"It's another gay disease": an intersectional qualitative approach contextualizing the lived experiences of young gay, bisexual, and other sexual minoritized men in the United States during the mpox outbreak.

BACKGROUND: The U.S. mpox outbreak in 2022 introduced new and exacerbated existing challenges that disproportionately stigmatize gay, bisexual, and other sexual minoritized men (GBSMM). This study contextualizes the perceptions, susceptibility, and lived experiences of the mpox outbreak among GBSMM in the U.S. using an intersectional framework. METHODS: Between September 2022 to February 2023, we conducted 33 semi-structured qualitative interviews with purposively sampled GBSMM in the Northeast and the South region of the United States on various aspects related to their experience during the mpox outbreak. RESULTS: We identified four themes: (1) understanding and conceptualizations of mpox, (2) mpox vaccine availability and accessibility, (3) mpox vaccine hesitancy and mistrust, and (4) call to action and recommendations. GBSMM collectively discussed the elevated mpox stigmatization and homophobic discourse from mainstream social media and news outlets. GBSMM also discussed the lack of availability of mpox vaccines, unclear procedures to receive the vaccine, and continued mistrust in government, non-government, and other institutions of health that were complicit in anti-LGBTQ + narratives related to mpox. However, they expressed that these challenges may be addressed through more LGTBQ + representation and leveraging ways to empower these communities. CONCLUSION: GBSMM have mpox experiences that are distinct and multifaceted. Effectively addressing mpox and mitigating public health emergencies for GBSMM requires prioritizing destigmatizing communication channels and vaccine distribution strategies by centering their stories and lived experiences to advance health equity.

Interventions to Reduce Alcohol Use and HIV Risk among Sexual and Gender Minority Populations: a Systematic Review.

PURPOSE OF REVIEW: Sexual and gender minority (SGM) individuals are diagnosed with HIV at disproportionate rates, and hazardous alcohol use can increase their HIV risk. This review assessed the state of the literature examining interventions for addressing alcohol use and sexual HIV risk behaviors among SGM individuals. RECENT FINDINGS: Fourteen manuscripts from 2012 to 2022 tested interventions that address both alcohol use and HIV risk behaviors among SGM populations, with only 7 randomized controlled trials (RCTs). Virtually all the interventions targeted men who have sex with men, with none focused on transgender populations or cisgender women. While they demonstrated some evidence of effectiveness in reducing alcohol use and/or sexual risk, the outcomes varied widely between studies. More research is needed that tests interventions in this area, particularly for transgender individuals. The use of larger-scale RCTs with diverse populations and standardized outcome measures are needed to strengthen the evidence base.

A qualitative assessment of barriers to healthcare and HIV prevention services among men who have sex with men in non-metropolitan areas of the south.

HIV cases are increasing in the rural Southern United States, especially among men who have sex with men (MSM). To facilitate healthcare access and encourage HIV prevention for non-metropolitan MSM, it is essential to examine their barriers to care. This qualitative study conducted semi-structured interviews with 20 MSM living in non-metropolitan areas of the South. Analysis revealed that MSM experience multiple barriers accessing healthcare in non-metropolitan areas such as finding knowledgeable and affirming providers with desired characteristics and beliefs and communicating with providers about sexual health and HIV prevention. To aid in identification, many respondents expressed a desire for providers to publicly signal that they provide care for sexual and gender minority patients and are an inclusive clinical space. Overall, results suggest that MSM face unique healthcare-related challenges, beyond those typically experienced by the broader population in non-metropolitan areas, because of tailored identity-based needs. To better support MSM in non-metropolitan areas, especially in the South where increased experiences of stigma are found, providers should seek further training regarding sexual health communication and HIV prevention, indicate on websites and in offices that they support sexual and gender minority patients, and provide telehealth services to MSM living in more geographically isolated areas.

The Relationship Between Drinking Behavior and Conversational Processes During a Brief Alcohol Reduction Intervention for People with HIV.

