Challenges and Opportunities for Evaluating a State-wide Safe Sleep Program

Full Description: The Safe Baby Program was developed by the Healthy Start Coalition of Hillsborough County, FL to address the leading causes of Infant Mortality through universal countywide parent education, such as reducing Sudden Unexpected Infant Death by improving safe infant sleep practices. This study was part of an evaluation of the Safe Baby survey completed by parents and caregivers at 3-6 months post-partum. One analysis examined the effectiveness of the Safe Baby Program in promoting safe-infant sleep practices compared with mothers who responded to statewide-implemented “Florida Pregnancy Risk Assessment Monitoring System (PRAMS) survey. Another analysis focused on the rates of recommended practices and strategies for safe infant sleep, including assessment of the sociodemographic characteristics associated with participants who reported that they “Sometimes” co-sleep with their infants (vs. “Never”, “Rarely”, “Often” or “Always”). Methods included univariate descriptive analysis, bivariate and multivariate analyses to generate crude and adjusted odds’ ratios. Logistic regression models were calculated at 95% confidence intervals using SAS 9.4. Indirect standardization method was used to estimate overall adjusted sleep practice rates for Safe Baby program participants based on the program’s population distribution using the PRAMS rates. Results concluded that Safe Baby Respondents had better rates than PRAMS respondents for safe infant sleep practices. The demographics and reasons associated with “Sometimes” co-sleep also have implications for tailoring cultural, practical, and educational barriers. Opportunities include understanding the factors related with co-sleeping practices among participants and how they differ according to different population groups. Comparison with PRAMS reinforced the effectiveness of safe sleep education programs in promoting safe infant sleep practices among mothers. Challenges include selection bias among Safe Baby survey respondents compared to PRAMS survey participants, lack of strict definition of different frequency of sleep leading to subjective interpretation of participants, non-response bias, and missing data. However, due to the community-wide reach of the Safe Baby Program, our results can be impactful for diverse families, majority of who are WIC beneficiaries. Identification of differences in safe sleep practices among population and catering to subgroups to address the most pressing needs of reducing infant mortality highlight the importance of our study. Existing inequalities due to income, education, cultural practices, race, and ethnicity have created disparities in SUID rates so far. Our findings showcase the consequences of these reflections in safe sleep practices. We recommend updating the Safe Baby curriculum and provider training to tailor the education based on the needs of diverse population in order to reduce preventable causes of infant mortality and address existing disparities in SUID rates.

Abbreviated Description: The Safe Baby Program was created by the Healthy Start Coalition of Hillsborough County, FL, to promote safe infant sleep practices among parents and caregivers to address rising SUID rates. Rates of safe infant sleep practices and the existing sociodemographic disparities were analyzed using univariate descriptive, bivariate, and multivariate analyses. We further compared the Safe Baby participant behaviors to Florida PRAMS mothers using indirect standardization methods. Results demonstrated considerable socio-demographic differences existing between parents who “Sometimes” co-sleep vs. those who reported that they “Never”, “Rarely”, “Often” and “Always” co-sleep with infants. Overall, Safe Baby respondents had better rates than PRAMS respondents for safe infant sleep practices.