Breastfeeding Initiation Commercial

Grant Proposal

Brittany Clawson

Lauren Harper

Rachel Lusk

Christie Saliba

Leigh Waldrop

Nutrition 412

Mrs. Bachman
Project Title: Breastfeeding Initiation Commercial

Grant Program: Nutrition 412 Graduate Students

Proposed Start Date: August 1, 2010

Proposed End Date: December 31, 2011

Funds Requested: $164,442.20

Project Director:

Kelly Martin, Ph.D., R.D.

Nutrition Services Director

University of Tennessee

1215 Cumberland Avenue

Knoxville, Tennessee 37916

Phone: 865-555-5555

Fax: 865-222-2222

E-Mail: kmartin@utk.edu

The award should be made to:

The University of Tennessee

Authorized Organizational Representative:

Michelle Adams, Dean of Research

Office of Research & Sponsored Programs

1215 Cumberland Avenue

Knoxville, Tennessee 37916

Phone: 865-777-7777

Fax: 865-444-4444
ABSTRACT

Introduction and goal

Breastfeeding initiation in early postpartum women in Knox County, Tennessee occurs at a rate of

68.5% (1). The goal of this program is to increase the rate of breastfeeding mothers in Knox County by

13.5%, to the Healthy People 2020 objective of 82% of women (2).

Methods

To increase current breastfeeding rates, a survey about breastfeeding will be developed and

distributed to Knox County hospitals and administered to pregnant women to identify their knowledge

about breastfeeding. Then, an educational breastfeeding commercial will be developed and aired on

Knox County TV stations.

Timeline

Commercial production will begin by August 31, 2011 and will air by December 31, 2011. By

December 31, 2012, the objective is to observe a 13.5% increase in breastfeeding initiation in Knox

County.

Personnel

Those involved with the planning of the commercial will include a project manager and commercial

coordinator. Other staff, including two actors, a director, a producer, a camera operator, and a make-up

artist, will be hired to produce the commercial.

Budget

The total required budget, including all direct and indirect costs, is $164,442.20.

Conclusion

In conclusion, this proposed grant aims to increase breastfeeding initiation rates in Knox County by

utilizing the unique advantage of advertising media on network television.

INTRODUCTION

Breastfeeding rates in the U.S. vary by not only by race and ethnicity, but also by geographic

location (3). The percentage of African-American mothers who attempt to breastfeed is 54.4%,

compared to 74.3% for Caucasian mothers, and 80.4% of Hispanic mothers (3). The south has some of

the lowest rates of breastfeeding, with less than 30% of infants in Tennessee breastfed at six months (3).

In Knox County, only 69% of new mothers intend to breastfeed their newborns (1). There are many

factors associated with low breastfeeding rates including lack of education, adequate resources, and

support (3). One method that may improve breastfeeding initiation rates is through commercial media,

which would allow for a larger number of mothers to be reached and educated on the infant and

maternal benefits of breastfeeding. The program’s specific aim is to have a direct impact on raising the

breastfeeding initiation rate in Knox County.

The following are the proposed program’s goal and objectives:

Program goal: Increase the rate of breastfeeding mothers in Knox County, TN.

Outcome objective: By December 31, 2012, there will be a 13.5% increase in early postpartum

breastfeeding initiation rates from 68.5% to the Healthy People 2020 objective of 82% among new

mothers in Knox County (1, 2).

Impact objective: By December 31, 2011, Knox County mothers will report increased awareness and

knowledge about making the decision of whether or not to breastfeed based on a survey data collected

in Knox County hospitals.

Process objective: By December 31, 2011, a 30-second commercial about breastfeeding and

child/maternal impacts will be developed and air on local Knox County TV stations during evening news

spots once a week for three months.

Structural objective: By August 31, 2011 writers, producers, a camera crew, and actors will be hired to

produce and direct an educational commercial about the benefits of breastfeeding.

