Racial and Ethnic Differences in Maternal Social Support and Relationship to Mother-Infant Health Behaviors

Published:February 25, 2022DOI:



      To examine racial and ethnic differences in maternal social support in infancy and the relationship between social support and mother-infant health behaviors.


      Secondary analysis of baseline data from a multisite obesity prevention trial that enrolled mothers and their 2-month-old infants. Behavioral and social support data were collected via questionnaire. We used modified Poisson regression to determine association between health behaviors and financial and emotional social support, adjusted for sociodemographic characteristics.


      Eight hundred and twenty-six mother-infant dyads (27.3% non-Hispanic Black, 18.0% Non-Hispanic White, 50.1% Hispanic and 4.6% Non-Hispanic Other). Half of mothers were born in the United States; 87% were Medicaid-insured. There were no racial/ethnic differences in social support controlling for maternal nativity. US-born mothers were more likely to have emotional and financial support (rate ratio [RR] 1.14 95% confidence interval [CI]: 1.07, 1.21 and RR 1.23 95% CI: 1.11, 1.37, respectively) versus mothers born outside the United States. Mothers with financial support were less likely to exclusively feed with breast milk (RR 0.62; 95% CI: 0.45, 0.87) yet more likely to have tummy time ≥12min (RR 1.28; 95% CI: 1.02, 1.59) versus mothers without financial support. Mothers with emotional support were less likely to report feeding with breast milk (RR 0.82; 95% CI: 0.69, 0.97) versus mothers without emotional support.


      Nativity, not race or ethnicity, is a significant determinant of maternal social support. Greater social support was not universally associated with healthy behaviors. Interventions may wish to consider the complex nature of social support and population-specific social support needs.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Academic Pediatrics
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Feeney B.C.
        • Collins N.L.
        New look at social support: a theoretical perspective on thriving through relationships.
        Pers Soc Psychol Rev. 2015; 19: 113
        • Uchino B.N.
        Social Support and Physical Health : Understanding the Health Consequences of Relationships.
        Yale University Press, 2004
        • Popo E.
        • Kenyon S.
        • Dann S.-A.
        • et al.
        Effects of lay support for pregnant women with social risk factors on infant development and maternal psychological health at 12 months postpartum.
        PloS One. 2017; 12e0182544
        • Gerald L.B.
        • Anderson A.
        • Johnson G.D.
        • et al.
        Social class, social support and obesity risk in children.
        Child Care Health Dev. 1994; 20: 145-163
        • Lindberg L.
        • Ek A.
        • Nyman J.
        • et al.
        Low grandparental social support combined with low parental socioeconomic status is closely associated with obesity in preschool-aged children: a pilot study.
        Pediatric Obesity. 2016; 11: 313-316
        • Katzow M.
        • Messito M.J.
        • Mendelsohn A.L.
        • et al.
        The protective effect of prenatal social support on infant adiposity in the first 18 months of life.
        J Pediatr. 2019; 209: 77-84
        • Taveras E.M.
        Childhood obesity risk and prevention: shining a lens on the first 1000 days.
        Childhood obesity (Print). 2016; 12: 159-161
        • Gill S.L.
        • Reifsnider E.
        • Lucke J.F.
        Effects of support on the initiation and duration of breastfeeding.
        Western J Nurs Res. 2007; 29: 708-723
        • Field T.
        Postnatal anxiety prevalence, predictors and effects on development: a narrative review.
        Infant Behav Devel. 2018; 51: 24-32
        • Racine N.
        • Plamondon A.
        • Hentges R.
        • et al.
        Dynamic and bidirectional associations between maternal stress, anxiety, and social support: the critical role of partner and family support.
        J Affective Disord. 2019; 252: 19-24
        • Hnatiuk J.
        • Salmon J.
        • Campbell K.J.
        • et al.
        Early childhood predictors of toddlers’ physical activity: longitudinal findings from the Melbourne InFANT Program.
        Int J Behav Nutr Phys Activity. 2013; 10: 123
        • Hish A.J.
        • Wood C.T.
        • Howard J.B.
        • et al.
        Infant television watching predicts toddler television watching in a low-income population.
        Acad Pediatr. 2020;
        • Daniels S.R.
        • Hassink S.G.
        • Committee on Nutrition, C. O
        The role of the pediatrician in primary prevention of obesity.
        Pediatrics. 2015; 136: e275-e292
        • World Health Organization
        Guidelines on Physical Activity, Sedentary Behaviour and Sleep for Children Under 5 Years of Age.
        World Health Organization, 2019 (Available at:) (Accessed February 10, 2022)
        • Hewitt L.
        • Kerr E.
        • Stanley R.M.
        • et al.
        Tummy time and infant health outcomes: a systematic review.
        Pediatrics. 2020; : 145
        • Tombeau Cost K.
        • Korczak D.
        • Charach A.
        • et al.
        Association of parental and contextual stressors with child screen exposure and child screen exposure combined with feeding.
        JAMA Netw Open. 2020; 3e1920557
        • Villalonga-Olives E.
        • Almansa J.
        • Knott C.L.
        • et al.
        Social capital and health status: longitudinal race and ethnicity differences in older adults from 2006 to 2014.
        Int J Public Health. 2020; 65: 291-302
        • Ajrouch K.J.
        • Antonucci T.C.
        • Janevic M.R.
        Social networks among blacks and whites: the interaction between race and age.
        J Gerontol Series B. 2001; 56: S112-S118
        • Tigges L.M.
        • Browne I.
        • Green G.P.
        Social isolation of the urban poor: race, class, and neighborhood effects on social resources.
        Sociolog Quart. 1998; 39: 53-77
        • Cooper D.C.
        • Ziegler M.G.
        • Nelesen R.A.
        • et al.
        Racial differences in the impact of social support on nocturnal blood pressure.
        Psychosomat Med. 2009; 71: 524-531
        • Rook K.S.
        Parallels in the study of social support and social strain.
        J Soc Clin Psychol. 1990; 9: 118-132
        • Perrin E.M.
        • Rothman R.L.
        • Sanders L.M.
        • et al.
        Racial and ethnic differences associated with feeding- and activity-related behaviors in infants.
        Pediatrics. 2014; 133: e857-e867
        • Ogden C.L.
        • Carroll M.D.
        • Kit B.K.
        • et al.
        Prevalence of obesity and trends in body mass index among US children and adolescents, 1999-2010.
        JAMA. 2012; 307: 483-490
        • Sanders L.M.
        • Perrin E.M.
        • Yin H.S.
        • et al.
        “Greenlight Study”: a controlled trial of low-literacy, early childhood obesity prevention.
        Pediatrics. 2014; 133: e1724-e1737
        • Kendler K.S.
        • Myers J.
        • Prescott C.A.
        Sex differences in the relationship between social support and risk for major depression: a longitudinal study of opposite-sex twin pairs.
        Am J Psychiatr. 2005; 162: 250-256
        • Reblin M.
        • Uchino B.N.
        Social and emotional support and its implication for health.
        Curr Opin Psychiatr. 2008; 21: 201-205
      1. NHANES 2007 -2008: Social support data documentation, codebook, and frequencies. Available at: Accessed February 10, 2022.

