Using Theory of Planned Behavior to Understand the Prevalence of Formula Feeding among Chinese Community in New York City - a Mixed-Methods Study

Background To date, the vast majority of studies on infant feeding behavior of Chinese population have been conducted in Asian and some western countries but not the U.S. As the fastest growing Asian subgroup and with the largest Chinese community outside of Asia, studies that focus on their health choices in the U.S. are long overdue. Where studies are available, the overseas Chinese population is often regarded as high formula feeding and low breastfeeding. Chinese mothers often cite family, cultural, and social expectations as the determining factors for their choice of infant feeding. Given the cultural beliefs and traditions of Chinese immigrant population in the U.S., this study argues for the importance of including the input of the overall community, as opposed to only mothers, as a more data-based explanation of the prevalence of formula feeding among the Chinese community in New York City, and in addition, why this community continues to accept formula feeding as the norm. Methods Guided by Theory of Planned Behavior, this study incorporated both quantitative and qualitative components. A total of 434 surveys and 20 in-person interviews were collected in Chinese populated areas in New York City. Results In examining the prevalence of formula feeding in the Chinese community, both quantitative and qualitative findings consistently identified the central role friends and family played in motivating certain groups to use formula. These less acculturated, educated, and China-born subgroups are likely to conform to the idea that breast milk supplemented by infant formula is necessary in order to meet the nutritional demand of a growing infant. For the first-generation immigrants who breastfeed for health benefits and tradition, their attitudes towards infant feeding shifted after seeing other formula-fed children in populated Chinese communities as evident by shorter breastfeeding durations for the child born in the U.S. as compared to previous child born in China. As for the second-generation, who are more acculturated and educated, although they are aware of the benefits of breastfeeding and intend to breastfeed, they are expected by the older generation to continue the formula feeding tradition in the family. Conclusion When investigating why infant formula remained as the popular choice of feeding and is often perceived as the norm by this community, the current study identified the psychosocial variables that motivated individual subgroups and the context underlay. The findings provided new insights to the current literature and are intended to help guide future studies and to develop educational policy interventions to improve the overall infant feeding experiences for the Chinese community in New York City.