Breastfeeding rates among African American women lag far behind those of white and Hispanic women, and
nationally, the lowest rates of breastfeeding among all women, are among African American women under 20
years of age. In addition to the evidence of health benefits to mothers and infants from breastfeeding, recent
research results show that lactation is inversely associated with aggressive triple negative breast cancer
(TNBC) that disproportionately affects young African American women. These results clearly confirmed that
parity-- formerly considered a risk reduction factor—is actually increasing risk of TNBC in African American
women.1 Moreover, these results demonstrated that these risks can be totally ameliorated in African American
women if they breastfeed.1 Research and health behavior theories show that perceived risk for health
problems can be a motivating factor for behavior change. Thus, the breastfeeding and breast cancer risk
results, combined with the known role of perceived risk as a motivator of behavior change, provides a
compelling basis for developing and testing an intervention strategy centered around Peer Counselors
educating young African American mothers about these links. The goal of the proposed study is to develop and
evaluate a risk reduction intervention using multi-level cognitive and affective strategies through Women,
Infants and Children (WIC) Peer Counselors (PCs) to increase breastfeeding by high risk African American
mothers who are least likely to breastfeed. The Specific Aims are: Aim 1. Develop intervention strategies with
WIC PCs to disseminate to African American mothers through community-engaged approach; Aim 2. Assess
the comparative cognitive, affective, sociocultural measures, and breastfeeding intent and outcomes with
mothers exposed to the new strategies compared to mothers served by the existing WIC PC program. This
study will not only assess the impact of the intervention on breastfeeding outcomes, but will also allow us to
examine cognitive and affective factors related to decision making for breastfeeding behaviors in familial and
sociocultural context, providing important insights into the role and relative importance of feelings, knowledge
and beliefs, economics, behavioral and social barriers related to disparities in breastfeeding. Expected
outcomes: Results will provide crucial information to determine if risk perceptions can be transformative in
creating a shift from formula-as-an-equivalent-feeding-practice to “Breast is Best” among African American
women within their social context-- basically creating a culture-change model.
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