Sleep duration < 7 h increases risk for chronic disease, which makes identifying short sleep duration critical to public health. The goal of this study is to evaluate objective short sleep duration among individuals who self-report insufficient sleep to test and evaluate predictors of the subjective–objective sleep duration difference. This study presents baseline data from a sleep extension study involving adults aged 18–65, fluency in English, and self-reported sleep duration ≤ 7 h and elevated blood pressure. Objective sleep duration was measured with actigraphy, and subjective–objective sleep difference was calculated as the difference between self-reported habitual sleep duration and actigraphically measured sleep duration. Data were analyzed using regression models, Bland–Altman plots and exploratory spline-based logistic regression models. Among 195 adults (age m = 42 ± 11 years), 54

Study Objectives:Women from racially and ethnically minoritized communities experience cardiometabolic health disparities. Insufficient sleep and poor sleep quality are common and potentially modifiable factors that impact cardiometabolic health; however, women face unique challenges to sleep. A bi-directional community-integrated approach is used as a foundation to learn more about sleep in under-researched populations of Utah, resulting in a study approach that is both effective and rigorous. Methods:We present the protocol for community integration and development of focus groups among female community health workers who represent the four communities participating in this study: African Immigrant, Black/African American, Native Hawaiian/Pacific Islander, and Latina. We describe establishing relationships, initiating the project, and preparing and conducting data collection, analysis, and dissemination plans. Results:We anticipate the results of this project will provide unique perspectives about sleep in the participating communities, based on the experience of community health workers as community members and trusted leaders of their communities. Conclusions:This project continues an ongoing partnership between community health workers and academic researchers focused on reducing disparities in cardiometabolic disorders. The results of this project will lead to the identification of future research questions, outreach/education efforts, and development of a plan for future interventions among diverse racial and ethnic groups in our community.

Introduction Healthcare systems increasingly screen for social needs, yet referrals often fail to connect patients with services—particularly in emergency department (ED) settings where unmet social needs are common. Our research highlights critical barriers to service connection, including unstable access to cellphones, limited internet and low digital literacy. These challenges disproportionately affect socio-economically disadvantaged groups and are associated with poorer health outcomes and more frequent ED visits. With the recognition of information and communication technology (ICT) access as a ‘super social determinant of health’, we have a timely opportunity to test solutions that address these disparities. Methods and analysis We will conduct a three-arm randomised controlled trial enrolling 600 ED patients across three ED sites. Participants are eligible if they self-report at least one unmet social need using the validated Screener for Intensifying Community Referrals for Health (SINCERE) screening instrument, identify barriers to ICT access and want to be referred to community services. Arm 1 will receive community service referrals using email or alternate phone numbers (211 service navigator outreach, usual care). Arm 2 will receive stable cellphone access and community service referrals (cellphone with data+211 service navigator outreach). Arm 3 will receive cellphone access, community service referrals and tailored digital navigation support (Cellphone with data+211 service navigator outreach+digital navigation). Primary outcomes will include community service use and health-related outcomes such as depression, anxiety, social support, loneliness, self-reported global health and healthcare utilisation over 6 months. Using a mixed methods design, we will explore contextual and individual factors influencing engagement and outcomes. Ethics and dissemination This study has been approved by the University of Utah Institutional Review Board (IRB). Findings will be shared with clinical and policy stakeholders, community organisations and published in open-access journals. Trial registration number ClinicalTrials.gov NCT07174466 , start of enrolment 3 November 2025.* *The start date for this trial is listed as 8 August 2025 on ClinicalTrials.gov. This date marks the pilot procedures conducted with five patients under IRB approval. These patients were consented and the procedures were trialled to finalise the study protocol. These patients were not randomised and their data are not included in the trial. The trial was registered on ClinicalTrials.gov on 16 September 2025 and the first patient was enrolled and randomised on 3 November 2025.