People with HIV (PWH) frequently engage in unhealthy alcohol use, which can adversely affect antiretroviral adherence and HIV disease progression. Brief interventions based on Motivational Interviewing (MI), including the Brief Negotiated Interview (BNI), can help to reduce drinking. This study examines MI processes observed during a single 15-20 min BNI session delivered by social workers to PWH with unhealthy alcohol use (N = 59) in the context of a stepped care intervention to reduce alcohol consumption. BNI sessions were coded for technical and relational processes encouraged in MI, such as autonomy support, instructive language, and self-exploration. Multiple regression analyses explored the relationship between: (1) Participants' pre-intervention drinking behaviors (weekly drinks and heavy drinking days) and these MI processes, and (2) MI processes and intervention outcomes. Results indicated that PWH who reported more weekly drinks at baseline engaged in less self-exploration, while social workers delivering the BNI used less instructive language for those who reported more heavy drinking days. PWH who engaged in more self-exploration and received more autonomy support had fewer heavy drinking days 6 months after the intervention. These findings suggest the value of providing more opportunities within BNIs to encourage self-exploration, as it may help to enhance intervention efficacy.

A Mixed Media Campaign to Promote Bystander Intervention and Reduce Alcohol Use Among College Students: A Pilot Study.

This study examined the limited efficacy of a mixed media campaign that promoted bystander intervention as a sexual violence (SV) prevention strategy and aimed to decrease alcohol use. A quasi-experimental design was used to assess the limited efficacy of the Be a Watch Dawg mixed media campaign implemented at a large Southeastern public university in 2017. Social marketing along with social cognitive theory, social norms theory, and theory of planned behavior were utilized as the framework for the campaign. Be a Watch Dawg promoted bystander intervention in SV risk situations and targeted bystanders' alcohol use via social media (e.g., Facebook, Instagram, and Twitter) and printed materials (e.g., posters, stickers, and handbills). Participants included 244 undergraduate students 18 to 24 years of age. Study outcomes included bystander intervention, intentions to intervene, and alcohol use. Adjusted linear regression and logistic regression models were used to examine differences in outcomes between pre and postcampaign samples as well as associations with campaign exposure. Significant increases in bystander intervention were observed between the pre and postcampaign samples. Campaign exposure was marginally related to intentions to intervene but was not significantly associated with bystander intervention. Social media analytics revealed that the campaign reached 39,466 social media users and received 50,854 impressions and 19,523 views. A mixed media campaign may be a promising and low-resource approach to increase bystander intervention as a strategy to combat campus SV.

Dating app use among rural men who have sex with men and its relationship to HIV prevention and risk behaviors: a mixed-methods analysis.

INTRODUCTION: Men who have sex with men (MSM) in rural areas have limited access to HIV prevention and education resources. Given the growing usage of mobile dating apps among the wider MSM population, this research sought to explore their use among MSM in rural areas and their potential for delivering HIV prevention information. METHODS: Participants were recruited from different areas of the rural Southern USA. This mixed-methods study consisted of an online survey (n=85) and follow-up qualitative phone interviews with 20 survey respondents. The survey assessed dating app use, sexual behaviors, and pre-exposure prophylaxis (PrEP) awareness, usage, and attitudes among MSM in the rural, Southern USA. Interviews explored perceptions of dating apps and their potential value as a source of health and HIV prevention information. RESULTS: Among survey respondents, 74% had used a dating app, with Grindr being the most frequently used app. Of individuals who were in a relationship, 41% had met their current partner online. Using a dating app was associated with having a greater number of sexual partners. Three-quarters of participants had heard of PrEP, but only 7% had ever received a prescription for it and less than one-third reported that it would be easy to get PrEP if they wanted it. Dating app users were more likely than non-app users to have more positive attitudes toward taking PrEP and interest in taking PrEP. In qualitative interviews, respondents expressed support for integrating HIV prevention information into dating apps. CONCLUSION: Dating app usage is high among rural MSM. Individuals who use these apps have more sexual partners and also are more interested in PrEP for HIV prevention, suggesting that this is an ideal group to target for PrEP education and interventions. This could be especially beneficial for MSM in rural areas, as most have difficulty accessing PrEP and PrEP education.

