Breast feeding intention and initiation among rural, low-income Native American and African American adolescent mothers in North Carolina: testing the theory of planned behavior

Abstract Infant feeding practices can greatly impact a child's life with far reaching implications based upon decisions a mother makes for her newborn. Breastfeeding is the preferred method of infant feeding because of its association with health benefits to both the mother and child. The prevalence of breastfeeding among rural, low income, disadvantaged groups to include Native American (NA) and African American (AA) adolescent mothers is low. NAs and AAs bear a disproportionate burden of illness and health risks compared to other races and ethnic groups in the United States. Breastfeeding is a targeted public health strategy to improve the health of infants and children and decrease or eliminate the gap of health disparities among the maternal-child aggregate populations in our nation. The purpose of the study was to (1) test the Theory of Planned Behavior by examining the relationship of the components (attitudes, subjective norms, perceived control/ self-efficacy, and breastfeeding knowledge) to determine breastfeeding intention and initiation of rural, low-income Native American (NA) and African American (AA) adolescent mothers in rural communities in southeastern North Carolina\; (2) determine the significant similarities and differences between breastfeeding and formula feeding adolescent groups related to the constructs\; (3) explore the relationship of intention to initiation, and (4) examine the relationship between sociodemographic variables with breastfeeding intention and initiation of adolescent mothers. The sample included 60 NA and 60 AA adolescents recruited through resources of care that were offered to prenatal clients in two public health departments. Findings included the constructs of the TPB were significant in predicting the probability of breastfeeding intention and breastfeeding initiation in rural, low-income NA and AA adolescent mothers. Overall total variance explained by the model related to the prediction of breastfeeding initiation at 4 days postpartum was 73% and correctly classified 92.2% of cases. Three control measures were found to be statistically significant, with perceived breastfeeding control having the highest significance, followed by negative breastfeeding sentiments and social professional support. The model revealed a statistical significance in the relationship of breastfeeding intention and breastfeeding initiation at 4 days postpartum in rural, low-income NA and AA adolescent mothers. The strongest predictor of breastfeeding initiation was the Breastfeeding Control Scale. The formula feeding group scored significantly higher on the Negative Breastfeeding Sentiments scale, whereas the breastfeeding group scored significantly higher on the Breastfeeding Control Scale and the Positive Breastfeeding Sentiment Scale. Significant differences were found related to ethnic groups, with NA adolescents initiating breastfeeding more often, being married more often, and living with a significant other more often than AAs. More adolescents who attended childbirth classes and breastfeeding classes breastfed than those who did not. Recommendations of the study included the utilization of the constructs of the TPB in development of research based assessments and interventions that promote breastfeeding behavior among rural, low-income NA and AA adolescent mothers, and identification of at-risk individuals for not breastfeeding and promoting programs to assist with providing help for resolving barriers to breastfeeding, and nurse educators emphasizing the importance of promoting breastfeeding among adolescents and vulnerable population