Infant Feeding Exposure and Personal Experiences of African American Mothers

Abstract

Background:

Although exposure and personal experiences can guide breastfeeding decisions, the extant research on African American mothers is limited regarding the influence of infant feeding exposure. The persistent race-based breastfeeding disparities also underscore the lack of effective interventions to support breastfeeding among African Americans.

Objective:

To describe infant feeding exposure and personal experiences of African American mothers in the Midwestern United States with regard to decision making about breastfeeding behavior.

Materials and Methods:

Thirty individual qualitative interviews using a semistructured interview guide were conducted with African American mothers ≥18 years old with an infant 1–6 months of age. Interviews addressed participants' breastfeeding and formula feeding decisions. Data were coded line by line using thematic analysis.

Results:

Positive exposure to breastfeeding and health care providers' prenatal advice influenced nearly all participants to try breastfeeding. However, breastfeeding experiences were unexpected, they did not know how to handle challenges, and nearly half did not continue. Five central themes important to their decision-making processes were identified in the data including contact with breastfeeding mothers, guidance from health care providers, navigating the demands of breastfeeding, making the switch to formula, and my own research.

Conclusion:

Our findings support the importance of both prenatal and postnatal education, the influence of health care providers, and the impact of close social role models. Appropriate education about realistic breastfeeding information is needed to support African American mothers in their breastfeeding decision making. The high use of the Internet to access information also emphasizes the potential opportunity for breastfeeding interventions delivered through technology.

Introduction

Although ∼84% infants in the United States are breastfed, African American infants are breastfed at lower rates (74%) than Hispanic (83%) or white (87%) infants. This racial disparity persists for exclusive breastfeeding at 3 months,¹ which represents a significant public health concern given the impact of human milk on infant health outcomes. Based on estimates of disease outcomes and costs associated with suboptimal breastfeeding, African American infants were 3 times more likely than white infants to have necrotizing enterocolitis and 2 times more likely to die from sudden infant death syndrome.² The insistent gap in breastfeeding behavior and infant health outcomes indicate African American mothers may face greater challenges. There is a need to understand these challenges to develop effective culturally congruent breastfeeding interventions.

A review of published literature identified breastfeeding exposure, attitudes, knowledge of breastfeeding benefits, and complex lifestyles to be common determinants of breastfeeding behavior among African American mothers.³ Self-determination, empowerment, and spirituality were described as key factors by mothers successful with breastfeeding.⁴ However, challenges for breastfeeding mothers included structural barriers, such as returning to work early, lack of support, and problems pumping.^4,5 For mothers deciding not to breastfeed their infants, pain, lack of time, and health habits were identified as main reasons for formula feeding.^6,7 Limitations in this body of research specific to African American mothers include little attention to understanding the specific impact of infant feeding exposure as well as homogeneous samples. Studies have mainly focused on low income, lower educated mothers, or those who were successful breastfeeding, with formula feeding mothers commonly excluded preventing a clear understanding of how African American mothers make their infant feeding decisions. Therefore, we aimed to explore factors essential to infant feeding decisions among a diverse sample of African American mothers, including those who chose to feed formula.

The objectives were twofold: (1) describe infant feeding exposure and personal experiences and (2) describe psychosocial and cultural beliefs underlying breastfeeding and formula feeding decisions. In this article, we present our findings of the first objective.

Materials and Methods

Design and sampling

We used a descriptive qualitative design for this study allowing a low-inference naturalistic inquiry method⁸ well suited to elucidating complex context-based issues to prioritize voices of participants to inform interventions.⁹ Eligibility criteria were mothers ≥18 years of age and self-identified as African American (Black race, born in the United States) with an infant 1–6 months old. A purposive sampling strategy was used with flyers placed in local organizations in central Missouri serving African American mothers. Mothers contacted the principal investigator (PI) by e-mail or phone who screened participants for eligibility. Recruitment continued until data saturation occurred, then two additional participants were recruited to confirm no new information developed. The University of Missouri Health Science Institutional Review Board approved the study.

Data collection

Data were collected from February 2015 to July 2016 by individual in-depth interviews. For consistency, the PI conducted each interview and obtained written consent from participants. Demographic information regarding social, prenatal, and birth history was collected by a self-administered questionnaire.

