The purpose of this R15 proposal is to (1) use photo-elicitation interviewing as a form of participatory research in low-income urban communities to explore the lived experience of parenting and contextualize infant care practices among three non-Hispanic Black subgroups (African Americans, Afro-Caribbean immigrants, and African immigrants), and (2) quantitatively identify socio-cultural and environmental influences on sleep-related infant care practices in these communities using audio computer-assisted self-interviews (ACASI) to contribute to a social ecological model of infant sleep environments. In the United States (US), extreme disparities in infant mortality persist, with low-income non-Hispanic Black infants evidencing some of the highest rates of mortality. Sleep-related infant injuries are one of the leading causes of infant mortality and are thought to be preventable by altering the infant sleep environment. Most interventions have focused on changing practices thought to place infants at higher risk for these types of deaths (e.g., unsafe sleep surface, bed-sharing, prone sleep positioning, and excess bedding), an approach that has been criticized as overly broad. Little research has been devoted to the overarching context of these practices, including how factors related to poverty affect choices around risks for sleep-related injury. Moreover, despite the wide variation in infant mortality rate among racial and ethnic groups encompassed by the non- Hispanic Black category, little research has examined whether influences on sleep-related infant care practices, as well as the prevalence of the practices themselves, differ by nativity and region of origin. Social ecological theory posits that individuals interact with, and are influenced by, multiple levels of social phenomena, ranging from dyadic interaction, to family (or microsystem), neighborhood and community (mesosystem), state (exosystem) and cultural (macrosystem) dimensions. The research proposed conceptualizes the infant sleep environment as a complex intersection of these domains and employs a social ecological model of infant sleep in which multiple levels of factors, from individual-level beliefs and cultural attitudes, to structural factors related to living conditions, may influence the sleep environment. This study is foundational in that it will establish a base of knowledge upon which culturally appropriate intervention research can be built.
Racial disparities in infant mortality persist in the US, with non-Hispanic Black infants evidencing the highest rates of infant mortality. Sleep-related injury death is one of the leading causes of infant mortality and is seen as amenable to public health intervention by encouraging caregivers to alter the infant sleep environment. The proposed study will use qualitative interview and survey methods to examine multiple levels of influence on the infant sleep environment among mothers of three distinct racial/ethnic groups within the category of non- Hispanic Black to inform the development of culturally appropriate interventions.
