817516

research-article2018
JHLXXX10.1177/0890334418817516Journal of Human LactationHeathman et al.

Original Research
Journal of Human Lactation

Relationship among Breastfeeding

2019, Vol. 35(4) 782­–789
© The Author(s) 2018
Article reuse guidelines:
Exposure, Knowledge, and Attitudes in sagepub.com/journals-permissions
DOI: 10.1177/0890334418817516
https://doi.org/10.1177/0890334418817516

Collegiate Males Residing in East Texas journals.sagepub.com/home/jhl

Leslie Heathman, MS, RDN, LD1, Crystal Clark Douglas, PhD, RDN, LD2,
and Simone P. Camel, PhD, RDN, LD2

Abstract
Background: Researchers exploring breastfeeding attitudes and knowledge among women suggest the decision to breastfeed
is influenced by the male partner, yet few studies address males. Because collegiate males will soon enter fatherhood,
assessment of their attitudes and knowledge may inform interventions aimed at increasing intention to breastfeed.
Research aim: This study aimed to describe collegiate males’ exposure to, attitude toward, and knowledge about
breastfeeding.
Methods: A cross-sectional online survey was used with males ≥ 18 years of age enrolled at a Texas public university.
Attitude indices measured included social limitations, public displays of breastfeeding, and employer accommodations.
Descriptive statistics, correlational and regression analyses were employed.
Results: The participants’ (N = 949) average age was 25.48 years; > 80% reported not being fathers. Exposure to
breastfeeding was high; > 80% witnessed breastfeeding and/or had someone close breastfeed. High attitude scores indicated
social acceptability of breastfeeding. Knowledge appeared limited: only 16% identified the recommendation of exclusive
breastfeeding for the first 6 months of life; > 50% overlooked the reduced risk for overweight/obesity, ear infections,
diarrhea, or food allergies. Correlations between knowledge, exposure, total attitude, and index scores were positive
(p < .01) except for the public displays index. Stepwise multiple regression determined that breastfeeding exposure,
knowledge scores, and father’s educational level predicted total attitude score, (R2 = 0.13, F (3,851) = 44.02, p < .01).
Conclusion: The positive attitudes outcome among this male population is promising for breastfeeding support and
advocacy. Education efforts improving knowledge will likely increase behavioral intention, resulting in increased breastfeeding
rates and duration.

Keywords
Breastfeeding barriers, breastfeeding knowledge, breastfeeding promotion, breastfeeding support, social support.

