Introduction: The health benefits of adequate maternal and infant nutrition are so significant that the Surgeon General of the United States in Health People 2010 has targeted the incidence and duration of breastfeeding as a priority area for intervention. However, increasing the incidence and duration of breastfeeding may be especially challenging in the adolescent population in part because young mothers have different issues than older mothers, which may be magnified for African American adolescents. In addition, limited data exists as to how African American adolescent mothers make infant feeding choices and exactly what they are feeding their infants. Objective: This pilot study tested a model of individualized nutrition services (clinic/hospital/home visits, and telephone follow-up/availability) provided by a mother/child nutrition support team (MCNST; which consists of a perinatal advanced practice nurse and a registered dietitian) for African American adolescent mothers and their infants. Design: This randomized clinical trial compared maternal and infant outcomes between 2 groups of African American pregnant adolescents (< 17 years of age). Adolescents in the control group received pregnancy/postpartum nutrition services that are routine for women who deliver at the Hospital of the University of Pennsylvania (HUP), Philadelphia, Pennsylvania. Women in the intervention group received a structured but individualized nutrition intervention program through clinic, hospital and home visits, and telephone follow-up/availability provided by the MCNST from the time of enrollment in the 3rd trimester through six months postpartum. Care was provided through individualized hospital- and home-based interventions and telephone outreach/availability using the PEN3 Model as a framework for planning care. The PEN3 model suggests that health educators, clinicians and researchers should consider three interrelated and interdependent variables: 1) the target of the health education whether it be an individual person (P), the extended family(E), or the neighborhood (N); 2) the educational diagnosis for the health behavior; and 3) the cultural appropriateness of the health behavior. Population, Sample, Setting, Years: The sample consisted of a total of 14 African American adolescent mothers and their infants recruited during the years 2001-2002 from HUP, an urban tertiary care center (intervention group-n=7, control group-n=7). All mothers (ages 13-17) spoke English and had access to a phone. Outcome Variables: Maternal variables include initiation and duration of breastfeeding and increased appropriate feeding behaviors by adolescent mothers. The infant outcomes are human milk consumption and an improved nutritional intake. Methods: Breastfeeding and infant feeding practices were assessed by using an infant feeding inventory questionnaire completed by phone or in home visits every two weeks to determine all influences for feeding decisions, and all specifics related to feeding: breast feeding quantification (percentage of feeding from breast milk); infant formula selection, mixing techniques, storage of formula, and any additional foods added to formula or separately given to the infant. In addition, the MCNST kept detailed qualitative written logs on their interventions and their ability to utilize the principles of the PEN3 model. Findings: Four subjects in both the intervention group and the control group initiated breastfeeding. Duration of breastfeeding in the intervention group ranged from 7-183 days and in the control group from 3-140 days. Currently, this reflects truncated data, as one control subject is still breastfeeding and two experimental subjects are continuing to breastfeed. The infant feeding inventory provided data that allowed trends in infant feeding to be identified over time . Improper dilution of powdered formula, adding cereal to bottles, unsafe formula preparation and storage were commonly observed. For the intervention group, by having the MCNST in the home intervening with not only the adolescent but her extended family, as per the PEN3 model, we were able to decrease detrimental infant feeding practices. In fact, when reviewing the qualitative data, the most prevalent theme that arose was the role of family members and others in influencing infant feeding choice and practices. Conclusions: The MCNST is an effective team for intervening with the vulnerable population of African American adolescents and their infants. Home visitation is essential in order to establish rapport and assist the adolescent and her family in the context of their community in making healthy infant nutrition choices. The PEN3 model is an effective framework to use when working with the African American adolescent mother and her family. Implications: Using this information, health practitioners can begin to target specific strategies towards both the adolescent and her family to promote appropriate infant feeding practices. Home visitation is an important component of making an impact with the African American adolescent and should be further explored as an intervention modality.
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