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**Handout #1**

**Abstracts**

Breastfeeding Peer Counseling\
Programs with Diverse Populations

[Abstract #1]{.underline}

**Caulfield, L.E., Gross, S.M., Bentley, M.E., Bronner, Y., Kessler, L.,
Jensen, J., Weathers, B., & Paige, D.M. (1998). WIC-based interventions
to promote breastfeeding among African-American women in Baltimore:
Effects on breastfeeding initiation and continuation. Journal of Human
Lactation, 14(1): 15-22.**

This study evaluated the single and combined effects of a breastfeeding
motivational video and peer counseling on initiation and continuation
(at 7-10 days after delivery) rates among African American WIC
participants. Four clinics were randomly assigned to control and
treatment groups. Treatment groups included the use of a video, the use
of peer counselors, and the combined use of the video and peer
counselors. Complete data were collected for 242 women. Overall, 43.4%
of the women expressed an intention to breastfeed at enrollment and
47.5% reported initiating breastfeeding, with 31% reporting
breastfeeding at 7-10 days postpartum. The percentage of women who
reported breastfeeding within 7-10 days postpartum was significantly
higher among women from the three intervention clinics than the control.
Initiation rates among treatment groups included 50% in the video only
group, 62% in the peer counseling only group, and 52% in the combined
video and peer counseling group, compared to only 26% in the control
group. At 7-10 days, continuation of breastfeeding was 30%, 38%, and 38%
in each of these groups (respectively) and only 14% in the control.
Strong differences emerged in relation to intention to breastfeed at
baseline. Initiation of breastfeeding was positively associated with
cesarean delivery, infant feeding instruction, no artificial milk
discharge package, attending the peer counselor only clinic, and
intention to breastfeed. Breastfeeding continuation was significantly
positively associated with Intention to breastfeed, as well as infant
feeding instruction, and no artificial discharge package. The impact of
breastfeeding promotion activities was present but weak, and disappeared
by 7-10 days postpartum.

[Abstract #2]{.underline}

**Grummer-Strawn, L.M., Rice, S.P., Dugas, K., Clark, L.D., &
Benton-Davis, S. (1997). An evaluation of breastfeeding promotion
through peer counseling in Mississippi WIC clinics. Maternal and Child
Health Journal, 1(1): 35-42.**

The purpose of this study was to evaluate the effectiveness of a peer
counseling program at increasing breastfeeding by participants in the
Mississippi Special Supplemental Nutrition Program for Women, Infants,
and Children (WIC). This study differs from other studies on peer
counseling in that the entire WIC population of infants in the state was
studied, not just those receiving services. This was done to determine
cost-effectiveness. Data from the 1989-1993 Pediatric Nutrition
Surveillance System was used. This baseline represents the year prior to
the start of peer counseling. The study design was a natural experiment,
with 51 clinics having peer counseling programs, and 99 without.
Approximately half of the staff in the study was composed of peer
counselors. Additional data was collected through a staff questionnaire
that was designed to capture detailed information regarding the
programs, to study characteristics associated with greater success. The
main goals included focusing on the incidence of breastfeeding, and what
elements made a program more effective. The incidence of breastfeeding
in clinics with peer counseling programs was significantly greater than
in clinics without the program. Clinics that initiated the program
earlier showed even greater increases. The presence of specialized
staff, such as lactation specialists or consultants appeared to be more
important that the presence of peer counselors. In fact, clinics that
had only a lactation specialist or consultant were actually more
effective than those that include peer counselors. Peer counselors were
more effective if they spent more time (at least 45 minutes) per
participant. It was concluded that the peer counseling program
significantly increased the incidence of breastfeeding, specifically in
clinics with lactation specialists and consultants. Likewise, to be
effective peer counselors should spend a significant amount of time with
each participant.