Background decreased healthcare program costs and removal of the

It is well established that breastfeeding offers benefits to
both mother and infant. For the mother, breastfeeding
provides protection against ovarian and breast cancer
(Chowdhury et al., 2015), increases child spacing (Domer
et al., 2015), and allows for a quicker return to pre-preg-
nancy body weight (Dujmović, Kresić, Mandić, Kenjerić &
Cvijanović, 2014). For the infant, human milk provides
optimal nutrition (Reifsnider et al., 2018; Andreas et al.,
2015; Spevacek et al., 2015), complete with immunologic
advantages (Parra-Llorca et al., 2018; Pedersen et al., 2016)
that reduce infectious diseases and, ultimately, infant mor-
tality (American Academy of Pediatrics, 2012; WHO,
2017). The benefits of human milk extend to the commu-
nity as human milk offers economic and environmental
advantages over human milk substitute feeding, including
need for disposable containers for transport (American
Academy of Pediatrics, 2012; World Health Organization,
2017). For these reasons, organizations, including the
American Academy of Pediatrics (AAP, 2012), the
American College of Obstetricians and Gynecologists
1
Huntsville Memorial Hospital, Food & Nutrition Services, Huntsville, TX,
USA
2
Sam Houston State University, College of Health Sciences, Family and
Consumer Sciences, Huntsville, TX, USA
Date submitted: April 3, 2018; Date accepted: November 13, 2018.
Corresponding Author:
Simone P. Camel, PhD, RDN, LD, Sam Houston State University, College
of Health Sciences, Family and Consumer Sciences, Department of 700
University Avenue, Box 2177, Huntsville, TX 77341-2176, USA.
Email: spc022@shsu.edu
Heathman et al. 783
(2016), Centers for Disease Control and Prevention (CDC,
2017), and the World Health Organization (WHO, 2017)
support and advocate for exclusive breastfeeding.
The AAP (2012) recommends exclusive breastfeeding for
the first six months of life, followed by continued breastfeed-
ing with the introduction of complimentary foods for the first
year of life or longer. Healthy People 2020, the most recent
objective plan for U.S. health, established target rates for
breastfeeding initiatives (Office of Disease Prevention and
Health Promotion, 2016). As of 2015, four of five infants
(83.2%) were breastfed (CDC, 2018). This rate has increased
and exceeds the national goal of 81.9%. However, breast-
feeding rates fall dramatically over time; only 57.6% of
infants are breastfed at 6 months of age, less than the national
goal of 60.6% (CDC, 2018). Similar findings are evident in
the state of Texas, the second most populated state in the
union. Breastfeeding initiation rates meet the target goal of
81.9%; however, rates at 6 months of age are 56.6%, below
the target goal (CDC, 2018). Researchers have identified that
women may intend to breastfeed but sometimes encounter
barriers along the way. Barriers to breastfeeding initiation
include young age, low education, obesity, and non-Hispanic
ethnicity. Additional barriers in the United States include
limited provider knowledge, marketing of human milk sub-
stitute feedings, employment requirements, and limited fam-
ily and social support (Sriraman, 2017). Given the numerous
health benefits of breastfeeding, it is critical that action is
taken to minimize barriers that preclude women from partici-
pating in this natural form of infant feeding.
The decision to breastfeed is often considered the moth-
er’s responsibility and is likely determined in the prenatal
period. In a cross-sectional survey of male and female ado-
lescents (12–18 years of age, N = 1064), including students
in Texas (n = 170), Swanson and colleagues (2017) found
that parenting beliefs and gender norms related to parenting
roles influenced breastfeeding intentions. Findings support
the need to explore and leverage factors impacting on the
breastfeeding intentions of males prior to fatherhood.
The mean age of fatherhood in the United States has risen
to 30.9 years of age (Khandwala, Zhang, Lu & Eisenberg,
2017). Four out of five males will become fathers at some
point (CDC, 2015). Therefore, most collegiate males have
yet to father a child or confront the debate of human milk
substitute feeding versus breastfeeding. Despite male part-
ners having an influential role in the decision to breastfeed
(Mueffelmann, Racine, Warren-Findlow & Coffman, 2015;
Sherriff, Hall & Panton, 2014), the body of research focused
on male attitudes toward breastfeeding remains limited
(Sherriff et al., 2014). Because collegiate males will likely
enter fatherhood within the next decade, it is important to
assess their breastfeeding knowledge and attitudes in order
to develop effective interventions that result in positive sup-
port for breastfeeding.
The aim of this study was to describe collegiate males’
exposure to, attitude toward, and knowledge about
Key Messages
•• Male attitude toward breastfeeding has a strong
impact on the woman’s decision to breastfeed; col-
legiate-age male attitude toward breastfeeding is
seldom examined.
•• Limited knowledge regarding the health benefits of
breastmilk was reported; collegiate males report high
social acceptance of breastfeeding and expect
employer accommodations to support breastfeeding.
•• Overall, collegiate males report a positive attitude
toward breastfeeding, suggesting these soon-to-be
fathers may endorse breastfeeding.
breastfeeding, as well as the relationship among these vari-
ables in the setting of a public university in East Texas.
Methods
Design
A prospective cross-sectional online survey design was
used. This design was chosen as descriptive data would
assist with characterizing the population for future plan-
ning of interventions. The Institutional Review Board of
Sam Houston State University approved this study prior to
data collection.
Setting
This study took place at Sam Houston State University
(SHSU), a public university located in rural East Texas,
between Houston and Dallas in the United States of America.
SHSU is classified as a doctoral research university and is
designated as a community-engaged university by the
Carnegie Commission on Higher Education. The student
enrollment is approximately 21,000; approximately 38.5%
are males. More than half of the student body is comprised of
first-generation college students (SHSU, 2017). SHSU is
located approximately one hour from a major medical center
and national survey measuring maternity practices ranks
Texas 34th out of 53 (CDC, 2016).
Sample
The target population for this study was collegiate males. A
convenience sample of all enrolled collegiate males was
recruited. Inclusion criteria included those who self-identi-
fied as male and were 18 years of age or older. Males under
18 years of age were excluded. Participation was encouraged
by offering an opportunity to win a $20 gift card.
There were a total of 960 responses; a 13.19% response
rate. Eleven participants were removed because they did not
select male gender (n = 7) or reported being under 18 years
784 Journal of Human Lactation 35(4)