Background Women of color face disproportionately high rates of cardiometabolic disease, partly due to inadequate sleep. Culturally tailored sleep health interventions are urgently needed to address these disparities. Community health workers as trusted community members offer valuable insight to inform intervention development. We sought to examine female community health worker perspectives on individual and sociocultural influences shape sleep health within African Immigrant/Refugee, Black/African American, Hispanic/Latinx(a), and Native Hawaiian or other Pacific Islander communities in Utah. Methods Eight focus groups were conducted with 77 female community health workers, stratified by racial/ethnic community. Using Grounded Theory, we employed inductive and deductive coding and iterative analysis informed by community advisors and socio-ecological behavior change models. Results Participants described prioritizing caregiving, family, and community obligations over sleep health, reflecting intersecting gender and occupational expectations. Perceived consequences of poor sleep included cognitive impairment, emotional dysregulation, diabetes, headaches, unsafe driving, and weight gain. "Hustle culture" emerged as a central theme characterizing the confluence of work, family, and community obligations compounded by racial and acculturation stressors. Sleep-related stigma and culturally rooted practices provided important context for culturally responsive interventions. Conclusion Findings highlight how structural and cultural factors shape sleep trade-offs within communities of color and provide insight to inform the development of targeted, sleep health interventions.

Introduction and Objective: Women with a history of gestational diabetes (GDM) are at risk of developing type 2 diabetes (T2D). Postpartum care following GDM should address this risk. The objective of this study was to explore such care within two academic health systems (University of Kentucky: UK and University of Utah: UU) and identify areas for improvement. Methods: Electronic health records (EHR) were queried to identify patients aged 18+ with a singleton pregnancy complicated by GDM between October 2021-September 2024. Providers identified through the query completed a survey about their care and suggestions for intervention. Results: Among 2311 patients (n=869 UK, n=1442 UU), 17% had documentation of a 2-hour oral glucose tolerance test by 12 weeks postpartum. Only 3% had documentation of postpartum referrals for diabetes education, dietitian, or lifestyle/wellness programs. Among 119 providers (n=41 UK, n=78 UU), most “strongly agreed” that GDM has long-term implications for women’s health (84%), and that T2D risk education is important (92%). However, only 52% highly prioritized telling patients with GDM about their increased risk for T2D and only 23% highly prioritized T2D screening. Areas for improving postpartum glucose screening included incorporating EHR alerts and phone/text screening reminders and providing educational materials enforcing need for postpartum screening. System-level resources endorsed by providers to better support them in the care of postpartum patients with a history of GDM included lists of community-based programs targeting risk factor modification (70%), patient educational materials on GDM in the postpartum period (66%), automatic EHR reminder of woman’s GDM (60%), and increased communication between OB and primary care providers (57%). Conclusion: Identified strategies to support optimal care following GDM were similar across two academic health systems. Implementation science approaches are needed to address gaps in postpartum care for women with GDM. Disclosure S.E. Simonsen: None. K. Heier: None. A. Jones: None. J. Kent-Marvick: None. A. McGrath: None. M. Sperry: None. K.L. Roper: None. Funding Research reported in this abstract was supported by the National Center for Advancing Translational Sciences of the National Institutes of Health under Award Numbers UL1TR004409 (Univ Utah) and UL1TR001998 (Kentucky). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Background: Multiple studies conducted between 1990s and 2010s reported increased rates of postpartum hemorrhage (PPH) among women with von Willebrand disease (VWD), even with specialized peripartum care. Objective: To generate contemporary data on pregnancy outcomes among women with VWD using a statewide database, the Utah Population Database. Methods: We included women with a first live singleton birth at Intermountain Health or University of Utah facilities from January 1, 2008, to December 31, 2020. VWD cases were identified using a validated algorithm incorporating diagnosis codes, laboratory, and medication data. Each case was matched (∼1:20) to controls by maternal birth year and age at delivery. Pregnancy outcomes were obtained from Utah birth certificates; PPH became reportable in 2017. Mixed effects logistic regression was used to compare pregnancy outcomes between women with and without VWD for the full cohort (2008-2020) and a limited cohort (2017-2020). Results: We identified 120 women with VWD matched to 2356 controls for the full cohort. Compared with controls, women with VWD had higher odds of blood transfusion (adjusted odds ratio [aOR] 12.8, 95% CI, 4.11-40.1) and preterm birth (aOR 1.82; 95% CI, 1.04-3.20), after adjusting for ethnicity. In the limited cohort, VWD was not significantly associated with PPH (aOR 1.59, 95% CI, 0.36-6.95). Conclusion: Despite increased awareness, women with VWD continue to face a higher risk of adverse pregnancy outcomes compared to the general population.

