Improving the Self-Efficacy of African American Parents in Infant Supine Sleep

描述(申请人提供)：非裔美国父母比非西班牙裔白人父母不太可能让他们的婴儿仰卧睡觉。非洲裔美国婴儿死于婴儿猝死综合症(SID)的比率也是非西班牙裔白人婴儿的2-3倍。让婴儿仰卧睡眠可显著降低婴儿死于婴儿猝死综合症的风险。婴儿猝死综合征被定义为“一岁以下婴儿的突然、原因不明的死亡”，是婴儿出生后第一个月死亡的主要原因。大多数小岛屿发展中国家的死亡(90%)发生在6个月大的婴儿，发病率最高的是2至4个月。自1992年首次提出仰卧睡眠建议以来，非洲裔美国婴儿和白人婴儿之间的仰卧睡眠比例差距一直存在，尽管非洲裔和非西班牙裔白人的总体仰卧睡眠率都有所上升。尽管来自医生、护士、报纸和其他媒体的公共卫生部门一致努力告知父母婴儿仰卧睡眠的重要性，但这种差异仍然存在。家长教育的重点是婴儿仰卧睡眠的安全性，尽管最近的研究表明，父母现在使用非仰卧姿势主要是为了婴儿舒适。这部分父母面临的具体障碍，以及仰卧婴儿的父母是如何遇到和克服这些障碍的，目前尚不清楚。我们提出了一项随机对照试验，以测试多媒体、量身定制、以父母为重点的干预措施的有效性，与目前可用的非定制材料相比，该干预措施增加了非裔美国婴儿仰卧睡眠的患病率。使用焦点小组数据和参与者访谈，干预材料将包含针对父母报告的障碍和信念的文化相关解决方案，帮助父母让婴儿处于适合婴儿发育阶段的仰卧姿势的具体技术，以及关于睡眠环境和姿势的推荐指南。控制和干预材料将在两个发育阶段发送：在哭闹/绞痛突出时(6周大)，以及婴儿开始变得更活跃时(4个月大)。干预材料将包括一本包含上述信息的小册子和一张说明适当环境、位置和解决技术的DVD。对照组的父母将收到目前可用的关于婴儿仰卧睡眠的教育手册和一张关于婴儿安全的通用DVD。由于我们的初步数据显示，为孩子配备非裔美国医生的非裔美国父母比那些孩子的医生来自其他种族的父母保持婴儿仰卧睡眠的时间更长，因此我们将随机改变干预材料中医生-模特的种族。我们假设，1)接受干预的父母将使他们的婴儿保持仰卧睡眠的比率高于对照组父母，以及2)当医生-模型种族和谐时，这种影响会增强。 公共卫生相关性：增加婴儿仰卧睡眠的患病率是2010年和2020年健康人的目标。解决父母的观念和仰卧睡眠的障碍，并提供实用的、适合发育的建议，应该会使干预组与对照组相比，仰卧睡眠的患病率显著增加。这种干预措施可以很容易地进行修改，以便在普通人群中使用。

DESCRIPTION (provided by applicant): African American parents are less likely than non-Hispanic White parents to place their infant to sleep in a supine position. African American infants also die of Sudden Infant Death Syndrome (SIDS) at rates 2-3 times greater than non-Hispanic White infants. Placing infants to sleep in the supine position significantly reduces the risk of death from SIDS. Defined as the "sudden, unexplained death of an infant younger than one year old," SIDS is the leading cause of infant deaths occurring after the first month of life. Most SIDS deaths (90%) occur by 6 months of age with the highest incidence between 2 and 4 months. The disparity between African American and White infants in supine sleep prevalence has persisted since the first supine sleep recommendation was made in 1992, although overall rates of supine sleep have increased for both African American and non-Hispanic Whites. This disparity endures despite a concerted public health effort to inform parents about the importance of infant supine sleep from physicians, nurses, newspapers, and other media. Parent education has focused on the safety of infant supine sleep, though recent studies demonstrate that parents now use the non-supine position primarily because of infant comfort. The specific barriers faced by this subset of parents and how parents of supine-sleeping infants have met and overcome those barriers is unknown. We propose a randomized controlled trial to test the effectiveness of a multi-media, tailored, parent- focused intervention to increase the prevalence of African American infant supine sleep as compared to currently available non-tailored materials. Using focus group data and participant interviews, the intervention materials will contain culturally relevant solutions to parent reported barriers and beliefs, specific techniques to assist parents in settling the infant in the supine position that are appropriate to the infant's developmental stage along with the recommended guidelines about the sleep environment and position. Control and intervention materials will be sent at two developmental stages: when crying /colic is prominent (6 weeks of age), and when the infant is becoming more physically active (4 months of age). The intervention materials will consist of a brochure containing the information mentioned above and a DVD illustrating the appropriate environment, position, and settling techniques. Control group parents will receive currently available educational brochures about infant supine sleep and a generic DVD on infant safety. Because our preliminary data suggests that African American parents who have an African American physician for their child maintain the infant supine sleeping position longer than those whose child's physician is of another race, we will randomly vary the race of physician-model in the intervention materials. We hypothesize that 1) parents who receive the intervention will keep their infants sleeping supine at a higher rate than control group parents, and 2) this effect is enhanced when the physician-model is race-concordant. PUBLIC HEALTH RELEVANCE: Increasing the prevalence of infant supine sleep is an objective of Healthy People 2010 and 2020. Addressing parental beliefs and barriers to supine sleep and providing practical, developmentally appropriate advice should create a significantly greater prevalence of supine sleep in the intervention group compared to the control group. This intervention could be easily modified for use in the general population.