A semistructured interview guide (Table 1) was used to elicit responses to open-ended questions. Infant feeding exposure was defined for participants as contact with media, someone who has breastfed or formula fed, or education about infant feeding. The interview guide was developed based on the theory of planned behavior that posits intentions and behavior are a function of behavioral, normative, and control beliefs that are influenced by background factors (e.g., culture, education, and past experiences). Examining the effect of specific background factors offers insight into the determinants of human behavior.¹⁰ Interviews were audio recorded and transcribed verbatim by a trained research assistant. Data were deidentified and kept on a secure server. Participants were compensated with a $35 gift card.

Table 1.

Interview Guide

Exposure	Describe the type of infant feeding exposure you have experienced.
	Probe questions:
	Tell me about your experience seeing women you know breastfeed or formula feed their baby.
	Tell me about any health care provider who talked to you about your infant feeding decision. How did this make you feel?
	Describe anything else you have seen, heard, or read about infant feeding methods.
Personal experiences	Tell me about your own personal experiences feeding your baby.
	Probe questions:
	Describe your experience feeding your baby after giving birth.
	What guides your decision to give your baby breast milk or formula?
	When you stopped breastfeeding, what were your reasons?

Data analysis

Data collection and analysis occurred concurrently using Dedoose software.¹¹ Thematic analysis occurred in six phases.¹² The first phase involved data immersion, reading, and rereading narratives noting perceptions. In the second phase, the first and third authors coded data independently line by line using an inductive approach, a process of coding that is data driven to generate a list of initial codes reflecting meaningful information.¹² Next, we met regularly to compare and sort codes in phase 3 searching for potential themes. Themes were then refined for coherent patterns exploring the relationship between concepts (phase 4) and named to reflect the underlying significance of broad meaning (phase 5) categorizing the story it tells with subthemes identified.¹²

As we worked systematically through the data, reflexive writing was conducted to examine how ideas evolved and a paper trail of analysis was maintained. In the final phase, the second author reviewed the paper trail for consistency, confirming agreement with results and relevant participant quotes were selected.¹²

Results

Thirty individual interviews were conducted with African American mothers (mean age = 26 years). Participant demographics are displayed in Table 2. Five central themes emerged with seven subthemes (Tables 3 –5). Themes illustrating infant feeding exposure included contact with breastfeeding mothers and guidance from health care providers. Themes depicting personal experiences with infant feeding were navigating the demands of breastfeeding and making the switch to formula. The theme my own research overlapped both exposure and personal experience narratives.

Table 2.

Demographic Characteristics (N = 30)

Characteristics	n
Maternal age (years)
19–24	15
25–30	10
31–36	5
Marital status
Single	15
Married	14
Widowed	1
Highest education level
<12th grade	4
High school diploma	8
Associate degree	13
Bachelor's degree	4
Graduate degree	1
Employment status
Full time	13
Part time	5
Looking for work	8
Yearly income
<$20,000	16
$20,000–$44,999	12
>$45,000	1
Prenatal infant feeding intentions
Breastfeeding	25
Formula feeding	2
Combination (breast milk and formula)	3
No. of children
1	12
2 or more	18
Breastfed other children
Yes	11
No	19
Infant feeding method at time of interview
Exclusive breastfeeding	13
Formula feeding	12
Combination (breast milk and formula)	5

Table 4.

