The goal of this proposal is to address serious and ongoing challenges related to adherence to public health recommendations known to reduce the risk of SIDS. Adherence has reached a plateau at an unacceptably low level both in the overall US population and especially in Black infants leading to a halt in the decline in infant mortality and a widening in the racial disparity in infant mortality. The current proposal is a collaborative effort that will capitalize on the extensive experience of the investigators in studying barriers to adherence to safe sleep practices to develop two complementary, culturally competent, intervention strategies and to test the effectiveness of each strategy as well as both strategies in combination. Innovative aspects of the Social Media and Risk-reduction Training of Infant Care Practices (SMART) study include its: 1) unique collaboration of leaders in the field;2) leveraging of the currently operational infant care practices study infrastructure and hospitals 3) use of two complementary interventions with the potential for synergistic impact;4) use of social marketing strategies;5) use of mobile technology (mHealth) to deliver messages;and 6) collaboration with community resources and expertise. The SMART study will have four arms in which 16 hospitals are randomly assigned to one of the following study groups: 1) Safe Sleep Nursery Education and Breastfeeding mHealth messaging;2) Breastfeeding Nursery Education and Safe Sleep mHealth messaging;3) Safe Sleep Nursery Education and Safe Sleep mHealth messaging;4) Breastfeeding Nursery Education and Breastfeeding mHealth messaging. A total of 1600 mothers will be recruited (100/hospital), with 400 in each study group. The primary aim is to assess the effectiveness of the interventions aimed at promoting safe sleep practices compared with the breastfeeding control interventions. The secondary aim is to assess potential mediating factors that may explain the intervention effects on infant care practices and that may inform areas for future improved intervention approaches. With the successful completion of the SMART study, effectiveness data will have been provided for two interventions to improve adherence to safe sleep practices that are practical to disseminate nationally in multiple diverse settings.

Public Health Relevance

SIDS is the most common cause of infant mortality beyond the neonatal period, and adherence to safe infant sleep practices has been proven to reduce the risk of SIDS. If, as we believe, the proposed and relatively simple to implement interventions improve adherence to safe sleep practice recommendations, SMART would be expected to have the following important implications: 1) Hospitals and healthcare providers nationally will adopt these strategies for safe sleep education. This will lead to increased adherence to safe sleep practices, in turn resulting in fewer sleep-related deaths;and 2) These methods will be used in interventions for other health conditions, particularly those with racial/ethnic, educationl or socioeconomic disparities.

National Institute of Health (NIH)
Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD)
Research Project (R01)
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Special Emphasis Panel (ZRG1-BDCN-Q (55))
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Willinger, Marian
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Boston University
Public Health & Prev Medicine
Schools of Medicine
United States
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Kellams, Ann; Parker, Margaret G; Geller, Nicole L et al. (2017) TodaysBaby Quality Improvement: Safe Sleep Teaching and Role Modeling in 8 US Maternity Units. Pediatrics 140:
Moon, Rachel Y; Hauck, Fern R; Colson, Eve R et al. (2017) The Effect of Nursing Quality Improvement and Mobile Health Interventions on Infant Sleep Practices: A Randomized Clinical Trial. JAMA 318:351-359
Moon, Rachel Y; Hauck, Fern R; Kellams, Ann L et al. (2017) Comparison of Text Messages Versus E-mail When Communicating and Querying With Mothers About Safe Infant Sleep. Acad Pediatr 17:871-878