 ) . The duration of breast-feeding was also significantly longer in the intervention group ( P = .005 ) . CONCLUSIONS This lactation program increased the incidence and duration of breast-feeding in our low-income cohort . We suggest that similar efforts that are applied to analogous population s may increase the incidence and duration of breast-feeding in low-income population s in the United States OBJECTIVE To determine whether infants of women r and omized to a prenatal and postpartum lactation support intervention  incur fewer otitis media- , respiratory tract- , or gastrointestinal-related visits than controls . DESIGN R and omized , unmasked controlled trial recruiting women from prenatal care setting s. Breastfeeding sensitive ( BFS ) illness visits for otitis media or respiratory tract or gastrointestinal complaints were obtained up to 12 months . SETTING Two urban community health centers . PARTICIPANTS Analytic sample of 338 low-income , primarily Hispanic and /or black mother-infant dyads ( n = 163 for the intervention group and n = 175 for the control group ) . INTERVENTION Study lactation consultants attempted 2 prenatal meetings , 1 postpartum hospital and /or home visit , and telephone calls as needed . Controls received the st and ard of care . MAIN OUTCOME MEASURES Combined outpatient and emergency department visits with illness and BFS illness diagnoses . RESULTS There was a significant interaction between treatment and Medicaid ; among those not receiving Medicaid , the number of otitis media visits was higher among controls ( P</=.03 ) . Visits for any illness and BFS , gastrointestinal , or respiratory tract illnesses did not differ by treatment group . Intervention group infants received more breast milk than controls , but exclusive breastfeeding rates remained low and did not differ between groups at any point . CONCLUSIONS Only the number of otitis media visits was reduced , in a subset of the intervention group . The intervention did not reduce visits for respiratory tract or gastrointestinal illness . Limited intervention contact and low exclusive breastfeeding rates may have attenuated intervention effects . Future interventions design ed to yield markedly increased breastfeeding rates may show greater effects in low-income multiethnic sample s. Health coverage for visits may moderate intervention effects BACKGROUND Although there are many benefits to breastfeeding , its prevalence and duration in many countries is still lower than the international recommendation for 6-month exclusive breastfeeding . The objective of the present study was to investigate whether a knowledge sharing practice s with empowerment strategies ( KSPES ) program on antenatal education and postnatal support strategies improves the rates of 6-month exclusive breastfeeding during the first six months postpartum compared with a st and ard knowledge of breastfeeding techniques . MATERIAL AND METHOD A r and omized controlled trial was conducted . Pregnant women of more than 32 weeks ' gestation were r and omly assigned to receive a routine st and ard knowledge of breastfeeding techniques alone ( control group ) or with KSPES on antenatal education and postnatal support strategies ( study group ) . The primary outcome was the rate of exclusive breastfeeding at 6-month postpartum . The secondary outcomes were rates at 7 days , 14 days , 1 , 2 , 3 , 4 , and 5 months postpartum . RESULTS Rates of exclusive breastfeeding in the study group were significantly higher when compared with those in the control group at 14 days ( 82.5 % vs. 52.6 % , p = 0.005 ) , 1 month ( 77.5 % vs. 52.6 % , p = 0.021 ) , 2 months ( 62.5 % vs. 368 % , p = 0.023 ) , 4 months ( 35.0 % vs. 7.9 % , p = 0.008 ) , 5 months ( 25.0 % vs. 2.6 % , p = 0.012 ) , and 6 months postpartum ( 20.0 % vs. 0 % , p = 0.005 ) . CONCLUSION KSPES on antenatal education and postnatal support strategies significantly improve rates of exclusive breastfeeding at 6-month postpartum . These strategies also significantly improve rates of exclusive breastfeeding at 14 days , 1 , 2 , 4 , 5 , and 6 months postpartum BACKGROUND Prenatal pediatric visits have been recommended by the American Academy of Pediatrics to allow the pediatrician to counsel parents on infant care issues , establish a supportive relationship , and provide pediatric practice information to parents . We hypothesized that prenatal pediatric visits would have an impact on breastfeeding decisions , health care behaviors , health care utilization , and the doctor-patient relationship . METHODS We conducted a r and omized controlled trial of  prenatal pediatric visits for urban , low-income families to measure the impact on breastfeeding decisions , infant car safety seat use , circumcision , health maintenance , and emergency room visits and the pediatrician 's perception that he/she would know the mother better . Pregnant women were recruited prenatally from the obstetrics clinic . Outcomes were