        • Thompson A.L.
        • Mendez M.A.
        • Borja J.B.
        • et al.
        Development and validation of the Infant Feeding Style Questionnaire.
        Appetite. 2009; 53: 210-221
        • Koren A.
        • Kahn-D'angelo L.
        • Reece S.M.
        • et al.
        Examining childhood obesity from infancy: the relationship between tummy time, infant BMI-z, weight gain, and motor development-an exploratory study.
        J Pediatr Health Care. 2019; 33: 80-91
        SIDS and other sleep-related infant deaths: updated 2016 recommendations for a safe infant sleeping environment.
        Pediatrics. 2016; 138
        • Radloff L.S.
        The CES-D scale: a self-report depression scale for research in the general population.
        Appl Psycholog Measure. 1977; 1: 385-401
      2. R Core Team. (2020). R: a language environment for statistical computing.

      3. Marmot, M., & Wilkinson, R. G.Social Determinants of Health. World Health Organization. Available at: Accessed February 10, 2022.

        • McInnes R.J.
        • Chambers J.A.
        Supporting breastfeeding mothers: qualitative synthesis.
        J Adv Nurs. 2008; 62: 407-427
        • DeVane-Johnson S.
        • Giscombe C.W.
        • Williams R.
        • et al.
        A qualitative study of social, cultural, and historical influences on African American Women's infant-feeding practices.
        J Perinatal Educ. 2018; 27: 71-85
        • Hohl S.
        • Thompson B.
        • Escareño M.
        • et al.
        Cultural norms in conflict: breastfeeding among Hispanic immigrants in rural Washington State.
        Mater Child Health J. 2016; 20: 1549-1557
        • Freeman A.
        Skimmed : Breastfeeding, Race, and Injustice.
        Stanford University Press, 2019
        • Jones K.M.
        • Power M.L.
        • Queenan J.T.
        • et al.
        Racial and ethnic disparities in breastfeeding.
        Breastfeed Med. 2015; 10: 186-196
        • Mueffelmann R.E.
        • Racine E.F.
        • Warren-Findlow J.
        • et al.
        Perceived infant feeding preferences of significant family members and mothers’ intentions to exclusively breastfeed.
        J Human Lactation. 2015; 31: 479-489
        • Gao L.
        • Sun K.
        • Chan S.W.
        Social support and parenting self-efficacy among Chinese women in the perinatal period.
        Midwifery. 2014; 30: 532-538
        • Leahy-Warren P.
        • McCarthy G.
        • Corcoran P.
        First-time mothers: social support, maternal parental self-efficacy and postnatal depression.
        J Clin Nurs. 2012; 21: 388-397
        • Watt T.T.
        • Martinez-Ramos G.
        • Majumdar D.
        Race/ethnicity, acculturation, and sex differences in the relationship between parental social support and children's overweight and obesity.
        J Health Care Poor Underserved. 2012; 23: 1793-1805
        • Sagrestano L.M.
        • Feldman P.
        • Rini C.K.
        • et al.
        Ethnicity and social support during pregnancy.
        Am J Commun Psychol. 1999; 27: 869-898
        • Almeida J.
        • Molnar B.E.
        • Kawachi I.
        • et al.
        Ethnicity and nativity status as determinants of perceived social support: testing the concept of familism.
        Soc Sci Med. 2009; 68: 1852-1858
        • Turney K.
        • Kao G.
        Assessing the private safety net: social support among minority immigrant parents.
        Sociolog Quart. 2009; 50: 666-692
        • Hurtado-de-Mendoza A.
        • Gonzales F.A.
        • Serrano A.
        • et al.
        Social isolation and perceived barriers to establishing social networks among Latina immigrants.
        Am J Commun Psychol. 2014; 53: 73-82
        • Gross R.S.
        • Mendelsohn A.L.
        • Yin H.S.
        • et al.
        Randomized controlled trial of an early child obesity prevention intervention: impacts on infant tummy time.
        Obesity (Silver Spring, Md). 2017; 25: 920-927
        • Brown C.R.L.
        • Dodds L.
        • Legge A.
        • et al.
        Factors influencing the reasons why mothers stop breastfeeding.
        Can J Public Health. 2014; 105: e179-e185