- About IGPA
- Press Room
- Study Centers
2013 Family Impact Seminar takes a close look at reducing disparities in safe sleep practices and infant care
On Friday, April 26, more than 60 health practitioners and researchers attended the 2013 Family Impact Seminar. Guarding All Children in Sleep: New Ideas for Reducing Disparities in Safe Sleep Practices brought together researchers from across the country, and a keynote speaker from New Zealand, to discuss ways to end preventable infant death through public education.
The U.S. experienced rapid declines in infant mortality during the 1990s. These drops are widely attributed to the national “Back to Sleep” campaign, which began in 1994. Despite the progress made, the U.S. infant mortality rate plateaued in the 2000s. Particularly concerning is the fact that the U.S. still has higher rates of infant mortality than many other industrialized nations (for a full overview, see the Organisation for Economic Co-operation and Development’s Infant Mortality Report). And, deaths due to accidental suffocation or unsafe environments have been on the rise.
Racial and ethnic disparities in SIDS also persist. According to Dr. Fern Hauck, Professor of Family Medicine and Professor of Public Health Sciences at the University of Virginia, “Even back in 1995, and continuing to 2009 and 2010, the highest incidence of SIDS is in the Native American and Black populations.” Although we do see a decline in deaths across all races from 1992 on, we also still see racial disparity of about two to one in the Native American and Black populations compared to the Asian, Hispanic and White populations. “After declining from three to one in the nineties, it has stayed pretty rock solid over the past ten years or so,” Hauck said.
These problems—the plateau of infant death rates and persistent racial and ethnic disparities—require rethinking of and investment in new strategies to promote safe sleep practices.
Successful Education and Outreach in New Zealand
This year’s Family Impact Seminar was intended to create dialogue about strategies going forward. States are grappling with how to address this problem through public policy. Recent legislation in Illinois requires hospitals and child care providers to change their practices to promote safe sleep. There is also increasing debate over “bumpers,” or crib liners, which are now banned in the city of Chicago.
The seminar sought to provide one example of recent success through education and outreach, which occurred in New Zealand. The event featured a keynote presentation by Stephanie Cowan (above), founding director of Change for our Children, a social innovations company with a focus on solutions that benefit children. Cowan’s work in New Zealand has been immensely successful in decreasing the country’s ethnic disparity in infant death.
“The arms that lay a baby down for sleep have the greatest power to protect from sudden infant death. And these arms have more than 500 opportunities to get it right or get it wrong before a baby is 12 weeks old,” Cowan said. “These are the arms we need to resource.”
In New Zealand in the early 2000s, the disparity between the indigenous Maori population and the total population was very similar to the disparity for Black Americans today. Similarly to the U.S., New Zealand experienced a rapid decline in infant mortality with the "Back to Sleep" campaign, but then a leveling out in rates. However, in 2012 a sharp fall in deaths for Maori babies almost closed the inequality gap.
Cowan described the framework for her efforts in public education as a true commitment to “shifting the way we think.” The education campaigns sought to shift from telling parents what to do, to enabling them to do it. The efforts transformed the strict messages communicated to parents into principles that offered a framework enabling parents to apply information to different situations. As an example, a “fear of choking” was discussed in terms of “confidence in the gag and swallow reflex”. And most importantly, the campaign sought to transform perspectives on safe sleep from "avoiding risk" to "pursuing protection".
Cowan described three applications for this new thinking. One of the most headline-making efforts has been the Pepi-Pod sleep space program (see left--pepi means baby in Maori and pod is symbolic of protection in nature). The sleep space approach was created in response to unsafe sleeping practices in vulnerable groups, such as babies born prematurely, or living in an environment with a high incidence of smoking and (or) alcohol use.
The sleep space itself is a small, lined box that is set up with mattress and bedding for when babies sleep in, or on, an adult bed, on a couch, or away from home. Cowan stressed that the Pepi-Pod sleep space was not intended to replace traditional sleep spaces such as bassinets, but instead were created to address the common sleep practice of bed sharing in the Maori culture where smoking is also more common.
The campaign delivered the Pepi-Pods sleep spaces to vulnerable babies who were often in risky locations. The distribution began as an emergency response to a series of earthquakes in Christchurch, NZ in 2011 when families were displaced, and parents kept babies close as fear of aftershocks were widespread. The program has developed into a safe sleep intervention for more vulnerable babies generally.
When accepting the Pepi-Pod sleep spaces, parents receive a thorough safety briefing and other important issues to consider for safe sleep and infant care are discussed. The Pepi-Pod has been received exceptionally well by the more than 5,000 parents who have used it.
Two other applications used coordinated education approaches rooted in clear, inclusive language to support key conversations between practitioners and parents. One, “Te Awatea,” features a whole-community approach to smokefree pregnancies. Te Awatea is a Maori concept that means “from darkness to light.” A distinctive feature of the program was the participation of a network of community members for using conversation cards to promote smokefree pregnancies and support people to quit.
