High School Breastfeeding Education In Southern Appalachia

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Breastfeeding rates in Northeast Tennessee are much lower than national rates and the Healthy People 2020 targets. The purpose of this research was to develop and evaluate a high school breastfeeding education intervention.


Literature review and interviews with regional stakeholders informed development of an educational intervention for high school students aimed at increasing breastfeeding rates in this southern Appalachian region. An interactive educational game was developed based on the Theory of Planned Behavior (TPB) to provide age-appropriate information about breastfeeding. Health science classes from two regional high schools participated. Prior to the game, the students were given a 35-question pre-survey to assess knowledge, attitudes, subjective norms, perceived behavioral control, and intentions, the tenets of the TPB. Education was delivered during a single class session and included information about related health careers. A post-survey was given two weeks after the educational intervention and compared to the pre-test results using t-tests and Cohen’s d to assess changes in mean summary scores of measures of the TPB tenets.


Surveys were completed by 107 students (75% female, 68% freshman/sophomores). Intention to breastfeed in the future significantly increased from 47.6% to 66.3% following the intervention. Measures of knowledge, attitudes, and perceptions of subjective norms related to breastfeeding were all significantly improved after the intervention. Levels of breastfeeding knowledge were low at baseline and demonstrated the largest improvement of all of the TPB tenets following the intervention (Cohen’s d = 1.6). Results were not found to vary significantly based on gender or grade level.


Breastfeeding education is not common in middle and high schools and published research evaluating the effects of breastfeeding education in schools is limited. While this study did not assess the impact of the intervention on breastfeeding rates, the changes observed suggest that an educational intervention based on the TPB may have the potential to increase the breastfeeding rates in the future. Limitations of the study include only having one session of education and a short follow-up period of only two weeks.


New Orleans, LA

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