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Revisiting Safe Sleep Recommendations for African-American Infants: Why Current Counseling is Insufficient

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Abstract

The American Academy of Pediatrics recommends that children be placed in the supine position on firm bedding and not bed share with parents or other children. Health professionals increasingly understand that many African-American parents do not follow these recommendations, but little research exists on provider reactions to this non-compliance. This study was intended to better understand how low-income, African-American mothers understand and act upon safe sleep recommendations for newborns and how providers counsel these mothers. We conducted focus groups with 60 African-American, low-income, first-time mothers and telephone interviews with 20 providers serving these populations to explore provider counseling and patient decision making. The large majority of mothers reported understanding, but not following, the safe-sleeping recommendations. Key reasons for non-compliance included perceived safety, convenience, quality of infant sleep and conflicting information from family members. Mothers often take measures intended to mitigate risk associated with noncompliance, instead increasing SIDS risk. Providers recognize that many mothers are non-compliant and attribute non-compliance largely to cultural and familial influence. However, few provider attempts are made to mitigate SIDS risks from non-compliant behaviors. We suggest that counseling strategies should be adapted to: (1) provide greater detailed rationale for SIDS prevention recommendations; and (2) incorporate or acknowledge familial and cultural preferences. Ignoring the reasons for sleep decisions by African-American parents may perpetuate ongoing racial/ethnic disparities in SIDS.

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References

  1. Task Force on Sudden Infant Death Syndrome. (2011). SIDS and other sleep-related infant deaths: Expansion of recommendations for a safe infant sleeping environment. Pediatrics, 128(5), e1341–e1367.

    Article  Google Scholar 

  2. Pickett, K. E., Luo, Y., & Lauderdale, D. S. (2005). Widening social inequalities in risk for sudden infant death syndrome. American Journal of Public Health, 95(11), 1976–1981.

    Article  PubMed Central  PubMed  Google Scholar 

  3. Centers for Disease Control and Prevention. (2013). Infant mortality statistics from the 2009 period linked birth/infant death data set. In National vital statistics reports, 201.

  4. Maternal and Child Health Bureau. (2011). Perinatal health status indicators. Health Services Research Administration.

  5. Centers for Disease Control and Prevention. (2011). Sudden unexpected infant death and sudden infant death syndrome. March 24, 2014 from http://www.cdc.gov/sids/suidabout.htm.

  6. American Academy of Pediatrics Task Force on Sudden Infant Death Syndrome. (2005). The changing concept of sudden infant death syndrome: Diagnostic coding shifts, controversies regarding the sleeping environment, and new variables to consider in reducing risk. Pediatrics, 116(5), 1245–1255.

    Article  Google Scholar 

  7. Willinger, M., et al. (2003). Trends in infant bed sharing in the United States, 1993–2000: The National Infant Sleep Position Study. Archives of Pediatrics and Adolescent Medicine, 157, 43–49.

    Article  PubMed  Google Scholar 

  8. Vennemann, M. M., et al. (2009). Does breastfeeding reduce the risk of sudden infant death syndrome? Pediatrics, 123(3), e406–e410.

    Article  CAS  PubMed  Google Scholar 

  9. Vennemann, M. M., et al. (2012). Bed sharing and the risk of sudden infant death syndrome: Can we resolve the debate? Journal of Pediatrics, 160(1), 44e2–48e2.

    Article  Google Scholar 

  10. Joyner, B. L., et al. (2010). Where should my baby sleep: A qualitative study of African American infant sleep location decisions. Journal of the National Medical Association, 102(10), 881–889.

    PubMed  Google Scholar 

  11. McKenna, J. J., & McDade, T. (2005). Why babies should never sleep alone: A review of the co-sleeping controversy in relation to SIDS, bedsharing and breast feeding. Paediatric Respiratory Reviews, 6(2), 134–152.

