title: Impact of peer counselling breast-feeding support programme protocols on any and exclusive breast-feeding discontinuation in low-income women.
abstract: OBJECTIVE
  Peer counselling (PC) programmes have been shown to improve breast-feeding outcomes in populations at risk for early discontinuation. Our objective was to describe associations between programme components (individual and combinations) and breast-feeding outcomes (duration and exclusivity) in a PC programme for low-income women.
  
  
  METHODS
  Secondary analysis of programme data. Multivariable-adjusted Cox proportional hazards models were used to examine associations between type and quantity of peer contacts with breast-feeding outcomes. Types of contacts included in-person (hospital or home), phone or other (e.g. mail, text). Quantities of contacts were considered 'optimal' if they adhered to standard programme guidelines.
  
  
  METHODS
  Programme data collected from 2005 to 2011 in Michigan's Breastfeeding Initiative Peer Counseling Program.
  
  
  METHODS
  Low-income (n 5886) women enrolled prenatally.
  
  
  RESULTS
  For each additional home, phone and other PC contact there was a significant reduction in the hazard of discontinuing any breast-feeding by 6 months (hazard ratio (HR)=0·90 (95% CI 0·88, 0·92); HR=0·89 (95% CI 0·87, 0·90); and HR=0·93 (95% CI 0·90, 0·96), respectively) and exclusive breast-feeding by 3 months (HR=0·92 (95% CI 0·89, 0·95); HR=0·90 (95% CI 0·88, 0·91); and HR=0·93 (95% CI 0·89, 0·97), respectively). Participants receiving greater than optimal in-person and less than optimal phone contacts had a reduced hazard of any and exclusive breast-feeding discontinuation compared with those who were considered to have optimum quantities of contacts (HR=0·17 (95% CI 0·14, 0·20) and HR=0·28 (95% CI 0·23, 0·35), respectively).
  
  
  CONCLUSIONS
  Specific components of a large PC programme appeared to have an appreciable impact on breast-feeding outcomes. In-person contacts were essential to improving breast-feeding outcomes, but defining optimal programme components is complex.
authors.affiliation: 1Department of Food Science and Human Nutrition,Michigan State University,East Lansing,MI,USA.
authors.forename: Mary R
authors.initials: MR
authors.lastname: Rozga
authors.affiliation: 2Department of Epidemiology and Biostatistics,Michigan State University,East Lansing,MI,USA.
authors.forename: Jean M
authors.initials: JM
authors.lastname: Kerver
authors.affiliation: 1Department of Food Science and Human Nutrition,Michigan State University,East Lansing,MI,USA.
authors.forename: Beth H
authors.initials: BH
authors.lastname: Olson
mesh_terms: D000328:Adult; D001942:Breast Feeding / Q000009:adverse effects; D003376:Counseling; D005260:Female; D063105:Food Assistance; D062489:Health Impact Assessment; D006801:Humans; D007398:Interpersonal Relations; D053208:Kaplan-Meier Estimate; D008824:Michigan; D017145:Models, Educational; D018673:Nutrition Policy; D010349:Patient Compliance; D010379:Peer Group; D011203:Poverty; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012944:Social Support; D055815:Young Adult
keywords: Breast-feeding; Peer counselling; Programme protocol; Survival analysis