Doctor of Philosophy, University of Toledo, 2022, Health Education

Background: The purpose of this study was to examine and understand the impact of prenatal stressful life events and racial discrimination on breastfeeding behaviors and duration. This study aimed to develop an understanding of why breastfeeding and exclusive breastfeeding rates significantly decrease eight weeks after birth among mothers. Methods: For the first of two related studies, using data from the Pregnancy Risk Assessment Monitoring System (PRAMS) from 2012-2018, multivariable logistic regression was used to estimate adjusted odds ratios (AORs) and 95% confidence intervals. The two main exposure variables were stressful life events during pregnancy and discrimination. Stressful life events during pregnancy were categorized into 4 numerical groups while discrimination was categorized into “yes” or “no” dichotomized groups. For the second study, a qualitative analysis of semi-structured telephone interviews was conducted among racially diverse women (N=66) who gave birth between 2019-2021 in Ohio. Interviews were conducted between March 2022-May 2022 by a trained female, African American facilitator. Interviews were digitally recorded, transcribed verbatim, analyzed, coded, and organized into themes. Results The results in the first study indicated that 86% of the study participants breastfed for more than 8 weeks and 33.1% reported having no stressful life events during pregnancy. In the multivariable adjusted model, there was a statistically significant interaction between racial discrimination and number of stressful life events stratified by race. The odds of experiencing racial discrimination was higher among all three racial/ethnic minority groups who experienced at least one stressful life event compared to women who did not experience any stressful life events. When compared with participants who were married, unmarried Non-Hispanic Black and White participants were less likely to breastfeed for >8 weeks. In the second study, after thematic analysis o (open full item for complete abstract)

Committee: Joseph Dake (Committee Chair); Kerri Knippen (Committee Member); Erica Czaja (Committee Member); Barbara Saltzman (Committee Member) Subjects: Public Health; Public Health Education

PhD, University of Cincinnati, 2006, Nursing : Nursing, Doctoral Program

Problem: Breastfeeding has long been recognized as the preferred method of feeding in the first year of life (American Academy of Pediatrics, 1997). Extensive research confirms the nutritional, economic, biomedical, immunological, and psychological advantages of breast milk. Despite the clear benefits of breastfeeding to mother and infant, breastfeeding rates today continue to remain below the recommended levels in the United States (US), most notably among low-income mothers. Research has shown that breastfeeding self-efficacy is one predictive factor affecting breastfeeding duration. Theoretical Framework: Dennis's (1999) Breastfeeding Self-Efficacy Theory, was the basis for this study. Using this theory, the Breastfeeding Self-Efficacy Intervention Program (BSEIP) was developed. The intervention consisted of a one-hour program delivered during the last trimester of pregnancy. The BSEIP consisted of measures to increase breastfeeding self-efficacy, including education, practice, and demonstration of breastfeeding techniques. Social support and practical advice were provided in the first two-weeks of the postpartum period. Methods: A quasi-Experimental design was used to test the effect of the BSEIP on duration of breastfeeding. A convenience sample of 36 low-income predominately non-Hispanic White women was recruited from two prenatal clinics on the outskirts of a large metropolitan area. All women indicated their intent to breastfeed their infant. Women were assigned by prenatal clinic to either receive or not receive the BSEIP. Data were collected using the Breastfeeding Self-Efficacy Scale (BSES) and a demographic profile. Women were contacted by telephone at two and six weeks postpartum to determine if they were still breastfeeding and to complete the BSES.. Results: Women who received the BSEIP had greater breastfeeding self-efficacy at two and six weeks postpartum than women who did not receive the intervention; women who received the intervention also incre (open full item for complete abstract)

Committee: Dr. Susan Elek (Advisor) Subjects: Health Sciences, Nursing