BACKGROUND:American Indian and Alaska Native (AI/AN) women experience more vasomotor symptoms during menopausal transition compared to women of other racial and ethnic groups. Yet, there have been no evidence-based interventions aimed at peri‑ and post-menopause treatment among midlife AI/AN women. The aim of this exploratory study was to refine a culturally informed intervention for perimenopause/menopause treatment for midlife AI/AN women. METHODS:A Convergent parallel mixed methods design incorporating the principles of community-based participatory research was used. Community Advisory Board members (n = 8) from an urban community of Native women, who also served as participants, participated in meetings on Zoom to refine the intervention. Participants also completed an online survey that included demographics, health status, and integrative health therapy options. Quantitative measures were summarized using descriptive statistics. Content analysis was conducted on summaries of the community advisory board sessions. RESULTS:All participants self-reported as AI/AN women. During the sessions, women named the intervention, Waning Moon, and shared the following: a) content to be prioritized to best support the needs of Native women; b) mode of delivery and duration of Waning Moon; and c) promoting Waning Moon within the community. Quantitative surveys results revealed that 40% of participants had used integrative health. Synthesizing both quantitative and qualitative findings, responses aligned across data sources regarding willingness to use integrative health approaches and the use of preventative care. CONCLUSION:Waning Moon incorporates conventional and integrative health and is greatly desired by AI/AN women. Women's health clinicians should note that integrative and Native treatments are more likely to be accepted by AI/AN women when culturally tailored.

Despite a large number of African-born individuals residing in the United States, there is a significant disparity in how this community accesses and utilizes mental health treatment. Low screening rates for common mental health concerns is one crucial part of ongoing inequities in mental healthcare access. Willingness to engage in screening is negatively impacted by a lack of culturally responsive ways to make screening more acceptable and stigma with mental health. This study therefore aimed to examine the perceived acceptability and utility of community-developed patient vignettes created to increase willingness to be screened for common mental health concerns. Employing a qualitative approach, a community advisory board (CAB) (n = 5) was enlisted to co-develop vignettes outlining an African community member’s symptoms of anxiety and subsequent help-seeking behavior. Two focus groups of community members (n = 18) provided qualitative feedback on the vignettes and shared their general attitudes towards mental health and recommendations for mental health screening and treatment in the African community. Using a hybrid inductive and deductive qualitative descriptive approach and classifying responses based on the socioecological model, four major themes emerged from the data: (1) between support and strain: the role of family; (2) reducing stigma: community voices as education; (3) culture as a barrier and a bridge; and (4) the importance of stories that reflect lived experience. Overall, participants were receptive to the culturally-responsive mental health vignettes and provided fruitful suggestions for how these stories can be used to reduce stigma and increase willingness to seek screening and treatment in African-born residents of the United States.

Abstract Background Women who did not meet their breastfeeding goals often experience breastfeeding grief (BG) and may be likely to have postpartum depression (PD). Furthermore, PD is nearly twice as common in African American (AA) women as in Non-Hispanic White women. No research exists on BG and its role in PD. This study examined AA women’s experiences of BG and its possible contributions to PD symptoms. Methods A convergent parallel mixed methods design was used. A purposive sample of 16 AA women with children aged 6 months to 2 years with BG participated in individual semi-structured interviews about their experiences of BG and completed an online survey including the Edinburgh Postnatal Depression Scale (EPDS). Qualitative and quantitative data were analyzed using reflexive thematic analysis and descriptive statistics, respectively. Both data were integrated using joint display of data and side-by-side comparison. Results Participants’ mean age was 29.5 years. Four meaning-based themes about BG were generated including: We looked forward to breastfeeding, But it did not go as expected , So we grieve , and These would have helped. From quantitative results, 87.5% of participants reported a history of PD symptoms and almost 44% had EPDS scores >11. All participants reported that experiencing BG contributed to their PD symptoms. Findings suggest that BG influenced PD symptoms in AA women without prior diagnosis of depression. Conclusions Qualitative and quantitative findings from this novel exploratory study revealed an overlap that AA women with BG report PD symptoms. Clinicians should support women to achieve their breastfeeding goals to prevent BG and PD.

