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

描述（由申请人提供）：非裔美国父母比非西班牙裔白色父母更不可能让婴儿仰卧睡觉。非洲裔美国婴儿也死于婴儿猝死综合症（SIDS），其死亡率是非西班牙裔白色婴儿的2-3倍。让婴儿以仰卧位睡觉可以显著降低SIDS的死亡风险。婴儿猝死综合症被定义为“一岁以下婴儿的突然、不明原因的死亡”，是婴儿出生一个月后死亡的主要原因。大多数SIDS死亡（90%）发生在6个月大时，最高发生率在2至4个月之间。自1992年第一次提出仰卧睡眠建议以来，非裔美国人和白色婴儿仰卧睡眠患病率的差异一直存在，尽管非裔美国人和非西班牙裔白人的仰卧睡眠总体比率都有所增加。 尽管医生、护士、报纸和其他媒体都在协调一致地向父母宣传婴儿仰卧睡眠的重要性，但这种差异仍然存在。父母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位主要是因为婴儿舒适。这部分父母所面临的具体障碍以及仰卧睡眠婴儿的父母如何遇到和克服这些障碍尚不清楚。 我们提出了一项随机对照试验，以测试多媒体，量身定制的，以父母为中心的干预措施，以增加非洲裔美国婴儿仰卧睡眠的患病率相比，目前可用的非定制材料的有效性。使用焦点小组数据和参与者访谈，干预材料将包含与父母报告的障碍和信念相关的文化解决方案，帮助父母将婴儿安置在仰卧位的具体技术，这些技术适合婴儿的发育阶段沿着关于睡眠环境和姿势的推荐指南。 对照和干预材料将在两个发育阶段发送：当哭泣/绞痛突出时（6周龄），以及当婴儿变得更加活跃时（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、位置和安置技术的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关于婴儿安全的通用DVD。因为我们的初步数据表明，非裔美国人的父母谁拥有一个非裔美国人的医生为他们的孩子保持婴儿仰卧睡姿的时间比那些孩子的医生是另一个种族，我们将随机改变种族的医生模型的干预材料。我们假设：1）接受干预的父母将以高于对照组父母的速度保持婴儿仰卧睡眠，2）当医生模型与种族一致时，这种效果会增强。 公共卫生相关性：提高婴儿仰卧睡眠的普及率是2010年和2020年健康人群的目标。解决父母的信念和仰卧睡眠的障碍，并提供实用的，发展适当的建议，应创建一个显着更大的仰卧睡眠的患病率在干预组相比，对照组。这种干预措施可以很容易地修改，用于一般人群。

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.