Outcome Evaluation of the You Can Do It Initiative to Promote Exclusive Breastfeeding Among Women Enrolled in the New York State WIC Program by Race/Ethnicity.

OBJECTIVE: To evaluate the effectiveness of You Can Do It at improving exclusive breastfeeding (BF) among New York State women enrolled in Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). DESIGN: Quasi-experimental study, September, 2013 through February, 2016. SETTING: Multicomponent intervention paired with a yearlong learning community in 12 clinics. PARTICIPANTS: Women who were enrolled in WIC during the first trimester, intended to breastfeed or were undecided, and continued in WIC after delivery, comprised 1 baseline cohort (n = 688) and 2 intervention cohorts: Breastfeeding Attrition Prediction Tool (BAPT) (consented, n = 362) and non-BAPT (declined, n = 408). INTERVENTION: The BAPT was offered to all eligible women in the intervention enrollment period. Consenting women received multiple counseling sessions tailored to individual BAPT results throughout pregnancy and were contacted promptly after delivery. MAIN OUTCOME MEASURE(S): Prevalence of exclusive BF at 7, 30, and 60 days. ANALYSIS: Multivariate logistic regression, stratified by race/ethnicity. Statistical significance set at P < .05. RESULTS: Prevalence of exclusive BF at 7 and 30 days was significantly higher among BAPT women compared with non-BAPT or baseline cohorts. Non-Hispanic black and Hispanic women in the BAPT cohort achieved significantly higher exclusive BF rates at 30 and 60 days compared with those in non-BAPT and baseline cohorts. CONCLUSIONS AND IMPLICATION: The initiative seems to be effective at increasing exclusive BF, particularly among non-Hispanic black and Hispanic women in the New York State WIC program.

Implementing a WIC-Based Intervention to Promote Exclusive Breastfeeding: Challenges, Facilitators, and Adaptive Strategies.

OBJECTIVE: Understand factors that contributed to the implementation of a successful multicomponent intervention to promote exclusive breastfeeding (EBF) within Special Supplemental Nutrition Program for Woman, Infants, and Children (WIC) clinics. DESIGN: Qualitative study of staff implementers' experiences using implementation status reports, facilitated group discussion immediately after implementation, and WIC administrative data. SETTING: WIC staff from 12 clinics participated in an EBF Learning Community composed of 8 intervention trainings and ongoing support from trainers and peers. PARTICIPANTS: A total of 47 WIC staff including 11 directors, 20 other administrators, 8 nutritionists, and 6 peer counselors. INTERVENTION: A WIC-integrated EBF promotion initiative, supported through a Learning Community, composed of prenatal screening, tailored trimester-specific counseling, and timely postpartum follow-up. PHENOMENON OF INTEREST: Challenges and facilitators to implementation within clinics. ANALYSIS: Iterative qualitative analysis using directed, emergent, and thematic coding. RESULTS: Implementation experiences were characterized by (1) perceived benefits of implementation, including improved EBF knowledge and counseling confidence among staff; and (2) managing implementation, including responding to challenges posed by clinic settings (resources, routine practices, values, and perceptions of mothers) through strategies such as adapting clinic practices and intervention components. CONCLUSIONS AND IMPLICATIONS: Implementation was shaped by clinic setting and adaptive strategies. Future WIC interventions may benefit from formal consideration of intervention fit with local clinic setting and allowable adaptations.

Environmental influences on small eating behavior change to promote weight loss among Black and Hispanic populations.

Small eating behavior changes are proposed as more feasible to achieve and maintain than larger changes used in traditional behavioral weight loss studies. However, it is unclear whether overweight Black and Hispanic adults in a low-income urban setting experience small changes as feasible and what might influence feasibility. Participants' experiences in a 12-week pilot weight loss intervention were explored qualitatively to determine the feasibility of making small eating behavior changes in this population. After the intervention (69% retention), semi-structured interviews with 46 men and women (mean age 51, 50% Non-Hispanic Black, 43% Hispanic) revealed that making small eating changes was a process shaped by participants' intrapersonal and interpersonal eating environments. Participants responded to intrapersonal and interpersonal eating environmental challenges by adapting small change strategies, navigating eating environments, and negotiating household eating practices. Findings highlight how even small eating behavior changes called for adaptation, navigation, and negotiation of complex eating environments in daily life. These findings were used to improve the trial that followed and underline the importance of feasibility studies to inform community trials. Findings also add to understanding of contextual challenges and the skills needed to implement small changes in a low income, ethnic minority population.