The second, “Through the tubes,” also used conversation cards to engage new parents in brief discussions about preventing accidental suffocation. Images on the card show the different ways that infants get oxygen both before and after birth and ways to protect airways during sleep. This approach has enabled practitioners to engage in educational conversations about infant sleep safety clearly and concisely with new parents.
Following the keynote, Dr. Wendy Middlemiss, Associate Professor of Educational Psychology at the University of North Texas, shared her efforts to translate Cowan’s success to the United States. Middlemiss’ efforts to create clear and accurate safe sleep information include the creation of websites for parents in both English and Spanish, as well as websites and training for pediatricians and nurses as part of residency training. She is also working on a webinar for clinical lactation consultants, and modules for in-home visiting by lay health advisors.
Dr. Middlemiss’ efforts build on another of Cowan’s innovations, called Baby Essentials. By focusing the education on dialogue between parents and practitioners, rather than a list of “dos” and “don’ts" Middlemiss said the campaigns seek to create messages that will work for the entire population.
Applying Lessons Learned in New Zealand to the United States
The second half of the event featured break-out sessions intended to provide the latest recommendations on safe sleep from the American Academy of Pediatrics, and to discuss new ways to decrease disparities in the U.S.
Every five years, the American Academy of Pediatrics updates its recommendations for promoting safe infant sleeping environments. Dr. Hauck, a member of the Academy’s Task Force, shared the recommendations in a one of the sessions. The report summary can be found here and the technical report, including a background literature review and data can be found here.
The recommendations are detailed and based in long-term academic research, yet Hauck said communicating them will be the real challenge. “You must tailor your messages depending on your audience,” Hauck said. “Take into account the culture and beliefs of your audience. You want to enhance people’s feeling that what they are doing is right, and that they can do it.”
Tailoring messages was also a focus of Dr. Lane Volpe, a medical anthropologist and consultant on implementing evidence-based practice. Volpe discussed the importance of considering the tradeoffs mothers make in navigating nighttime infant care. For example, parents might use unsafe sleeping positions for their infants as a way to promote prolonged infant sleep periods and alleviate maternal sleep disruption.
Practitioners can be most effective when they identify and value parents’ needs and motivations, use a shared decision-making approach to develop strategies that meet those needs while ensuring infant safety, and acknowledge the rationale underlying many risk-related behaviors.
“Parenting behavior, including the management of infant sleep environments, involves complex trade-offs,” Volpe said. “And it is important to acknowledge that there may be costs involved in some of the behaviors we are asking parents to adopt. Therefore, it is important to support and enhance the capacity of individuals to implement desired behaviors and to assist parents in identifying strategies for negotiating trade-offs without compromising infant safety.”
In the second break-out session, Nancy Maruyama, RN, BSN, Director of Education, SIDS of Illinois, provided a formal training presented throughout the state by SIDS of Illinois on the latest safe sleep standards, and ways to communicate them to new families of different cultures and backgrounds.
You can download the powerpoints used by presenters here (some file sizes are large, and may take a minute or more to open):
(PDF powerpoint) Stephanie Cowan, founding director of Change for our Children, a social innovations company with a focus on solutions that benefit children
(PDF powerpoint) Rachel A. Gordon, Associate Professor of Sociology at the University of Illinois at Chicago and a faculty member of the Institute of Government and Public Affairs (IGPA)
(PDF powerpoint) Dr. Fern Hauck, Spencer P. Bass, MD Twenty-First Century Professor of Family Medicine and Professor of Public Health Sciences at the University of Virginia Dr.
(PDF powerpoint) Wendy Middlemiss, Associate Professor of Educational Psychology at the University of North Texas
(PDF powerpoint) Dr. Lane Volpe, medical anthropologist and the Vice President of The Implementation Group, a research, evaluation and consultation firm based in Boulder County, CO
(PDF powerpoint) Nancy Maruyama, RN, BSN, Director of Education, SIDS of Illinois
This year's Family Impact Seminar was co-hosted by Sudden Infant Death Services of Illinois, Inc., the UIC Maternal and Child Health Program in the School of Public Health, the UIC Department of Anthropology, and the UIC Institute for Research on Race and Public Policy in the College of Urban Planning and Public Affairs. IGPA is part of a national network of 21 universities to offer FIS. Building on IGPA’s existing programs, these briefings regularly contribute to knowledge-based dialogue around family policy issues. The Family Impact Seminars provide evidence-based information to Illinois policymakers, practitioners, and the public on pressing family-policy issues that are currently facing the state. The Policy Institute for Family Impact Seminars network is directed by Karen Bogenschneider of the University of Wisconsin-Madison. Since 2006, IGPA has offered seminars on playful learning in early childhood, differential response to child welfare” or “early childhood education, child abuse and neglect. Learn more about the Family Impact Seminars here.