Date of Award

Spring 5-2019

Degree Name

Master of Public Health (MPH)

Advisor(s)

SHREELA V. SHARMA, PhD, RD, LD

Second Advisor

LAURA S. MOORE, MED, RD, LD

Abstract

Despite nationwide improvements in breastfeeding behaviors, many minority, low-socioeconomic status women in the United States fail to follow breastfeeding recommendations. Healthy Eating Active Living (HEAL), a free antenatal program in Houston, Texas, teaches pregnant women healthy lifestyle behaviors and promotes breastfeeding. The objective of this paper was to determine the impact of HEAL on breastfeeding initiation and length of breastfeeding duration among predominantly low income, minority, underserved women in Houston, TX. Methods: HEAL is a natural experiment rooted in Social Cognitive Theory and Theory of Planned Behavior. Data was collected from two sources, the HEAL pregnancy post-delivery survey and the HEAL infancy baseline survey. Data used was collected from March 2015 through October 2018. Women in the intervention group were recruited through University of Texas (UT) Physicians clinics to participate in HEAL pregnancy. Women in the control group did not attend HEAL pregnancy but did attend HEAL infancy and were also recruited through UT Physicians. Logistic regression analysis was conducted to evaluate the impact of HEAL on both breastfeeding initiation and duration. Further analysis was conducted adjusting for covariates of interest. Results: Of the 328 women analyzed in this study, 164 were in the intervention group and 164 in the control group. Those in the intervention group receiving HEAL pregnancy program had 1.57 times the odds of initiating breastfeeding compared to those who did not receive HEAL pregnancy program in the control group, but differences in rates of initiation between intervention and control groups were not significant. When analyzed by category, intervention group participants with an annual income of $25,000 or greater had 4.59 times greater odds of initiate breastfeeding compared to those with an income less than $10,000. Those in the intervention group receiving HEAL pregnancy program had two times greater odds of breastfeeding for 12 weeks or longer as compared to those in the control group, but differences in length of duration between the intervention and control groups were not significant. Further analysis revealed those in the intervention group who had an income greater than $25,001 had 5.5 times greater odds of breastfeeding 12 weeks or longer as compare to those with an annual income less than $10,000 (Adj. OR= 5.47, 95% OR=1.588-18.852, p=0.007). Conclusion: This study revealed both breastfeeding initiation and length of breastfeeding duration improved among women who participated in the HEAL pregnancy program as compared to women who did not participate in the intervention. Although results were not significant, relatively small sample size and ceiling effect may have attributed to the results. Further research is needed to understand how antenatal breastfeeding education affects breastfeeding behaviors after delivery.

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