Background. Breastfeeding is unsurpassed as the preferred method of feeding infants all over the world due to the fact that its benefits far outweigh those of infant formula. Mothers from all cultures prefer breastfeeding, yet with immigration and emigration so widespread from developing countries, women's value systems are changing to adapt to their new surroundings. The United States has experienced a great influx of Middle Easterners; California in particular has a dominant presence of Middle Easterners. Many are faced with obstacles and stresses in acculturation, which may lead to lack of breastfeeding their infants. Few studies are available on Middle Eastern women and their attitudes towards breastfeeding, creating an opportunity to further research and find new ways to better serve this understudied population.

Purpose. The purpose of this study was to identify the attitudes and intentions of Middle Eastern women towards breastfeeding and to examine the relationship between acculturation and breastfeeding.

Methodology. This study used an observational, cross-sectional design to examine the attitudes and intentions of Middle Eastern women towards breastfeeding. The study was based on Ajzen's theory of planned behavior (TPB) (2006). In addition to assessing the TPB constructs of attitude, subjective norms, and perceived behavioral control, using a modified version of the Breastfeeding Attrition Prediction Tool (Janke, 1994), the following variables were measured: socioeconomic status, knowledge of breastfeeding, culture, and acculturation. Participants (n=168) were Middle Eastern women aged 20-40 living in Southern California, recruited online through Facebook and in-person at church social functions and Middle Eastern festivals.

Results. Linear regression was used to determine the overall and independent relationships between the intention to breastfeed and the TPB variables. The TPB variables of attitude (adjusted R=0.296, p<0.0001), subjective norms (adjusted R = 0.246, p<0.0001), and perceived behavioral control (adjusted R =0.384, p<0.0001) were significantly and independently related to intention to breastfeed. There was no significant association between acculturation and intention to breastfeed (R=-0.055 , p< 0.445), or between religion and intention to breastfeed (Z= -0.381, p< 0.703).

Implications for Health Education. A more thorough understanding of breastfeeding perceptions and intentions among Middle Eastern women is needed in order to create culturally relevant programs and to increase breastfeeding rates in this population. Further research is needed to specify the differences in generations of Middle Eastern women with regards to intentions to breastfeed.


School of Public Health

First Advisor

Naomi Modeste

Second Advisor

R. Patti Herring

Third Advisor

Helen Hopp Marshak

Degree Name

Doctor of Public Health (DrPH)

Degree Level


Year Degree Awarded


Date (Title Page)




Library of Congress/MESH Subject Headings

Breastfeeding -- Psychological aspects; Breastfeeding -- Religious aspects; Breastfeeding -- Cross-cultural studies; Middle Eastern Americans; Breast Feeding; Breast Feeding -- ethnology; Acculturation -- United States



Page Count

xii; 151

Digital Format


Digital Publisher

Loma Linda University Libraries

Usage Rights

This title appears here courtesy of the author, who has granted Loma Linda University a limited, non-exclusive right to make this publication available to the public. The author retains all other copyrights.


Loma Linda University Electronic Theses and Dissertations

Collection Website



Loma Linda University. Del E. Webb Memorial Library. University Archives