Poster #105 - Collateral Benefits from a School-Readiness Intervention on Breastfeeding

• In Event: 1-061 - Poster Session 02
  In Poster Session: PS 02 Section - Health, Growth, Injury

Integrative Statement

In testing the efficacy of an intervention, there is value in assessing the total impact of a program on participants, and in understanding the mechanisms by which those impacts occur. Specifically, studies have shown unexpected positive health impacts from school-readiness interventions. For instance, participation in Head Start has been shown to reduce childhood obesity and improve later metabolic and cardiovascular health in adulthood (Campbell et al., 2014; Frisvold & Lumeng, 2011). While the pathways by which these later health changes occurred are unknown, one hypothesized mechanism is infant feeding behaviors like breastfeeding. However, the impact of school-readiness interventions on breastfeeding behaviors has yet to be examined.

In the current study, we tested the impact of a school-readiness, parenting intervention on breastfeeding behaviors. The Smart Beginnings (SB) project is an ongoing, randomized controlled trial in hospital-based primary-care clinics serving primarily low-income families in Pittsburgh and New York City. SB is a tiered intervention, intended to deliver universal primary prevention services to at-risk families through Video Interaction Project (VIP, which began at birth and included reviewing brief video recordings of parent-child play interactions with an interventionist to reinforce strengths), with secondary/tertiary services delivered to families with additional psychosocial risk factors through Family Check Up (FCU) beginning at 6 months. Control families received pediatric care as usual. Notably, there is not an explicit health promotion component to the intervention model, though delivery in a pediatric primary care setting may tacitly promote healthy feeding behaviors. Analyses used an intent-to-treat design and accounted for demographic covariates predictive of breastfeeding and breastfeeding intention at birth. Based on the differences in breastfeeding rates at the two sites (70% at NYC versus 16% at Pittsburgh at 6 months), analyses were conducted separately by site.

We did not find treatment effects on the likelihood of engaging in any breastfeeding at 6 months at either site (AOR Pittsburgh=1.06, p=0.900; AOR NYC=0.70, p=0.366). However, at Pittsburgh, mothers randomly assigned to the intervention were over three times as likely to be breastfeeding exclusively compared with mothers assigned to the control condition (AOR=3.6, p=0.038; 15.4 % vs. 5.8%, respectively). This impact held despite mothers in Pittsburgh having equal breastfeeding exclusivity intentions at birth (MTx=1.47 and MControl=1.51; F=0.04, p=0.841) and equal likelihood of initiating breastfeeding (59% vs. 66%; X2=1.1, p=0.293) across the two conditions. In NYC, no group differences were evident on the likelihood of exclusive breastfeeding (AOR=0.67, p=0.324); however, there may have been ceiling effects due to overall high levels of exclusive breastfeeding in the NYC sample.

Differences in the two clinic settings may have contributed to the disparate findings across site. For instance, parents experiencing breastfeeding difficulty were often referred to an on-site lactation consultant who was employed full time by the pediatric clinic in Pittsburgh, while no such service was offered in NYC. These findings contribute to the small, but growing, literature on the potential health benefits of early childhood interventions by examining the causal impacts of a school-readiness intervention on maternal health behaviors with known links to later child health.

Group Authors

Smart Beginnings Team

Authors

• Mackenzie Danielle Marie Whipps, New York Univeristy
  Presenting Author

• Elizabeth B Miller, New York Univeristy
  Non-Presenting Author

• Rachel Gross, New York University School of Medicine
  Non-Presenting Author

• Debra L. Bogen, University of Pittsburgh School of Medicine
  Non-Presenting Author

• Alan L. Mendelsohn, New York University School of Medicine
  Non-Presenting Author

• Pamela A. Morris, New York Univeristy
  Non-Presenting Author

• Daniel S. Shaw, University of Pittsburgh
  Non-Presenting Author