LITERATURE REVIEW

Breastfeeding is an important part of postnatal care. Too often in today’s society, new mothers

fail to recognize the benefits of providing their newborns with breast milk (4). Increasing breastfeeding

practices, including rates of initiation, length of duration, and exclusivity of breastfeeding is essential for

the wellbeing of mothers and their children. Postnatal care providers need to find ways to compete with

baby formulas and other forms of neonatal nourishment. Television commercials provide a potential

avenue to initiate the change from formula to breastfeeding.

Healthy People 2020 set national goals for the initiation and continuation of breastfeeding (2).

Currently, 75% of babies born in the US are initially breastfed, but rates decrease to 43% by 6 months

and to 22% by 12 months (2). Healthy People 2020 goals are for 82% of mothers to initiate breastfeeding

and for 61% and 34% to continue to breastfeed at 6 and 12 months, respectively (2). The American

Academy of Pediatrics recommends that infants be exclusively breastfed for the first 6 months of life,

but only 13% of American infants are currently exclusively breastfeeding at 6 months (5).

The benefits of breastfeeding are tremendous for both the infant and mother. Studies have

provided strong evidence that breastfed infants have a decreased risk of infectious diseases including

meningitis, diarrhea, diabetes, obesity, asthma and sudden infant death syndrome (SIDS) (5).

Furthermore, mortality rates in the US are reduced by 21% in infants that receive human milk (6).

Research has also found that there is a decreased risk for ovarian and breast cancer and a possible

decrease in hip fractures and osteoporosis for mothers whom breastfed (5). Breastfeeding has the

potential to decrease annual health care costs in the US by $3.6 billion as well as decrease parental
employee absenteeism, reduce waste caused by disposal of formula bottles, and decrease production

costs of formula (5).

Measures need to be taken in order to increase breastfeeding rates in new mothers. Although

important, education alone does not guarantee behavioral change. Education gives people knowledge of

the need for change and teaches them the benefits of making a change. Additionally, the active

engagement provided by commercial advertisements would be optimal for increasing awareness and

initiation rates of breastfeeding. Snyder et al (7) conducted a meta-analysis on the effect of health

campaigns on behavior change in the United States and found that 9% more people followed the

healthy behavior after the campaign than before. These results indicate that advertising can have a

strong effect on changing behaviors (7).

The formula industry has increased its customer base through its use of aggressive marketing

strategies that include direct advertising and endorsements by health care providers (8). The use of

these same strategies by public health agencies to encourage breastfeeding may counter the effects that

the formula industry has created and increase rates of breastfeeding in the U.S.

The U.S. has a long way to go to meet the Healthy People 2020 and American Academy of

Pediatrics goals and recommendations for breastfeeding (2,5). Commercials promoting breastfeeding

have the potential to aid with increasing the breastfeeding rates in the U.S. and achieving the national

goals. The commercial advertisements produced by this grant will raise awareness about the benefits of

breastfeeding, which is expected to result in an increase in the amount of new mothers initiating

breastfeeding and well as the number who continue to breastfeed for a longer duration.
 PROJECT NARRATIVE

Methods/Procedures
A. Survey for new Knox County mothers
To collect baseline data to determine the level of knowledge about breastfeeding in pregnant women

in Knox County, a survey will be distributed at Knox County hospitals to pregnant women in their last

trimester. This survey will evaluate knowledge of breastfeeding as well as how confident the mothers

feel about making the decision at whether or not to their baby. The results from this survey will be used

to develop the materials for the commercial.

B. Development of breastfeeding educational commercial

The first step in creating the commercial will be to hire the appropriate staff, including writers,

producers, a camera crew, and actors (women, infants, and a narrator). The staff, along with the grant

investigators, will develop an educational commercial about the benefits of breastfeeding and will

address information collected from the survey of Knox County mothers. The narrative will include

information about the benefits of breastfeeding for both the baby and mother.

