Anderson, A. K., Damio, G., Young, S., Chapman, D. J., & Perez-Escamilla, R. (2005). A randomized trial assessing the efficacy of peer counseling on exclusive breastfeeding in a predominantly Latina low-income community. Archives of Pediatrics & Adolescent Medicine, 159(9), 836–841. https://doi.org/10.1001/archpedi.159.9.836
| Screening decision | Screening conclusion | HomVEE procedures and standards version |
|---|---|---|
| Passes screens | Eligible for review | Version 2 |
| Rating | Design | Attrition | Baseline equivalence | Compromised randomization | Confounding factors | Valid, reliable measure(s) |
|---|---|---|---|---|---|---|
| High | Randomized controlled trial | Low | Not assessed for randomized controlled trials with low attrition |
No | No |
Yes |
| Study participants | Pregnant women were recruited at prenatal clinics. To be eligible, the mother had to be age 18 or older, up to 32 weeks pregnant, have no medical conditions that could impair successful breastfeeding, and have household earnings below 185 percent of the federal poverty level. At the time of birth, mother-child dyads were screened a final time and deemed eligible for the study if the newborn was born at term and with normal birth weight, no medical complications requiring treatment in the neonatal intensive care unit, and an Apgar score of 6 or higher at one and five minutes after birth. Among eligible mothers, 77 were randomly assigned to the Breastfeeding: Heritage and Pride™ (BHP) home visiting intervention group and 85 to the comparison group. The analytic sample included 135 mother-child dyads, 63 in the BHP group and 72 in the comparison group. Outcomes were measured at birth and at one month, two months, and three months postpartum. Seventy-two percent of mothers were Hispanic, 18 percent were Black, seven percent were Caucasian, and three percent reported they were another race. |
|---|---|
| Setting | The study took place in Hartford, Connecticut. |
| Intervention services | The Breastfeeding: Heritage and Pride™ (BHP) intervention consisted of three prenatal home visits, daily in-hospital visits during postpartum hospitalization, and nine postpartum home visits. All visits were conducted by peer counselors, one of whom was assigned to each mother-child dyad. The first prenatal home visit took place within one to two weeks of study enrollment; the second took place before the 36th week of pregnancy, and the third took place during the 36th week. During prenatal home visits, the peer counselor provided education on a range of topics including the benefits of exclusively breastfeeding, reasons for avoiding bottles or pacifiers, behaviors that impede early initiation and successful breastfeeding, infant feeding cues, and proper latch-on technique or positioning. Other members of the family were encouraged to participate in the prenatal visits. During the postpartum period, there were three home visits in the first week postpartum, two in the second week, and one each week from Weeks 3 through 6. The peer counselor provided one-on-one breastfeeding support and counseling based on the mother’s needs. |
| Comparison conditions | Mothers assigned to the comparison condition received conventional breastfeeding education at prenatal clinic visits, and one-on-one breastfeeding assistance and education during postpartum hospitalization. If any mothers experienced breastfeeding problems requiring assistance beyond that provided routinely by staff nurses, a hospital lactation consultant on duty provided support to the mother. |
| Subgroups examined |
This field lists subgroups examined in the manuscript (even if they were not replicated in other samples and not reported on the summary page for this model’s report). There were no subgroups reported in this manuscript. |
| Funding sources | This research was supported by the Centers for Disease Control and Prevention through a subcontract with the Association of Teachers of Preventative Medicine. |
| Author affiliation | The authors are affiliated with the University of Connecticut, the Hispanic Health Council, and Hartford Hospital. One of the authors is affiliated with the Hispanic Health Council, which sponsors the Breastfeeding: Heritage and Pride™ home visiting model. |
| Peer reviewed | Yes |
Clinicaltrials.gov Identifier: None found. SocialScienceRegistry.org Identifier: None found. Registry of Efficacy and Effectiveness Studies Identifier: None found. Study registration was assessed by HomVEE for Clinicaltrials.gov beginning with the 2014 review, and for other registries beginning with the 2021 review.
