Enhancing Safe Sleep Practices of Urban Low-Income Mothers

描述（由申请人提供）：在美国，每年有超过4500名婴儿在没有明显原因的情况下猝死。这些婴儿意外猝死（SUID）中有一半是由于婴儿猝死综合症（SIDS）造成的，这是导致婴儿猝死的主要原因，也是1-12个月婴儿死亡的主要原因。虽然美国儿科学会（AAP）的“重返睡眠”运动导致了仰卧睡眠的增加，并且自1994年以来，小岛屿发展中国家（SIDS）的发病率也大幅下降，但令人震惊的种族和民族差异仍然存在。对儿童死亡情况的审查有助于确定重要的危险因素，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，并在必要时方便地获得便携式婴儿床，防止其他健康的婴儿死亡。本研究的具体目的是：1)评估安全睡眠干预（医生咨询+加强健康教育+婴儿床分配）对父母在出生后4个月为婴儿创造和维持安全睡眠环境的知识、信念、意图、技能和实践的影响；2)描述关于安全睡眠的医生预期指导的特征，并确定在健康儿童访问中与该主题覆盖相关的医生、患者和家长特征；3)评估健康婴儿（BHB）安全睡眠运动信息和服务在研究参与者中的传播情况。这项为期4年半的研究将在约翰·霍普金斯大学哈里特·莱恩诊所进行。方法包括一项三组随机对照试验，比较两周健康儿童访问时提供的安全睡眠干预与标准护理和注意匹配的对照组。收集的数据包括：1)对父母的安全睡眠相关知识（包括对BHB活动的了解）、信念、意图、技能和做法的基线评估；2)录音医生与家长、健康教育者与家长的互动以及家长报告的接触评估；3) 3-4周龄和2-3月龄婴儿睡眠相关习惯和环境的家庭观察。这项工作的结果将促进理论驱动的教育和环境干预的应用，以解决高危家庭的伤害预防需求。研究结果将广泛应用于向儿科临床护理机构传播有效的安全睡眠行为改变方案，为类似的高危家庭提供服务。

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.