title: WIC peer counselors' perceptions of breastfeeding in African American women with lower incomes.
abstract: BACKGROUND
  African American women have the lowest breastfeeding rates among all racial/ethnic groups in the United States. Peer counseling is an effective intervention in improving breastfeeding in this population. However, little is known on peer counselors' perceptions of breastfeeding in African American women.
  
  
  OBJECTIVE
  As part of a larger qualitative study, the goal of this study was to understand the contextual factors influencing breastfeeding decisions of low-income African American women from the perspective of breastfeeding peer counselors (PCs).
  
  
  METHODS
  Three focus groups were conducted with 23 PCs from the Women, Infants, and Children program in a southeastern state. All focus group discussions were audio-recorded, professionally transcribed, and analyzed using thematic analysis. Bronfenbrenner's socioecological model was used to group categories into themes.
  
  
  RESULTS
  Of the sample, 47.8% were African American, 78.2% were married, and 56.5% had some college education. Five main themes emerged to describe factors at multiple levels influencing breastfeeding in PCs' low-income African American clients: individual, microsystem, exosystem, macrosystem, and chronosystem. Novel findings included (1) having breast pumps may give African American women a "sense of security," (2) cultural pressures to be a "strong black woman" can impede breastfeeding support, and (3) breastfeeding "generational gaps" have resulted from American "slavery" and when formula was "a sign of wealth."
  
  
  CONCLUSIONS
  As PCs described, low-income African American women's breastfeeding decisions are affected by numerous contextual factors. Findings from this study suggest a need to broaden the public health approach to breastfeeding promotion in this population by moving beyond individual characteristics to examining historical and sociocultural factors underlying breastfeeding practices in African American women.
authors.affiliation: Center for Interdisciplinary Research in Women's Health, University of Texas Medical Branch, Galveston, TX, USA tygross@utmb.edu.
authors.forename: Tyra T
authors.initials: TT
authors.lastname: Gross
authors.affiliation: Department of Health Promotion & Behavior, University of Georgia, Athens, GA, USA.
authors.forename: Rachel
authors.initials: R
authors.lastname: Powell
authors.affiliation: Department of Foods & Nutrition, University of Georgia, Athens, GA, USA.
authors.forename: Alex K
authors.initials: AK
authors.lastname: Anderson
authors.affiliation: Department of Lifelong Education, Administration, and Policy, University of Georgia, Athens, GA, USA.
authors.forename: Jori
authors.initials: J
authors.lastname: Hall
authors.affiliation: Department of Health Promotion & Behavior, University of Georgia, Athens, GA, USA.
authors.forename: Marsha
authors.initials: M
authors.lastname: Davis
authors.affiliation: Department of Health Promotion & Behavior, University of Georgia, Athens, GA, USA.
authors.forename: Karen
authors.initials: K
authors.lastname: Hilyard
mesh_terms: D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data; D001291:Attitude of Health Personnel; D001942:Breast Feeding / Q000208:ethnology*; D000072117:Counselors; D005260:Female; D017144:Focus Groups; D005845:Georgia; D040361:Healthy People Programs; D006801:Humans; D007231:Infant, Newborn; D000068101:Maternal-Child Health Services; D010379:Peer Group; D011203:Poverty
keywords: African Americans; WIC; breastfeeding; focus groups; peer counselors; qualitative