Am J Perinatol
DOI: 10.1055/s-0041-1735262
Original Article

Impact of State Prioritization of Safe Infant Sleep Programs on Supine Sleep Positioning for Non-Hispanic White and Non-Hispanic Black Infants

Sunah S. Hwang
1  Department of Pediatrics, Section of Neonatology, University of Colorado School of Medicine, Aurora, Colorado
2  Department of Health Systems, Management, and Policy, Colorado School of Public Health, Aurora, Colorado
,
Suhong Tong
1  Department of Pediatrics, Section of Neonatology, University of Colorado School of Medicine, Aurora, Colorado
3  Department of Biostatistics, Colorado School of Public Health, Aurora, Colorado
,
Laura Pyle
1  Department of Pediatrics, Section of Neonatology, University of Colorado School of Medicine, Aurora, Colorado
3  Department of Biostatistics, Colorado School of Public Health, Aurora, Colorado
,
Catherine Battaglia
2  Department of Health Systems, Management, and Policy, Colorado School of Public Health, Aurora, Colorado
,
Beth McManus
2  Department of Health Systems, Management, and Policy, Colorado School of Public Health, Aurora, Colorado
,
Susan Niermeyer
1  Department of Pediatrics, Section of Neonatology, University of Colorado School of Medicine, Aurora, Colorado
,
Angela Sauaia
3  Department of Biostatistics, Colorado School of Public Health, Aurora, Colorado
› Author Affiliations

Abstract

Objective Investigate whether safe infant sleep prioritization by states through the Title V Maternal and Child Block Grant in 2010 differentially impacted maternal report of supine sleep positioning (SSP) for Non-Hispanic White (NHW) and Non-Hispanic Black (NHB) U.S.-born infants.

Methods We analyzed retrospective cross-sectional data from the Pregnancy Risk Assessment Monitoring System (PRAMS) from 2005 to 2015 from 4 states: WV and OK (Intervention) and AR and UT (Control). PRAMS is a population-based surveillance system of maternal perinatal experiences which is linked to infant birth certificates. Piece-wise survey linear regression models were used to estimate the difference in the change in slopes of SSP percents in the pre- (2005–2009) and post- (2011–2015) periods, controlling for maternal and infant characteristics. Models were also stratified by race/ethnicity.

Results From 2005 to 2015, for NHW infants, SSP improved from 61.5% and 70.2% to 82.8% and 82.3% for intervention and control states, respectively. For NHB infants, SSP improved from 30.6% and 26.5% to 64.5% and 53.1% for intervention and control states, respectively. After adjustment for maternal characteristics, there was no difference in the rate of SSP change from the pre- to post- intervention periods for either NHW or NHB infants in intervention or control groups.

Conclusions and relevance Compared with control states that did not prioritize safe infant sleep in their 2010 Title V Block Grant needs assessment, intervention states experienced no difference in SSP improvement rates for NHW and NHB infants. While SSP increased for all infants during the study period, there was no causal relationship between states' prioritization of safe infant sleep and SSP improvement. More targeted approaches may be needed to reduce the racial/ethnic disparity in SSP and reduce the risk for sleep-associated infant death.

Key Points

  • Supine sleep positioning improved for Black and White infants in the U.S.

  • State prioritization of safe infant sleep did not directly impact SSP for NHB or NHW infants.

  • More targeted approaches may be needed to reduce racial/ethnic disparities in safe sleep practices



Publication History

Received: 25 February 2021

Accepted: 20 July 2021

Publication Date:
20 September 2021 (online)

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