Table 1.  Percent Agreement with Attitudes Scale Items (N = 949).

Strongly Agree Agree Neutral Disagree Strongly Disagree

n (%) n (%) n (%) n (%) n (%)
Social limitations of breastfeeding index
  Breastfeeding makes a woman’s breasts look unattractive 13 (1.4) 45 (4.7) 279 (29.4) 338 (35.6) 229 (24.1)
later in life
  A mother cannot breastfeed her baby and work outside 10 (1.1) 24 (2.5) 77 (8.1) 334 (35.2) 458 (48.3)
the home
  Breastfeeding will tie a mother down and interfere too 8 (0.8) 24 (2.5) 86 (9.1) 380 (40.0) 404 (42.6)
much with her social life
  I am embarrassed when a woman who I do not know 22 (2.3) 56 (5.9) 101 (10.6) 276 (29.1) 446 (47.0)
breastfeeds in front of me
  Mothers should only breast feed in their own homes 16 (1.7) 32 (3.4) 102 (10.7) 282 (29.7) 467 (49.2)
Public displays of breastfeeding index
  It is appropriate to show a woman breastfeeding her baby 227 (23.9) 286 (30.1) 258 (27.2) 81 (8.5) 45 (4.7)
on a magazine cover
  It is appropriate to show a woman breastfeeding her baby 215 (22.7) 253 (26.7) 274 (28.9) 103 (10.9) 50 (5.3)
on a billboard or poster
  It is appropriate to show a woman breastfeeding her baby 228 (24.0) 315 (33.2) 213 (22.4) 96 (10.1) 42 (4.4)
on a television show that you would watch with your
children or grandchildren
Attitudes toward employer accommodations index
  Employers should provide flexible work schedules, such as 305 (32.1) 358 (37.7) 141 (14.9) 57 (6.0) 32 (3.4)
additional break times, for breastfeeding mothers to feed
their babies or pump breast milk
  Employers should provide a private room, such as a lounge 226 (23.8) 272 (28.7) 223 (23.5) 120 (12.6) 52 (5.5)
or break room, for breastfeeding mothers to feed their
babies or pump breast milk

Note. The social limitations of breastfeeding subscale consisted of 5 items (α= .78), the public displays of breastfeeding subscale consisted of 3 items
(α= .92), and the attitudes toward employer accommodations subscale consisted of 2 items (α= .75). Missing individual statement responses range from
45 to 56 or .05–.06 percent.

