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

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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 identifier NCT01361880

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American Academy of Pediatrics


Confidence interval


International Classification of Diseases, 10th revision


Sudden infant death syndrome


Special Supplemental Nutrition Program for Women, Infants, and Children


  1. Mathews, T. J., & Macdorman, M. F. (2013). Infant mortality statistics from the 2010 period linked birth/infant death data set. National Vital Statistics Reports, 62(8), 1–27.

    PubMed  Google Scholar 

  2. Shapiro-Mendoza, C. K., Kimball, M., Tomashek, K. M., Anderson, R. N., & Blanding, S. (2009). US infant mortality trends attributable to accidental suffocation and strangulation in bed from 1984 through 2004: Are rates increasing? Pediatrics, 123(2), 533–539.

    Article  PubMed  Google Scholar 

  3. United States Department of Health and Human Services (US DHHS), Centers of Disease Control and Prevention (CDC), National Center for Health Statistics (NCHS), Office of Analysis and Epidemiology (OAE), Division of Vital Statistics (DVS), Linked Birth / Infant Death Records on CDC WONDER Online Database. Accessed 27 July 2016.

  4. Ateah, C. A., & Hamelin, K. J. (2008). Maternal bedsharing practices, experiences, and awareness of risks. Journal of Obstetric, Gynecologic, and Neonatal Nursing, 37(3), 274–281.

    Article  PubMed  Google Scholar 

  5. Willinger, M., Ko, C. W., Hoffman, H. J., Kessler, R. C., & Corwin, M. J. (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(1), 43–49.

    Article  PubMed  Google Scholar 

  6. Blair, P. S., Fleming, P. J., Smith, I. J., et al. (1999). Babies sleeping with parents: Case-control study of factors influencing the risk of the sudden infant death syndrome. CESDI SUDI Research Group. BMJ, 319(7223), 1457–1462.

    CAS  PubMed  Google Scholar 

  7. Carpenter, R. G., Irgens, L. M., Blair, P. S., et al. (2004). Sudden unexplained infant death in 20 regions in Europe: Case control study. Lancet, 363, 185–191.

    Article  CAS  PubMed  Google Scholar 

  8. McGarvey, C., McDonnell, M., Hamilton, K., O’Regan, M., & Matthews, T. (2006). An 8 year study of risk factors for SIDS: Bed-sharing vs. non bed-sharing. Archives of Disease in Childhood, 91(4), 318–323.

    Article  CAS  PubMed  Google Scholar 

  9. McGarvey, C., McDonnell, M., Chong, A., O’Regan, M., & Matthews, T. (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(12), 1058–1064.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

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

    Article  PubMed  Google Scholar 

  11. Ruys, J. H., de Jonge, G. A., Brand, R., Engelberts, A. C., & Semmekrot, B. A. (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 

  12. Fleming, P. J., Blair, P. S., Bacon, C., 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 stillbirths and deaths in infancy. Confidential Enquiry into Stillbirths and Deaths Regional Coordinators and Researchers. BMJ, 313(7051), 191–195.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Hauck, F. R., Herman, S. M., Donovan, M., 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 Part 2), 1207–1214.

    PubMed  Google Scholar 

  14. Adler, M. R., Hyderi, A., Hamilton, A., & Brown, P. (2006). Clinical inquiries: What are safe sleeping arrangements for infants? The Journal of Family Practice, 55(12), 1083–1084.

    PubMed  Google Scholar 

  15. Scragg, R., Mitchell, E. A., Taylor, B. J., et al. (1993). Bed sharing, smoking, and alcohol in the sudden infant death syndrome. New Zealand Cot Death Study Group. BMJ, 307(6915), 1312–1318.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Ostfeld, B. M., Perl, H., Esposito, L., 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 

  17. Unger, B., Kemp, J. S., Wilkins, D., et al. (2003). Racial disparity and modifiable risk factors among infants dying suddenly and unexpectedly. Pediatrics, 111(2), E127–E131.

    Article  PubMed  Google Scholar 

  18. Fu, L. Y., Moon, R., & Hauck, F. R. (2010). Bed sharing among black infants and sudden infant death syndrome: Interactions with other known risk factors. Academic Pediatrics, 10(6), 376–382.

    Article  PubMed  Google Scholar 

  19. Lahr, M. B., Rosenberg, K. D., & Lapidus, J. A. (2007). maternal-infant bedsharing: Risk factors for bedsharing in a population-based survey of new mothers and implications for SIDS risk reduction. Maternal and Child Health Journal, 11(3), 277–286.

    Article  PubMed  Google Scholar 

  20. Hauck, F. R., Signore, C., Fein, S. B., & Raju, T. N. (2008). Infant sleeping arrangements and practices during the first year of life. Pediatrics, 122(Suppl 2), S113–S120.

    Article  PubMed  Google Scholar 

  21. Fu, L. Y., Colson, E. R., Corwin, M. J., & Moon, R. Y. (2008). Infant sleep location: Associated maternal and infant characteristics with sudden infant death syndrome prevention recommendations. The Journal of Pediatrics, 153(4), 503–508.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Joyner, B. L., Oden, R., Ajao, T. I., & Moon, R. (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.

