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Health Messaging and African–American Infant Sleep Location: A Randomized Controlled Trial

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Abstract

Infant-parent bedsharing increases the risk of SIDS and other sleep-related deaths. Despite AAP recommendations to avoid bedsharing, public health efforts have been unsuccessful in changing behaviors. African–American infants are more than twice as likely to die from SIDS and other sleep-related deaths, and are also twice as likely to bedshare with their parents. Further, African–American parents have a high degree of self-efficacy with regards to preventing infant suffocation, but low self-efficacy with regards to SIDS risk reduction. It is unclear whether messages emphasizing suffocation prevention will decrease bedsharing. To evaluate the impact of specific health messages on African–American parental decisions regarding infant sleep location. We conducted a randomized, controlled trial of African–American mothers of infants. The control group received standard messaging emphasizing AAP-recommended safe sleep practices, including avoidance of bedsharing, for the purposes of SIDS risk reduction. The intervention group received enhanced messaging emphasizing safe sleep practices, including avoidance of bedsharing, for both SIDS risk reduction and suffocation prevention. Participants completed interviews at 2–3 weeks, 2–3 months, and 5–6 months after the infant’s birth. 1194 mothers were enrolled in the study, and 637 completed all interviews. Bedsharing, both usually (aOR 1.005 [95 % CI 1.003, 1.006]) and last night (aOR 1.004 [95 % CI 1.002, 1.007]) increased slightly but statistically significantly with infant age (p < 0.001). Receipt of the enhanced message did not impact on sleep location. Maternal belief that bedsharing increased the risk of SIDS or suffocation declined over 6 months (p < 0.001) and did not differ by group assignment. African–American mothers who received an enhanced message about SIDS risk reduction and suffocation prevention were no less likely to bedshare with their infants. Clinical Trials Registration: Clinical Trials.gov identifier NCT01361880

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Abbreviations

AAP:

American Academy of Pediatrics

CI:

Confidence interval

ICD-10:

International Classification of Diseases, 10th revision

SIDS:

Sudden infant death syndrome

WIC:

Special Supplemental Nutrition Program for Women, Infants, and Children

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Acknowledgments

This project was supported by the Maternal and Child Health Bureau, Health Resources Service Administration 1R40MC21511, the National Institute for Minority Health and Health Disparities P20MD000198, and the NIH National Center for Advancing Translational Sciences UL1TR000075. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the Health Resources Service Administration or the NIH. The study sponsors had no role in (1) study design; (2) the collection, analysis, and interpretation of data; (3) the writing of the report; and (4) the decision to submit the paper for publication.

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Correspondence to Rachel Y. Moon.

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We declare no potential conflict of interest, real or perceived. Dr. Moon wrote the first draft of the manuscript. No honorarium, grant, or other form of payment was given to anyone to produce the manuscript.

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Moon, R.Y., Mathews, A., Joyner, B.L. et al. Health Messaging and African–American Infant Sleep Location: A Randomized Controlled Trial. J Community Health 42, 1–9 (2017). https://doi.org/10.1007/s10900-016-0227-1

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