C. Securing of commercial slot on local Knox County TV news stations

Evening commercial time slots will be obtained for the breastfeeding commercial on local Knox

County TV news stations. The commercial will be aired by December 31, 2011 and will appear in evening

news spots once a week for 3 months.

Timeline
Task Year 01 Year 02

Study Preparation 08/10-11/10

Production of Survey Materials 10/10-12/10

Obtain Survey Results 01/11 – 03/11

Analyze Survey Results 03/11 – 06/11

Recruitment of Staff 06/11 – 08/11

Produce Commercial 08/11 – 12/11

Air Commercial on Knox County News Stations 12/31/11

Obtain Survey Results from follow up survey 04/11 – 07/11

Data Management and Publishing 08/11-12/11

Outcomes/Deliverables

This project will produce a TV commercial aimed at increasing knowledge about breastfeeding in

pregnant women in Knox County. The goal of the program is to observe an increase in awareness and

knowledge about breastfeeding, which will lead to an increase in breastfeeding initiation in new

mothers in Knox County.

Evaluation

To determine whether program objectives are being met, there will be a pre-test, post-test study

design. Before the commercial airs, the pre-test will be given to a random sample of soon-to-be

mothers. After the commercial airs for 3 months, the post-test will be given to a different random

sample of pregnant women to assess their knowledge about and confidence towards breastfeeding.

Dissemination

The results of this project will be published in a newsletter and shared with the American Pregnancy

Association and the National Women’s Health Information Center. The outcomes will also be submitted

as a manuscript to the Journal of the American Dietetic Association. These results will inform the

organizations whether or not commercials are an effective medium to educate new mothers about

breastfeeding.
PERSONNEL

Senior Personnel

The Project Director is Kelly Martin, Ph.D., R.D. Dr. Martin currently serves as the Nutrition Services

Director at the University of Tennessee. Before coming to the University of Tennessee, Dr. Martin

completed her undergraduate degree in Nutrition Science at the University of California. Dr. Martin then

completed the dietetic internship program at the University of Tennessee. After obtaining certification

as a Registered Dietitian, Dr. Martin worked as a RD in the Knox County Department of Health for five

years and the Women, Infants, and Children (WIC) office for three years. After gaining vast nutrition

experience in the Knoxville community, Dr. Martin returned to the University of Tennessee to complete

her Ph.D. in Community Nutrition. While completing her degree, Dr. Martin worked extensively with

several researchers in the Community Nutrition department to conduct research about breastfeeding.

Dr. Martin is now a full-time nutrition researcher at the University of Tennessee, and her field of interest

is maternal and infant health.

The Commercial Coordinator is Andrew Jones. Mr. Jones completed his undergraduate degree at

Middle Tennessee State University with a major in Electronic Media Management. Mr. Jones then

sought his Master’s degree at Middle Tennessee State University in Mass Communication. After

completing his degree, Mr. Jones became employed by WSMV, a local Nashville, Tennessee television

news station as the producer of the local evening news. While in this position, Mr. Jones was also in

charge of recruiting commercial sponsors for advertising times on WSMV. Mr. Jones worked in this

position for ten years, and he is now a producer for the Knoxville news station WBIR.

Other Personnel
 For this commercial, other employees, including two actors, a director, a producer, a make-up artist,

and a camera-operator will also be hired.

BUDGET
Direct Costs

A. Personnel Wages:
1. Senior Personnel
a. Program Director $11,430
b. Commercial Coordinator $15,521
2. Other Personnel
a. Actor $8,788
b. Actor $8,788
c. Camera Operator $6,380
- Total $50,907

B. Fringe Benefits: $12,217

C. Equipment:
1. Lights $7,000
2. Camera System $50,470
3. Set $5,000
- Total $62,470

D. Material & Supplies:

- Actor Wardrobe $200
-Total $200

E. Other Direct Costs: $700

F. Total- Direct Cost $126,494

Indirect Costs (30% of direct cost) $37,948.20

Total Cost: $164,442.20

Budget Justification

A: Personnel Wages:
 1. Program director: 20% time for a total of $11,430 (9). Responsibilities include implementing

a plan for a breastfeeding education commercial.

