Planning a WIC Research Agenda Workshop Summary (2011) / Chapter Skim
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4 Research Needed to Improve Breastfeeding Protection, Promotion, and Support Within WIC
4 Research Needed to Improve Breastfeeding Protection, Promotion, and Support Within WIC
Pages 37-50
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From page 37... ...
During the session, the presenters (Karen Bonuck, Maya Bunik, and Cynthia Howard) focused on different aspects of breastfeeding research and provided suggestions related to surveillance, breastfeeding research involving the WIC food packages, staffing issues (especially peer counseling)
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Preventive Services Task Force (USPSTF, 2008) of the effects of breastfeeding interventions on initiation, duration, and exclusivity of breastfeeding.
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From page 39... ...
• Establishing links among health professionals leads to a recognition of the value of breastfeeding support. Figure 4-1, taken from the WIC Breastfeeding Peer Counseling Study Final Implementation Report (USDA/FNS, 2010)
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From page 40... ...
Among the key covariates for studies of breastfeeding are prenatal breastfeeding intentions, past breastfeeding history/experience, early hospital experience, reasons for the feeding choice, and the WIC food package the mother has chosen. In addition, it would be useful to collect information on maternal and infant health outcomes, such as the body mass index of the mother and infant and, for the mother, data on cardiovascular disease and diabetes.
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From page 41... ...
does not allow ran domization involving the food package. • Peer counselors seem to be the focus of funding.
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• Is there communication with the hospital or primary care site? Research Considerations Bunik briefly addressed possible research designs, listed in Box 4-2, and then ended her presentation with two suggestions for studying interventions that combine a continuum of care with incentives: 1.
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From page 43... ...
have reported non-significant or positive effects of WIC participation on breastfeeding outcomes. The conflicting data emphasize the importance of selecting an appropriate control group and gathering data regarding the mother's infant feeding intentions when she enters the program.
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From page 44... ...
Howard provided further detail on the proposed study to examine the effects of peer counseling on breastfeeding and other health outcomes: • Test components of peer counseling implemented by WIC agen cies with high-performing programs, prioritizing exclusive breast feeding and giving attention to ethnic background, race, and acculturation. • Test interventions that are feasible, replicable in many setting, and affordable, such as staffing and the supervision of peer counselors; the role of the WIC retailer in facilitating community partnerships; tools to facilitate referrals to WIC from medical care settings and social service agencies; and hospital rounding and collaborations.
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From page 45... ...
Funding for peer counseling has grown to $80 million, but, as noted by earlier presenters, the U.S. Preventive Services Task Force found inconclusive evidence of its effectiveness, and there is limited information on the aspects that can improve effectiveness.
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From page 46... ...
Given the long list of questions about different aspects of peer counseling, Grummer-Strawn argued for less emphasis on causality (that is, on group-randomized controlled trials, which can answer only one question at a time) and more on plausibility (relative effectiveness of different kinds of programs)
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From page 47... ...
Preliminary findings According to Pat Gradziel,4 with the introduc • tion of the new food package in the California state WIC program, the rate of exclusive breastfeeding jumped upward, the rate of partial breastfeeding decreased substantially, and these changes have persisted. Bonuck's study has found that the trimester of entry into WIC is positively associated with the initiation and duration of breastfeeding but that the effects differ for first births versus higher-order births.
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From page 48... ...
is a valuable approach when examining covariates in studies. SUMMARY OF SUGGESTED RESEARCH TOPICS The research suggestions made during this session focused mainly on the study of support services for breastfeeding, especially research related to staffing (e.g., roles of peer counselors and IBCLCs, where and when they provide care, and their collaboration with a variety of other care providers)
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From page 49... ...
2007. Special Supplemental Nutrition Program for Women, Infants, and Children and infant feeding practices.
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