measured by maternal interview prenatally and when the infant was 2 months old , in addition to review of the nursery record . Physicians were interviewed after the 2-month visit . Health care utilization was measured by chart review at 7 months . RESULTS A total of 156 pregnant women were enrolled and r and omized , 81 to the intervention group and 75 to the control group . Of mothers who breastfed , 45 % in the intervention group changed their mind in favor of breastfeeding after enrollment compared with 14 % in the control group . Mothers in the intervention group compared with the control group were more likely to make fewer emergency room visits , 0.58 compared with 1.0 . Pediatricians were more likely to think that they knew mothers in the intervention group well , 54 % versus 29 % in the control group , yet 67 % of mothers in both groups agreed their pediatrician knew them well . There were no differences between groups in initiation or duration of breastfeeding at 30 or 60 days , infant car safety seat use , circumcision , or health maintenance visits . CONCLUSIONS Prenatal pediatric visits have potential impact on a variety of health care outcomes . Among urban , low-income mothers , we found beneficial effects on breastfeeding decisions , a decrease in emergency department visits , and an initial impact on the doctor-patient relationship . We suggest urban practice s actively promote prenatal pediatric visits OBJECTIVE To determine whether docosahexaenoic acid ( DHA ) is related to visual and neural development in term breast-fed infants . DESIGN A prospect i ve study of 83 infants who were exclusively breast-fed for at least 3 months . We determined red blood cell and plasma fatty acids at 2 months , visual acuity at 2 , 4 , 6 , and 12 months , speech perception and an object search task at 9 months , Bayley 's mental development index and psychomotor development index at 6 and 12 months , and novelty pReference at 6 and 9 months . RESULTS The infant red blood cell phosphatidylethanolamine DHA was significantly related to visual acuity at 2 months of age ( r = 0.32 , P = .01 ) and 12 months of age ( r = 0.30 , P = .03 ) . The ability to discriminate nonnative retroflex and phonetic contrasts at 9 months of age was related to the plasma phospholipid DHA ( r = 0.48 , P < .02 ) and red blood cell phosphatidylethanolamine DHA ( r = 0.26 , P = .02 ) at 2 months of age after adjusting for covariates . CONCLUSION DHA may influence the development of visual acuity and neural pathways associated with the developmental progression of language acquisition in term breast-fed infants . The extent to which our results can be attributed solely to DHA from maternal sources through breast milk or in gestation or other confounding factors remains to be determined Background Promotion of healthy eating and physical activity in early childhood is recommended as a global chronic disease prevention strategy . Centre-based childcare services represent a promising setting to provide children with opportunities to improve healthy eating and physical activity . Evidence to inform implementation of childcare obesity prevention guidelines into routine practice in childcare , however , is lacking . This study aims to assess the effectiveness of an intervention , delivered to childcare staff , aim ing to increasing service implementation of healthy eating and physical activity-promoting policies and practice s. Methods and analysis A pragmatic parallel group r and omised controlled trial will be undertaken with 165 childcare services in the Hunter New Engl and region of New South Wales , Australia . Services will be r and omised to receive either a 10-month evidence -based performance review intervention with other re sources to support practice change , or to a waitlist control group . The primary trial outcome is the proportion of services implementing all of the following recommended healthy eating and physical activity promoting practice s : written nutrition , physical activity and small screen recreation policies ; providing information to families regarding healthy eating ( including breastfeeding ) , physical activity and small screen time ; providing twice weekly healthy eating learning experiences to children ; providing water and only plain milk to children ; providing fundamental movement skills activities for children every day ; and limiting and using electronic screen time more for educational purpose s and learning experiences . Effectiveness will be assessed using a telephone interview of practice implementation with childcare staff at baseline and 12 months following baseline . Ethics and dissemination The study was approved by the Hunter New Engl and Human Research Ethics Committee and the University of Newcastle Human Research Ethics Committee . Study findings will be disseminated widely through peer- review ed publications and conference presentations . Trial registration number Australian New Zeal and