May 2001 - Home and Videotape Intervention Found to be Effective in Delaying Early Introduction of Complementary Feeding Among First-Time African-American Adolescent Mothers

An article based on the findings from a HRSA/MCHB supported study of African-American mothers appears in the May, 2001 issue of the journal Pediatrics. This is one of several articles representing the first and second wave of findings from a group of minority group-specific longitudinal studies of infant health and development first funded by the HRSA/MCHB Extramural Research Program in the early 1990s. Years earlier, the Bureau had made the decision to pursue the evolution of a minority group-specific scientific knowledge base that would allow MCHB's service programs to develop and deliver to mothers and children efficacious and culturally-based program interventions.

The article, Home and Videotape Intervention Delays Early Complementary Feeding Among Adolescent Mothers (Pediatrics, May 2001, 107(5), 1-8) evaluated the efficacy of an intervention designed to delay the early introduction of complementary feeding among first-time African-American adolescent mothers living in multigenerational households. The principal investigators of the research and authors of the article are Maureen M. Black, Ph.D., et al from the Department of Pediatrics of the University of Maryland School of Medicine at Baltimore. The intervention focused on reducing the cultural barriers to the acceptance of the recommendation of the American Academy of Pediatrics, WIC, and the World Health Organization on complementary feeding. In addition to messages about the type and timing of infant feeding, the intervention showed mothers how to read their infants' cues, provided nonfood strategies for managing infants' behavior, and addressed mother/grandmother negotiations regarding intergenerational conflicts on what and how infants should be fed. The intervention was delivered through a mentorship model in which a videotape made by an advisory group of African-American adolescent mothers was incorporated into a home-visiting program and evaluated through a randomized, controlled trial.

Study findings indicate that infant characteristics (e.g., size), infant behavior (e.g., signals of hunger or satiety), and caregiver concerns about infants not sleeping through the night or crying were salient cultural issues that shaped the adolescent mothers feeding practices. Specifically, sixty-one percent of the infants of the study received complementary foods before 3 months old. Multivariate analyses were conducted to determine which factors best predicted optimal and less optimal adolescent mother feeders. After controlling for infant age and family income, mothers of infants in the optimal feeders group were found to be more likely to report accurate messages from advice sources such as WIC regarding timing of complementary food and nearly four times more likely to be in the intervention group. The most common complementary food was cereal mixed with formula in the bottle.

The investigators of the study mention four possible reasons for the success of the intervention. First, the intervention was guided by ecological theory which assumed infants play an active role in the shaping of the caregiving process. Second, both the videotape and the home-visiting curriculum extended the focus on infant feeding to include mother/grandaughter negotiations skills. Third reason mentioned was the cultural sensitivity of the methods used to implement the intervention. By featuring adolescent mothers, fathers, and grandmothers in the videotape and by conducting the intervention in the home, the investigators tried to make the intervention culturally acceptable so that other family members would recognize the important role that they play in supporting the adolescent mother and child. Finally, the mentorship model used may have highlighted the recommendations provided by the advice sources and the pediatrician and possibly could have helped mothers determine why and how they would follow the recommendations.

There are several limitations to the study. First, results are specific to young African-American mothers living in multigenerational households. The families in the intervention received both the videotape and the home-visiting curriculum. Therefore, it is not possible to assess the unique contributions of each component of the intervention. Third, it is possible that the positive findings are the result of generalized attention from the home visitor, rather than the specifics of the intervention.

Reprints of the article are available from the HRSA/MCHB Extramural Research Program Office, telephone: (301) 443-2190; e-mail: rhaggerty@hrsa.gov. State, county and municipal MCH program offices interested in replicating/validating the intervention tested by the study are advised to contact the HRSA/MCHB Extramural Research Program Office at (301) 443-2190 to arrange contact with the Principal Investigator of the study and for technical assistance.

Prepared by Gontran Lamberty, Dr. P.H., 5/8/01

 

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