2. Commercial coordinator: 20% time for a total of $15,521 (9). Responsibilities include

coordinating a breastfeeding education commercial.

3. 2 actors: 20% time each for a grand total of $17,576 (9). Responsibilities include portraying the

roles of breastfeeding mothers in need of breastfeeding education

4. Camera operator: 20% of time for a total of $6,380 (9). Responsibilities include operating

professional camera equipment.

B: Fringe benefits: Fringe benefits are 24% for 1 project director, 1 commercial coordinator, 2

actors, and 1 camera operator @ .24 x (11,430 + 15,521 + 8,788 + 8,788 + 6,380) for a total of

$12,217.

C: Equipment: 1 Panasonic Multi-Format HD/SD Studio Camera System @ $50,470 (10). 1

Chimera lighting system @ $7,000 (11).

The set for the commercial will be rented from a local theatre company.

C: Materials and Supplies: It was estimated that each actor would require $100 for the attire

needed for the production of the commercial.

D: Other Direct Costs:

- Delivery and Postage- $400
- Telephone & Fax- $200
- Printing Supplies- $100

E: Total Direct Cost: Total costs for A through D equals $126,490

Indirect Costs
Indirect costs equals $37,948.20 (30% of total direct cost)

Total Cost
Total direct and indirect costs equal $164,442.20 ($126,494+ $37,948.20)
 REFERENCES

1. Knox County Health Department. 2010 Community Health Status Assessment.

http://www.healthyknox.org/images/chsa_full_report.pdf. Accessed March 20, 2011.

2. U.S. Department of Health and Human Services. Office of Disease Prevention and Health

Promotion. Healthy People 2020 Breastfeeding Objectives.

http://www.healthypeople.gov/2020/topicsobjectives2020/objectiveslist.aspx?topicid=26.

Accessed April 6, 2011.

3. CDC Centers for Disease Control and Prevention, National Center for Health Statistics. U.S.

Department of Health and Human Services, Centers for Disease Control and Prevention.

Breastfeeding Report Card-United States, 2010.

http://www.cdc.gov/breastfeeding/data/reportcard.htm. Accessed April 13, 2011.

4. Shannon T, O’Donnell MJ, Skinner K. Breastfeeding in the 21 st century: overcoming barriers

to help women and infants. Nurs Womens Health. 2007;6:570-575.

5. Gartner LM, Morton J, Lawrence RA, Naylor AJ, O’Hare D, Schanler RJ, Eidelman AI;

American Academy of Pediatrics Section on Breastfeeding. Breastfeeding and the use of

human milk. Pediatrics. 2005;15:496-506.

6. Lamaze International. Position paper: breastfeeding is priceless: no substitute for human

milk. 2010.
 http://www.lamaze.org/AboutLamaze/Policies/PositionPaperBreastfeedingisPriceless/tabid

/585/Default.aspx. Accessed April 11, 2011.

7. Snyder L, Hamilton M, Mitchell E, Kiwanuka-Tondo J, Fleming-Milici F, Proctor D. A meta-

analysis of the effect of mediated health communication campaigns on behavior change in

the United States. J Health Commun. 2004;9:71-96.

8. Kaplan D, Graff K. Marketing Breastfeeding- Reversing corporate influence on infant feeding

practices. J Urban Health: Bulletin of the New York Academy of Medicine. 2008;85:486-504.

9. Salary Listings. http://www.salary.com. Accessed April 12, 2011.

10. Panasonic. Camera Price Listings. http://www.panasonic.com. Accessed April 12, 2011.

11. Chimera Lighting. Lighting Equipment Price Listing. http://www.chimeralighting.com.

Accessed April 12, 2011.