OBJECTIVES:To develop the Perception of Future Pregnancy Risk Questionnaire (PFPRQ) to assess perceived risk related to future pregnancies by adapting the existing Perception of Pregnancy Risk Questionnaire. The PFPRQ was psychometrically evaluated among parous, reproductive-age women with cardiometabolic disease risk factors. STUDY DESIGN:A cross-sectional study. MAIN OUTCOME MEASURES:The PFPRQ was evaluated for construct validity using exploratory factor analysis. Criterion-related validity was assessed through correlations with the Generalized Anxiety Disorder-7 (GAD-7) scale, the American Diabetes Association Diabetes Risk Test, and demographic variables. Reliability was examined using Cronbach's alpha. RESULTS:The PFPRQ, consisting of 7 items rated on a visual analog scale from 0 (no risk at all) to 100 (extremely high risk), was administered to 243 participants and demonstrated a single-factor structure (Risks for Mother and Baby in Future Pregnancy) with high internal consistency reliability (Cronbach's alpha = 0.89). Higher scores on the PFPRQ indicate higher perception of risk. Criterion-related validity showed a weak positive correlation between anxiety and PFPRQ scores (Spearman's rho = 0.173, p = 0.007). Higher PFPRQ scores were also associated with diagnosis of high blood pressure (p < 0.001), intention for future pregnancy (p < 0.001), and willingness to delay pregnancy for health reasons (p = 0.02), supporting its criterion-related validity of the PFPRQ. DISCUSSION:The PFPRQ demonstrated good internal consistency and showed evidence of construct and criterion-related validity for assessing perceived future pregnancy risk among reproductive-age women with cardiometabolic factors. It provides valuable insights to support risk communication and preconception counseling.

Background Women who did not meet their breastfeeding goals often experience breastfeeding grief (BG) and may be likely to have postpartum depression. Postpartum depression is nearly twice as common in African American women as in Non-Hispanic White women. No research exists on BG and its role in postpartum depression. This study examined African American women’s experiences of BG and its possible contributions to postpartum depressive symptoms. Methods Convergent parallel mixed methods design. A purposive sample of 14 African American women with children aged 6 months-2 years with BG participated in individual semi-structured interviews about their experiences of BG and completed an online survey including the Edinburgh Postnatal Depression Scale (EPDS). Qualitative and quantitative data were analyzed using reflexive thematic analysis and descriptive statistics, respectively. Both data were integrated using joint display of data and side-by-side comparison. Results Participants’ mean age was 29.6 years. Four meaning-based themes about BG were generated: Yearning to fulfill maternal responsibilities, Disconnect between idealized plans and lived realities, Navigating the disconnect, and The disconnect is preventable. From quantitative results, all participants reported history of postpartum depressive symptoms, and they all reported that experiencing BG contributed to their postpartum depressive symptoms. Half of participants also had EPDS scores ≥11. Findings suggest that BG may contribute to postpartum depressive symptoms in African American women without prior diagnosis of depression. Conclusions Qualitative and quantitative findings from this novel exploratory study revealed an overlap that African American women with BG may experience postpartum depressive symptoms.

Background Latinas in the U.S. experience higher rates of sleep disturbances and shorter sleep durations compared to non-Hispanic White women. This study employed community-engaged research methods to explore sleep-related knowledge, beliefs, attitudes, and behaviors within the Latina socio-cultural context, utilizing insights from focus groups with Latina community health workers (CHWs). Methods CHWs served on a community advisory board (CAB) to develop focus group questions addressing sleep among diverse women. CHWs from four racial/ethnic groups, including Latinas, conducted three focus groups. CAB members facilitated participant recruitment and focus groups. Thematic analysis guided coding of emergent themes. We conducted sessions in Spanish and were recorded, transcribed, and analyzed collaboratively. Results Thirty-one Latinas participated, revealing four overarching cultural themes influencing sleep behaviors: (1) Familismo , prioritizing family needs over personal well-being; (2) Marianismo, self-sacrifice and duty to maternal and spousal roles, often neglecting sleep; (3) Confianza , the importance of trust, particularly in healthcare relationships; and (4) Self-reliance , addressing sleep concerns through culturally accepted solutions. Conclusion Findings underscore the connection between culture and sleep-health behaviors, highlighting the necessity of culturally sensitive interventions. CHWs demonstrated confidence in advocating for sleep health within their communities. Building trust with CHWs facilitated actionable insights for future development of effective sleep interventions.

