Individual Breastfeeding Support with Contingent Incentives for Low-Income Mothers

为低收入母亲提供个人母乳喂养支持和或有激励措施

• 批准号: 10404554
• 负责人: Yukiko Washio
• 金额: $ 48.95万
• 依托单位: RESEARCH TRIANGLE INSTITUTE
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-08-09 至 2025-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10404554
• 关键词: Academy; Address; Adherence; African American; American; Black American; Black race; Breast Feeding; Breastfed infant; Caring; Child; Child Support; Childhood; Communicable Diseases; Communities; Cost Effectiveness Analysis; Cost Savings; Counseling; Data Collection; Direct Costs; Education; Emergency department visit; Exclusive Breastfeeding; Goals; Health Care Costs; Healthy People 2020; Hispanic; Home; Home visitation; Incentives; Individual; Infant; Infant Care; Infant Health; Infant formula; Insurance; Intervention; Interview; Investigation; Life; Low Income Population; Low income; Maternal Health; Maternal and Child Health; Mediating; Medical; Medical Care Costs; Methods; Minority Women; Mission; Monitor; Mothers; Motivation; National Institute of Child Health and Human Development; Obesity; Outcome; Participant; Pediatrics; Perinatology; Philadelphia; Pilot Projects; Policies; Population; Postpartum Period; Pregnancy; Problem Solving; Public Health; Puerto Rican; Randomized; Randomized Controlled Trials; Recommendation; Research; Risk; Savings; Self Efficacy; Services; Site; Special Supplemental Nutrition Program for Women, Infants, and Children; Structure; System; Testing; Translating; Translational Research; Weaning; Weight Gain; Woman; base; efficacy evaluation; efficacy testing; ethnic minority; evidence based guidelines; financial incentive; follow-up; health disparity; high risk population; improved; incentive-based intervention; infant outcome; intervention cost; mortality; overweight child; peer support; postpartum health; primary outcome; programs; public health priorities; racial and ethnic; randomized trial; secondary outcome; societal costs; socioeconomic disadvantage; standard care; treatment as usual

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.

项目总结/摘要 在此R 01应用程序中，我们建议检查每月财务激励的有效性， 观察母乳喂养（BF），补充现有的特殊补充营养支持 妇女、婴儿和儿童方案和家庭为基础的个人育儿支助， 收入母亲低收入种族/少数民族妇女母乳喂养的平均时间为4个月 尽管美国儿科学会循证推荐完全母乳喂养， 除了在第一年继续母乳喂养外，任何BF持续时间不足 与多种母婴健康问题有关，增加BF持续时间可以节省成本 医学上和社会上。虽然同伴支持在延长BF持续时间方面是有效的，但效果并不明显。 对于符合WIC条件的低收入母亲来说，一种基于激励的干预措施在低- 在一项试点研究（R 03 HD 077057）中， 根据观察BF 6个月结合WIC BF常规护理的经济奖励，与 仅WIC BF常规治疗（BF率：1个月时89% vs. 44%; p = 0.01; 3个月时89% vs. 17%; p<0.01; 72% vs. 0%; p<0.01; N = 36）。我们提出了一个2组平行随机对照试验，其中一半的 168名符合WIC条件的母亲将被分配到两个研究组：（1）标准护理BF支持 (WIC支助+家庭为基础的个人支助;标准护理（SC））和（2）根据 证明成功的母乳喂养（SC +母乳喂养奖励; SC+BFI）。随机分配至SC的受试者将 接受WIC提供的标准母乳喂养服务，并进行家访，以获得个人支持和解决问题- 解决随机分配至SC+BFI组的受试者将接受与对照组相同的服务，但每月 财务奖励取决于观察到的BF，并在每个月底交付。本研究将 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特拉华州威尔明顿。主要结局是产后6个月的BF率， 探索性结局为产后12个月的BF率，次要结局为婴儿 结果（即，体重增加和急诊室就诊）。我们假设SC+BFI将增加BF率 在产后6个月时减少25%，婴儿体重增加和急诊室就诊率显著降低， 婴儿在产后3个月，相比SC。我们将跟踪干预的成本，购买配方奶粉， 两组的母亲和婴儿医疗保健。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 对妇女、儿童和青少年母亲进行基于激励的干预。该提案的目标是以NICHD的使命为指导， 妊娠与围产期分支科长期改善低收入母婴健康 通过在转化研究的背景下鼓励母乳喂养，

项目成果

A behavioral economic demand analysis of mothers' decision to exclusively breastfeed in the workplace.

• DOI: 10.1002/jeab.772
• 发表时间: 2022-07
• 期刊: JOURNAL OF THE EXPERIMENTAL ANALYSIS OF BEHAVIOR
• 影响因子: 2.7
• 作者: Hayashi, Yusuke;Fisher, Nicole M.;Hantula, Donald A.;Furman, Lydia;Washio, Yukiko
• 通讯作者: Washio, Yukiko

Systematic review on use of health incentives in U.S. to change maternal health behavior.

• DOI: 10.1016/j.ypmed.2021.106442
• 发表时间: 2021-04
• 期刊: Preventive medicine
• 影响因子: 5.1
• 作者: Washio Y;Atreyapurapu S;Hayashi Y;Taylor S;Chang K;Ma T;Isaacs K
• 通讯作者: Isaacs K

Cannabis use and breastfeeding: do we know enough?

• DOI: 10.1177/0081246319893934
• 发表时间: 2020-03-01
• 期刊: South African journal of psychology = Suid-Afrikaanse tydskrif vir sielkunde
• 作者: Williams PP;Washio Y;Myers B;Jaspan H;Browne FA;Wechsberg WM;Parry C
• 通讯作者: Parry C

Emerging Opportunities to Improve Treatment Access for Substance Use Disorders and Other Comorbid Health Issues Among Women Enrolled in WIC.

• DOI: 10.1177/15248399211069094
• 发表时间: 2023-03
• 期刊: HEALTH PROMOTION PRACTICE
• 影响因子: 1.9
• 作者: Washio, Yukiko;Collins, Bradley N.;Kilby, Linda M.
• 通讯作者: Kilby, Linda M.

Teaching antenatal hand expression: a feasibility study in an inner urban U.S. hospital.

• DOI: 10.1186/s13006-023-00578-w
• 发表时间: 2023-08-10
• 期刊: International breastfeeding journal
• 影响因子: 3.5