Social media photos of substance use and their relationship to attitudes and behaviors among ethnic and racial minority emerging adult men living in low-income areas.

OBJECTIVES: Emerging adult minority males have inequitable negative consequences from substance abuse. They are also frequent users of social media, logging into popular sites up to 25 times per week on average, so there may be opportunities to use these technologies for better understanding and preventing substance use behaviors. Through mobile phone monitoring, this study examined how social media sites are used to post substance use-related images and how posting such images is related to behaviors and attitudes. It also explored how self-presentation of masculinity norms, such as coolness and toughness, was related to posting of substance use-related photos. METHODS: Instagram and/or Twitter posts of 65 minority males aged 18-25 living in low-income areas were monitored for three months using phone tracking software. Over 2200 posted images were content analyzed to determine if they were related to alcohol or marijuana and if they displayed masculinity norms. Behavioral interviewing was also used to examine alcohol and marijuana attitudes, use, and problematic use. Analyses utilized t-tests and multiple and logistic regression. RESULTS: Many participants posted at least one substance use-related photo and a strong majority were exposed to such images through their network. Individuals who posted substance use-related images had more "followers." Posting substance-use related photos was related to marijuana use attitudes, behaviors, and problem behaviors, as well as depictions of toughness in photos. CONCLUSIONS: Social media monitoring has potential for use in identifying individuals at-risk for substance abuse and those who may be perpetuating unhealthy substance use norms.

The Differential Effects of Social Media Sites for Promoting Cancer Risk Reduction.

Social media are potentially valuable tools for disseminating cancer education messages, but the differential effects of various sites on persuasive outcomes are unknown. In an effort to inform future health promotion, this research tested the effects of Facebook, YouTube, Twitter, and blogs for delivering a cancer risk reduction message. Using an experimental design, participants were randomly placed in several conditions that delivered the same message but with different forms of social media. Effects on comprehension and attitudes were examined, as they are important variables in the behavior change process. YouTube led to higher comprehension and stronger attitudes toward cancer risk reduction than Twitter, but there were no differences between other sites. Additionally, YouTube led to stronger attitudes toward cancer risk reduction as compared to Facebook, but not any other sites. These results demonstrate that, even if the message is kept constant, the form of social media used to deliver content can have an effect on persuasive outcomes. More research is needed to determine the mechanisms behind the differences found, however. Altogether, this line of research is valuable for any individuals seeking to use social media for health promotion purposes and could have direct implications for the development of cancer risk reduction campaigns.

The Effects of Viewing and Preferences for Online Cancer Information Among Patients' Loved Ones.

Emotional and psychological distress is common among loved ones of cancer patients, who sometimes report more severe mental health issues than the patients themselves. In addition, many loved ones feel as though their information needs are not being met, which can lead them to seek out additional information online. This survey research examined the experiences of cancer patients' loved ones in viewing online content about the disease and the emotional outcomes of such browsing sessions. Participants (N = 191) were recruited from cancer- and caregiver-related nonprofits and online discussion boards. Results indicated that patients' loved ones were active users of online cancer Web sites. They primarily viewed and expressed a desire for information-based, rather than support-based, content. Many individuals desired in-depth treatment information, and those who viewed it had significantly more hope. Interestingly, multiple regression analysis revealed that viewing user-generated content was associated only with negative emotions, illustrating the potential dangers of social media spaces. Overall, this study shows the need for supporting patients' loved ones during their almost inevitable viewings of online cancer information. More research is needed in order to determine the best methods of mitigating potential negative effects of cancer Web sites and developing a useful online resource for this population.

A Qualitative Exploration of Attitudes Toward Global Positioning System Tracking and Ecological Momentary Assessment Among Individuals in Substance Use Treatment.

