Methods: Cross sectional data (n=436) were utilized from a survey conducted with female primary caregivers enrolled in Special Supplemental Nutrition Program for Women, Infants and Children (WIC) clinics in the Greater New Orleans Area. Multivariate analyses encompassed ordered logistic regression models to test the association between neighborhood injunctive norms and attitudes toward CP and frequency of CP use, adjusting for covariates and including effect modification.
Results: Perceived collective efficacy was not significantly associated with attitudes toward CP, and had a marginally significant association with CP use (X2 (2, N= 436)= 8.88, p=0.06). Further, participants with positive perceived injunctive norms of neighbors (i.e., perceived higher levels of approval of CP from their neighbors) were positively associated with positive attitudes toward CP (AOR: 6.43; 95% CI: 4.00, 10.33) as well as greater frequency of CP use (AOR: 2.57; 95% CI: 1.62, 4.09). Perceived collective efficacy did not moderate the association between perceived injunctive norms and attitudes toward CP. There was evidence of effect modification by perceived collective-efficacy on the relation between injunctive norms of neighbors and frequency of CP use (p=0.082). For those who reported high perceived neighborhood collective efficacy, there was a significant association between positive neighborhood injunctive norms and frequency of CP use (AOR: 3.24; 95% CI: 1.51, 6.95).
Conclusions and Implications: The normative influence of neighbors on parental CP use in this study demonstrates that collective efficacy does not buffer risk for CP use. Therefore, targeted efforts to change beliefs and attitudes regarding CP use at a neighborhood level may be valuable not only in shifting community norms supportive of CP but also in shifting to social control amongst neighbors to discourage use of CP by parents.