Infant Feeding Personal Experiences Themes, Subthemes, and Participant Quotes

Theme	Subtheme	Quote (Participant ID)
Navigating the demands of breastfeeding	Did not know what to expect	“I was very overwhelmed after pushing. So, they just set her on my boob. I'm like get her off of me…I'm like no not right now…I almost thought I'm not going to breastfeed.” (BF03)
		“I didn't know anything about the colostrum…I don't think any of the articles prepared me for the day of labor and what happens at that time.” (BF02)
		“Well as far as breastfeeding I feel like you're always told how easy it is and how natural it is and how you just do it and it's just wonderful. And it really wasn't.” (BF05)
	Breastfeeding is difficult	“He was hungry every thirty minutes it seemed like…he was being on each side and feed for like thirty, forty minutes and then he'd get hungry again. So, it was like he wasn't getting enough.” (FF11)
	Breastfeeding is difficult	“I'm not able to pump as much there [part-time job] as I am at my full-time job so I felt like my supply was diminishing a little bit. So that's when I contacted the WIC department…to get information on how I could try to get it back or if I should quit or what my options were at that time.” (BF04)
Making the switch to formula	Formula decisions	“One of the key factors in my switching from breast milk to formula was the convenience first and foremost. I would say the consistency of how much he eats, is the main reason I switched to Enfamil.” (FF07)
Making the switch to formula	Formula decisions	“Him being so small and just coming off the feeding tube…so it was kind of hard to get him to latch on. And then it [breast milk] started gradually going. I was getting less and less bottles.” (FF03)
	Feeling guilty	“I felt bad. I thought I was supposed to do this for him. So, I felt bad quitting…trying to weigh the pros and cons.” (FF01)
	Feeling guilty	“I was like set on breastfeeding him. But since I've switched to formula feeding him his doctor has helped me like try to figure out which formula to put him on due to gassiness or fussiness which he didn't have those problems when he was breastfeeding. But now he's switched to this formula we've had to try like three different kinds and it's terrible.” (FF08)

BF, breastfeeding participant; CF, combination feeding participant; FF, formula feeding participant; WIC, Special Supplemental Nutrition Program for Women, Infants, and Children.

Table 3.

Infant Feeding Exposure Themes, Subthemes, and Participant Quotes

Theme	Subtheme	Quote (Participant ID)
Contact with breastfeeding mothers	My personal environment	“My sister from Big Brother Big Sister Program, she has two kids and she breastfed with both of them. She's always encouraged me all throughout my life and she still is.” (FF01)
		“Watching my friend breastfeed, I was like okay this isn't weird. It's not like inappropriate or anything. I thought at first it was nasty but when I see my other friend do it; it seems like the parent thing to do.” (BF01)
		“That was kind of my first exposure to people like actually breastfeeding and returning to work and pumping. So, it was getting the reinforcement from my coworkers…just kind of seeing how to fit that routine into working.” (BF05)
		“Most of the women in my life who I keep close contact with if they have children, they all breastfed.” (CF02)
		“My coworker she had a bad experience and also I have a cousin who had a bad experience because it was just hard for them to get the baby to latch on and…they wasn't producing enough milk.” (FF09)
Guidance from health care providers	Specific information about breastfeeding benefits	“The WIC office puts a lot of emphasis behind breastfeeding. Not only for the mother & the child…their development, their growth, certain minor sicknesses that come behind you not breastfeeding versus you breastfeeding.” (FF07)
		“I learned from a doctor that breastfeeding was very healthy…like it helps their immune systems.” (CF04)
		“When they gave me information about it…I wanted to at least try breastfeeding first because I know I was formula fed. It just helped me confirm it. Like yes I do want to try breastfeeding before I would do formula.” (BF07)
		“They weren't pushy. They did reassure me that there are numerous resources in the community as far as other people I can reach out to. So, everyone was overall very helpful.” (BF13)

BF, breastfeeding participant; CF, combination feeding participant; FF, formula feeding participant; WIC, Special Supplemental Nutrition Program for Women, Infants, and Children.

Table 5.

My Own Research Subtheme and Participant Quotes

Theme	Subtheme	Quote (Participant ID)
My own research	Easy access to information	“I looked online a whole lot. Kelly mom, I think that's what it's called. I just did a lot of online research…reading and stuff like that to kind of try to prepare myself for it.” (BF11)
		“I go on there [Facebook] and I read like what other moms go through and their questions. And then I just read the comments and that's how I got exposed to that.” (BF01)
		“For about maybe a week or two after coming home, she had complications with latching…Got on Google again it said mainly since I had went ahead and starting pumping and letting the dad feed her, it could have been a little bit of confusion. So, I went out and got a nipple shield. She hasn't really had any issues since then. Now she's back on my natural breast.” (BF10)
		“I talked to the peer consultant here [WIC]. She gave me some resource for some other lactation consultant. That was over a weekend. So, for that weekend, while I had to wait for my appointment, I went on messaging boards to ask questions to other moms. I went on YouTube to look at videos…because it was to the point where it hurt and I was like I just want to quit. So, I just looked up those resources to get through the weekend and then it also gave me some good questions to ask once I went to the appointment.” (BF05)

BF, breastfeeding participant; WIC, Special Supplemental Nutrition Program for Women, Infants, and Children.