BACKGROUND: The use of tracking technology in substance use research can uncover the role of contextual factors, such as social networks and environmental cues, in triggering cravings and precipitating return to use. Few studies have explored the opinions of individuals in substance use treatment related to tracking technology. METHODS: We conducted 30 semi-structured interviews with individuals in substance use treatment facilities in Connecticut and Georgia. Interviews were not limited to individuals with any specific substance use disorder. Interviewers described a hypothetical study involving ecological momentary assessment and global positioning system tracking to examine place-based predictors of substance use. Participants were invited to share reactions to this description. We used thematic analysis to identify themes in participant perceptions of this hypothetical research study. RESULTS: Most participants shared positive opinions about study participation and expressed little to no concern about the tracking components. Participant concerns focused on the security of their information and the potential burden of responding to study questions. Participants largely understood the importance of study participation for promoting greater understanding of substance use and identified potential therapeutic effects of study participation on their own recovery. CONCLUSIONS: Individuals in substance use treatment expressed little concern with research studies or interventions incorporating mobile-tracking elements. Future studies should explore the responsible use of tracking elements in recovery support interventions.

Combined Motivational Interviewing and Ecological Momentary Intervention to Reduce Hazardous Alcohol Use Among Sexual Minority Cisgender Men and Transgender Individuals: Protocol for a Randomized Controlled Trial.

BACKGROUND: Sexual minority cisgender men and transgender (SMMT) individuals, particularly emerging adults (aged 18-34 years), often report hazardous drinking. Given that alcohol use increases the likelihood of HIV risk behaviors, and HIV disproportionately affects SMMT individuals, there is a need to test interventions that reduce hazardous alcohol use and subsequent HIV risk behaviors among this population. Ecological momentary interventions (EMIs), which use mobile phones to deliver risk reduction messages based on current location and behaviors, can help to address triggers that lead to drinking in real time. OBJECTIVE: This study will test an EMI that uses motivational interviewing (MI), smartphone surveys, mobile breathalyzers, and location tracking to provide real-time messaging that addresses triggers for drinking when SMMT individuals visit locations associated with hazardous alcohol use. In addition, the intervention will deliver harm reduction messaging if individuals report engaging in alcohol use. METHODS: We will conduct a 3-arm randomized controlled trial (N=405 HIV-negative SMMT individuals; n=135, 33% per arm) comparing the following conditions: (1) Tracking and Reducing Alcohol Consumption (a smartphone-delivered 4-session MI intervention), (2) Tracking and Reducing Alcohol Consumption and Environmental Risk (an EMI combining MI with real-time messaging based on geographic locations that are triggers to drinking), and (3) a smartphone-based alcohol monitoring-only control group. Breathalyzer results and daily self-reports will be used to assess the primary and secondary outcomes of drinking days, drinks per drinking day, binge drinking episodes, and HIV risk behaviors. Additional assessments at baseline, 3 months, 6 months, and 9 months will evaluate exploratory long-term outcomes. RESULTS: The study is part of a 5-year research project funded in August 2022 by the National Institute on Alcohol Abuse and Alcoholism. The first 1.5 years of the study will be dedicated to planning and development activities, including formative research, app design and testing, and message design and testing. The subsequent 3.5 years will see the study complete participant recruitment, data collection, analyses, report writing, and dissemination. We expect to complete all study data collection in or before January 2027. CONCLUSIONS: This study will provide novel evidence about the relative efficacy of using a smartphone-delivered MI intervention and real-time messaging to address triggers for hazardous alcohol use and sexual risk behaviors. The EMI approach, which incorporates location-based preventive messaging and behavior surveys, may help to better understand the complexity of daily stressors among SMMT individuals and their impact on hazardous alcohol use and HIV risk behaviors. The tailoring of this intervention toward SMMT individuals helps to address their underrepresentation in existing alcohol use research and will be promising for informing where structural alcohol use prevention and treatment interventions are needed to support SMMT individuals. TRIAL REGISTRATION: ClinicalTrials.gov NCT05576350; https://www.clinicaltrials.gov/study/NCT05576350. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/55166.

