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As part of $2 million NIH grant, Collins to explore whether monetary incentives can encourage breastfeeding

Research shows that breastfeeding through the first six months of a child’s life can have key health benefits for infants, such as reduced risk of obesity and Type 2 diabetes, as well as for mothers, such as a lesser likelihood of high blood pressure and breast cancer. Yet, while breastfeeding rates have risen steadily in recent years, mothers who live in poverty or lack a college education are still less likely to breastfeed their infant through their child’s first six months compared to higher-income, college-educated mothers. A similar phenomenon is seen with race: African-American and Hispanic mothers are less likely to breastfeed than white mothers.

Two Temple faculty members’ research project on improving low breastfeeding rates among low-income African-American and Hispanic mothers recently received a five-year, $2 million grant from the National Institutes of Health. Professor of Social and Behavioral Sciences Bradley Collins and Lewis Katz School of Medicine associate professor Gail Herrine will serve as site principal investigator and project co-investigator, respectively. This multi-site study, which will examine whether a monetary incentive can encourage breastfeeding, will be spearheaded by principal investigator Yukiko Washio, a researcher in the Substance Use, Gender, and Applied Research unit at RTI International.

Building off a successful pilot project that saw breastfeeding rates increase, this larger-scale project will test a behavioral intervention among Delaware- and Pennsylvania-based African-American and Hispanic mothers who receive support from Women, Infant and Child (WIC) programs. Women will be randomized to either a control group that receives standard WIC counselor advice, support and resources to facilitate breastfeeding, or an experimental group that receives the same WIC services plus a monthly monetary incentive (known in the study as Breastfeeding Onset and Onward with Support Tools, or “BOOST”)  to mothers for continuing to breastfeed their infants.

The smaller pilot study, Collins said, provided a “proof of concept” for this larger study and suggested that a monetary incentive could “drastically improve” breastfeeding rates among low-income mothers. The researchers hope that the larger study will provide firm evidence that a financial incentive can tip the scales toward higher levels of breastfeeding among mothers who face both economic and cultural barriers.

“Despite the breastfeeding support and services available in the community, continued breastfeeding rates drop tremendously for low-income, non-white women,” says Washio. Barriers, such as the misconception that formula milk makes infants healthier as well as the difficulty to keep breastfeeding after  returning to an unsupportive work environment, can be major deterrents for these mothers. “The study works to provide linkage to existing breastfeeding support in the community and provide monthly home visitations to maintain motivation and confidence levels to continue breastfeeding with social and financial support,” she says.

This larger study, which will recruit 168 mothers in total, is still in its early phases—researchers were notified that the project would receive a grant in August—but it should be fully underway in early 2019, according to Collins. Herrine’s role as medical director of the postpartum clinic at Temple University Hospital will be crucial to recruiting and assessing mothers in the Philadelphia area. “In the pilot, the results showed a pretty dramatic, positive effect,” Collins says. “To test the BOOST intervention in a full-scale trial could show not only the potential efficacy of this intervention, which could improve maternal and child health, but also bolster evidence supporting its potential sustainability.”

Read more research from the Department of Social and Behavioral Sciences.

— Tara W. Merrigan

Posted:  November 19, 2018