Established Evidence Results

Intervention Components (click on component to see a list of all articles that use that intervention): POPULATION-BASED SYSTEMS, COMMUNITY, Other (Communities)

Intervention Description: To determine whether integrating influence strategies (reciprocation, consistency, consensus, feeling liked, authority, and scarcity) throughout Chickasaw Nation Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) clinics (1) changed participants' perception of the WIC experience and (2) affected breastfeeding initiation rates.

Intervention Results: The demonstration project resulted in 5 improved influence measures (P < .02), aligning with the influence principle of "feeling liked." The model had a small effect (φ = 0.10) in distinguishing breastfeeding initiation; women in the influence model were 1.5 times more likely (95% CI, 1.19-1.86; P < .05) to initiate breastfeeding compared with women in the traditional model, controlling for parity, mother's age, and race.

Conclusion: Consistent with Social Cognitive Theory, changing the WIC environment by integrating influence principles may positively affect women's infant feeding decisions and behaviors, specifically breastfeeding initiation rates.

Study Design: QE: non-equivalent control group

Setting: 4 WIC clinics in Chickasaw Nation, OK

Population of Focus: Parents and caregivers who were pregnant or had a child ≤ 3 years old

Data Source: Mother self-report

Sample Size: Intervention (n=846) Control (n=807)

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER, Group Education, COMMUNITY, Other (Communities), POPULATION-BASED SYSTEMS

Intervention Description: To assess the clinical effectiveness and cost effectiveness of a policy to provide breastfeeding groups for pregnant and breastfeeding women.

Intervention Results: The number of breastfeeding groups increased from 10 to 27 in intervention localities, where 1310 women attended, and remained at 10 groups in control localities. No significant differences in breastfeeding outcomes were found.

Conclusion: A policy for providing breastfeeding groups in relatively deprived areas of Scotland did not improve breastfeeding rates at 6-8 weeks. The costs of running groups would be similar to the costs of visiting women at home.

Study Design: Pragmatic cluster RCT

Setting: 14 clusters of general practices

Population of Focus: Clusters of general practices that collected breastfeeding data through the Child Health Surveillance Program of the National Health Service Scotland from Oct 2002 forward

Data Source: Child Health Surveillance Programme

Sample Size: Intervention (n=7) Control (n=7) N=Clusters

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): COMMUNITY, Other (Communities), Social Supports

Intervention Description: The Children's Healthy Living (CHL) Program focuses on prevention of childhood obesity in the Pacific region, which is known to track into obesity and type 2 diabetes in adulthood. The CHL trial used a social ecological framework of health and wellness designed to act on multiple levels and in multiple components within behavioral, physical, social, cultural, economic, and policy environments to reduce the prevalence of overweight and obesity among children in multiple USAP communities, ultimately reducing it by 3.9% during a 2-year period. The CHL intervention was develped by a consortium of collborators at land grant colleges in the USAP region. The trial used a common template of 19 activities that were selected to address target behaviors. The intervention activities were grouped into 4 functions (or strategies): environmental change, organizational policy change, social marketing, and training that addressed the interersonal (training role of models, parents, and teachers), community (increasing access to healthy foods and environments for safe play), and organizational and policy (strengthening preschool wellness policies) levels of the social ecological model.

Intervention Results: Among the 9840 children included in the analysis (4866 girls [49.5%] and 4974 boys [50.5%]; 6334 [64.4%] aged 2-5 years), the intervention group showed significant improvements compared with the control group from times 1 to 3 in prevalence of overweight plus obesity (d = −12.60% [95% CI, −20.92% to −4.28%]), waist circumference (d = −1.64 [95% CI, −2.87 to −0.41] cm), and acanthosis nigricans prevalence (d = −3.55% [95% CI, −6.17% to −0.92%]). Significant improvements were also observed from times 2 to 3 in prevalence of overweight plus obesity (d = −8.73% [95% CI, −15.86% to −1.60%]) but not in waist circumference (d = −0.81 [95% CI, −1.85 to 0.23] cm).

Conclusion: This randomized clinical trial found that the outcomes of the Children’s Healthy Living intervention were maintained and enhanced 6 years after the intervention among young children in the US-affiliated Pacific region. The prevalence of overweight, obesity, and acanthosis nigricans was further reduced in communities, suggesting that multilevel multicomponent interventions may help reduce child overweight and obesity in this region.

Study Design: Randomized clinical trial

Setting: Communities in 5 jurisdictions (Hawaii, Alaska, Commonwealth of the Northern Mariana Islands, American Samoa, and Guam) of the US-affiliated Pacific Region

Population of Focus: Children aged 2-8 yrs of age in the 27 selected communities

Sample Size: 9,840 children

Age Range: Children ages 2-8 years

Intervention Components (click on component to see a list of all articles that use that intervention): Other (Communities)

Intervention Description: The Surgeon General's Call to Action outlines a society-wide approach to support mothers and babies who are breastfeeding. It describes specific actions that can be taken by various actors - mothers and families, communities, health care systems, employers, researchers, and public health infrastructure - to improve breastfeeding support and overcome barriers. The actions aim to increase public awareness, provide education and training, implement supportive policies and practices, strengthen research and data collection, and enhance leadership on breastfeeding promotion.

Intervention Results: The Call to Action highlights data showing suboptimal breastfeeding rates in the U.S., with only 43% of infants breastfeeding at 6 months and 22.4% at 12 months. Disparities persist by race/ethnicity, socioeconomic status, and geography. It cites evidence on the risks of not breastfeeding, including increased rates of ear infections, diarrhea, asthma, obesity, and diabetes among infants, as well as higher maternal risks of breast and ovarian cancer. Successful interventions that increased breastfeeding rates are described, such as the Baby-Friendly Hospital Initiative, support from lactation consultants, and workplace accommodations for nursing mothers.

Conclusion: Despite the well-recognized health benefits of breastfeeding, significant barriers remain that prevent many mothers from achieving their breastfeeding goals. The Call to Action emphasizes the need for concerted, collaborative efforts across multiple sectors to create a society that enables and supports breastfeeding. By implementing the recommended actions, the public health impact can be increased, disparities reduced, and support improved for mothers and families to initiate and continue breastfeeding.

Study Design: N/A

Setting: N/A

Data Source: N/A

Sample Size: N/A

Age Range: N/A

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER, Educational Material, Other Education, Provision of Breastfeeding Item, PROVIDER/PRACTICE, Hospital Policies, Other (Provider Practice), POPULATION-BASED SYSTEMS, COMMUNITY, Other (Communities), Provider Training/Education

Intervention Description: A breastfeeding promotion program conducted on the Navajo reservation.

Intervention Results: Based on medical records review of feeding practices of all the infants born the year before (n = 988) and the year after (n = 870) the intervention, the program was extremely successful.

Conclusion: This combination of techniques, including qualitative and quantitative research into local definitions of the problem, collaboration with local institutions and individuals, reinforcement of traditional understandings about infant feeding, and institutional change in the health care system, is an effective way of facilitating behavioral change.

Study Design: QE: pretest-posttest

Setting: Shiprock, NM

Population of Focus: All mothers with infants born at the Shiprock hospital

Data Source: Medical record review

Sample Size: Preintervention (n=988) Postintervention (n=870)

Age Range: Not specified