Funded Projects

Randomized Messaging Trial to Reduce African-American Infant Mortality

Grantee: Children's Research Institute
Principal Investigator: Rachel Moon
Project Number: R40MC21511
Project Date: 2/1/2011

Age group(s)

• Perinatal/Infancy (0-12 months)

Targeted/Underserved Population

• African American

Abstract

In the US, SIDS and other sleep-related deaths account for ~4600 infant deaths annually. While the incidence of SIDS has declined, infant deaths from accidental suffocation and strangulation in bed have quadrupled. 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. Certain infant sleeping practices (e.g., prone sleeping, use of soft bedding and soft sleep surfaces, and bedsharing) likely play a contributory role in both SIDS and SUID, and in the disparities seen therein. In this application, we propose an intervention to change African-American parental behaviors pertaining to a safe infant sleep environment and thus reduce sleep-related infant mortality rates. This study is directly responsive to two of MCHB's Strategic Research Issues: a systematic approach to eliminating health disparities and barriers to health care access for MCH populations, and promoting the healthy development of MCH populations. In the current paradigm for clinical practice, the use of supine positioning, avoidance of soft bedding, and room sharing without bedsharing are recommended to reduce the risk of SIDS. However, our recent research suggests that African-Americans have problems with this message, because they have a low degree of selfefficacy 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." 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 counseling could thus address a critical barrier to further progress in reducing infant mortality rates, particularly among African-American families. The overall purpose of this randomized trial is to develop and evaluate a systematic approach to improve African-American parental behaviors specifically with regards to the infant sleep environment. Our specific aim is to evaluate the impact of additional messages on these parental behaviors. African-American parents of newborn, healthy term infants will be randomized to receive either a standard message to avoid bedsharing, eliminate use of soft bedding and soft sleep surfaces, and to place infants in the supine position for sleep to

Publications

Listed is descending order by year published.

Mathews A, Oden R, Joyner B, He J, et al. Differences in African-American maternal self-efficacy regarding practices impacting risk for sudden infant death. J Community Health. 2015;1-6.

Centers for Disease Control and Prevention (CDC). CDC Grand Rounds: public health approaches to reducing U.S. infant mortality. MMWR Morb Mortal Wkly Rep. 2013 Aug 9;62(31):625-8. PubMed PMID: 23925172.