Health Indicator Report of Safe Sleep
Placing babies on their backs to sleep reduces the risk for Sudden Infant Death Syndrome (SIDS) and other sleep-related infant deaths, collectively termed Sudden Unexpected Infant Death (SUID).
NotesThis is Healthy New Jersey 2020 Objective MCH-6.
Data SourcePregnancy Risk Assessment Monitoring System, Maternal and Child Health Epidemiology, Division of Family Health Services, New Jersey Department of Health, [http://www.nj.gov/health/fhs/maternalchild/outcomes/prams/]
- Infants Who Are Put on Their Backs to Sleep, by Year and Race/Ethnicity, New Jersey, 2003-2016
- Infants Who Are Put on Their Backs to Sleep by Race/Ethnicity, New Jersey, 2016
- Infants Who Are Put on Their Backs to Sleep, by Year and Mother's Insurance Type During Pregnancy, New Jersey, 2003-2016
- Infants Who Usually Sleep in a Shared Bed, New Jersey, 2003-2015
- Infants Who Usually Share a Bed for Sleeping, by Year and Mother's Insurance Type During Pregnancy, New Jersey, 2003-2015
DefinitionSelf-reported practice of putting infants on their backs to sleep
NumeratorNumber of mothers who put their infants on their backs to sleep
DenominatorNumber of mothers who responded to the survey
Healthy People Objective: Increase the proportion of infants who are put to sleep on their backsU.S. Target: 75.8 percent
State Target: 74.1 percent
Other Objectives'''Revised Healthy New Jersey 2020 Objective MCH-6''': Increase the proportion of infants who are put to sleep on their backs to 74.1% among the total population, 83.7% among Whites, 53.7% among Blacks, 66.8% among Hispanics, and 82.5% among Asians.
How Are We Doing?Putting infants on their backs for every sleep is associated with a lower rate of sleep-related infant deaths, including SIDS. This practice increased from 57.8% in 2003 to 69.4% in 2016. To achieve the [https://www.state.nj.us/health/chs/hnj2020/about/intro/ Healthy New Jersey 2020] (HNJ2020) target, the proportion of infants placed on their backs to sleep needs to rise an additional 4.7% by 2020. As in other states, there are population group disparities in the reported use of back to sleep. *Among Whites, this practice increased from 69.2% in 2003 to 80.5% in 2016, within 3.2% of the 2020 target. *From 2003 to 2015, the practice in Black infants increased from 37.8% to 58.3%, thus exceeding the HNJ2020 target in both 2014 and 2015. However, in 2016 there was an atypical decline to 52.5%. *Among Hispanics, this practice increased from 42.1% in 2003 to 60.2% in 2016, within 6.6% of the 2020 target. *Among Asians, this practice increased from 67.2% in 2003 to 79.8% in 2015 and approximated the target in 2013 and 2014. However, in 2016, there was an atypical decline to 71.3%. [[br]] Back to sleep patterns were also calculated by mother's type of insurance, a proxy for income. Poverty impacts safe sleep practices. The highest compliance level was by privately insured families. Racial disparity in poverty levels[https://inequality.stanford.edu/sites/default/files/Pathways_SOTU_2017.pdf ^1^] thus provides a context for disparity in the use of supine sleep. Bed sharing, another risk factor, fell to its lowest level of 17.4% in 2015. Compliance varied by insurance source, a proxy for income, with the privately insured least likely to bed share. Although usual bed sharing was more evident in the Medicaid and uninsured groups, from 2003-2015 it declined in the former from 30.1 to 21.4%. The uninsured group had the highest percentage of bed sharing and no sustained decline.
