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人父母更不可能让他们的婴儿以仰卧姿势睡觉。非裔美国婴儿死于婴儿猝死综合症（SIDS）的比率是非西班牙裔白人婴儿的2-3倍。让婴儿以仰卧姿势睡觉可以显著降低小岛屿发展中国家死亡的风险。SIDS被定义为“一岁以下婴儿突然、无法解释的死亡”，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个月大时，发病率最高的是2至4个月大。尽管非裔美国人和非西班牙裔白人婴儿仰卧睡眠的总体比例有所增加，但自1992年首次提出仰卧睡眠建议以来，非裔美国人和白人婴儿在仰卧睡眠患病率方面的差异一直存在。尽管医生、护士、报纸和其他媒体共同努力向家长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。这部分父母面临的具体障碍以及仰卧睡婴儿的父母如何遇到并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、以家长为中心的干预措施的有效性，与目前可用的非量身定制的材料相比，该干预措施可以提高非裔美国婴儿平卧睡眠的患病率。使用焦点小组数据和参与者访谈，干预材料将包含与文化相关的解决方案，以解决父母报告的障碍和信念，具体的技术来帮助父母将婴儿安置在适合婴儿发育阶段的仰卧位，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：当哭闹/绞痛突出时（6周龄），以及当婴儿变得更活跃时（4个月大）。干预材料将包括包含上述信息的小册子和DVD，说明适当的环境，位置和沉降技术。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小册子和关于婴儿安全的通用DVD。由于我们的初步数据表明，有非裔美国医生的非裔美国父母比有其他种族医生的非裔美国父母保持婴儿仰卧睡姿的时间更长，因此我们将在干预材料中随机改变医生模型的种族。我们假设1)接受干预的父母比对照组的父母更倾向于让他们的婴儿仰卧睡觉，2)当医生模型是种族一致性的时候，这种效果会增强。

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.