The incidence of sudden infant death syndrome (SIDS) in the US has declined 50% since 1992, when the American Academy of Pediatrics (AAP) first recommended that infants be placed in a non-prone position for sleep. Despite the tremendous success of the subsequent Back to Sleep campaign, African-American (AA) infants remain twice as likely to be placed prone, and twice as likely to die from SIDS. The racial disparity exists across all educational and income categories, and the extent of the racial disparity has increased rather than decreased. The NICHD, in both its 2000 general Strategic Plan (From Cells to Selves) and its 2000 Strategic Plan for SIDS research (Targeting Sudden Infant Death Syndrome (SIDS): A Strategic Plan), highlighted the need to understand mechanisms leading to racial, ethnic, and social disparities as a research priority. ? ? Very little is known about the reasons why AA parents use the prone position. Further, no studies have taken advantage of the observed socioeconomic status(SES)-associated variability in SIDS and prone sleeping within the AA community. By examining within-group differences, it is possible to move beyond comparative racial descriptions to identification of potentially modifiable factors. The overall purpose of these investigations, therefore, is to better understand factors contributing to the comparatively high incidence of prone sleep positioning in AA infants. In order to achieve this, will address the following Specific Aims: 1) To compare knowledge, attitudes, and practices regarding infant sleep position in AA parents of higher and lower SES. 2) To identify risk factors for non-use of the recommended supine sleep position in AA families with higher and lower SES. 3) To develop a phenomenological understanding of the decisions made by AA parents of higher and lower SES who do not use recommended supine sleep position, through qualitative methods. 4) To develop, implement, and evaluate an appropriate intervention program based on the knowledge gained through Specific Aims 1-3. ? ? This study addresses important gaps in our understanding of factors informing parental decision regarding infant sleep positioning in AAs. By understanding the social and cultural factors, it should be possible to design more effective interventions, thereby potentially decreasing the rate of SIDS in AA infants. ? ?
