Community Participation Research of Breastfeeding Disparities in African American

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DESCRIPTION (provided by applicant): Community Participation Research of Breastfeeding Disparities in African American Women Objective: To use an iterative, Community-Based Participatory Research (CBPR) approach to engage representatives of academic and community-based partners including community organizations, business and lay persons in partnering and collaborating to assess, address and improve breast feeding among African American women in Durham County. Methods: This pilot study is focusing on breastfeeding in African American women of Durham County, a community chosen due to previous collaborative work and contacts with Durham County Health Department and other community programs as well as the foundation of collaborative work within the community itself. Facilitating factors include the large population of African-American women, existence of health disparities, rural/urban population mix and close proximity to the university. The existing collaborative includes representatives from health and human service organizations, academia, community-based organizations and civic organizations. Over a series of nine meetings, the collaborative identified gaps in current service delivery, developed a theme and formed sub-committees to collectively develop the research application, including the budget, specific aims, literature review, methods, dissemination plan and key personnel. Upon acquisition of the grant, the first step of the planned process is to expand the existing collaborative to include additional community partners so we benefit from involvement of all aspects medical, social, economic, cultural, historical, faith-based, and political. To familiarize and educate past and new members in the background of the initiative and bring everyone to a common start base, two half-day long meetings will take place in the beginning of the study period. In these two meetings, we will form sub-committees such as: outreach, data management, survey, focus groups, pilot study, dissemination, and writing. At least one representative from the community and one representative from academia will be in each sub-committee. The community and university Principal Investigators will share equal responsibility on overseeing the execution of this project and will meet on a weekly basis. The second step of the planned process is to develop sets of variables that will be used to assess breastfeeding patterns and potential factors that can influence these patterns. The latter will address the following domains: Mothers' knowledge, attitudes, beliefs, feelings, barriers, needs and available services in Durham County. These variables will initially be identified by a comprehensive review of the published literature on these topics and a review of breastfeeding guidelines, recommendations, and evidence-based interventions. Data collection will include the use of secondary/existing databases for general demographics and breastfeeding patterns in Durham County as well as primary data collected via focus groups with and surveys of African American pregnant women, African American women of reproductive age, partners of African American females of reproductive age, grandparents, and other groups in the community that may have an influence on breastfeeding choices (e.g. employers, child care directors, parishioners, health care providers). The third and final step of the planned process is to work with community-based agencies, organizations and individuals, to implement a pilot intervention, analyze the results, interpret the implications, disseminate the results, and plan for future full scale, community-wide effort to increase breastfeeding initiation and duration among African American women of Durham County. PUBLIC HEALTH RELEVANCE: AHRQ review of the evidence on the effects of breastfeeding on short- and long-term infant health outcomes from April 2007 show that children who are not breastfed suffer increased health problems such as ear infections, lower respiratory tract infections, skin rashes similar to eczema, asthmatic episodes, type I and type II diabetes, episodes of infant diarrhea, and incidents of childhood leukemia and sudden death syndrome. Also, exclusive breastfeeding for more than 6 months has been shown to be associated with leaner body shape at age five, and many reviews and case-control studies have shown the protective impact of breastfeeding against childhood obesity. North Carolina State Center for Health Statistics and NC CHAMPS 2005 show that in North Carolina, minority infants, who are less likely to be breastfed and when they do breastfeed, it is for significantly shorter durations on average, experience a disproportionate mortality from the same illnesses that are known to be reduced if one breastfeeds. Therefore, improved breastfeeding rates and duration could have a profound impact on death and disease in North Carolina's African American population. We created the } Durham B.E.S.T (Breastfeeding, Education & Support Team) Alliance for Babies} and propose to conduct community participation research of breastfeeding disparities in African American women in Durham County, North Carolina.