[Abstract #3]{.underline}

**Kistin, N. Abramson, R., & Dublin, P. (1994). Effect of peer
counselors on breastfeeding initiation, exclusivity, and duration among
low-income urban women. Journal of Human Lactation, 10(1): 11-18.**

This study focused on the effect of support offered by trained peer
counselors on breastfeeding initiation, duration, and exclusivity among
low-income urban women. The setting for the study, Cook County Hospital,
had established a peer counseling program in 1987. Peer counselors were
selected based on criteria that included having the same racial or
socio-economic background as the hospital patient population,
breastfeeding experience, and having the desire to help other women.
Training was provided to counselors was based on Freirean education
techniques of empowerment and confidence building. Graduation of the
training was granted after a peer counselor attended six of eight
two-hour trainings offered. Content of the peer counseling training
included the following: breastfeeding promotion and management,
nutrition, basic infant growth and development, common infant illnesses,
counseling techniques, how to make referrals to community resources, and
how to identify and make appropriate referrals to professionals when
problems are beyond the scope of peer counselors. Women who delivered
infants at Cook County Hospital requested a peer counselor either during
their prenatal class or after delivery while in the postpartum ward.
Women were assigned based on availability of counselors.

Counselor caseload was limited to two to five women, and not every woman
received a counselor. Women were matched with counselors of the same
race if possible. Counselors were provided with specific instructions
regarding their contact with women. If possible, they were to make
contact prior to delivery, twice a week after delivery, every one to two
weeks for two months after that. Telephone contact was the main mode of
contact. Contact was to be maintained for at least 12 weeks after
delivery. Women who received a counselor (N=59) had greater
breastfeeding initiation, exclusivity, and duration than women who did
not have a counselor (N=43). The findings suggest that peer counselors
do have a positive impact on breastfeeding practices among low-income
urban women.

[Abstract #4]{.underline}

**Long, D. Funk-Archuleta, M.A., Geiger, C.J., Mozar, A., & Heins, J.N.
(1995). Peer counselor program increases breastfeeding rates in Utah
Native American WIC population. Journal of Human Lactation, 11(4):
279-284.**

The purpose of this study was to investigate whether initiation and
duration of breastfeeding among low-income Native American WIC
participants were affected by the addition of a breastfeeding peer
counselor program. Historical controls were used a comparison group. Two
women were trained as peer counselors. Peer counselors contacted
participants prior to delivery, and at one, two, and four to six weeks
postpartum. Seventy-eight charts were reviewed for historical controls.
Women in the experimental group (N=63) were questioned regarding their
intention to breastfeed. Forty-seven percent of the women had intentions
to breastfeed. Among all women in the study breastfeeding, initiation
rates were approximately 15% higher in the peer counselor group than
among the historical controls and duration was longer as well. For women
in the experimental group that had complete data for three months, there
was a significantly higher rate of breastfeeding at initiation (84%)
than the control group (70%). The trend of higher rates among the
experimental group continued for three months postpartum, although
significance was not achieved. The program appeared to be successful for
improving initiation and duration of breastfeeding among low-income
Native American women.

[Abstract #5]{.underline}

**Volpe, E. & Bear, M. (2000). Enhancing breastfeeding initiation in
adolescent mothers through the Breastfeeding Educated and Supported Teen
(BEST) Club. Journal of Human Lactation, 16(3): 196-200.**

The purpose of the study was to determine if specific breastfeeding
education, provided by a lactation consultant in an alternative program
for pregnant adolescents would increase breastfeeding initiation rates.
The study used an experimental design, with 43 participants in the
experimental group and 48 in the control. Adolescents in the
experimental group attended three comprehensive breastfeeding education
sessions called the Breastfeeding Educated and Supported Teen (BEST)
Club. The control group received the program typically offered, which
provided limited breastfeeding education. The intervention used a
combination of role-playing and games, that consisted of three weekly,
1-hour sessions that utilized group interaction and participation. The
program incorporated maternal-child issues into the breastfeeding
education, including nutrition, safety, child development, and
preventive health care. The instructor of the BEST club was a nurse
clinician and IBCLC. A paid peer counselor from the local health
department served as an educational assistant, working closely with the
students during the sessions, and then visiting weekly to offer
follow-up support after the three educational sessions were completed.
The peer counselor also provided support for adolescents who chose to
initiate breastfeeding after their delivery for up to six months or
until they chose to wean. Results of the study revealed a significant
difference between adolescents who participated in the BEST intervention
and those in the control group with regard to infant feeding choice. The
results support the use of breastfeeding specific education and peer
support to increase breastfeeding initiation among adolescents.