Contact with breastfeeding mothers

Most participants had personal frequent contact with a breastfeeding mother (family, friends, or church member) who made them feel breastfeeding was the right thing to do. Those still breastfeeding consistently spoke about having someone close to call for help with breastfeeding concerns. Participants also mentioned white coworkers who openly talked about breastfeeding that helped them choose breastfeeding as a feasible option. Formula feeding mothers reported formula was the normal feeding choice for their family and generally identified breastfeeding exposure by more distant people they had limited contact with (mentors or health care providers).

Some participants identified their first breastfeeding exposure was during pregnancy, whereas others grew up in breastfeeding families and viewed formula feeding as an unacceptable option. Many participants, but not all, had positive breastfeeding exposures. Some participants reported hearing breastfeeding was painful, it was hard to produce enough milk, or were advised to give formula instead. Most participants disregarded negative exposures, but reported it created “some doubt” about their ability to be successful breastfeeding.

Guidance from health care providers

Health care providers, lactation consultants, and the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) had substantial influence on mothers' infant feeding intentions. Participants talked about receiving recommendations to breastfeed and specific information about breastfeeding benefits from health care providers as well as attending WIC education classes. Breastfeeding education was provided during prenatal visits by reading materials that participants reported gave the impression breastfeeding would be easy. Nonetheless, some participants described detailed breastfeeding conversations they had with their doctor while many stated they were simply asked their plans for infant feeding “and that was it” with no attempt to “sway me one way or another.”

Participants appreciated a relaxed positive approach to discussing infant feeding. This led them to feel more comfortable and motivated to try breastfeeding without a sense of pressure. Most participants were knowledgeable about the benefits of breastfeeding for infants and viewed it as the optimal infant feeding choice. However, none recalled learning specific breastfeeding techniques.

Navigating the demands of breastfeeding

Navigating breastfeeding demands illustrates the postpartum “learning curve.” Several participants described being overwhelmed and unprepared with the first few weeks of breastfeeding labeled as “rough” and “not easy” as expected. Some reported they did not know how many questions they had until after they began breastfeeding. They identified feeling apprehensive about needing to record the details of each breastfeeding to report to the nurse. In addition, multiple questions from nurses regarding infant feeding at the breast often left them feeling they were doing something wrong or the infant may not be eating enough. As a result, some participants spent more time expressing milk and supplementing with formula to physically see how much their infant was eating. Consequently, these participants also reported latch issues after discharge.

Overwhelmingly, the most difficult aspect of breastfeeding was reported as infant fussiness and hunger signs requiring “back to back” feedings, further giving the impression that their infant was not “getting enough.” For participants returning to work, issues with pumping and infants only wanting to eat directly at the breast were major challenges. Although all participants described breastfeeding as difficult, those still breastfeeding at the time of the interview were undeterred by challenges seeking professional lactation support and advice from close role models. One participant was surprised by the “in-depth and thorough help” she received from the community lactation consultant. Participants still breastfeeding reported they were able to “push past” the challenges to reach their goals, whereas formula feeding participants sometimes stated they felt they “gave up easy.”

Making the switch to formula

Some participants decided to switch to formula because “it was the easiest thing to do,” but others perceived it a necessity. One mother found it easy to make the switch after she exclusively breastfed the first week at home and her infant was readmitted to the hospital with severe dehydration. The switch for others was driven by the need for their infant “not to eat continuously.” However, this was a very difficult decision for one participant who reported a postpartum nurse at the hospital told her “it [formula] could give him brain damage.” She did not fully switch to formula until after discharge from the hospital, stating she felt “stressed out” about whether to breastfeed or formula feed her infant. As a result, she gave him bottles of water to counteract the possibility of brain damage from formula.

Some participants reported strong desires to continue breastfeeding but had factors beyond their control that impacted milk supply, such as being told their “medications were incompatible with breastfeeding.” Four participants had infants who were in the neonatal intensive care unit after birth. It was important to these participants to “strictly breastfeed,” but challenging to keep up milk supply and simultaneously deal with their own health issues. Some described feeling relieved after their decision to switch to formula, whereas others depicted feeling guilty due to knowledge of breast milk benefits for their infant. Nearly all had a difficult time finding a formula their infant could tolerate. Some infants on formula were fussy, constipated, and vomiting and their mothers also expressed remorse wishing they could have “stuck with breastfeeding.”