    Article  PubMed  Google Scholar 

  12. Ostfeld, B. M., et al. (2006). Sleep environment, positional, lifestyle, and demographic characteristics associated with bed sharing in sudden infant death syndrome cases: A population-based study. Pediatrics, 118(5), 2051–2059.

    Article  PubMed  Google Scholar 

  13. Thach, B. T. (2005). Where should baby be put back to sleep? Journal of Pediatrics, 147(1), 6–7.

    Article  PubMed  Google Scholar 

  14. Trifunov, W. (2014). The practice of bed sharing: A systematic literature and policy review. May 14, 2010 from http://www.phac-aspc.gc.ca/dca-dea/prenatal/pbs-ppl-eng.php.

  15. Ball, H. (2003). Breastfeeding, bed-sharing, and infant sleep. Birth, 30(3), 181–188.

    Article  PubMed  Google Scholar 

  16. Ball, H. (2006). Parent-infant bed-sharing behavior. Human Nature, 17(3), 301–318.

    Article  Google Scholar 

  17. Arnstad, M., et al. (2001). Changes in the epidemiological pattern of sudden infant death syndrome in southeast Norway, 1984–1998: Implications for future prevention and research. Archives of Disease in Childhood, 85, 108–115.

    Article  Google Scholar 

  18. Blair, P. S., et al. (1999). Babies sleeping with parents: Case–control study of factors influencing the risk of the sudden infant death syndrome. BMJ, 319, 1457–1462.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  19. Fleming, P. J., et al. (1996). Environment of infants during sleep and risk of the sudden infant death syndrome: Results of 1993–5 case–control study for confidential inquiry into stillbirthds and deaths in infancy. BMJ, 313, 191–195.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  20. Ruys, J. H., et al. (2007). Bed-sharing in the first four months of life: A risk factor for sudden infant death. Acta Paediatrica, 96(10), 1399–1403.

    Article  PubMed  Google Scholar 

  21. Scragg, R., et al. (1993). Bedsharing, smoking, and alcohol in the sudden infant death syndrome. BMJ, 307, 1312–1318.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  22. Hauck, F. R., et al. (2003). Sleep environment and the risk of sudden infant death syndrome in an urban population: The Chicago Infant Mortality Study. Pediatrics, 111(5), 1207–1214.

    PubMed  Google Scholar 

  23. McGarvey, C., et al. (2003). Factors relating to the infant’s last sleep environment in sudden infant death syndrome in the Republic of Ireland. Archives of Disease in Childhood, 88, 1058–1064.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  24. Tappin, D., Ecob, R., & Brooke, H. (2005). Bedsharing, roomsharing, and sudden infant death syndrome in Scotland: A case–control study. Journal of Pediatrics, 147(1), 32–37.

    Article  PubMed  Google Scholar 

  25. Carpenter, R. G., et al. (2004). Sudden unexplained infant death in 20 regions in Europe: Case control study. The Lancet, 363, 185–191.

    Article  CAS  Google Scholar 

  26. McGarvey, C., et al. (2006). An 8 year study of risk factors for SIDS: Bed-sharing versus non-bed-sharing. Archives of Disease in Childhood, 91(4), 318–323.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  27. Fu, L. Y., et al. (2008). Infant sleep location: Associated maternal and infant characteristics with sudden infant death syndrome prevention recommendations. Journal of Pediatrics, 153(4), 503–508.

    Article  PubMed Central  PubMed  Google Scholar 

  28. Oden, R. P., et al. (2010). Factors influencing African American mothers’ decisions about sleep position: A qualitative study. Journal of the National Medical Association, 102(10), 870–880.

    PubMed  Google Scholar 

  29. Moon, R. Y., & Omron, R. (2002). Determinants of infant sleep position in an urban population. Clinical Pediatrics, 41(8), 569–573.

    Article  PubMed  Google Scholar 

  30. Colson, E. R., et al. (2006). Barriers to following the supine sleep recommendation among mothers at four centers for the Women, Infants, and Children Program. Pediatrics, 118(2), e243–e250.