Findings that rate moderate or high
| Rating | Outcome measure | Effect | Sample | Timing of follow-up | Sample size | Intervention group | Comparison group | Group difference | Effect size | Statistical significance | Notes |
|---|---|---|---|---|---|---|---|---|---|---|---|
| High | Breastfeeding not initiated |
FavorableUnfavorable or ambiguousNo Effect |
BHP and conventional breastfeeding support vs. conventional breastfeeding support RCT, Connecticut, 2003-2004, full sample |
At hospital discharge |
135 mother/child dyads | Unadjusted proportion = 0.09 | Unadjusted proportion = 0.24 | Mean difference = -0.15 | Study reported = 2.48 | Statistically significant, p= <0.05 |
Negative effect is favorable to the intervention. The reported effect size is the relative risk, which is expressed as a positive value. |
| High | Experiencing 1 or more diarrhea episodes |
FavorableUnfavorable or ambiguousNo Effect |
BHP and conventional breastfeeding support vs. conventional breastfeeding support RCT, Connecticut, 2003-2004, full sample |
3 months old |
135 mother/child dyads | Unadjusted proportion = 0.18 | Unadjusted proportion = 0.38 | Mean difference = -0.20 | Study reported = 2.15 | Statistically significant, p= <0.05 |
Negative effect is favorable to the intervention. The reported effect size is the relative risk, which is expressed as a positive value. |
| High | Non-exclusive breastfeeding |
FavorableUnfavorable or ambiguousNo Effect |
BHP and conventional breastfeeding support vs. conventional breastfeeding support RCT, Connecticut, 2003-2004, full sample |
At hospital discharge |
135 mother/child dyads | Unadjusted proportion = 0.41 | Unadjusted proportion = 0.56 | Mean difference = -0.15 | Study reported = 1.35 | Not statistically significant, p= >0.05 |
Negative effect is favorable to the intervention. The reported effect size is the relative risk, which is expressed as a positive value. |
| High | Non-exclusive breastfeeding (24 hour recall) |
FavorableUnfavorable or ambiguousNo Effect |
BHP and conventional breastfeeding support vs. conventional breastfeeding support RCT, Connecticut, 2003-2004, full sample |
1 month old |
135 mother/child dyads | Unadjusted proportion = 0.65 | Unadjusted proportion = 0.92 | Mean difference = -0.27 | Study reported = 1.41 | Statistically significant, p= <0.05 |
Negative effect is favorable to the intervention. The reported effect size is the relative risk, which is expressed as a positive value. |
| High | Non-exclusive breastfeeding (24 hour recall) |
FavorableUnfavorable or ambiguousNo Effect |
BHP and conventional breastfeeding support vs. conventional breastfeeding support RCT, Connecticut, 2003-2004, full sample |
2 months old |
135 mother/child dyads | Unadjusted proportion = 0.71 | Unadjusted proportion = 0.96 | Mean difference = -0.24 | Study reported = 1.34 | Statistically significant, p= <0.05 |
Negative effect is favorable to the intervention. The reported effect size is the relative risk, which is expressed as a positive value. |
| High | Non-exclusive breastfeeding (24 hour recall) |
FavorableUnfavorable or ambiguousNo Effect |
BHP and conventional breastfeeding support vs. conventional breastfeeding support RCT, Connecticut, 2003-2004, full sample |
3 months old |
135 mother/child dyads | Unadjusted proportion = 0.73 | Unadjusted proportion = 0.97 | Mean difference = -0.24 | Study reported = 1.33 | Statistically significant, p= <0.05 |
Negative effect is favorable to the intervention. The reported effect size is the relative risk, which is expressed as a positive value. |
| High | Non-exclusive breastfeeding (previous week's recall) |
FavorableUnfavorable or ambiguousNo Effect |
BHP and conventional breastfeeding support vs. conventional breastfeeding support RCT, Connecticut, 2003-2004, full sample |
1 month old |
135 mother/child dyads | Unadjusted proportion = 0.67 | Unadjusted proportion = 0.92 | Mean difference = -0.25 | Study reported = 1.38 | Statistically significant, p= <0.05 |
Negative effect is favorable to the intervention. The reported effect size is the relative risk, which is expressed as a positive value. |