Comparison of communication and personal characteristics of living kidney donors and a matched quota sample.

Deceased organ donation does not meet the need for kidney transplants. Thus, it is important to examine topics relevant to kidney donors such as communication leading to the donation decision and donor characteristics. This study reports personal characteristics and communication leading to the decision to donate among living kidney donors and a demographically matched quota sample. Donors had higher scores for compassion, while non-donors reported more volunteerism. Donors and non-donors did not differ in conversation or conformity orientations of family communication styles. Only 4.7% of donors reported being asked to donate directly. Matched respondents reported feeling more comfortable than unsettled with the idea of being asked directly and indicated a preference to learn of the need directly or indirectly, giving them the option to volunteer. The majority of donors were giving to family members and friends, and the matched sample indicated greater willingness to donate to immediate family members, followed by friends. Practical implications of the findings are offered.

An exploratory study of indicators of recent nonmedical prescription stimulant use among college students.

Objective: To explore the relationship between past 30-day nonmedical prescription stimulant use (NPSU) and past 30-day marijuana and/or alcohol use, past 30-day risky marijuana and/or alcohol use, student demographics, and student activity involvement among college students. Participants: Sample of 604 college-aged students at two large universities in the southeastern U.S. Methods: A cross-sectional survey was completed electronically. Logistic regression was used to identify and test covariates of past 30-day NPSU. Results: Over 20% of participants self-reported past NPSU. Using both marijuana and alcohol in the past 30 days (B = 3.293, p = .002, OR= 26.91, 95% CI OR= 3.42, 211.92) and engaging in both risky marijuana and alcohol use (B = 2.095, p < .001, OR = 8.13, 95% CI OR = 2.52, 25.17) were significantly related to past 30-day NPSU. Conclusions: NPSU may be indicative of broader polysubstance use problems among college-aged students.

The moderating effect of physical activity on the relationship between bullying and mental health among sexual and gender minority youth.

BACKGROUND: Sexual and gender minority youth frequently experience bullying, which often contributes to higher depressive symptoms and lower self-esteem. Given that physical activity (PA) can mitigate depressive symptoms and improve self-esteem, we examined the moderating effect of PA on the relationship between bullying and mental health among sexual and gender minority youth. METHODS: Data from the Lesbian, Gay, Bisexual, Transgender, and Queer National Teen Survey (n = 9890) were analyzed. Hierarchical regression analyses examined the influence of history and frequency of being bullied, PA, and the interaction of these variables on depressive symptoms and self-esteem. Simple slopes analyses were used to probe significant interactions. RESULTS: Results indicated the importance of accounting for bullying history when examining effects of PA on mental health. PA was negatively related to depression (t = -4.18, p < 0.001) and positively related to self-esteem (t = 12.11, p < 0.001). Bullying frequency was positively related to depression (t = 19.35, p < 0.001) and negatively related to self-esteem (t = -12.46, p < 0.001). There was a significant interaction between bullying frequency and PA for depression (t = 4.45, p < 0.001) and self-esteem (t = -4.69, p < 0.001). Post hoc analyses suggested that the positive effects of PA on mental health may be limited to those not bullied because it had a negligible effect on those who were bullied. CONCLUSION: Results suggest that sexual and gender minority youth exercise interventions aiming to improve mental health should first address bullying history; otherwise, their effectiveness may be limited to those who have been bullied.

Pilot Trial of a Smartphone-Based Intervention to Reduce Alcohol Consumption among Veterans with HIV.

