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Sudden Unexpected Infant Death (SUID) accounts for approximately 3,500 deaths in the United States annually. Research suggests that SUID can be prevented by following infant safe sleep practices, which include placing infants on their backs to sleep, and avoiding bed sharing, soft and loose bedding, and exposure to tobacco and other chemicals. Nationwide initiatives, such as the Safe to Sleep campaign and local prevention efforts, were successful in decreasing the SUID rates in the U.S. The rates, however, have stagnated in the recent years and remain higher than in other developed countries. This unfavorable trend warrants further prevention efforts. The current study evaluated the effectiveness of a comprehensive, multi-level, SUID preventive intervention to promote safe infant sleep practices among caregivers in urban low-income areas.
Methods
The Longitudinal Infant and Family Environment (LIFE) study was launched in an effort to educate caregivers of infants about safe sleep practices and to increase their access to safe sleep environments. Participants were recruited at a mother-infant unit at a large urban university medical center. Eligible and consenting mothers (N = 339) received an intervention consisting of 15-minutes of psychoeducation at the hospital, a Baby Box complete with a firm foam mattress and cotton fitted sheet, and a postpartum home visit by a pediatric nurse. Surveys focused on safe sleep practices, and knowledge of SUID risk factors were collected at the baseline and at the 7-day follow-up.
Results
The sample consisted predominantly of African Americans (56%) and Caucasians (30%). Nearly half of the participants reported annual household incomes lower than $25,000. Our results showed a good understanding of safe sleep practices among caregivers at the baseline. Almost all (98.5%) mothers were planning to put their babies on their back to sleep, and 90.0% were not planning to share a bed. At the follow-up, 98.0% of participants reported placing babies on their backs to sleep, and 91.2% of participants reported that they were not sharing a bed with their infants during the past week. The majority of the participants were familiar with the risk factors for SUID. Approximately three-fourths of participants reported that sleeping on a couch (71.3%), sleeping face down (86.3%), and sleeping with pillows or blankets (78.9%) can be very dangerous for a baby. Knowledge of the SUID risk factors increased at the 7-day follow-up. Mothers reported that sleeping on a couch (75.2%), sleeping face down (89.1%), and sleeping with pillows or blankets (82.1%) can be very dangerous for a baby.
Discussion and implications
SUID in the U.S. remains a public health issue. The LIFE study was launched as a comprehensive safe sleep intervention with the aim to educate caregivers about safe sleep practices and to increase caregivers’ access to safe sleep environments. Prevention efforts, such as the LIFE intervention, can be effective in promoting safe sleep practices and, thus, preventing SUID.