Cross-generational effect of food insecurity: Understanding the relationship between food insecurity and breastfeeding behaviors.

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Project Summary The American Academy of Pediatrics recommend exclusive breastfeeding for the first 6 months of life. Breastmilk protects infants from infectious and chronic diseases both in the short term and later in life. Especially, breastfeeding ensures security and optimal nutrition for infants. However, breastfeeding rates are lower among low-income women. Preliminary results of our current R15 study with low-income, mainly African American and Hispanic mothers, indicated that 90% initiated breastfeeding, but only 24% were exclusively breastfeeding at 2 months of infant’s age. In estimating risk factors, it was found that food-insecure mothers were 1.5 times less likely to breastfed at 2 months compare to their secure counterparts after controlling for socio-demographic variables. Hence, grounded in Social Cognitive Theory, the overall goal of this R15 renewal study is to characterize how food insecurity often involving intermittent food shortage affects stress levels and frequency of breastfeeding. We hypothesize that in food-insecure households, an inconsistent home food supply causes discontinuation of exclusive breastfeeding through 1) increased stress, and 2) irregularity in nursing or breast pumping. Ultimately, irregular breastfeeding leads to onset of involution or begin of constriction of mammary glands to return to a non-milk-producing state, contributing to decreased milk production, low breastfeeding self-efficacy, and ultimately discontinuation of breastfeeding. To address our hypothesis, the 4 specific aims we propose are: Determine associations between postpartum food insecurity in the form of inconsistency in home food supply and-- 1) breastmilk cortisol levels; 2) breast milk feeding pattern; 3) onset of involution or constriction of mammary glands to a non-milk producing state; 4) breastfeeding self-efficacy. For the study, 6 weekly home visits will be conducted with 45 low-income mothers who initiated breastfeeding at the hospital. The weekly home visits will occur starting from 3 to 4 days after hospital discharge. At each home visit, home food inventory will be conducted, and breastmilk samples will be collected to measure cortisol (stress) and biomarkers of mammary gland involution. During each visit, we will also interview mothers to assess frequency of breastmilk feeding or pumping. Breastfeeding self- efficacy and social support will also be measured. The results of this study will provide important new data on the relationship between food insecurity breastfeeding. Further, this R15 renewal will help us continue providing research training to first-generation and traditionally underrepresented students.