    Article  PubMed  Google Scholar 

  23. Moon, R. Y., Oden, R. P., Joyner, B. L., & Ajao, T. I. (2010). Qualitative analysis of beliefs and perceptions about sudden infant death syndrome (SIDS) among African–American mothers: Implications for safe sleep recommendations. The Journal of Pediatrics, 157(1), 92–97.

    Article  PubMed  Google Scholar 

  24. Mathews, A., Oden, R., Joyner, B., He, J., McCarter, R., & Moon, R. Y. (2016). Differences in African–American maternal self-efficacy regarding practices impacting risk for sudden infant death. Journal of Community Health, 41(2), 244–249.

    Article  PubMed  Google Scholar 

  25. Willinger, M., Hoffman, H. J., Wu, K.-T., et al. (1998). Factors associated with the transition to nonprone sleep positions of infants in the United States: The National Infant Sleep Position Study. JAMA, 280, 329–335.

    Article  CAS  PubMed  Google Scholar 

  26. Muhuri, P. K., MacDorman, M. F., & Ezzati-Rice, T. M. (2004). Racial differences in leading causes of infant death in the United States. Paediatric and Perinatal Epidemiology, 18(1), 51–60.

    Article  PubMed  Google Scholar 

  27. Brenner, R., Simons-Morton, B. G., Bhaskar, B., et al. (1998). Prevalence and predictors of the prone sleep position among inner-city infants. JAMA, 280, 341–346.

    Article  CAS  PubMed  Google Scholar 

  28. Brenner, R. A., Simons-Morton, B. G., Bhaskar, B., Revenis, M., Das, A., & Clemens, J. D. (2003). Infant-parent bed sharing in an inner-city population. Archives of Pediatrics and Adolescent Medicine, 157(1), 33–39.

    Article  PubMed  Google Scholar 

  29. Hoffman, H. J., Damus, K., Hillman, L., & Krongrad, E. (1988). Risk factors for SIDS. Results of the National Institute of Child Health and Human Development SIDS Cooperative Epidemiological Study. Annals of the New York Academy of Sciences, 533, 13–30.

    Article  CAS  PubMed  Google Scholar 

  30. Hoffman, H. J., & Hillman, L. S. (1992). Epidemiology of the sudden infant death syndrome: Maternal, neonatal, and postneonatal risk factors. Clinics in Perinatology, 19(4), 717–737.

    CAS  PubMed  Google Scholar 

  31. Mitchell, E. A., Tuohy, P. G., Brunt, J. M., et al. (1997). Risk factors for sudden infant death syndrome following the prevention campaign in New Zealand: A prospective study. Pediatrics, 100(5), 835–840.

    Article  CAS  PubMed  Google Scholar 

  32. Lesko, S. M., Corwin, M. J., Vezina, R. M., et al. (1998). Changes in sleep position during infancy: A prospective longitudinal assessment. JAMA, 280, 336–340.

    Article  CAS  PubMed  Google Scholar 

  33. Ottolini, M. C., Davis, B. E., Patel, K., Sachs, H. C., Gershon, N. B., & Moon, R. Y. (1999). Prone infant sleeping despite the “Back to Sleep” campaign. Archives of Pediatrics and Adolescent Medicine, 153, 512–517.

    Article  CAS  PubMed  Google Scholar 

  34. Shapiro-Mendoza, C. K., Tomashek, K. M., Anderson, R. N., & Wingo, J. (2006). Recent national trends in sudden, unexpected infant deaths: More evidence supporting a change in classification or reporting. American Journal of Epidemiology, 163(8), 762–769.

    Article  PubMed  Google Scholar 

  35. Huang, Y., Hauck, F. R., Signore, C., et al. (2013). Influence of bedsharing activity on breastfeeding duration among US mothers. JAMA Pediatrics, 167(11), 1038–1044.

    Article  PubMed  Google Scholar 

  36. Colson, E. R., Willinger, M., Rybin, D., et al. (2013). Trends and factors associated with infant bed sharing, 1993–2010: the National Infant Sleep Position study. JAMA Pediatrics, 167(11), 1032–1037.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Mathews, A. A., Joyner, B. L., Oden, R. P., Alamo, I., & Moon, R. Y. (2015). Comparison of infant sleep practices in African–American and US Hispanic families: Implications for sleep-related infant death. Journal of Immigrant and Minority Health, 17(3), 834–842.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Brown, H., & Prescott, R. (2006). Applied Mixed Models in Medicine (2nd ed.). Chichester: Wiley.

    Book  Google Scholar 

  39. Liu, H., & Wu, T. (2005). Sample size calculation and power analysis of time-averaged difference. Journal of Modern Applied Statistical Methods, 4(2), 434–445.

    Google Scholar 

  40. Diggle, P. J., Liang, K. Y., & Zeger, S. L. (1994). Analysis of Longitudinal Data. New York, NY: Oxford University Press.

    Google Scholar 

  41. DeJoy, D. M. (1989). The optimism bias and traffic accident risk perception. Accident Analysis and Prevention, 21(4), 333–340.

    Article  CAS  PubMed  Google Scholar 

  42. Slovic, P. (1987). Perception of risk. Science, 236(4799), 280–285.

    Article  CAS  PubMed  Google Scholar 

  43. U.S. Census Bureau 2006–2010 American Community Survey. 2012. Accessed March 23, 2012.

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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).

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