Introduction The 2-1-1 system is a nationwide social service provider that connects callers with unmet needs to appropriate community resources. Every year, over two million Americans experiencing food insecurity (FI) seek help from 2-1-1. Yet, little is known about the FI experiences among 2-1-1 callers seeking food-related support, specifically, who they are, the circumstances that lead them to contact 2-1-1, and the strategies they believe could help reduce FI.Methods To address this gap, we interviewed 30 food-related callers (20 in English and 10 in Spanish) to the Utah 2-1-1 system between November 2024 and January 2025.Results Thematic analysis revealed three primary reasons for seeking food-related help from 2-1-1: (1) ineligibility for federal nutrition and financial assistance programs; (2) facing non-income-related barriers to accessing food; and (3) experiencing unexpected life events. Callers suggested strengthening and adapting federal nutrition assistance programs, improving emergency food provision systems, and enhancing informational support.Conclusion Based on these insights, we provide suggestions on how to leverage the 2-1-1 system to intervene on FI.

BACKGROUND:Nocturnal blood pressure (BP) phenotypes predict cardiovascular risk, yet most prior work relies on self-reported sleep rather than actigraphy with ambulatory BP monitoring (ABPM). OBJECTIVE:To test whether actigraphy-measured total sleep time (TST) and sleep efficiency (SE) are associated with nocturnal BP phenotypes in adults with elevated BP and habitual short sleep. METHODS:Baseline data from adults with elevated clinic BP and self-reported sleep <7 h/night included approximately seven nights of wrist actigraphy and 24-h ABPM. Linear models estimated continuous outcomes, and Poisson regression estimated prevalence ratios (PRs) for systolic/diastolic non-dipping and asleep hypertension across unadjusted, demographic-adjusted, and fully adjusted models. RESULTS:Longer TST was associated with a lower prevalence of diastolic non-dipping in unadjusted (PR per 10 min = 0.989, 95 % CI 0.981-0.997) and demographic-adjusted models (PR = 0.991, 95 % CI 0.984-0.997), with attenuation in fully adjusted models. SE was positively associated with systolic dipping in unadjusted models (β = 0.002, p = 0.036) and was nonsignificant after adjustment. Neither TST nor SE predicted asleep hypertension. CONCLUSIONS:Among short-sleeping adults with elevated BP, longer actigraphy-measured TST relates to more favorable nocturnal BP, specifically lower diastolic non-dipping, although effects attenuate with full adjustment. Findings support integrating actigraphy with ABPM to improve characterization of nocturnal BP phenotypes.

Nearly half of adults do not achieve the recommended 7 hours of sleep per night, a pattern associated with increased cardiovascular and metabolic health risks. However, sleep discrepancy—the difference between subjective and objective sleep duration—may indicate a bias in risk perception, as individuals may underestimate their sleep deficits. The goal of this study was to examine sleep discrepancy in self-reported short sleepers (< 7 hours) screened to participate in a sleep extension intervention. Data were drawn from persons screened to participate in a randomized study of sleep extension among individuals with elevated blood pressure recruited from primary care clinics, online, and community sources. Participants had self-reported sleep < 7 hrs and standardized office blood pressure □120 mmHg systolic and/or 80 mmHg diastolic. Participants completed 7 days of wrist actigraphy, questionnaires including Insomnia Severity Index (ISI), Perceived Stress Scale (PSS), Epworth Sleepiness Scale (ESS), and PROMIS Sleep Disturbance and Sleep-Related Impairment scales. Sleep discrepancy was calculated as reported sleep minus objectively measured actigraphy sleep. Data were analyzed using regression models, including a full model (all predictors) and individual models (each predictor separately). Covariates included age, sex, and race. We included 195 participants with mean age of 42 years (SD=11); 36% were female. Average sleep discrepancy was -0.5 hrs (indicating self-report was 0.5 hr less than objective) and 54% was correctly identified as a short sleeper based on self-report (both self-report and objective sleep were < 7 hrs). Higher perceived stress (PSS) was significantly associated with sleep underestimation in both models, with the full model showing a negative association (b=-0.0948, 95% CI [-0.165, -0.025], p=.008). Sleep disturbance (PROMIS) was linked to underestimation in both models (b=-0.0420, 95% CI [-0.072, -0.012], p=.007). Insomnia severity (ISI) was associated with sleep underestimation in only the individual model (b=-0.0497, 95% CI [-0.086, -0.013], p=.008). This study highlights the psychological significance of sleep perception among self-identified short sleepers. Higher perceived stress, sleep disturbance, and insomnia severity were linked to underestimating sleep duration and psychological distress. Screening data offered insights, emphasizing the need for combined subjective-objective assessments to address misperceptions. Support: Supported by grant R01NR018891

