Enhancing Safe Sleep Practices of Urban Low-Income Mothers

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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.