Enhancing Safe Sleep Practices of Urban Low-Income Mothers

描述(申请人提供)：在美国，每年有超过4500名婴儿突然死亡，原因不明。在这些婴儿猝死(SUID)中，有一半是由于婴儿猝死综合症(SID)，这是1-12个月婴儿猝死和所有死亡的主要原因。尽管美国儿科学会(AAP)的回归睡眠运动导致仰卧睡眠增加，而且自1994年以来，小岛屿发展中国家的数量急剧减少，但令人震惊的种族和民族差异依然存在。对SUID的儿童死亡回顾有助于确定重要的风险因素，以指导预防工作。这项拟议工作的最终目标是通过提供创新的、理论驱动的教育，并在必要时方便地使用便携式婴儿床，防止本来健康的婴儿死亡。该研究的具体目的是：1)评估安全睡眠干预措施(医生咨询+加强健康教育+婴儿床分发)对父母在婴儿出生后四个月内为其创造和维持安全睡眠环境的知识、信念、意图、技能和做法的影响；2)描述医生对安全睡眠的预期指导的特点，并确定与健康儿童访视主题相关的医生、患者和家长的特征；以及3)评估S安全睡眠运动在我们研究参与者中的传播情况。这项为期41年半的研究将在约翰·霍普金斯大学哈里特·莱恩诊所进行。方法将包括一项3组随机对照试验，比较在2周的健康儿童访视中提供的安全睡眠干预与标准护理和注意匹配的对照组。将收集的数据包括：1)父母与安全睡眠有关的知识(包括接触BHB运动)、信念、意图、技能和做法的基线评估；2)医生-父母和健康教育者-父母互动的录音，以及父母报告的对接触的评估；以及3)婴儿3-4周和2-3个月大时对婴儿睡眠相关做法和环境的家庭观察。这项工作的结果将推动以理论为导向的教育和环境干预措施的应用，以解决高危家庭的伤害预防需求。研究结果将对向服务于类似高危家庭的儿科临床护理机构传播有效的安全睡眠行为改变计划具有广泛的实用价值。

DESCRIPTION (provided by applicant): Every year in the United States, more than 4,500 infants die suddenly of no immediately obvious cause. Half of these Sudden Unexpected Infant Deaths (SUID) are due to Sudden Infant Death Syndrome (SIDS), the leading cause of SUID and of all deaths among infants aged 1-12 months. While the American Academy of Pediatrics' (AAP) Back to Sleep campaign has led to increased supine sleeping and coincided with a dramatic reduction in SIDS since 1994, staggering racial and ethnic disparities have persisted. Child death reviews of SUID have been beneficial in identifying important risk factors to guide prevention efforts. The ultimate goal of this proposed work is to prevent otherwise healthy infants from dying by providing innovative, theory-driven education coupled with easy access to a portable crib, when necessary. The specific aims of the study are: 1) To evaluate the impact of safe sleep interventions (physician counseling + enhanced health education + crib distribution) on parents' knowledge, beliefs, intentions, skills and practices related to creating and maintaining a safe sleep environment for their infants during the first four months of life; 2) To describe the characteristics of physician anticipatory guidance about safe sleep and identify physician, patient and parent characteristics associated with coverage of the topic at the well-child visits; and 3) To evaluate the dissemination of the B'more for Healthy Babies (BHB)'s safe sleep campaign messages and services among our study participants. This 41/2 year study will take place in the Johns Hopkins Harriet Lane Clinic. Methods will include a 3- group randomized controlled trial comparing the safe sleep intervention delivered at the 2-week well-child visit to standard of care and attention matched control groups. Data to be collected include: 1) baseline assessments of parents' safe sleep-related knowledge (including exposure to the BHB campaign), beliefs, intentions, skills and practices; 2) audio-recording of physician-parent and health educator-parent interactions and parent-reported assessments of the encounters; and 3) home observations of infant sleep-related practices and environments when the infant is 3-4 weeks and 2-3 months old. Results of this work will advance the application of theory-driven educational and environmental interventions addressing the injury prevention needs of high-risk families. Results will have widespread utility for disseminating effective safe sleep behavior change programs to pediatric clinical care settings serving similar high-risk families.