Clinical Trials Registry ACTRN12614000972628 OBJECTIVE To assess whether an antenatal teaching session on position and attachment of the baby on the breast had an effect on postnatal nipple pain , nipple trauma and breast feeding duration . The study was planned as a pilot study to allow an adequate sample size to be calculated for a larger study . DESIGN An observer blind experimental design was used . Women were r and omly assigned to either the experimental group teaching session or the control group . SETTING One public hospital in Western Australia . PARTICIPANTS 70 primiparae who intended to breast feed their baby were recruited from the antenatal clinic of the study hospital at 36 weeks ' gestation . INTERVENTION Antenatal group sessions on position and attachment of the baby on the breast were conducted by a lactation consultant . MEASUREMENTS AND FINDINGS During the first four postnatal days , position and attachment was measured by LATCH ( Latch on , Audible swallow , Type of nipple , Comfort and Help ) ( Jensen et al 1994 ) , nipple pain was measured by the Visual Analogue Scale ( VAS ) and nipple trauma was measured by the Nipple Trauma Index ( NTI ) . The analysis of variance ( ANOVA ) results indicated that the women in the experimental group were better able to attach the baby on the breast and had significantly less nipple pain and trauma than the control group . At six weeks postnatally , 31 of the 35 women in the experimental group were breast feeding compared to 10 of the 35 in the control group . CONCLUSIONS AND IMPLICATION S These initial findings suggest that midwives can make the best use of decreasing re sources by using practical ' h and s on ' antenatal group teaching as an effective strategy to increase breast feeding rates Educational intervention programs in Florin , Greece , a mountainous rural area with a low ( 15 - 20 % ) attendance at prenatal clinics , were conducted to reduce perinatal and infant morbidity and mortality and to promote physical and psychomotor development . Prior community diagnostic surveys had identified low income , poor living conditions , and illiteracy as very closely linked with poor hygiene , poor nutrition , nonutilization of services , frequent infections and high perinatal and infant mortality . The objectives of the intervention were to assess the effects of health education on breast feeding practice s and use of available medical services . 300 pregnant women participants were r and omly identified by the clinic as the intervention group and 200 as controls . Both groups were similar with predominantly low socioeconomic status ( 69 - 73 % ) and peasant farmers . There were few basic housing amenities ( 13.1 with interventions and 12.7 for controls ) . 70 % of the women lived in extended families . The intervention involved home visits on nutrition , general hygiene , breast feeding , and newborn care . Visits were scheduled every 2 weeks in the 1st 2 months of pregnancy and every month until the infant was 12 months old . It was found that nutrition counseling was positively associated with maternal weight between interventions and controls ( 11.33 vs. 10.30 p.05 ) but not on low birth weight . Prematurity was reduced ( 3.7 % intervention vs. 8.3 % controls , p.04 ) . The perinatal mortality was 31 % for interventions vs. 41 % for controls , but there were a significantly higher number of fetal deaths ( 28 weeks ) for interventions . There was no discernible impact on breast feeding practice s except for dem and feeding ( 61 % interventions vs. 38 % controls ) perhaps because both groups considered breast milk the best . Overfeeding was affected by health counseling , but was reflected only after the 1st year ( 12.1 % control vs. 6.7 % intervention in the 90th percentile ) . The presence of anemia followed a similar pattern with intervention impact after the 1st year . There was no measurable impact in psychomotor development . Reported illness days had a significant lower mean 1 year for interventions . Illness reports checked against clinic visits showed underreporting for both groups . Colds , otitis , and gastroenteritis were the most common ailments . Both showed greater illness between 8 and 12 months with a slightly higher incidence of feverish episodes , gastroenteritis and otitis among controls . Hospitalizations were not significantly different . Both groups used the clinic for infant illness ; home visits depressed the use of free routine checkups for interventions from 0 to 4 months . 