Veterans engage in disproportionate levels of alcohol use, which can impact treatment outcomes among veterans with HIV. The TRAC (Tracking and Reducing Alcohol Consumption) intervention, which combines smartphones, mobile breathalyzers, and motivational interviewing (MI), was developed to help reduce alcohol use among this population. This study reports results of an 8-week pilot trial of TRAC among veterans with HIV (N = 10). Participants attended weekly MI sessions conducted via videoconferencing or phone and completed twice-daily self-monitoring of alcohol consumption using breathalyzers and surveys. They also completed pre- and post-intervention questionnaires and a qualitative interview. Analyses explored adherence to self-monitoring tasks, perceptions of the intervention, and preliminary effects of TRAC on alcohol use and readiness to change drinking behavior. Participants completed 76% of breathalyzer readings and 73% of surveys and completed more daytime than evening monitoring tasks. AUDIT hazardous drinking scores significantly decreased between baseline and post-test. Qualitative interviews revealed positive attitudes toward the technologies and MI sessions. Overall, this pilot demonstrated that the TRAC intervention has potential to reduce alcohol use among veterans with HIV, though additional effort is needed to improve adherence to mobile monitoring. Results were used to refine the intervention in preparation for a randomized controlled trial.

Diabetes management via mobile phones: a systematic review.

BACKGROUND: This study sought to understand the most common uses and functions of mobile phones in monitoring and managing diabetes, their potential role in a clinical setting, and the current state of research in this area. METHODS: We identified peer-reviewed articles published between 2000 and 2010. Twenty-one articles were analyzed for this systematic literature review. RESULTS: The majority of studies examined the use of mobile phones from the patient's perspective. Subjects with type 1 diabetes were enrolled exclusively in over 50% of the studies. Seventy-one percent of the studies used a study-specific application, which had supplemental features in addition to text messaging. The outcomes assessed varied considerably across studies, but some positive trends were noted, such as improved self-efficacy, hemoglobin A1c, and self-management behaviors. CONCLUSIONS: The studies evaluated showed promise in using mobile phones to help people with diabetes manage their condition effectively. However, many of these studies lacked sufficient sample sizes or intervention lengths to determine whether the results might be clinically or statistically significant. Future research should examine other key issues, such as provider perceptions, integration into a healthcare practice, and cost, which would provide important insight into the use of mobile phones for chronic disease management.

The feasibility of using smartphones and mobile breathalyzers to monitor alcohol consumption among people living with HIV/AIDS.

BACKGROUND: For people living with HIV/AIDS (PLWHA), alcohol consumption is associated with poor treatment outcomes and medication adherence. This pilot study examined the feasibility of using smartphones and mobile Bluetooth breathalyzers for monitoring alcohol consumption among PLWHA (N = 17). METHODS: For 2 weeks, participants responded to twice-daily text message prompts by completing a breathalyzer reading and a mobile survey about their alcohol use. They also completed baseline questionnaires assessing alcohol consumption and hazardous drinking behaviors. RESULTS: Participants completed an average of 22 of 28 breathalyzer readings and 17 of 28 mobile surveys, and were more likely to complete daytime (vs. evening) monitoring tasks. Results suggested that self-reported frequency of binge drinking at baseline was related to an increased number of days with alcohol consumption according to breathalyzer and mobile surveys, as well as a higher average blood alcohol content. Qualitative interviews found generally positive attitudes toward the technologies, but some participants reported experiencing technical difficulties. CONCLUSIONS: Overall, this preliminary research suggests that smartphone monitoring of alcohol consumption among PLWHA may reflect cross-sectional self-reported alcohol consumption behaviors, but could use improvements to increase adherence to monitoring tasks.

Sexual Behaviors, Mobile Technology Use, and Sexting Among College Students in the American South.