of age or 99 years old (n = 4). Once these responses were
removed, the final sample size for analysis was 949.
Measurement
A questionnaire was developed using Qualtrics software
(Qualtrics, Provo, UT). It consisted of 31 items: 11 demo-
graphic items; 11 attitude items, of which 10 were from the
2007 Texas Behavioral Risk Factor and Surveillance System
(BRFSS; Vaaler et al., 2011) and one was developed by the
researchers; five knowledge; and four exposure questions.
The ten statements from the 2007 Texas BRFSS were divided
into three indices that can be seen in Table 1. The one ques-
tion developed by the researchers was “It is appropriate for a
mother to breastfeed in a public women’s restroom”. This
question was not included in the tool reliability or outcome
analyses. Cronbach’s alpha was calculated to measure the
reliability of the BRFSS indices in this sample. The social
limitations index had a Cronbach’s alpha of .78, the public
displays index had a Cronbach’s alpha of .92, and the atti-
tudes index had a Cronbach’s alpha of .75 in this sample.
The five knowledge and four exposure items delineated
in the supplementary material were created by the
researchers based on current breastfeeding guidelines
(AAP, 2012; American Association of Family Physicians,
n.d.). Specifically, demographic items included gender,
age, race, ethnicity, mother and father’s highest education
level, current area of academic study, fatherhood status,
and sibling rank. The 10 BRFSS attitude statements were
divided into three indices: Social limitations of breast-
feeding, public displays of breastfeeding, and employer
accommodations toward breastfeeding (Vaaler, et al.,
2011). For each attitude statement, participants rated their
opinion on a five-point Likert scale ranging from strongly
disagree to strongly agree. Statements in the indices of
public displays of breastfeeding and employer accommo-
dations toward breastfeeding were reverse coded making
the higher scores reflect more positive attitudes towards
breastfeeding. Previous researchers have illustrated the
reliability of this BRFSS tool, with each index having a
Cronbach’s alpha >.69 (Vaaler et al., 2011).
To assess knowledge, participants were asked if they
agreed or disagreed with statements regarding infant diar-
rhea, the affordability of breastfeeding, the composition of
human milk, exclusive breastfeeding duration recommenda-
tions, and benefits associated with breastfeeding.
Heathman et al. 785