| High | Non-exclusive breastfeeding (previous week's recall) |
FavorableUnfavorable or ambiguousNo Effect |
BHP and conventional breastfeeding support vs. conventional breastfeeding support RCT, Connecticut, 2003-2004, full sample |
2 months old |
135 mother/child dyads | Unadjusted proportion = 0.75 | Unadjusted proportion = 0.96 | Mean difference = -0.21 | Study reported = 1.29 | Statistically significant, p= <0.05 |
Negative effect is favorable to the intervention. The reported effect size is the relative risk, which is expressed as a positive value. |
| High | Non-exclusive breastfeeding (previous week's recall) |
FavorableUnfavorable or ambiguousNo Effect |
BHP and conventional breastfeeding support vs. conventional breastfeeding support RCT, Connecticut, 2003-2004, full sample |
3 months old |
135 mother/child dyads | Unadjusted proportion = 0.75 | Unadjusted proportion = 0.97 | Mean difference = -0.23 | Study reported = 1.30 | Statistically significant, p= <0.05 |
Negative effect is favorable to the intervention. The reported effect size is the relative risk, which is expressed as a positive value. |
| High | Non-exclusive breastfeeding (since birth recall) |
FavorableUnfavorable or ambiguousNo Effect |
BHP and conventional breastfeeding support vs. conventional breastfeeding support RCT, Connecticut, 2003-2004, full sample |
3 months old |
135 mother/child dyads | Unadjusted proportion = 0.79 | Unadjusted proportion = 0.99 | Mean difference = -0.19 | Study reported = 1.24 | Statistically significant, p= <0.05 |
Negative effect is favorable to the intervention. The reported effect size is the relative risk, which is expressed as a positive value. |
| High | Non-exclusive breastfeeding (since birth recall) |
FavorableUnfavorable or ambiguousNo Effect |
BHP and conventional breastfeeding support vs. conventional breastfeeding support RCT, Connecticut, 2003-2004, full sample |
1 month old |
135 mother/child dyads | Unadjusted proportion = 0.73 | Unadjusted proportion = 0.93 | Mean difference = -0.20 | Study reported = 1.27 | Statistically significant, p= <0.05 |
Negative effect is favorable to the intervention. The reported effect size is the relative risk, which is expressed as a positive value. |
| High | Non-exclusive breastfeeding (since birth recall) |
FavorableUnfavorable or ambiguousNo Effect |
BHP and conventional breastfeeding support vs. conventional breastfeeding support RCT, Connecticut, 2003-2004, full sample |
2 months old |
135 mother/child dyads | Unadjusted proportion = 0.76 | Unadjusted proportion = 0.99 | Mean difference = -0.22 | Study reported = 1.29 | Statistically significant, p= <0.05 |
Negative effect is favorable to the intervention. The reported effect size is the relative risk, which is expressed as a positive value. |
| High | Not breastfeeding |
FavorableUnfavorable or ambiguousNo Effect |
BHP and conventional breastfeeding support vs. conventional breastfeeding support RCT, Connecticut, 2003-2004, full sample |
3 months old |
135 mother/child dyads | Unadjusted proportion = 0.51 | Unadjusted proportion = 0.64 | Mean difference = -0.13 | Study reported = 1.26 | Not statistically significant, p= >0.05 |
Negative effect is favorable to the intervention. The reported effect size is the relative risk, which is expressed as a positive value. |
| Rating | Outcome measure | Effect | Sample | Timing of follow-up | Sample size | Intervention group | Comparison group | Group difference | Effect size | Statistical significance | Notes |
|---|---|---|---|---|---|---|---|---|---|---|---|
| High | Maternal lactational amenorrhea status |
FavorableUnfavorable or ambiguousNo Effect |
BHP and conventional breastfeeding support vs. conventional breastfeeding support RCT, Connecticut, 2003-2004, full sample |
3 months old |
135 mother/child dyads | Unadjusted proportion = 0.48 | Unadjusted proportion = 0.67 | Mean difference = -0.19 | Study reported = 1.40 | Statistically significant, p= <0.05 |
The reported effect size is the relative risk, which is expressed as a positive value. |