In the U.S., SIDS and other sleep-related deaths (such as accidental suffocation and strangulation in bed, and ill-defined deaths) account for ~4,000 infant deaths annually. Although the incidence of SIDS has declined since 1992, the incidence of other sleep-related deaths has increased, and the rate of post-neonatal deaths has not declined in the past two decades. Furthermore, racial disparities in SIDS and other sleep-related deaths have increased. Although the 1992 "Back to Sleep" campaign initially resulted in substantial decreases in prone positioning, the practices of prone positioning, bed-sharing, and use of soft bedding remain prevalent and have increased more recently. Similar to other social behaviors, parental behaviors regarding infant sleep practices are not easily altered via education because they are not entirely based on scientific information;they are instead highly reliant on nonfactual information from family, friends, and peers - i.e., the social network. Socia norms (explicit and implicit rules of a group that define appropriate behaviors, values, and attitudes), which are influenced by social networks, are important considerations in decision-making. It is important to understand these norms and social networks if behavior change is to occur in a community. To date, there are no published data about social norms regarding parental behaviors related to infant care generally and to SIDS and sleep-related deaths specifically. Our data show that mothers assume the primary responsibility for making decisions pertaining to their infant, and they seek information from trusted sources (e.g., family members, friends) to guide decisions. With regard to advice about sleep practices, mothers-and particularly African-American mothers-consider their social network to be a more trustworthy resource than medical providers. Therefore, the influence of social networks and norms, if contrary to recommended health practices, is a major barrier to acceptance of safe sleep practices. The overall purpose of the proposed study is to determine if and how social norms and network characteristics are influential in parental decisions about infant sleep practices, and how differences in social networks and norms contribute to the racial disparities in SIDS and sleep-related deaths.
Our Specific Aims are to 1) determine how social network characteristics and social norms influence infant sleep practices;2) determine differences in social norms between racial/ethnic groups and their potential effects on infant sleep practices;and 3) examine the differential influences of social networks and other sources of information in decision-making, and the process by which social norms are established. The proposed study will provide new information about the role and influence of social norms and networks on parental practices. Our long-term objective is to develop an intervention strategy, using the data generated in this study, which will ultimately result in a change in the social norms regarding infant sleep practices, in turn leading to a reduction in the persistently high rate of sleep-relatd deaths in African-Americans.
There are persistent, substantial racial disparities in sleep-related infant deaths, which comprise a large proportion of post-neonatal deaths;many of the risk factors for these deaths can be modified by changes in parental practice, particularly with regards to where and how the infant sleeps. The overall purpose of the proposed study is to determine if and how social norms and network characteristics are influential in parental practices regarding where and how their infant sleeps, and how differences in social networks and norms contribute to the racial disparities in SIDS and sleep-related deaths. Impacting the social network and norms may lead to a significant reduction in the incidence of sleep-related deaths and the racial disparities therein, and our long-term goal is to develop an intervention strategy, using social networks and opinion-leaders, which will confront common myths and misconceptions and will ultimately result in a change in the social norms regarding infant sleep position, bed-sharing, and use of soft bedding.