To assess exposure, participants were asked whether they Table 2.  Demographic Characteristics of Sample (N = 949).
had been breastfed, had ever witnessed anyone breastfeed,
Collegiate Male Characteristics n (%)
knew close friends or family who had breastfed, and if they had
a
ever discussed breastfeeding. These items required a “yes, no” Race, Ethnicity
or “I don’t know” selection; the amount or delivery method was   American Indian or Alaska Native, Hispanic 18 (2.0)
not defined (Noel-Weiss, 2012). The questions were chosen by   American Indian or Alaska Native, not Hispanic 8 (.08)
the researchers to assess participant exposure and deemed   Asian, Hispanic 1 (.01)
appropriate after reviewing similar literature (Van Wagenen,   Asian, not Hispanic 29 (3.0)
Magnusson & Neiger, 2015; Vari et al., 2013). Supplementary   Black or African American, Hispanic 9 (1.0)
material includes a complete copy of the survey.   Black or African American, not Hispanic 120 (12.6)
  White, Hispanic 185 (19.5)
  White, not Hispanic 572 (60.3)
Data Collection College of Studyb
  Business Administration 152 (16.0)
Data collection began in August 2017 and concluded in
  Criminal Justice 166 (17.5)
September 2017. The SHSU Division of Information
 Education 46 (4.8)
Technology generated a contact list of all males enrolled at   Fine Arts and Mass Communication 102 (10.7)
SHSU. Three separate recruitment emails, containing a link   Health Sciences 95 (10.0)
to the questionnaire, were sent biweekly to 7,277 males.   Humanities and Social Sciences 116 (12.2)
Participants provided consent and confirmed their age prior to   Science and Engineering Technology 229 (24.1)
receiving access to the questionnaire. Collected data remained Mother’s Highest Education Levelc
in the Qualtrics database until the close of the study, and was   Did not complete high school 53 (5.6)
subsequently downloaded into IBM Statistical Package for   High school/GED 201 (21.2)
the Social Sciences (SPSS) software for analysis (IBM Corp,   Some college 210 (22.1)
2013). The ability to connect questionnaire responses to IP   Associate’s Degree 94 (9.9)
addresses was disabled to protect the anonymity of the par-   Bachelor’s Degree 264 (27.8)
ticipants. All research data was downloaded to a password   Master’s Degree 89 (9.4)
protected computer from Qualtrics and kept secure in a locked  Ph.D. 16 (1.7)
office. Data access was limited to the primary researchers.   Not Sure 12 (1.3)
Father’s Highest Education Leveld
  Did not complete high school 84 (8.9)
Data Analysis   High school/GED 209 (22.0)
Descriptive statistics including mean, range, and frequencies   Some college 175 (18.4)
  Associate’s Degree 63 (6.6)
were calculated. Items were first summed to create a score
  Bachelor’s Degree 247 (26.0)
for attitude, knowledge, and exposure. Pearson correlations
  Master’s Degree 93 (9.8)
and two-tailed, multiple regression were used to assess the
 Ph.D. 29 (3.1)
relationships among the variables. For all analyses, an alpha   Not Sure 36 (3.8)
≤ .05 was used to indicate statistical significance. Fatherhood Statuse
  Father, present throughout infancy 157 (16.5)
Results   Father, not present throughout infancy 14 (1.5)
  Not a father 763 (80.4)
Participant Demographics and Characteristics
Note. aMissing values = 8; bMissing values = 43; cMissing values = 10;
The average age of the participants was 25.48 years d
Missing values = 13; eMissing values = 15.
(SD = 8.30). Most of the participants identified as Caucasian
and reported they had yet to father a child. Approximately someone breastfeed. Eighty percent (n = 744) reported having
two thirds of participants’ parents had some college educa- a close friend or family member breastfeed. Exposure,
tion; approximately 28% had earned a Bachelor’s degree. assessed by whether the topic of breastfeeding had ever sur-
Refer to Table 2 for additional sociodemographic character- faced in conversation, was also fairly high. Two out of three
istics of this sample. participants reported having engaged in a discussion about
breastfeeding. Interestingly, nearly 21% of participants were
Exposure unsure whether they were breastfed as infants.
Mean scores were calculated for the variables of exposure,
attitude, and knowledge (Table 3). Prior exposure to breast-
Attitude
feeding was relatively high for this population. Approximately The high social limitations of breastfeeding index score sug-
90% (n = 824) of the participants reported witnessing gests the participants’ perceived a minimal amount of social
786 Journal of Human Lactation 35(4)

Table 3.  Mean Scores of Survey Variables (N = 949).

Variable n M (SD)
a
Exposure 925 2.93 (1.06)
Knowledgeb 909 2.01 (1.05)
Social limitations of breastfeeding indexc 899 20.88 (3.31)
Public displays of breastfeeding indexd 894 10.84 (3.12)
Attitudes toward employer accommodations indexe 893 7.51 (1.98)
Total attitudef 893 39.24 (6.64)

Note. Missing values on variable scores range from 24 to 56 or .03–.06 percent.

a
Exposure scores ranged from 0–4 with higher scores indicating more exposure. bKnowledge scores ranged from 0–5 with higher scores indicating more
knowledge. cSocial limitations scores ranged from 5–25 with higher scores indicating more positive attitudes. dPublic displays index scores ranged from
3–15 with higher scores indicating more positive attitudes. eEmployer accommodation index scores ranged from 2–10 with higher scores indicating more
positive attitudes. fTotal attitude scores ranged from 10–50 with higher scores indicating more positive attitudes.

Table 4.  Correlations Between Knowledge, Exposure, Total Attitude, and Index Scores (N = 949).

Employer
Social Limitations Public Displays Accommodations Total
Exposure Knowledge Index Index Index Attitude
Exposure -  
Knowledge .288** -  
Social Limitations Index .275** .163** -  
Public Displays Index .209** .134** .480** -  
Employer Accommodations Index .208** .210** .402** .338** -  
Total Attitude .298** .207** .845** .811** .658** -
Fatherhood .158** .293** .083* .031 .147** .100*

Note: Missing scores range from 24 to 56 or .03–.06 percent.