PURPOSE: To examine sexual, mobile technology, and sexting behaviors of college students. DESIGN: A cross-sectional study design was employed. SETTING: Study sites were 2 universities in the southern United States. SUBJECTS: Data were collected from 254 participants via online survey of college students. MEASURES: The survey included 268 items inclusive of measures from previously validated sources. Variables for this study included technology ownership/use, online/mobile dating site use, sexting behaviors/attitudes, and sexual behaviors. In particular, the Sexting Attitudes Scale has been previously validated with other researchers providing comparative data. ANALYSIS: Chi-square and Mann-Whitney tests were used for group comparisons. Logistic regression analysis was used to examine predictors of sexting behavior. RESULTS: Of the 254 participants, over 80% had ever had sex, and participants were more likely to use condoms with partners who they were not in a committed relationship compared to those to whom they were committed (χ2 = 27.324, P = .0001). Seventy percent had ever sexted, and sexting attitudes ranged from approximately 80% agreeing that sexting is "risky" or can leave one "vulnerable" compared to 43% agreeing that sexting is "fun." Sexting was associated with having multiple sexual partners (odds ratio [OR] = 2.47, 95% confidence interval [CI]: 1.36-4.47) and sexually transmitted infection testing history (OR = 2.08, 95% CI: 1.03-4.18). CONCLUSION: Study findings should be considered as interventionists plan sexual health and risk prevention programs for college students.

It Takes an E-Village: Supporting African American Mothers in Sustaining Breastfeeding Through Facebook Communities.

BACKGROUND: Lack of breastfeeding support is a common barrier reported by African American mothers, whose breastfeeding rates remain significantly below the national average. Despite mothers' reported use of social network sites to access support on topics relating to child rearing, few studies have examined their use to exchange breastfeeding support. RESEARCH AIMS: To describe (1) the experiences of African American mothers who participate in breastfeeding support groups on Facebook and (2) the breastfeeding beliefs, practices, and outcomes for this population of mothers. METHODS: This was a prospective, cross-sectional qualitative study with an online focus group design. The study was guided by Black Feminist Thought and an integrated model of behavior prediction. Four online focus groups (N = 22) were conducted using video conferencing during September 2017 with African American mothers who were participating in breastfeeding support groups on Facebook. RESULTS: Thematic analysis was used to develop four themes and two subthemes, including creating a community for Black mothers, online interactions and levels of engagement, advantages of participating in online support groups, critiques of online support groups, empowerment of self and others, and shifts in breastfeeding perceptions and decisions. Among participants in this study, positive imagery of African American breastfeeding mothers and ongoing support from women with shared experiences improved confidence with public breastfeeding and prolonged goals for breastfeeding duration. CONCLUSION: Receiving peer support within Facebook communities may positively influence breastfeeding norms and confidence in breastfeeding, help mothers to overcome breastfeeding challenges, and ultimately extend intended breastfeeding duration.

Facebook support for breastfeeding mothers: A comparison to offline support and associations with breastfeeding outcomes.

OBJECTIVES: For breastfeeding mothers, online support groups through Facebook may be a more convenient and preferred source for accessing breastfeeding information and support, but few studies exist that examine the use of Facebook groups specifically for breastfeeding support. This study explores the sources of support among users of Facebook breastfeeding support groups and a possible mechanism by which support received on Facebook may translate to behavioral outcomes among breastfeeding mothers. METHODS: From July-September 2017 a survey was distributed online to African American mothers (N = 277) who participate in breastfeeding support groups on Facebook. The survey assessed network support from Facebook and other sources of breastfeeding support, perceived breastfeeding norms, breastfeeding self-efficacy and breastfeeding attitudes. Correlations and linear regression analysis were used to examine the relationship between covariates and outcome variables. RESULTS: The average intended breastfeeding duration among participants in this study was 19 months. Participants reported the highest amount of breastfeeding support received from their Facebook support group, in comparison to other sources of support, and Facebook support was significantly correlated with intended breastfeeding duration (p < 0.05). Self-efficacy and breastfeeding attitudes remained significant predictors of intended breastfeeding duration within the final regression model. CONCLUSIONS: Breastfeeding support received within Facebook groups may compensate for inadequate support received within mothers' networks. More research is needed to understand the mechanism through which Facebook support may contribute to prolonged breastfeeding durations.