    Article  PubMed  Google Scholar 

  31. Ottolini, M. C., et al. (1999). Prone infant sleeping despite the “Back to Sleep” campaign. Archives of Pediatrics and Adolescent Medicine, 153, 512–517.

    Article  CAS  PubMed  Google Scholar 

  32. Gazmararian, J., et al. (2013). What new mothers need to know. Maternal and Child Health Journal, 18, 839–851.

  33. Miles, M. B., & Huberman, A. M. (1994). Qualitative data analysis: An expanded sourcebook. Thousand Oaks: Sage.

    Google Scholar 

  34. Creswell, J. (2013). Qualitative inquiry and research design: Choosing among five approaches. Thousand Oaks: Sage.

    Google Scholar 

  35. American Academy of Pediatrics Task Force on Sudden Infant Death Syndrome. (2011). SIDS and other sleep-related infant deaths: Expansion of recommendations for a safe infant sleeping environment. Pediatrics, 128(5), e1341–e1367.

    Article  Google Scholar 

  36. US Department of Health and Human Services. (2014). National CLAS standards. Office of Minority Health.

  37. Agency for Healthcare Research and Quality. (2004). Setting the agenda for research on cultural competence in health care. Retrived May 29, 2014 from http://www.ahrq.gov/research/findings/factsheets/literacy/cultural/cultural.pdf.

  38. Kirmayer, L. (2012). Rethinking cultural compentence. Transcultural Psychiatry, 49(2), 149.

    Article  PubMed  Google Scholar 

  39. Purnell, L. D., & Paulanka, B. J. (Eds.). (2012). Transcultural health care: A culturally competent approach (4th ed., pp. 357–373). Philadelphia, PA: F.A. Davis Company.

  40. Like, R. C. (2011). Educating clinicians about cultural competence and disparities in health and health care. Journal of Continuing Education in the Health Professions, 31(3), 196–206.

    Article  PubMed  Google Scholar 

  41. United States Department of Health and Human Services. (2001). What is cultural competency? March 24, 2014 from http://minorityhealth.hhs.gov/templates/browse.aspx?lvl=2&lvlID=11.

  42. National Suddent and Unexpected Infant/Child Death and Pregnancy Loss Resource Center: Helping baby “Back To Sleep”, pp. 1–4, 2009. Retrived May 29, 2014 from http://www.mchlibrary.info/suid-sids/documents/SIDRC/BackToSleep.pdf.

  43. Centers for Disease Control and Prevention. (2013). Progress in increasing breastfeeding and reducing racial/ethnic differences—United States, 2000–2008 births. MMWR, 62(5), 77–90.

    Google Scholar 

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Acknowledgments

Special thanks to Jonathan Hawley, Lauren Corboy and Yesenia Merino of The Rollins School of Public Health at Emory University for their assistance with this study. This study was funded by the Georgia Department of Public Health, Office of Maternal and Child Health.

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Authors and Affiliations

  1. Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, GA, USA

    Laura M. Gaydos & Sarah C. Blake

  2. Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA

    Julie A. Gazmararian

  3. Emory University Hospital, Atlanta, GA, USA

    Whitney Woodruff

  4. Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA, USA

    Winifred W. Thompson

  5. School of Nursing, Emory University, Atlanta, GA, USA

    Safiya George Dalmida

Authors
  1. Laura M. Gaydos
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  2. Sarah C. Blake
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  3. Julie A. Gazmararian
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  4. Whitney Woodruff
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  5. Winifred W. Thompson
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  6. Safiya George Dalmida
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Correspondence to Laura M. Gaydos.

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Gaydos, L.M., Blake, S.C., Gazmararian, J.A. et al. Revisiting Safe Sleep Recommendations for African-American Infants: Why Current Counseling is Insufficient. Matern Child Health J 19, 496–503 (2015). https://doi.org/10.1007/s10995-014-1530-z

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  • DOI: https://doi.org/10.1007/s10995-014-1530-z

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