*p < .01; **p < .001.

limitations for breastfeeding. The social limitations of breast-
feeding index had the highest mean index score, indicating
the participants’ possess a high social acceptability of breast-
feeding. More than 80% of participants disagreed or strongly
disagreed that breastfeeding would prevent a mother from
working outside the home. Nearly 70% were in agreement
that employers should provide flexible work schedules to
allow for mothers to pump, while 52.5% agreed that employ-
ers should provide a private space for the breastfeeding
mother. More than half responded that it was appropriate for
a woman to breastfeed on a family television show. Moreover,
nearly 60% disagreed that breastfeeding makes a woman’s
breasts look unattractive later in life. Disagreement with
public displays of breastfeeding were only recorded by
approximately 15% of the participants. Stepwise multiple
regression analysis determined that breastfeeding exposure,
knowledge scores, and father’s educational level predicted
total attitude score, (R2 = 0.13, F (3,851) = 44.02, p < .01).
Knowledge
Despite increased exposure, breastfeeding knowledge among
participants appeared limited. Most participants (90%) were
able to identify human milk as an affordable option for infant
nourishment; however, 33% were unsure if the nutrient com-
position of human milk and human milk substitute were
identical. Further indicators of knowledge deficit included
the failure to recognize the benefits of breastfeeding for the
infant. For example, the health benefits of human milk
including reduced risk for overweight and obesity, ear infec-
tions, and food allergies were overlooked by more than 50%
of participants. Nearly three-fourths (72%) failed to distin-
guish the relationship between human milk and diminished
risk of the occurrence of diarrhea. The AAP recommendation
for exclusive breastfeeding for the first 6 months of life was
identified correctly by only 16.12% (n = 153). A two-tailed,
stepwise multiple regression determined that fatherhood sta-
tus, breastfeeding exposure score, total attitude score, and
age predicted the knowledge score (R 2 = 0.17, F (4,850)
= 42.69, p > .01). Race and parental education were not indi-
cators of breastfeeding knowledge.
Correlations between knowledge, exposure, total attitude,
and index scores can be seen in Table 4. All but one of the cor-
relations were found to be positively statistically significant
(p < .01). The only non-significant correlation found was
between the public displays index score and fatherhood status.
Heathman et al. 787
Discussion
Although the advantages of human milk are numerous and
afford benefits to both mother and infant, human milk substi-
tute is an acceptable form of infant feeding in our society.
The complex decision to breastfeed is generally made before
pregnancy or within the first trimester, and is considered to
be the woman’s responsibility. Nonetheless, this complex
decision is shaped by a number of factors including demo-
graphics, socioeconomics, father’s pregnancy intention, and
modifiable behaviors (Cabieses, Waiblinger, Santorelli &
McEachan, 2014; Wallenborn, Masho & Ratcliffe, 2017).
This cross-sectional study assessed collegiate males’
exposure, attitudes, and knowledge, towards breastfeeding.
To our surprise, this relatively young population reported a
high exposure to breastfeeding, with the majority reporting
being breastfed as an infant. The reported rate of breastfeed-
ing from this sample exceeded the national rate 25 years ago;
however, it failed to meet the prevailing Healthy People
2000 target of 75% (CDC, 1993) nor does it meet the current
Healthy People 2020 target of 81.9% (CDC, 2018). The true
rate may have been even higher as one in five participants
reported that they were unsure whether or not they had been
breastfed as an infant. High exposure to breastfeeding was
also supported by the fact that the majority of participants
reported having either a family member or close friend
breastfeed or being directly involved in a conversation about
breastfeeding. This is consistent with previous findings in
college males in a study by Jefferson and colleagues (2017).
Despite the high scores for exposure, breastfeeding
knowledge scores were relatively low. Participants recog-
nized the affordability of breastfeeding, yet many were
unaware that the nutrition offered by human milk is superior
to human milk substitute feeding. Also, the inability of the
men in the sample to recognize the multiple health benefits
of human milk is worrisome. Perhaps the influence of human