BACKGROUND:When using electronic health records (EHRs) to conduct population-based studies on inherited bleeding disorders (IBDs), using diagnosis codes alone results in a high number of false positive identifications. OBJECTIVE:The objective of this study was to develop and validate an algorithm that uses multiple data elements of EHRs to identify pregnant women with IBDs. METHODS:The population included pregnant women who had at least one live birth or fetal death (>20 weeks gestation) at our institution from 2016 to 2023. We iteratively developed the algorithm using a composite criteria of encounter diagnosis codes, laboratory and medications data. We assessed the performance of the algorithm for sensitivity and positive predictive value (PPV) using our local registry and manual chart review. RESULTS:Using the source population between 2016 and 2020, the initial algorithm identified 25 pregnant women with IBDs. Eight women with a known diagnosis of an IBD were missed resulting in a sensitivity of 75.8 % and a PPV of 100 %. We revised the algorithm to remove certain IBD diagnosis codes that resulted in contamination and added additional criteria to improve the sensitivity. The revised algorithm had a sensitivity of 97.0 % and a PPV of 91.4 %. The revised algorithm was validated using the source population between 2021 and 2023 and had a sensitivity of 97.1 % and a PPV of 91.7 %. CONCLUSION:This study demonstrates the utility of an algorithm to better identify pregnant women with specific types of IBD, mainly hemophilia and hemophilia carriers, and von Willebrand disease, within EHRs.

BACKGROUND:Refugees experience high rates of food insecurity (FI) and its associated health outcomes, such as depression and hypertension. Prior research has identified barriers in accessing food among U.S. refugees. What remains unknown is when accessing food becomes a problem for U.S. refugees and what their preferred strategies are to address FI. Therefore, the objectives were to explore FI experiences among refugees to identify time points at which accessing food becomes a problem and to identify refugees' preferred strategies to address FI. METHODS:In collaboration with one of the U.S. resettlement agencies in Utah, refugees were recruited for semi-structured interviews using convenience and snowball sampling. Thirty-six interviews were conducted between July and September 2024, in four different languages: English (4 interviews), Dari (6), Arabic (12), and Kinyarwanda (14). Interview transcripts were analyzed using thematic analysis. RESULTS:FI was at its peak among refugees at four time points. First, when they found their first job in the U.S. Second, after six months in the U.S., when they had to renew their Supplemental Nutrition Assistance Program (SNAP) application. Third, when they were no longer receiving caseworkers' support from resettlement agencies. Fourth, when they faced fluctuations in employment or household expenditures. Refugees' preferred strategies to address FI were addressing language barriers, providing a champion to check on them frequently and help when needed, providing information on addressing unmet needs, extending and expanding SNAP benefits, and providing gardens to grow food. CONCLUSION:Four time points when refugees are at higher risk of FI were identified. Community organizations, policymakers, and resettlement agencies should therefore develop interventions to address FI among refugees, specifically around these four time points and informed by refugees' preferred strategies.

PURPOSE:The aim of this narrative review was to map the current literature on culturally informed breastfeeding interventions for African American women. BACKGROUND:Breastfeeding is associated with positive health outcomes for women and infants. Nonetheless, despite interventions aimed at improving breastfeeding for African American women, they continue to have lower breastfeeding rates compared to Hispanic and Non-Hispanic White women. Therefore, there is a need for culturally informed interventions to promote exclusive breastfeeding in African American women. METHODS:PubMed, EmCare, CINAHL complete, APA PsycInfo, Scopus and Web of Science were systematically searched for articles published between 2001 and 2024. Preprints were searched in medRxiv; dissertations were searched in ProQuest Dissertations & Theses and EBSCO Open Dissertations; and other gray literatures were searched in governmental/organizational websites. Hand searches of reference lists were conducted. Data were synthesized using narrative synthesis. RESULTS:Sixteen articles that met inclusion criteria were included. Randomized controlled trial design was used in 7 studies and community-based participatory research design was used in 4 studies. Multilevel breastfeeding education and support provided mostly in-person across 4 socioecological levels (individual, interpersonal, community, and culture) was associated with increased breastfeeding knowledge, self-efficacy, intention, initiation, duration, and exclusivity in African American women. No policy-level intervention was identified. Seven different terms were used to describe the incorporation of culture into breastfeeding interventions. CONCLUSION:This narrative review provides evidence on the utility and essence of culturally informed breastfeeding interventions for African American women. Multilevel breastfeeding education provided across the perinatal period is effective to promote breastfeeding outcomes in African American women.