African American parents are less likely than non-Hispanic White parents to place their infant to sleep in a supine position. African American infants also die of Sudden Infant Death Syndrome (SIDS) at rates 2-3 times greater than non-Hispanic White infants. Placing infants to sleep in the supine position significantly reduces the risk of death from SIDS. Defined as the "sudden, unexplained death of an infant younger than one year old," SIDS is the leading cause of infant deaths occurring after the first month of life. Most SIDS deaths (90%) occur by 6 months of age with the highest incidence between 2 and 4 months. The disparity between African American and White infants in supine sleep prevalence has persisted since the first supine sleep recommendation was made in 1992, although overall rates of supine sleep have increased for both African American and non-Hispanic Whites. This disparity endures despite a concerted public health effort to inform parents about the importance of infant supine sleep from physicians, nurses, newspapers, and other media. Parent education has focused on the safety of infant supine sleep, though recent studies demonstrate that parents now use the non-supine position primarily because of infant comfort. The specific barriers faced by this subset of parents and how parents of supine-sleeping infants have met and overcome those barriers is unknown. We propose a randomized controlled trial to test the effectiveness of a multi-media, tailored, parent- focused intervention to increase the prevalence of African American infant supine sleep as compared to currently available non-tailored materials. Using focus group data and participant interviews, the intervention materials will contain culturally relevant solutions to parent reported barriers and beliefs, specific techniques to assist parents in settling the infant in the supine position that are appropriate to the infant's developmental stage along with the recommended guidelines about the sleep environment and position. Control and intervention materials will be sent at two developmental stages: when crying /colic is prominent (6 weeks of age), and when the infant is becoming more physically active (4 months of age). The intervention materials will consist of a brochure containing the information mentioned above and a DVD illustrating the appropriate environment, position, and settling techniques. Control group parents will receive currently available educational brochures about infant supine sleep and a generic DVD on infant safety. Because our preliminary data suggests that African American parents who have an African American physician for their child maintain the infant supine sleeping position longer than those whose child's physician is of another race, we will randomly vary the race of physician-model in the intervention materials. We hypothesize that 1) parents who receive the intervention will keep their infants sleeping supine at a higher rate than control group parents, and 2) this effect is enhanced when the physician-model is race-concordant.
Increasing the prevalence of infant supine sleep is an objective of Healthy People 2010 and 2020. Addressing parental beliefs and barriers to supine sleep and providing practical, developmentally appropriate advice should create a significantly greater prevalence of supine sleep in the intervention group compared to the control group. This intervention could be easily modified for use in the general population.