title: A clinic-based breastfeeding peer counselor intervention in an urban, low-income population: interaction with breastfeeding attitude.
abstract: 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.
  
  
  OBJECTIVE
  We aimed 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 randomization 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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Division of General Pediatrics, Medical University of South Carolina, Charleston, SC, USA srinivag@musc.edu.
authors.forename: Ganga L
authors.initials: GL
authors.lastname: Srinivas
authors.affiliation: Columbia University Mailman School of Public Health, New York, NY, USA.
authors.forename: Mary
authors.initials: M
authors.lastname: Benson
authors.affiliation: Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Sarah
authors.initials: S
authors.lastname: Worley
authors.affiliation: General Pediatrics, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Elaine
authors.initials: E
authors.lastname: Schulte
mesh_terms: D000293:Adolescent; D000328:Adult; D001294:Attitude to Health; D001942:Breast Feeding; D000072117:Counselors; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007484:Iowa; D000068101:Maternal-Child Health Services; D010379:Peer Group; D011203:Poverty; D015397:Program Evaluation; D012944:Social Support; D014505:Urban Population; D055815:Young Adult
keywords: attitude; breastfeeding; intervention; peer counselor; randomized clinical trial; self-efficacy