5  neonatal deaths  occurred among controls and interventions . It was anticipated that mortality is also affected by linkages to the community and improvement in medical services . The results were mixed but the program was partly successful OBJECTIVE To identify environmental factors involved in the etiology of  insulin-dependent diabetes mellitus ( IDDM ) . RESEARCH DESIGN AND METHODS An estimated 90 % of all incident cases of IDDM in patients 0–14 years of age in New South Wales , Australia , were ascertained over 18 months . For each IDDM patient , two age- and sex-matched control subjects were r and omly selected from the population . Past environmental exposures were determined with a question naire completed by the parents . Response rates were 92 % for the IDDM patients ( 217 of 235 ) and 55 % for the control subjects ( 258 of 470 ) . The relative risk associated with each exposure was estimated with the odds ratio ( OR ) adjusted for confounding factors using multiple logistic regression . RESULTS The introduction of cow 's milk-based infant formula into the diet before 3 months of age was associated with an increased risk ( OR 1.52 , 95 % confidence interval [ CI ] 1.04–2.24 ) . Exclusive breast-feeding for ≥3 months was associated with a protective effect ( OR 0.66 , 95 % CI 0.45–0.97 ) . High dietary intake of cow 's milk protein in the 12 months before the onset of diabetic symptoms was also associated with an increased risk ( OR 1.84 , 95 % CI 1.12–3.00 ) . A recent infection ( during the 3 months before onset of diabetic symptoms ) was more common in the patients than the control subjects ( OR 2.92 , 95 % CI 1.96–4.35 ) , as was day care attendance before the age of 3 ( OR 1.73 , 95 % CI 1.00–3.00 ) . When two age-groups , defined by the median age at onset of diabetes , were compared , the associations with early infant-feeding were stronger among the younger group ( < 9.2 years ) , and associations with recent diet and recent infection were stronger among the older group ( ≥9.2 years ) . CONCLUSIONS These results indicate an increased risk of IDDM associated with early dietary exposure to cow 's milk-containing formula , short duration of exclusive breast-feeding , high intake of cow 's milk protein in the recent diet , recent infection , and early attendance at day care OBJECTIVE Although improving mothers ' knowledge about breastfeeding can increase rates and duration of breastfeeding , little is known about the influence of fathers ' knowledge . The purpose of this study was to assess the knowledge of mothers and fathers about breastfeeding before and after receiving  postpartum advice  and its relationship to the frequency of breastfeeding . METHODS A clinical trial was performed with mothers and fathers of normal children born at the Hospital de Clínicas de Porto Alegre , Brazil , between July 1994 and March 1995 . The study intervention consisted of postpartum advice supplied by means of a video film discussing basic topics of breastfeeding , an explanatory leaflet , and open discussion after viewing the video .  The first 208 couples comprised the control group , the next 197 comprised experimental group 1 , and the remaining 196 comprised experimental group 2 . Immediately after delivery , mothers and fathers in the three groups answered a test on breastfeeding knowledge ; they completed the same test at the end of the first month . All families received home visits at the end of the first , second , fourth , and sixth months , or until breastfeeding ceased . Logistic regression was used to evaluate the association between the mothers ' and fathers ' knowledge and frequency of breastfeeding . RESULTS Postpartum advice increased the breastfeeding knowledge of mothers and fathers . The mothers with the highest level of knowledge had a 6.5 times higher chance of exclusively breastfeeding at the end of the third month , and 1.97 times higher chance of continuing breastfeeding to the end of the sixth month compared with other mothers . The fathers ' knowledge also significantly influenced breastfeeding rates . The children whose fathers knew more had a 1.76 higher chance of being exclusively breastfed at the end of the first month , and 1.91 higher chance of receiving maternal milk at the end of the third month . CONCLUSION A simple , inexpensive strategy can increase the level of breastfeeding knowledge of mothers and fathers and , consequently , have a positive impact on the frequency of breastfeeding BACKGROUND Social support has been shown to be greatly important for breastfeeding success . The objective of this study was to investigate if  mothers who were attended by midwives and nurses specially trained in breastfeeding counseling  perceived better continuity of care and emotional and informative breastfeeding support than mothers who received only routine care . METHOD Ten municipalities , each with an antenatal center and child health center , in southwest Sweden were r and omized either to intervention or control municipalities . The intervention included a process-oriented training in breastfeeding counseling and continuity of care at the antenatal and child health centers . Primiparas were asked to evaluate the care given , and those living in the control municipalities were divided into control groups A and B. Data collection took place at different points in time for the two control groups . The 540 mothers responded