Background Early breastfeeding cessation is a societal concern given its importance to the health of mother and child. More effective interventions are needed to increase breastfeeding duration. Prior to developing such interventions more research is needed to examine breastfeeding supports and barriers from the perspective of breastfeeding stakeholders. One such framework that can be utilized is the Socio-Ecological Model which stems from Urie Broffenbrenner’s early theoretical frameworks (1973–1979). The purpose of this study was to examine supports and barriers to breastfeeding across environmental systems. Methods A total of 49 representatives participated in a telephone interview in Nebraska, USA in 2019. Interviewees represented various levels of the model, based on their current breastfeeding experience (i.e., mother or significant other) or occupation. A direct content analysis was performed as well as a constant comparative analysis to determine differences between level representatives. Results At the Individual level, breastfeeding is a valued behavior, however, women are hindered by exhaustion, isolation, and the time commitment of breastfeeding. At the Interpersonal level, social media, peer-to-peer, and family were identified as supports for breastfeeding, however lack of familial support was also identified as a barrier. At the community level, participants were split between identifying cultural acceptance of breastfeeding as support or barrier. At the organizational level, hospitals had supportive breastfeeding friendly policies in place however lacked enough personnel with breastfeeding expertise. At the policy level, breastfeeding legislation is supportive, however, more specific breastfeeding legislation is needed to ensure workplace breastfeeding protections. Conclusion Future efforts should target hospital-community partnerships, family-centered education, evidence-based social media strategies and improved breastfeeding legislation to ensure breastfeeding women receive effective support throughout their breastfeeding journey.

BACKGROUND: Early breastfeeding cessation is a societal concern given the massive benefits associated with breastfeeding for mother and child. More effective interventions are needed to increase breastfeeding duration. Prior to developing such interventions more research is needed to examine breastfeeding supports and barriers from the perspective of breastfeeding stakeholders. One such framework that can be utilized is the Socio-Ecological Model which stems from Urie Broffenbrenner’s early theoretical frameworks (1973-1979). The purpose of this study was to examine supports and barriers to breastfeeding across environmental systems. METHODS: A total of 49 representatives participated in a telephonic interview. Interviewees represented various levels of the model based on their current breastfeeding experience (i.e., mother or significant other) or occupation. A direct content analysis was performed as well as a constant comparative analysis to determine differences between level representatives. RESULTS: Common supports identified by all interviewees were in-hospital breastfeeding education (organizational level) and the existence of breastfeeding protection legislation (policy level). Barriers identified by all interviewees included a lack of support (interpersonal level), lack of hospital resources (organizational level) and lack of specificity within the existing breastfeeding protection legislation (policy level). Other identified supports and barriers varied by representatives for each level of the model. CONCLUSION: Future efforts should target multiple levels of the SEM to eliminate the disparities between breastfeeding mothers’ perceptions and the stakeholders working to increase breastfeeding initiation and duration rate.

Objectives Nebraska Double Up Food Bucks (NDUFB) is an incentive program intended to increase the purchase of fresh fruits and vegetables (F&V) by Supplemental Nutrition Assistance Program (SNAP) recipients. The objective of the NDUFB program is to provide evidence and best practices for implementing a sustainable Policy, System, and Environmental (PSE) program to improve food security and diet quality among SNAP recipients. Methods Program site selection was dependent on the availability of funding, organizational capacity, and technology levels (POS machine) of the business, geographical location, and the capacity of local Extension staff in the area. At participating sites, SNAP recipients use the program by purchasing qualifying items with their federal benefits (EBT card) to earn NDUFB in equal amounts (in $2 increments) up to $20 per day. NDUFB can be used to purchase fresh fruits, vegetables, and herbs (F&V) at any participating site that day or any day in the future during site's normal business hours. Evaluation includes a mixed methods approach including customer, vendor and manager surveys, tracking purchases (customer logs and receipts) and redemptions (bank records) as well as qualitative feedback and satisfaction. Intervention took place June 2017- December 2019. Results On average, 74% of NDUFB customer survey respondents (n = 96) self-identified as food insecure. There were positive and significant (P < 0.05) correlations between how long respondents reported using NDUFB and the following: ease of using NDUFB to buy F&V and consumption of green leafy or lettuce salads, non-fried kinds of potatoes, and other vegetables. In total, SNAP recipients used NDUFB to purchase over $40,000 worth of F&V. This dollar amount is on top of the money they spent on F&V ($67,052) to earn NDUFB. All together, the program contributed to over $107,000 worth of F&V spending among 1342 families. Redemption rate for NDUFB is 80%, an industry leader in nutrition incentive programs. Conclusions The primary outcomes of the study include increased purchases of fresh fruits and vegetables, with an emphasis on locally grown produce among SNAP recipients. In addition, we show an increased use of the program by customers and retailers each year. Funding Sources Children's Hospital & Medical Center, CHI Health, SNAP-Ed, USDA NIFA.

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BACKGROUND: Early breastfeeding cessation is a societal concern given the massive benefits associated with breastfeeding for mother and child. More effective interventions are needed to increase breastfeeding duration. Prior to developing such interventions more research is needed to examine breastfeeding supports and barriers from the perspective of breastfeeding stakeholders. One such framework that can be utilized is Brofenbrenner’s Social Ecological Model. The purpose of this study was to examine supports and barriers to breastfeeding based on the Social Ecological Model. METHODS: A total of 49 representatives participated in a telephonic interview. Interviewees represented various levels of the model based on their current breastfeeding experience (i.e., mother or significant other) or occupation. A direct content analysis was performed as well as a constant comparative analysis to determine differences between level representatives. RESULTS: Common supports identified by all interviewees were in-hospital breastfeeding education (organizational level) and the existence of breastfeeding protection legislation (policy level). Barriers identified by all interviewees included a lack of support (interpersonal level), lack of hospital resources (organizational level) and lack of specificity within the existing breastfeeding protection legislation (policy level). Other identified supports and barriers varied by representatives for each level of the model. CONCLUSION: Breastfeeding organizations such as state and local coalitions should utilize this information to guide future strategy as well as develop interventions to eliminate the disparities between breastfeeding mothers’ perceptions and the stakeholders working to increase breastfeeding initiation and duration rate.