My own research

In this final theme, participants described the importance of easy access to information. Receiving pamphlets about the benefits of breastfeeding from health care providers prompted participants to do more research on breastfeeding, particularly through the Internet. Smartphones provided convenience to access resources quickly. Participants were aware not everything online “is true” and tried searching for reliable information. As mothers searched for more detailed information, some also read parenting magazines and books. Others joined social media groups, such as “Black Women Do Breastfeed” on Facebook.

Access to information online allowed participants to do their own research during pregnancy and focus on specific topics of interest. Before giving birth, they read mainly about the benefits of breastfeeding compared with formula that led most participants to decide that “breastfeeding was the way to go.” However, after discharge from the hospital, only participants who were still breastfeeding at the time of the interview used the Internet to search for information when needing help with breastfeeding. Easy access to the Internet helped these mothers overcome challenges and continue breastfeeding. Using the Internet to connect with other breastfeeding mothers on social media sites also helped breastfeeding participants not “feel alienated” and know other mothers share the same experience.

Discussion

African American mothers in our study identified breastfeeding as most beneficial for infants. Breastfeeding exposure from family, friends, coworkers, health care providers, and the Internet influenced nearly all of them to initiate breastfeeding. However, many had little practical information about how to breastfeed or navigate challenges and had a hard time adjusting to breastfeeding demands in early postpartum. This caused nearly half of participants to switch to formula feeding that was accompanied by feelings of guilt. Nonetheless, most participants continued to exclusively breastfeed, relying on social media, lactation consultants, and personal support to overcome challenges. These findings highlight that although African American mothers in this study were clearly receiving the message that “breast is best” and wanted to do what they believed was best for their infants, the barriers to continue breastfeeding were substantial for some mothers.

Although formula feeding was more common in families of many mothers in our study, this did not deter them from initiating breastfeeding. Exposure to other mothers normalized breastfeeding, and participants identified breastfeeding mothers in their personal circle as important influencers for infant feeding decisions as other research has found.^5,7,13,14

Lutenbacher et al.⁵ found African American mothers reported both the influence of distant and close role models as important to their breastfeeding decisions. However, for our participants, only close role models appeared to have substantial influence. These close role models allowed mothers access to people they had contact with in their everyday life and trusted to call after discharge from the hospital to get individual advice about breastfeeding. Some participants who were still breastfeeding also accessed professional lactation support. Conversely, formula feeding participants were only exposed to breastfeeding by distant people in their lives, such as health care providers. This highlights the need to connect African American mothers with other successful breastfeeding mothers before birth to establish the close personal relationships that facilitates breastfeeding initiation and duration.

Receiving information from health care providers about the benefits of breastfeeding was highly influential in participants' infant feeding intentions. Research indicates that African American mothers report varied experiences with prenatal care providers that range from encouraging and educational to nonexistent.^4,5,12–15 Many participants in our study (most of whom delivered at baby-friendly hospitals) reported their providers simply asked about their infant feeding preferences, whereas others discussed breastfeeding benefits and made recommendations for breastfeeding over formula. This approach to infant feeding education appeared generally beneficial in that participants reported feeling comfortable about trying breastfeeding but not unduly pressured to breastfeed and the majority initiated breastfeeding.

Many participants did not receive practical information about how to actually breastfeed, did not anticipate that it would be difficult, and they struggled to adjust to the demands of breastfeeding. This challenging period occurred in the early weeks postpartum, which Lutenbacher et al.⁵ also found to be a critical time for breastfeeding support. Although participants had help with breastfeeding in the hospital, they were unprepared to meet expectations.

Normal aspects of breastfeeding, such as tracking feeding patterns and frequent feedings, made participants feel breastfeeding was more demanding and their infant was not getting enough milk. This led some mothers to express milk and bottle feed or supplement with formula that caused latch difficulties. Participants did not understand the connection between tracking breastfeeding activity and infant output as a strategy to show adequate infant intake and support breastfeeding success. Previous research also identified that the main reason for introducing formula or discontinuing breastfeeding was due to a concern of insufficient milk intake.⁶

Although participants in our study did not express a need for more support, like Hinson et al.,¹³ we found a need for specific prenatal education about what to expect after birth and how to breastfeed. Although participants indicated they received plenty of information on the benefits of breastfeeding for infants, they were not aware of benefits for mothers. Simply knowing the benefits for infants was not enough to influence breastfeeding duration or maintain milk supply when returning to work. This finding echoed a previous study,⁶ but participants in our study who were still breastfeeding at the time of the interview demonstrated a strong commitment to breastfeeding as they were able to push past difficulties by seeking help from close family or friends, searching the Internet for information, and professional support from lactation consultants. Past studies also report successful breastfeeding mothers expressed a strong desire to breastfeed and were self-determined to meet their goals despite negative support and challenges.^4,5 Nonetheless, all African American mothers should receive specific information about how to breastfeed.

