A RANDOMIZED TRIAL TO PROMOTE PROLONGED BREAST FEEDING

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Current pediatric authorities recommend infants be exlusively breast fed for at least the first four months of life. Paradoxically, low income women, whose infants benefit most from the protective effects of breast-feeding against infectious and nutritional morbidity, are more likely than more priviledged women to discontinue breast-feeding prematurely. The proposed study employs a randomized single blind 2x2 factorial design to assess the effectiveness of two interventions to prolong the duration of breast-feeding in a multiethnic sample of 240 low income mothers. The first intervention replaces commercial discharge packs containing advertising pamphlets and bottles of water prepared by infant formula companies with a research discharge pack containing noncommercial printed information and supplies designed to facilitate breast-feeding. The second intervention provides interactive telephone lactation counseling (TLC) consisting of 7 outreach calls initiated by a counselor to mothers during the first three months of the infant's life and the 24 hour availability of the counselor to receive calls from the mother for assistance in solving breast-feeding problems. After giving informed consent study mothers will be randomly assigned to one of four groups: standard care, each intervention alone, or both in combination. When the infant is 120 days old, an interviewer blind to group membership will contact study mothers by telephone to ascertain the following outcome measures: 1) proportion of total infant feeds that were breast feeds in the 24 hours prior to the call; 2) age of infant when breast-feeding was discontinued if already stopped; and 3) age of infant at introduction of formula and solids. Analysis of variance will be used to assess the main effects of each intervention in comparison to each other and to standard care and to determine possible interaction effects between the be easily implemented in other settings to assure the health benefits of prolonged breast-feeding in low income populations.