Table 1.
Summary of published randomized trials evaluating breastfeeding interventions targeting minority women1
| Study | Study Population | Intervention | Outcomes (I vs. C) |
| Peer counseling | |||
| Chapman et al. (6) | N = 219; 80% Hispanic (mostly Puerto Rican), 9% black | Home visits: 1 prenatal, 3 PP Hospital visits: daily Telephone support and breast pumps available |
Initiation: 91 vs. 77%* BF 1 mo: 64 vs. 51% BF 3 mo: 44 vs. 29% EBF: NS at any time point |
| Anderson et al. (25) | N = 182; 72% Hispanic (mostly Puerto Rican), 18% black | Focus: EBF promotion/support Home visits: 3 prenatal, 9 PP Hospital visits: daily Telephone support and breast pumps |
Initiation: 91 vs. 76%* BF 3 mo: 49 vs. 36% EBF 3 mo: 27 vs. 3%* Infant diarrhea, 3 mo: 18 vs. 38%* Maternal amenorrhea, 3 mo: 52 vs. 33%* |
| Chapman et al. (26) | N = 206; overweight/obese, low-income women, 82% Hispanic (mostly Puerto Rican), 10% black | Focus: specialized PC for obese women, EBF promotion Home visits: 3 prenatal, 11 PP Hospital visits: daily EBF promotion, telephone support, breast pumps and BF sling available |
Initiation: 97 vs. 99% >50% BM feedings, 2 wk PP: 81 vs. 67%* BF 3 mo: 47 vs. 51% EBF 1 mo: 18 vs. 12% Infant rehospitalization 3 mo: 8 vs. 22%* |
| Merewood et al. (27) | N = 101; BF mothers of healthy, preterm, NICU infants (26–37 wk gestational age); 69% black, 19% Hispanic | Focus: BF support for preterm infants Hospital visits: within 72 h of birth and weekly through 6 wk PP (if still hospitalized) Telephone support: weekly after hospital discharge through 6 wk PP |
Feeding at 12 wk: any BF (OR: 2.81, 95% CI: 1.11–7.14; P = 0.03)EBF: NS |
| Professional support | |||
| Bunik et al. (28) | N = 341; 88% Hispanic (mostly Mexican), 6% black | RN support Daily telephone call from bilingual RN (day of discharge through 14 d PP) |
BF 3 mo: 49 vs. 54% BF 6 mo: 28 vs. 37% Sick infant visit, 1 mo: 25 vs. 36%# |
| Grossman et al.(29) | N = 97; 54% black | RN support Hospital visits: 4 RN visits (30–45 min) Telephone support: 4 RN PP calls | BF 3 mo: 35 vs. 48% BF 6 mo: 14 vs. 27% |
| Bonuck et al. (30,31) | N = 304; 57% Hispanic, 36% black | LC support Home visits: 2 prenatal, 1 PP Telephone support as needed Nursing bra provided. Breast pumps provided as needed. | BF through 20 wk: 53 vs. 39%* >50% BM, 1 wk: 69 vs. 37%*** >50% BM, through 9 wk: 46 vs. 33%* EBF: NS at any time point |
| Petrova et al. (32) | N = 104; 88% Hispanic (mostly Mexican), 6% black | LC support Home visits: 2 prenatal Hospital visit/call: 1 Telephone support: 2 calls | BF 3 mo: 78 vs. 63% EBF 1 wk: 46 vs. 29% EBF 1 mo: 30 vs. 24% EBF 3 mo: 14 vs. 11% |
| Breastfeeding team (peer counselor + professional) | |||
| Pugh et al. (33) | N = 41; 93% black | RN + PC team Hospital visits: daily Home visits: 3 (in first month PP) PC telephone support through 6 mo PP | BF 6 mo: 45 vs. 35% EBF 3 mo: 45 vs. 25% EBF 6 mo: 40 vs. 15% |
| Pugh et al. (34) | N = 328; 87% black | RN + PC team Hospital visits: daily Home visits: 3 (in first month PP) PC telephone support through 6 mo Unlimited RN contact via pager | BF 6 wk (OR: 1.72, 95% CI: 1.1–2.8; P = 0.03) BF 12 wk (OR: 1.58, 95% CI: 1.0–2.49; P = 0.05) |