to 3 question naires at 3 days and at 3 and 9 months postpartum . The perception of support provided by the health professionals and from the family classes was rated on Likert scales . RESULTS Intervention group mothers rated the breastfeeding information given during the family class as significantly better during pregnancy than both control groups , and better than control group B mothers at 3 months postpartum ; compared with both control groups , intervention group mothers perceived that they received significantly better overall support and that postnatal nurses provided better information about breastfeeding and the baby 's needs . At 9 months , intervention group mothers were more satisfied with knowledge about social rights , information about the baby 's needs , and their social network than control group B mothers . Both intervention group and control group B mothers perceived better overall support than control group A during pregnancy . At 3 and 9 months , intervention group mothers perceived that postnatal nurses were more sensitive and underst and ing compared with both control groups . CONCLUSIONS After implementation of a process-oriented breastfeeding training program for antenatal midwives and postnatal nurses that included an intervention guaranteeing continuity of care , the mothers were more satisfied with emotional and informative support during the first 9 months postpartum . The results lend support to family classes incorporating continuity of care The rate of breastfeeding among immigrant Vietnamese women in Western countries is low compared to those in Vietnam . To counteract this trend , a language and culture specific education program was developed . An experimental design was used to test the effectiveness of this program . The sample consisted of 182 prenatal Vietnamese women . Data collection included question naires and interviews . Results suggested that the education program had significant effects on knowledge , attitudes , planned and actual behaviour towards breastfeeding . However , the effect did not sustain until 6 months postpartum . Implication s for nursing practice and further research are discussed OBJECTIVES : To assess the implementation and the impact of the  Breastfeeding Counselling Course  WHO/UNICEF on knowledge and skills of health workers . METHODOLOGY : The implementation of the course was assessed by participant observation ; the impact on participants was assessed with an experimental controlled study where 20 health workers were r and omly allocated as course participants ( Exposed Group-EG ) and 40 as non participants ( Control Group -CG )  . Impact on knowledge was verified with pre and post evaluations , with multiple choice questions ; clinical and counselling skills were assessed through pre and post tests , observing participants in clinical consults with mother and baby pairs in rooming-in before and after the course . Kruskal-Wallis test of variance of means was used in analysis . RESULTS : In the post test of knowledge , the mean of the EG was 8.35 and that of the CG was 5.54 ( p=0,0000 ) . In clinical and counselling skills , the means of the EG were higher when compared with the CG in all items observed ( p < 0,05 ) . Some difficulties were found in breastfeeding history and in breastfeeding observation . Counselling skills were the most incorporated aspects . CONCLUSION : The course may be implemented as proposed ; participants acquired counselling skills , but clinical management should be reinforced ; participants shoud have continued support to put what they learned in practice A r and omized controlled trial study design was used to investigate the effectiveness of a Healthy Families America model prenatal intervention for increasing breastfeeding rates among Latina immigrants residing in an impoverished New York City community . Exposure to the intervention did not affect mother report of any breastfeeding ( ABF ) during the first week postpartum , but it did affect mother report of exclusive breastfeeding ( EBF ) . Thirty-two percent ( 44/137 ) of mothers exposed to the intervention reported EBF during the first week postpartum compared to 20 % ( 20/101 ) of mothers not exposed to the intervention ( odds ratio 1.92 ; 95 % confidence interval 1.05 - 3.52 ) . This positive effect of the intervention on EBF remained statistically significant after controlling for the negative effect of household income on EBF ( adjusted odds ratio , 1.89 ; 95 % confidence interval , 1.02 - 3.50 ) . Additional research is needed on the effectiveness of breastfeeding promotion programs targeting low-income Latinas . J Hum Lact . 25(4):404 - 411
BACKGROUND Breast milk is well recognised as the best food source for infants .
The impact of antenatal breastfeeding ( BF ) education on the duration of BF has not been evaluated .
OBJECTIVES To assess the effectiveness of antenatal breastfeeding ( BF ) education for increasing BF initiation and duration .