Research Article| Volume 46, ISSUE 6, P458-466, November 2014

Innovative Use of Influential Prenatal Counseling May Improve Breastfeeding Initiation Rates Among WIC Participants



      To determine whether integrating influence strategies (reciprocation, consistency, consensus, feeling liked, authority, and scarcity) throughout Chickasaw Nation Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) clinics (1) changed participants' perception of the WIC experience and (2) affected breastfeeding initiation rates.


      Two-part, quasi-experimental design.


      Four WIC clinics.


      Parents and caregivers of children birth to 3 years.


      Behavior change intervention based on Social Cognitive Theory using Caildini's Principles of Influence. Traditional-model groups (control) received services prior to the intervention; influence-model groups (experimental) received services after initiation of the intervention.

      Main Outcomes

      The preliminary demonstration project surveyed 2 groups to measure changes in their perceptions of the WIC environment. Secondary data analysis measured changes in breastfeeding initiation in 2 groups of postpartum women.


      Frequency analysis, independent sample t tests, chi-square for independence, step-wise logistic regression.


      The demonstration project resulted in 5 improved influence measures (P < .02), aligning with the influence principle of “feeling liked.” The model had a small effect (φ = 0.10) in distinguishing breastfeeding initiation; women in the influence model were 1.5 times more likely (95% CI, 1.19–1.86; P < .05) to initiate breastfeeding compared with women in the traditional model, controlling for parity, mother's age, and race.

      Conclusions and Implications

      Consistent with Social Cognitive Theory, changing the WIC environment by integrating influence principles may positively affect women's infant feeding decisions and behaviors, specifically breastfeeding initiation rates.

      Key Words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access

      SNEB Member Login

      SNEB Members, full access to the journal is a member benefit. Login via the SNEB Website to access all journal content and features.


      Subscribe to Journal of Nutrition Education and Behavior
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Ip S.
        • Chung M.
        • Raman G.
        Tufts-New England Medical Center Evidence-based Practice Center. Breastfeeding and maternal and infant health outcomes in developed countries.
        Evid Rep Technol Assess. 2007; 153: 1-186
        • Penders J.
        • Thijs C.
        • Vink C.
        Factors influencing the composition of the intestinal microbiota in early infancy.
        Pediatrics. 2006; 118: 511-521
        • Rosenbauer J.
        • Herzig P.
        • Giani G.
        Early infant feeding and risk of type 1 diabetes mellitus—a nationwide population-based case-control study in pre-school children.
        Diabetes Metabl Res Rev. 2008; 24: 211-222
        • Das U.N.
        Breastfeeding prevents type 2 diabetes mellitus: but, now and why?.
        Am J Clin Nutr. 2007; 85: 1436-1437
        • Greer F.R.
        • Sicherer S.H.
        • Burks A.W.
        American Academy of Pediatrics Committee on Nutrition, American Academy of Pediatrics Section on Allergy and Immunology. Effects of early nutritional interventions on the development of atopic disease in infants and children: the role of maternal dietary restriction, breastfeeding, timing of introduction of complementary foods, and hydrolyzed formulas.
        Pediatrics. 2008; 121: 183-191
        • Akobeng A.K.
        • Ramanan A.V.
        • Buchan I.
        • Heller R.F.
        Effect of breastfeeding on risk of celiac disease: a systematic review and meta-analysis of observational studies.
        Arch Dis Child. 2006; 91: 39-43
        • American Academy of Pediatrics
        Policy Statement: breastfeeding and the use of human milk.
        Pediatrics. 2012; 129: e827-e841
      1. Healthy People 2020: breastfeeding objectives. United States Breastfeeding Committee. Accessed June 8, 2014.

        • Ip S.
        • Chung M.
        • Raman G.
        • Trikalinos T.A.
        • Lau J.
        A summary of the Agency for Healthcare Research and Quality's evidence report on breastfeeding in developed countries.
        Breastfeed Med. 2009; 4: S17-S30
      2. Breastfeeding Report Card—United States, 2012. Accessed June 8, 2014.

      3. Breastfeeding among U.S. children born 2000-2010. CDC National Immunization Survey. Accessed June 8, 2014.

        • Murimi M.
        • Dodge D.M.
        • Pope J.
        • Erickson D.
        Factors that influence breastfeeding decision among Special Supplemental Nutrition Program for Women, Infants, and Children participants from Central Louisiana.
        J Am Diet Assoc. 2010; 110: 624-627
        • Vaaler M.L.
        • Stagg J.
        • Parks S.E.
        • Erickson T.
        • Castrucci B.C.
        Breast-feeding attitudes and behavior among WIC mothers in Texas.
        J Nutr Educ Behav. 2010; 42: S30-S38
        • Chung M.
        • Raman G.
        • Trikalinos T.
        • Lau J.
        • Ip S.
        Interventions in primary care to promote breastfeeding: an evidence review for the US Preventative Services Task Force.
        Ann Intern Med. 2008; 149: 565-582
      4. WIC food packages. Food and Nutrition Services, US Department of Agriculture. Accessed June 8, 2014.

        • Perez-Escamilla R.
        • Hromi-Fiedler A.
        • Vega-Lopez S.
        • Bermudez-Millan A.
        • Sequra-Perez S.
        Impact of peer nutrition on dietary behaviors and health outcomes among Latinos: a systematic literature review.
        J Nutr Educ Behav. 2008; 40: 208-225
        • Cialdini R.B.
        Influence: The Psychology of Persuasion. Revised ed.
        Quill William Morrow, New York, NY1993
        • Thaler R.H.
        • Sunstein C.R.
        Nudge: Improving Decisions About Health, Wealth, and Happiness.
        Penguin Books, London, UK2009
        • Redelmeier D.A.
        • Cialdini R.B.
        Problems for clinical judgment: principles of influence in medical practice.
        CMAJ. 2002; 166: 1680-1684
        • Heath C.
        • Heath D.
        Switch: How to Change Things When Change Is Hard.
        Broadway Books, New York, NY2010
        • Bandura A.
        Foundations of Thought and Action: A Social Cognitive Theory.
        Prentice-Hall, Englewood Cliffs, NJ1986
        • Chapman D.J.
        • Perez-Escamilla R.
        US national breastfeeding monitoring and surveillance: current status and recommendations.
        J Hum Lact. 2009; 25: 139-150
        • Li R.
        • Scanlon K.S.
        • Serdula M.K.
        The validity and reliability of maternal recall of breastfeeding practice.
        Nutr Rev. 2005; 63: 103-110
        • Tapp A.
        • Warren S.
        • Rhodes C.
        • Condon L.
        • Withall J.
        Using social marketing to encourage teenage mothers to breastfeed.
        J Social Marketing. 2013; 3: 144-161
        • Humphreys A.S.
        • Thompson N.J.
        • Miner K.R.
        Intention to breastfeed in low-income pregnant women: the role of social support and previous experience.
        Birth. 1998; 25: 169-174