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Implementation of a Statewide Program to Promote Safe Sleep, Breastfeeding and Tobacco Cessation to High Risk Pregnant Women

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Infant mortality remains a problem in the United States with sleep-related deaths accounting for a significant portion. Known risk reduction strategies include breastfeeding, avoiding tobacco use and following the American Academy of Pediatrics’ safe sleep guidelines. The purpose of this project was to evaluate outcomes of Safe Sleep Instructor-led community baby showers, which included safe sleep promotion, breastfeeding promotion and tobacco cessation education. Certified Safe Sleep Instructors (n = 35) were trained on how to plan and host a Community Baby Shower to provide education to pregnant women of low socioeconomic status or with high risk of infant mortality. Eighteen Community Baby Showers were held across two urban and eight rural counties in Kansas. Surveys were administered pre- and post-event to assess participant knowledge, confidence and intentions to follow through with planned action related to safe sleep, breastfeeding and reducing tobacco risk. Matched data were summarized and evaluated for differences using McNemar’s and Wilcoxon Signed Rank tests. Significant increases were observed in Baby Shower participants’ (n = 845) reported plans to follow the AAP Safe Sleep guidelines (all p < 0.001), likelihood to breastfeed (p < 0.001), confidence in ability to breastfeed for more than 6 months (p < 0.001), knowledge of local breastfeeding support resources (p < 0.001), knowledge of ways to avoid second-hand smoke exposure (p < 0.001) and knowledge of local tobacco cessation services (p = 0.004). Based on the result of the pre- and post-event surveys, certified Safe Sleep Instructors were able to plan and host successful events to increase knowledge and confidence related to risk reduction strategies to reduce sleep-related infant deaths.

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  1. Centers for Disease Control and Prevention. (2017). Sudden unexpected infant death and sudden infant death syndrome: Data and statistics. Retrieved from

  2. Kansas Department of Health and Environment, Bureau of Epidemiology and Public Health Informatics. (2017). Selected special statistics stillbirths and infant deaths Kansas, 2016 Research Summary. Retrieved from

  3. Schmidt, D. (2017). Kansas state child death review board: 2017 annual report. Retrieved from

  4. Task Force on Sudden Infant Death Syndrome. (2016). SIDS and other sleep-related infant deaths: Updated 2016 recommendations for a safe infant sleeping environment. Pediatrics.

    Article  Google Scholar 

  5. Bombard, J. M., Kortsmit, K., Warner, L., et al. (2018). Vital signs: Trends and disparities in infant safe sleep practices - United States, 2009–2015. MMWR. Morbidity and Mortality Weekly Report, 67(1), 39–46.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Moon, R. Y., Hauck, F. R., & Colson, E. R. (2016). Safe infant sleep interventions: What is the evidence for successful behavior change? Current Pediatric Reviews, 12(1), 67–75.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Ahlers-Schmidt, C. R., Schunn, C., Dempsy, M., & Blackmon, S. (2014). Evaluation of community baby showers to promote safe sleep. Kansas Journal of Medicine, 7(1), 1–5.

    Article  Google Scholar 

  8. Ahlers-Schmidt, C. R., Schunn, C., Lopez, V., et al. (2016). A comparison of community and clinic baby showers to promote safe sleep for populations at high risk for infant mortality. Global Pediatric Health, 3, 1–6.

    Article  Google Scholar 

  9. Ahlers-Schmidt, C. R., Schunn, C., Kuhlmann, S., Kuhlmann, Z., & Engel, M. (2017). Developing a state-wide infrastructure for safe sleep promotion. Sleep Health, 3(4), 296–299.

    Article  PubMed  Google Scholar 

  10. Hauck, F. R., Thompson, J. M., Tanabe, K. O., Moon, R. Y., & Vennermann, M. M. (2011). Breastfeeding and reduced risk of sudden infant death syndrome: A meta-analysis. Pediatrics, 128(1), 103–110.

    Article  PubMed  Google Scholar 

  11. Mitchell, E. A., & Milerad, J. (2006). Smoking and the sudden infant death syndrome. Reviews on Environmental Health, 21(2), 81–103.

    Article  CAS  PubMed  Google Scholar 

  12. Hauck, F. R., & Tanabe, K. O. (2017). Beyond “Back to Sleep”: Ways to further reduce the risk of sudden infant death syndrome. Pediatric Annals, 46(8), e284–e290.

    Article  PubMed  Google Scholar 

  13. Kansas Department of Health and Environment, Bureau of Epidemiology and Public Health Informatics. (2017). Annual vital statistics summary, 2016. Retrieved from

  14. Colson, E. R., McCabe, L. K., Fox, K., et al. (2005). Barriers to following the back-to-sleep recommendations: Insights from focus groups with inner-city caregivers. Ambulatory Pediatrics, 5(6), 349–354.

    Article  PubMed  Google Scholar 

  15. Colson, E. R., Levenson, S., Rybin, D., 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 

  16. Colson, E. R., Rybin, D., Smith, L. A., Colton, T., Lister, G., & Corwin, M. J. (2009). Trends and factors associated with infant sleeping position: The National Infant Sleep Position Study, 1993–2007. Archives of Pediatrics & Adolescent Medicine, 163(12), 1122–1128.

    Article  Google Scholar 

  17. Oden, R. P., Joyner, B. L., Ajao, T. I., & Moon, R. Y. (2010). Factors influencing African American mothers’ decisions about sleep position: A qualitative study. Journal of the National Medical Association, 102(10), 870–880.

    Article  PubMed  Google Scholar 

  18. Sinha, B., Chowdhury, R., Sankar, M. J., et al. Interventions to improve breastfeeding outcomes: A systematic review and meta-analysis. Acta Paediatrica. 104(467), 114–134.

  19. Christiansen, B. A., Reeder, K. M., TerBeek, E. G., Fiore, M. C., & Baker, T. B. (2015). Motivating low socioeconomic status smokers to accept evidence-based smoking cessation treatment: A brief intervention for community agency setting. Nicotine & Tobacco Research, 17(8), 1002–1011.

    Article  Google Scholar 

  20. U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health. (2000). Reducing tobacco use: A report of the surgeon general. Atlanta, Georgia. Retrieved from

  21. Gladwell, M. (2000). The tipping point: How little things can make a big difference. Boston: Little, Brown and Co.

    Google Scholar 

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This project is supported in part by the Kansas Department of Health and Environment’s Bureau of Family Health Maternal and Child Health Services Block Grant #B04MC30614 funded by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS). This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.

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Correspondence to Carolyn R. Ahlers-Schmidt.

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Ahlers-Schmidt, C.R., Schunn, C., Engel, M. et al. Implementation of a Statewide Program to Promote Safe Sleep, Breastfeeding and Tobacco Cessation to High Risk Pregnant Women. J Community Health 44, 185–191 (2019).

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