Evaluate a Peer Counseling Program to Promote Breastfeeding in WIC Participants

评估同伴咨询计划以促进 WIC 参与者母乳喂养

• 批准号: 8337555
• 负责人: THEODORE J JOYCE
• 金额: $ 7.88万
• 依托单位: BERNARD M. BARUCH COLLEGE
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-08-06 至 2014-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8337555
• 关键词: Academy; American; Breast Feeding; Characteristics; Child; Client; Control Groups; Counseling; County; Coupled; Data; Dose; Effectiveness; Food; Infant; Infant Health; Infant formula; Information Systems; Intention; Intervention; Linear Regressions; Logistic Regressions; Maternal Health; Methods; Oregon; Outcome; Participant; Pediatrics; Randomized; Randomized Controlled Trials; Rest; Selection Bias; Services; Source; Surgeon; Telephone; Time; United States Dept. of Health and Human Services; Validity of Results; Woman; arm; base; comparison group; cost effective; design; improved; nutrition; peer; programs; response; safety net; treatment effect; trial comparing; voucher

DESCRIPTION (provided by applicant): A long-standing programmatic tension within the Supplemental Nutrition Program for Women, Infants and Children (WIC) has been the promotion of breastfeeding coupled with the availability of free infant formula. Breastfeeding initiation and duration is substantially lower among WIC participants than their eligible non-participants. Peer counseling has been viewed as a potentially cost-effective means of increasing breastfeeding without removing the safety net of free formula. In fact, the recent Surgeon General's Call to Action on Breastfeeding recommends that peer counseling become a core service in all WIC agencies. The proposed study will evaluate the effectiveness of a telephone-based peer counseling program to improve breastfeeding among WIC recipients. The study leverages already collected data from the largest randomized control trial (RCT) of peer counseling for breastfeeding ever undertaken among WIC clients by contrasting results from the RCT conducted in four counties in Oregon to those from a non-randomized peer counseling intervention of the same design that was implemented at the same time in two different counties in the state. As a third contrast, we will analyze changes in breastfeeding among WIC clients in the same state over the same study period but in counties that had no peer counseling intervention. Data from the last two sources will be extracted from Oregon's WIC administrative data system. We will compare estimates of the intention-to-treat as well the effect of treatment on the treated in the RCT to those obtained from a non-randomized design. This will provide the first estimates of selection bias associated with a peer counseling intervention based on observational data. In addition, we can estimate the potential external validity of results from th RCT by contrasting the characteristics and breastfeeding outcomes of WIC participants in the control arm of the RCT to those of WIC participants in counties with no peer counseling. By exploiting data in three distinct settings, (RCT of peer counseling, non-RCT of peer counseling and no peer counseling), we will provide a comprehensive examination of the potential of peer counseling to enhance the initiation, duration and exclusivity of breastfeeding among WIC participants. PUBLIC HEALTH RELEVANCE: Breastfeeding improves infant and maternal health and yet a long-standing tension within the Supplemental Nutrition Program for Women, Infants and Children (WIC) has been the promotion of breastfeeding coupled with the availability of free infant formula. Peer counseling has been viewed as a potentially cost-effective means of increasing breastfeeding without removing the safety net of free formula. This study will evaluate the effectiveness of a peer counseling program to enhance breastfeeding with data from randomized, and non- randomized intervention conduction simultaneously in the same state.

描述（由申请人提供）：妇女、婴儿和儿童补充营养计划（WIC）中长期存在的一个方案紧张关系是促进母乳喂养，同时提供免费婴儿配方奶粉。WIC参与者的母乳喂养开始和持续时间大大低于其合格的非参与者。同伴咨询被认为是一种潜在的具有成本效益的方法，可以在不取消免费配方奶粉安全网的情况下增加母乳喂养。事实上，最近卫生部长的母乳喂养行动呼吁建议，同侪咨询成为所有WIC机构的核心服务。这项拟议中的研究将评估基于电话的同伴咨询计划，以改善母乳喂养的WIC收件人的有效性。这项研究利用了已经收集的数据，从最大的随机对照试验（RCT）的同伴咨询母乳喂养曾经进行过WIC客户的对比结果从RCT在俄勒冈州的四个县进行的非随机同伴咨询干预的相同的设计，在同一时间在两个不同的县在该州。作为第三个对比，我们将分析在同一研究期间，同一个州的WIC客户之间的母乳喂养的变化，但在县没有同伴咨询干预。最后两个来源的数据将从俄勒冈州的WIC行政数据系统中提取。我们将比较随机对照试验中的意向治疗估计值以及治疗效果与非随机设计获得的结果。这将提供与基于观察数据的同伴咨询干预相关的选择偏差的第一次估计。此外，我们可以通过将RCT对照组中WIC参与者的特征和母乳喂养结果与没有同伴咨询的县中WIC参与者的特征和母乳喂养结果进行比较来估计RCT结果的潜在外部效度。通过利用三种不同环境中的数据，（同伴咨询的RCT，同伴咨询的非RCT和没有同伴咨询），我们将提供一个全面的检查同伴咨询的潜力，以提高WIC参与者中母乳喂养的开始，持续时间和排他性。 公共卫生关系：母乳喂养改善了婴儿和产妇的健康，但妇女、婴儿和儿童补充营养方案中长期存在的一个矛盾是，在推广母乳喂养的同时，还提供免费婴儿配方奶粉。同伴咨询被认为是一种潜在的具有成本效益的方法，可以在不取消免费配方奶粉安全网的情况下增加母乳喂养。本研究将评估同侪谘商计划对促进母乳哺育的成效，并同时以随机化与非随机化的干预方式进行。