Individual Breastfeeding Support with Contingent Incentives for Low-Income Mothers

项目摘要/摘要 在此R01应用程序中，我们建议检查每月财务激励的有效性，具体取决于 观察母乳喂养(BF)，补充特别补充营养提供的现有支助 妇女、婴儿和儿童计划(WIC)计划和基于家庭的个人BF支持，在低 有收入的母亲。低收入种族/少数民族妇女母乳喂养的平均持续时间为四个月 尽管美国儿科学会基于证据建议纯母乳喂养 六个月的生命，并在第一年期间继续母乳喂养。任何高炉的持续时间不足 与多种妇幼健康问题有关，延长产床时间可能会节省成本 在医学上和社会上。虽然同伴支持在延长高炉持续时间方面是有效的，但效果并不是这样。 对于符合WIC资格的低收入母亲来说，这一点也同样强劲。一项基于激励的干预措施在低收入人群中进行了测试 在一项试点研究中，波多黎各母亲的收入(R03HD077057)导致每月 财政奖励取决于观察6个月的BF加上WIC BF的日常护理，与 仅限WIC BF常规护理(BF率：1个月89%对44%；p=0.01；3个月89%对17%；p&lt；0.01；72% 6个月时为0%；P&lt；0.01；N=36)。我们提出了一项两组平行随机对照试验，其中一半 符合WIC条件的168名母亲将被分配到两个研究组：(1)标准护理BF支持 (WIC支持+基于家庭的个人支持；标准护理(SC))和(2)激励措施取决于 展示成功的BF(SC+母乳喂养奖励；SC+BFI)。随机进入SC的参与者将 接受来自WIC的标准母乳喂养服务，并对个人支持和问题进行家访- 解决问题。随机进入SC+BFI的参与者将获得与对照组相同的服务，只是每月 财政奖励取决于观察到的高炉，并在每个月底交付。这项研究将是 在低收入种族/少数民族母亲高度集中的两个区域地点进行， 宾夕法尼亚州费城和德州威尔明顿主要结果将是产后6个月的BF率， 探索性结果将是产后12个月的BF率，次要结果将是婴儿 结果(即体重增加和急诊室就诊)。我们假设SC+BFI将提高高炉出铁率 产后6个月降低25%，显著降低婴儿体重增加和急诊室就诊事件 与SC相比，产后3个月的婴儿。我们将跟踪干预的成本，购买的配方奶 母亲，以及两组婴儿的医疗保健。我们还将对企业进行采访 代表和保险公司探讨社区和政策层面的支持，以维持 针对WIC母亲的激励性干预。该提案的目标是以NICHD的使命为指导的 妊娠与围产科学分会长期改善低收入人群母婴健康 在翻译研究的背景下，通过鼓励母乳喂养来增加人口数量。

PROJECT SUMMARY/ABSTRACT In this R01 application we propose to examine the efficacy of monthly financial incentives contingent on observed breastfeeding (BF), supplemental to existing support from the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) program and home-based individual BF support, among low- income mothers. Low-income racial/ethnic-minority women breastfeed for an average duration of four months despite evidence-based recommendations by the American Academy of Pediatrics to exclusively breastfeed for six months of life in addition to continued breastfeeding through the first year. Insufficient duration of any BF is related to multiple maternal and child health problems, and increases in BF duration could be cost saving medically and societally. Though peer support has been effective in prolonging BF duration, the effect has not been as strong for WIC-eligible, low-income mothers. An incentive-based intervention was tested among low- income Puerto Rican mothers in a pilot study (R03HD077057) resulting in promising outcomes of monthly financial incentives contingent on observed BF for 6 months combined with WIC BF usual care, compared to WIC BF usual care only (BF rates: 89% vs. 44% at 1-month; p = 0.01; 89% vs. 17% at 3-month; p<0.01; 72% vs. 0% at 6-month; p<0.01; N = 36). We propose a 2-group parallel randomized controlled trial in which half of the 168 WIC-eligible mothers will be allocated into each of the two study groups: (1) Standard Care BF Support (WIC support + home-based individual support; Standard Care (SC)) and (2) Incentives contingent on demonstrating successful BF (SC + Breastfeeding Incentives; SC+BFI). Participants randomized into SC will receive standard breastfeeding services from WIC and home visitations for individual support and problem- solving. Participants randomized into SC+BFI will receive the same services as Control except that monthly financial incentives are contingent on observed BF and delivered at the end of each month. The study will be conducted in two regional sites with high concentrations of low-income racial/ethnic minority mothers, Philadelphia, PA and Wilmington, DE. The primary outcome will be the BF rate for 6-month postpartum, the exploratory outcome will be the BF rate at 12-month postpartum, and the secondary outcomes will be infant outcomes (i.e., weight gain and emergency room visits). We hypothesize that SC+BFI will increase the BF rate by 25% at 6-month postpartum and have significantly lower infant weight gain and incidents of ER visits for infants at 3-month postpartum, compared to SC. We will track the costs of intervention, formula purchased by mothers, and infant medical care in both groups. We will also conduct interviews with corporate representatives and insurance companies to explore community- and policy-level support to sustain the incentive-based intervention for WIC mothers. The aims of the proposal are guided by the mission of NICHD's Pregnancy and Perinatology Branch to improve the long-term maternal and infant health of low-income populations via encouraging breastfeeding in the translational research context.