Health care providers may vary in their approach to educating patients, offering multiple strategies during the prenatal and postpartum period. Future research should identify education strategies and assess knowledge to find the best way to teach African American mothers about maternal and infant benefits, realistic views of the breastfeeding experience, and a clear understanding about breast milk production. Having specific knowledge about how to handle common breastfeeding challenges may help mothers breastfeed for longer durations.

Most formula feeding participants in our study expressed intentions to breastfeed, but barriers led to short durations of breastfeeding. In line with research conducted by Cottrell and Detman,⁶ our study found that the level of dedication to breastfeeding was reflected in participants quick decision to switch to formula and lack of use of breastfeeding resources. Breastfeeding triggered stress for many participants and formula feeding seemed to provide relief. Consistent with previous research,¹⁴ feelings of guilt arose due to the emphasis placed on breastfeeding. Mothers in our study also expressed remorse regarding trouble finding a formula that did not cause gastrointestinal discomfort for their infant.

Health care providers should educate mothers that discontinuing breastfeeding before reaching their goal is not a failure. In addition, receiving incorrect information, such as formula causes brain damage, increased maternal stress and led to inappropriate infant feeding practices. More research is needed on how to best support African American breastfeeding mothers in the early postpartum period. Future research could identify what drives some mothers to have a strong commitment to breastfeeding while others give up easy.

Strengths and limitations

This study was designed to enhance trustworthiness of the findings. Reliability was fostered by consistency in data collection across participants with the same African American researcher conducting the interviews using a semistructured guide. Fidelity was also ensured with close monitoring of data collection by the coinvestigator providing feedback to the PI allowing opportunity for revisions and reducing bias.⁹ There are some limitations to consider. African American mothers self-selected to participate in the study and their experiences may differ from mothers not likely to take part in the research. Views expressed are from a small sample of 30 mothers living in an urban community in the Midwestern United States. Our findings are also limited to mothers' perceptions of education received as we did not assess the quality of educational materials provided. Given these limitations, the findings from our study are not broadly generalizable.

Conclusions

This study focused on infant feeding exposure and experiences of African American mothers that allowed insight regarding processes for breastfeeding decisions. Our findings add to the existing qualitative research that centers the experiences of African American mothers from various regions of the United States, indicating shared experiences that provide a cultural perspective for breastfeeding decisions, particularly the influence of infant feeding exposure. This evidence highlights the impact of exposure to close social relationships with other breastfeeding mothers in overcoming challenges and the need to identify effective education strategies for African American mothers. Breastfeeding education should include specific practical information on how to breastfeed and be presented to mothers in a way that avoids giving the impression that it will be easy. Breastfeeding is natural but not effortless.

For mothers deciding not to breastfeed because of personal choice or health issues, donor human milk is the first alternative that many African American mothers may not have access to leaving commercially prepared iron-fortified formula as their only infant feeding option. Therefore, mothers need to receive appropriate education about formula feeding. Placing emphasis only on breastfeeding may contribute to anxiety or feelings of guilt. Using a scare tactic approach regarding formula creates additional stress that can lead to inappropriate practices in a population already at greatest risk for poor outcomes.

Understanding the infant feeding perspectives of African American mothers can help develop effective interventions to address the racial disparity in breastfeeding. There is a need for culturally congruent breastfeeding interventions that allow convenient access to support focused on addressing challenges and monitoring by health care providers to permit early intervention that may reduce rehospitalizations. The high use of the Internet to access information emphasizes the potential opportunity for using technology to support breastfeeding.

Footnotes

Disclosure Statement

No competing financial interests exist.

Funding Information

This study was funded by the University of Missouri Research Council, Grant No. URC-15-057.

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