title: Health Messaging and African-American Infant Sleep Location: A Randomized Controlled Trial.
abstract: Infant-parent bedsharing increases the risk of SIDS and other sleep-related deaths. Despite AAP recommendations to avoid bedsharing, public health efforts have been unsuccessful in changing behaviors. African-American infants are more than twice as likely to die from SIDS and other sleep-related deaths, and are also twice as likely to bedshare with their parents. Further, African-American parents have a high degree of self-efficacy with regards to preventing infant suffocation, but low self-efficacy with regards to SIDS risk reduction. It is unclear whether messages emphasizing suffocation prevention will decrease bedsharing. To evaluate the impact of specific health messages on African-American parental decisions regarding infant sleep location. We conducted a randomized, controlled trial of African-American mothers of infants. The control group received standard messaging emphasizing AAP-recommended safe sleep practices, including avoidance of bedsharing, for the purposes of SIDS risk reduction. The intervention group received enhanced messaging emphasizing safe sleep practices, including avoidance of bedsharing, for both SIDS risk reduction and suffocation prevention. Participants completed interviews at 2-3 weeks, 2-3 months, and 5-6 months after the infant's birth. 1194 mothers were enrolled in the study, and 637 completed all interviews. Bedsharing, both usually (aOR 1.005 [95 % CI 1.003, 1.006]) and last night (aOR 1.004 [95 % CI 1.002, 1.007]) increased slightly but statistically significantly with infant age (p < 0.001). Receipt of the enhanced message did not impact on sleep location. Maternal belief that bedsharing increased the risk of SIDS or suffocation declined over 6 months (p < 0.001) and did not differ by group assignment. African-American mothers who received an enhanced message about SIDS risk reduction and suffocation prevention were no less likely to bedshare with their infants.
  
  
  BACKGROUND
  Clinical Trials.gov identifier NCT01361880.
authors.affiliation: Division of General Pediatrics and Community Health, Children's National Medical Center, Washington, DC, USA. rym4z@virginia.edu.|Center for Translational Science, Children's National Medical Center, Washington, DC, USA. rym4z@virginia.edu.|Department of Pediatrics, George Washington University, Washington, DC, USA. rym4z@virginia.edu.|Department of Pediatrics, University of Virginia, Charlottesville, VA, USA. rym4z@virginia.edu.|Division of General Pediatrics, University of Virginia, PO Box 800386, Charlottesville, VA, 22908, USA. rym4z@virginia.edu.
authors.forename: Rachel Y
authors.initials: RY
authors.lastname: Moon
authors.affiliation: Division of General Pediatrics and Community Health, Children's National Medical Center, Washington, DC, USA.
authors.forename: Anita
authors.initials: A
authors.lastname: Mathews
authors.affiliation: Division of General Pediatrics and Community Health, Children's National Medical Center, Washington, DC, USA.
authors.forename: Brandi L
authors.initials: BL
authors.lastname: Joyner
authors.affiliation: Division of General Pediatrics and Community Health, Children's National Medical Center, Washington, DC, USA.
authors.forename: Rosalind P
authors.initials: RP
authors.lastname: Oden
authors.affiliation: Center for Translational Science, Children's National Medical Center, Washington, DC, USA.
authors.forename: Jianping
authors.initials: J
authors.lastname: He
authors.affiliation: Center for Translational Science, Children's National Medical Center, Washington, DC, USA.|Department of Pediatrics, George Washington University, Washington, DC, USA.|Department of Epidemiology and Biostatistics, George Washington University, Washington, DC, USA.
authors.forename: Robert
authors.initials: R
authors.lastname: McCarter
mesh_terms: D000293:Adolescent; D000328:Adult; D001741:Black or African American / Q000193:education / Q000523:psychology / Q000706:statistics & numerical data; D001513:Beds; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006293:Health Promotion / Q000379:methods*; D006801:Humans; D007223:Infant; D007224:Infant Care / Q000379:methods / Q000706:statistics & numerical data; D007407:Interviews as Topic; D008297:Male; D020377:Self Efficacy; D012890:Sleep; D000070263:Sleep Hygiene; D013398:Sudden Infant Death / Q000517:prevention & control; D055815:Young Adult
keywords: Bedsharing; Infant mortality; SIDS; Self-efficacy; Sleep location; Suffocation