CBPR Initiative in Reducing Infant Mortality in American Indian Communities

描述(由申请人提供)：拟议研究的目标是让美国印第安人社区参与设计和实施干预措施，以降低由于不安全的睡眠环境而导致的婴儿猝死综合症(SIDS)和其他相关婴儿死亡的风险。美国印第安人/阿拉斯加土著人(AI/AN)对婴儿死亡率造成了不成比例的负担。根据疾病控制和预防中心(CDC)的数据，AI/AN的婴儿死亡率是非西班牙裔白人的1.6倍，死于小岛屿发展中国家的可能性是非西班牙裔白人婴儿的1.7倍。虽然婴儿死亡率有所下降，但北平原美洲印第安人的小岛屿发展中国家的死亡率为每1000名活产3.46人，而美国整个小岛屿发展中国家的死亡率为每1000名活产0.54人。不同种族的婴儿死亡率之间的差异在很大程度上是由新生儿后死亡率推动的。新生儿死亡发生在分娩后28天后，主要与小岛屿发展中国家和婴儿护理做法有关，包括与睡眠环境有关的因素，这些因素基本上被认为是可以预防的。来自其他种族研究的令人信服的证据表明，关于婴儿睡眠、安全和舒适的家庭和文化规范、态度和个人信念与婴儿睡眠环境的选择密切相关。目前的安全睡眠信息可能与美国印第安人社区固有的文化信仰相冲突。这种与《科学》关于安全睡眠的建议的冲突可能会影响行为，即使在对安全睡眠实践有足够的了解的情况下。这项提议为扩大我们目前在婴儿死亡率方面的工作提供了一个前所未有的机会，这一工作部分是通过小岛屿发展中国家和死胎中的产前酒精网络(NICHD 2U01-HD045935)建立的。在此期间，我们成功地与婴儿死亡风险最高的社区接触，并通过对话和信任建立了长期关系，以制定相互同意的研究方案和程序。与当地诊所、医院和社区服务机构合作，我们开发了一个临床站点基础设施，旨在招募和跟踪妇女，以便在多个保健环境和物理位置进行研究，以实现最佳保留和结果确定。运用基于社区的参与式研究模式，我们将调查父母的知识、文化信仰和获取资源的途径对婴儿睡眠环境决策的影响。在美国儿科学会婴儿安全睡眠建议的支持下，社区的投入和反馈将被用于制定一个具有文化根深蒂固的团体干预计划。这项干预措施将通过对150名怀孕的美国印第安人妇女进行随机开放试验进行测试，比较标准的安全睡眠教育模式和文化上合适的群体教育模式。

DESCRIPTION (provided by applicant): The objective of the proposed study is to engage American Indian communities in the design and implementation of an intervention to reduce the risk for Sudden Infant Death Syndrome (SIDS) and other related infant deaths due to unsafe sleep environments. American Indian/Alaskan Natives (AI/AN) carry a disproportionate burden of infant mortality. According to the Centers for Disease Control and Prevention (CDC), AI/AN have 1.6 times the infant mortality rate as non-Hispanic whites and are 1.7 times as likely as non-Hispanic white babies to die from SIDS. While there have been decreases in infant mortality rates, the Northern Plains American Indian SIDS rate is 3.46 per 1000 live births compared to the overall US SIDS rate of 0.54 per 1000 live births. The disparity between infant mortality rates by race is largely driven by post-neonatal mortality. Post-neonatal deaths occur after 28 days post-delivery and are primarily related to SIDS and infant care practices including, sleep environment related factors that are largely considered preventable. Compelling evidence from research in other racial populations suggests that family and cultural norms, attitudes and personal beliefs about infant sleep, safety and comfort are strongly associated with the choice of infant sleep environment. It may be possible that the current safe sleep messages are in conflict with inherent cultural beliefs within American Indian communities. This conflict with the scientifi recommendations regarding safe sleep may influence behavior, even in the presence of adequate knowledge about safe sleep practices. This proposal provides an unprecedented opportunity to expand our current work in infant mortality established, in part, through the Prenatal Alcohol in SIDS and Stillbirth (PASS) Network (NICHD 2U01- HD045935). During this time, we have successfully engaged communities at the highest risk of infant mortality and established long-term relationships through dialogue and trust, to develop mutually agreeable research protocols and procedures. In partnership with local clinics, hospitals and community service agencies, we have developed a clinical site infrastructure designed to recruit and follow women for research purposes through multiple health-care environments and physical locations to allow for optimal retention and outcome ascertainment. Using a Community Based Participatory Research model, we will investigate the influence of parental knowledge, cultural beliefs and access to resources on decision making regarding infant sleep environment. Community input and feedback will be utilized in development of a culturally embedded group intervention program, buoyed by the American Academy Pediatrics safe sleep recommendations for infants. The intervention will be tested using a randomized, open trial of a 150 pregnant American Indian women, comparing standard safe sleep education format to a culturally appropriate group education format.