Reduce African-American Infant Mortality

A persistent, significant racial disparity exists in infant mortality rates attributable to
Sudden Infant Death Syndrome (SIDS) and other types of sleep-related sudden unexpected
infant death (SUID), such as suffocation and undetermined causes of death. SIDS and other
sleep-related deaths account for ~4600 U.S. deaths annually.4 While the incidence of SIDS
has declined, infant deaths from accidental suffocation and strangulation in bed have
quadrupled.5 Additionally, racial disparities in SIDS and other sleep-related deaths have
increased over the past decade, with African-American infants twice as likely to die as
other infants.6, 7 Certain infant sleeping practices, such as prone (stomach) sleeping, use
of soft bedding and soft sleep surfaces, and bedsharing, likely play a significant role,
both in SIDS and SUID, and in the disparities seen therein. Elimination of health barriers
and racial/ethnic disparities, and promoting healthy development, have been highlighted as
MCHB research priorities; this application is directly responsive to both of these
priorities.

In the current system, health care providers and public health messages, using the American
Academy of Pediatrics (AAP) recommendations,8 stress the use of supine (back) positioning,
avoidance of soft bedding, and room sharing without bedsharing as recommendations to reduce
the risk of SIDS. However, our research suggests that African-Americans have problems with
this message, as they have a low degree of self-efficacy with regards to SIDS risk reduction
(i.e., they do not believe that their actions can make a difference in whether SIDS occurs)
and are suspicious of the concept of "risk reduction."2 However, African-American parents
have a high degree of self-efficacy with regards to preventing infant suffocation. Given the
increasing number of suffocation and other preventable sleep-related deaths and the fact
that many of the behavioral risk factors for both SIDS and preventable sleep-related deaths
are the same, providing parents with an additional safe sleep message that emphasizes
prevention of suffocation may be more effective in changing parent behavior. Such a message
would be carefully crafted based on our current community-based research1-3 to address
emerging risks of greatest concern and potential self-efficacy. A simple, easily
reproducible change in the system of newborn care could thus address a critical barrier to
further progress in reducing infant mortality rates, particularly among African American
families. The best systems of care to reduce disparities must use the best available and
culturally competent messaging based on strong empirical evidence and require rigorous
evaluation.

Inclusion Criteria:

- The purpose of the study is to determine the impact of a new educational strategy on
African American parents, all participants will be self identified as African
American. Although male parents will be allowed to participate in the followup
surveys, female parents will be the primary focus of this study.

Exclusion Criteria:

- Mothers under the age of 18 years will not be included in the study. Infants born
with congenital anomalies that would prevent them from sleeping in the supine
position or if the infant is born at less than 36 weeks gestation, requires
hospitalization for more than 1 week, or has ongoing medical problems.