milk substitute marketing is partially to blame for this defi-
ciency. Nearly half of the participants reported they did not
know about the AAP recommendations for exclusive breast-
feeding. These findings may, in part, help explain the low
breastfeeding initiation rates and high early discontinuation
rates observed in Texas. Future interventions aimed at
increasing knowledge should include a more comprehensive
level of content as knowledge appears limited.
A high social acceptance of breastfeeding among males,
most of whom have yet to father a child, was confirmed with
the high attitudes scores. Most participants reported that
breastfeeding would not interfere with a woman’s social life
or prevent her from maintaining a career outside the home,
elucidating the positive attitudes toward employer accommo-
dations. Attitudes, particularly regarding the public display of
breastfeeding, were generally positive as nearly half of the
participants agreed that the public display of breastfeeding,
whether on a magazine, billboard, or family TV show, was
acceptable. The social acceptance of breastfeeding in this
collegiate population is higher than previously recorded
among older men (Vaaler et al., 2011). The researchers believe
this distinction may be due to the education level of this popu-
lation, as well as that of their parents, as it is well documented
that knowledge influences breastfeeding. Furthermore, higher
acceptance rates of breastfeeding within the Caucasian popu-
lation have been reported (Jefferson, 2017; Van Wagenen,
Mangusson & Niger, 2015).
In addition to the social acceptance of breastfeeding, it
appears that participants also expect employers to make
accommodations for the breastfeeding mother. Given the
high percentage of male participants who stated that breast-
feeding and working outside the home was feasible, this out-
come is expected. Although it is speculative, this attitude
may serve as a good indicator of their stance on breastfeed-
ing in the future, as some are likely to pursue advisory posi-
tions following college. Attitudes, particularly regarding the
public display of breastfeeding, were positive. Participants
agreed that the public display of breastfeeding, whether on a
magazine, billboard, or family TV show, were similarly
acceptable. Acceptance of public breastfeeding has also be
reported to be influenced by the setting in which the mother
breastfeeds (Magnusson, 2017).
Limitations
The sample in this study was predominantly Caucasian;
therefore, analyses according to race were limited. Most
males reported that they had yet to father a child; therefore,
analyses represent views of the young, and largely inexperi-
enced with breastfeeding, population. Although the sample is
unique and large, it is not representative of the population or
the United States, and cannot be generalized to diverse popu-
lations. Although the statements used to assess attitude were
shown to be reliable in this study, it is unknown if the items
used to assess exposure and knowledge are non-biased, valid,
and reliable. In this study, the researchers did not distinguish
between the methods of human milk delivery, it was assumed
any form or amount of breastfeeding was being reported as
positive. Another potential limitation is that the data were
self-reported; therefore, the possibility of socially acceptable
answers was present.
Conclusion
The complex decision to breastfeed is shaped by numerous
factors, including the influence of the father. Despite the
young age of this cohort, likely soon to reach the state of
fatherhood, the positive attitudes of the participants are
promising, indicating support and advocacy for this type of
infant feeding. It is likely that future education efforts to
increase the knowledge of breastfeeding, specifically the
health benefits and recommendations for exclusive breast-
feeding, will increase behavioral intention to support
breastfeeding, resulting in increased breastfeeding rates
788 Journal of Human Lactation 35(4)
and duration. Although speculative, the findings within this
relatively young group of males may serve as a good indi-
cator of their stance on breastfeeding intentions.
Declaration of Conflicting Interests
The authors declared no potential conflicts of interest with respect
to the research, authorship, and/or publication of this article.
Funding
The authors received no financial support for the research, author-
ship, and/or publication of this article.
Supplemental Material
Supplemental material for this article is available online.
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