Enhancing Safe Sleep Practices of Urban Low-Income Mothers

描述（申请人提供）：在美国，每年有4,500多名婴儿突然死亡，没有立即明显的原因。这些婴儿意外猝死（SUID）中有一半是由于婴儿猝死综合症（SIDS），这是SUID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“回到睡眠”运动导致仰卧睡眠增加，并且自1994年以来，SIDS的急剧减少，但令人震惊的种族和民族差异仍然存在。SUID的儿童死亡审查有助于确定重要的风险因素，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、理论驱动的教育以及在必要时方便使用便携式婴儿床，防止健康婴儿死亡。本研究的具体目的是：1）评估安全睡眠干预措施的影响（医生咨询+加强健康教育+婴儿床分配）关于父母在出生后头四个月为婴儿创造和维持安全睡眠环境的知识、信念、意图、技能和做法; 2）描述医生关于安全睡眠的预期指导的特征，并识别与健康儿童访问时主题覆盖范围相关的医生、患者和家长特征;及3）评估B 'more健康婴儿安全睡眠活动的信息及服务在研究参与者中的传播情况。这项为期41/2年的研究将在约翰霍普金斯哈里特莱恩诊所进行。方法将包括一项3组随机对照试验，将在2周健康儿童访视时提供的安全睡眠干预与标准护理和注意力匹配对照组进行比较。收集的数据包括：1）对父母的安全睡眠相关知识（包括接触BHB活动）、信念、意图、技能和实践的基线评估; 2）对医生-父母和健康教育者-父母互动的录音以及父母报告的接触评估; 3）在婴儿3-4周和2-3个月大时对婴儿睡眠相关实践和环境的家庭观察。这项工作的结果将推进应用理论驱动的教育和环境干预措施，解决高风险家庭的伤害预防需求。研究结果将具有广泛的实用性，传播有效的安全睡眠行为改变计划，以儿科临床护理设置服务类似的高风险家庭。

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.