| Wambach et al. (35) | N = 289; teen mothers, 61% black | LC + PC team Prenatal group classes: 2 PC hospital visits: 1 Telephone support by LC or peer counselor: 5 calls through 4 wk PP Breast pump as needed Study groups: 1. Intervention2. Attention control3. Usual care | Unadjusted analyses (1 vs. 2 vs. 3) Initiation: 79 vs. 66 vs. 63%* Median BF duration: 177 vs. 42 vs. 61 d*** EBF 3 wk: 31 vs. 30 vs. 18% |
| Breastfeeding-specific clinic appointment | |||
| Serwint et al. (36) | N = 159; nulliparous, pregnant women, 91% black | Pediatric clinic: prenatal appointment to discuss BF Providers: pediatric residents who had received 3 h of additional BF training |
Response rate: 68% attended appointment Initiation: 42 vs. 31% BF 1 mo: 19 vs. 14% Planned FF, but BF: 45 vs. 14%* |
| Hopkinson et al. (37) | N = 522; 100% Hispanic mixed feeders (mostly Mexican) | Breastfeeding clinic: at hospital discharge, appointment card provided to attend BF clinic at 3–7 d PP Providers: PC with IBCLC supervision |
Response rate: Clinic visit by 1 wk PP: 35% Clinic visit by 3 wk PP: 56% Clinic visit/telephone call, 3 wk PP: 80% BF outcomes at 4 wk PP: EBF: 17 vs. 10%* Water given: 20 vs. 41%** Tea given: 16 vs. 28%** Ounces formula/d: 12 vs. 14* |
| Group prenatal counseling | |||
| Kistin et al. (38) | N = 159; 100% black | Prenatal BF education: 1. Group class (50–80 min) 2. Individual session (15–30 min) 3. Controls (no additional BF education) Providers: midwives | BF Initiation: Group class (OR: 5.2, 95% CI: 2.9–9.3; P = 0.006) Any intervention (OR: 4.3, 95% CI: 2.6–7.0; P = 0.004) Individual session: NS Controls: reference group Planned FF, but BF (1 vs. 2 vs. 3): 21 vs. 38 vs. 8%*** BF 12 wk (1 vs. 2 vs. 3) 15 vs. 4 vs. 4%* |
| Ickovics et al. (39) | N = 1047; 78% black, 13% Hispanic | Group prenatal care model:I: Group prenatal care (20-h contact time) C: Individual (2-h contact time)Providers: usual clinic staff | BF initiation: 67 vs. 55% (OR: 1.73, (95% CI: 1.28–2.35; P = 0.001) |
| Wolfberg et al. (40) | N = 59; 86% black | BF class for fathers I: Dads prenatal BF class (2 h) C: Dads prenatal infant care class (2 h) Same black male instructor for both classes | BF initiation: 74 vs. 41%* BF 1 mo: 38 vs. 35% BF 2 mo: 35 vs. 19% |
| Enhanced Breastfeeding Programs | |||
| Frank et al. (41) | N = 343; 65% black, 19% Hispanic | 1: Research-funded discharge bag (contains BF promotional materials) 2: Research counseling: perinatal visit + 8 telephone calls 3: Research bags + research counseling 4. Controls: standard bag (sterile water, nipples, formula company pamphlets) + standard limited counseling |
EBF duration: (1 + 3) vs. 4: 60 vs. 42 d** (1-tailed log rank test) Infant rehospitalization, 4 mo 2 vs. 3: 14 vs. 1%* |
| Caulfield et al. (42), Gross et al. (43) | N = 242; 100% black | WIC clinic-based intervention: 1: Peer counselor contact: 3 prenatal visits + weekly contact through 16 wk 2: BF promotion video/pamphlets 3: PC + video/pamphlets 4: Controls | BF initiation: 1 vs. 2 vs. 3 vs. 4: 62 vs. 50 vs. 52 vs. 26%* 1 vs. 4 (OR: 3.8, 95% CI: 1.4–10.2; P < 0.05)* BF termination 4 mo: 1: OR: 0.2, 95% CI: 0.1–0.4* 2: OR: 0.3, 95% CI: 0.1–0.8* 3: OR: 0.3, 95% CI: 0.1–0.6* 4: Reference |
1
*P < 0.05; **P < 0.01; ***P < 0.001; #P = 0.05. BF, breastfeeding; BM, breast milk; C, control; EBF, exclusive breastfeeding; FF, formula feeding; I, intervention; IBCLC, International Board Certified Lactation Consultant; LC, lactation consultant; PC, peer counseling; PP, postpartum; RN, registered nurse; WIC, Special Supplemental Nutrition Program for Women, Infants, and Children.