How Do We Compare With the U.S.?Sleep-related practices are obtained by survey in states participating in the [https://www.cdc.gov/prams/ Pregnancy Risk Assessment Monitoring System] (PRAMS). Compliance with safe sleep does not always predict a lower SUID rate.^2^ Possible reasons for a poor correlation include the presence of concurrent risks which have multiplicative effect on the impact of a single risk,^3^ and the role of social determinants such as poverty and access to healthcare. Parental expression of intent rather than practice may also be a limiting factor.^4^ In addition, compensatory factors may play a role in reducing the impact of some risks. For example, in New Jersey, Asian Indians bed share the most but have the lowest rate of SUID.^5^ This paradoxical finding may reflect compensatory factors in this group such as a high level of supine sleep and less poverty, smoking, or alcohol use. The cultural practice of involvement of the grandparents in early care may reduce maternal fatigue, a condition that increases the adverse impact of bed sharing. Such findings underscore the importance of using the SUID rate as the critical outcome measure. '''New Jersey continues to have one of the lowest rates of sudden unexpected infant deaths in the U.S.''' The most recent year with national and state data available from the Centers for Disease Control ([https://wonder.cdc.gov/lbd-current.html CDC WONDER]) for the linked birth/infant death file is 2015. For 2013-2015, the SUID rate of 0.61 per 1,000 live births for New Jersey fell well below the national rate of 0.87 and placed it among the five states with the lowest rate. [[br]][[br]] *New Jersey's SUID rate of 0.49 per 1,000 live births among Whites was the second lowest reported in the U.S for this group. *The SUID rate of 1.59 per 1,000 live births among Blacks was the sixth lowest of the 28 states with sufficient population for this group for calculation of a statistically reliable rate. *New Jersey's SUID rate of 0.44 per 1,000 live births among Hispanics placed it among the three states with the second lowest rate for this population group, based on the 17 states with sufficient population for the calculation of a statistically reliable rate. *The SUID rate among Asians in New Jersey is too low for a reliable calculation for the 2013-2015 era. However, for the 2000-2015 period, its rate of 0.2 per 1,000 live birth was the lowest compared to the rates for White, Black, and Hispanic infants in that time period. [[br]] According to 2013 NJ PRAMS data, 85% of New Jersey mothers recalled being told by a doctor, nurse, home visitor, or other health care provider about safe infant sleep. Use of the recommended safe sleep practices is therefore less likely to be about knowledge and more likely about other population-specific risks and barriers that affect practice such as cultural patterns and poverty. Other factors associated with SUID include preterm birth, access to care, smoking, neighborhood crime, and the use of alcohol and sedating drugs. Racial disparity in these determinants contributes to disparity in SUID rates independent of safe sleep practices. For example, the preterm birth rate among Black infants in New Jersey is 44% higher than the rate among all other women. Prematurity is a major risk factor. Infants born between 24 and 27 weeks of gestation have over three times the risk for SUID compared to a full term infant.^6^
What Is Being Done?In 1994, the "[http://pediatrics.aappublications.org/content/98/1/163.2 Back to Sleep]" campaign was enacted encouraging parents to place babies on their backs to sleep. This practice has been termed one of the seven most important research findings in pediatrics in the past 40 years and is associated with a reduction in SIDS and other sleep-related infant deaths such as accidental suffocation. This campaign was based on the evidence-based recommendations the American Academy of Pediatrics (AAP) began issuing in 1992 to reduce the risk of SIDS. Now termed the "[http://www.aappublications.org/content/33/12/18 Safe to Sleep]" campaign, the guidelines have expanded to address other risk factors and apply not only to SIDS but to other sleep-related infant deaths. All fall under the term Sudden Unexpected Infant Death (SUID). The guidelines are described in the Evidence-based Practices section below. The SIDS Center of New Jersey (SCNJ) is funded in part through a health services grant from the New Jersey Department of Health and carries out the state's mandate to provide bereavement support, to study risk factors associated with SUID, and to provide multilingual and culturally, racially, and ethnically-sensitive risk-reducing education. The SCNJ collaborates with and serves the educational needs of physicians, nurses, social service and child care providers, health care systems, including hospitals and clinics, home visiting programs, maternal and child health consortia, licensing systems, social service organizations, first responders, government agencies, community groups, clergy, and educational institutions with allied public health missions. It identifies barriers to compliance and addresses these and is represented in national initiatives to promote safe sleep. Its 24 hour hotline is noted below. Its programs, materials, and services, also noted below, can be accessed via its website: [http://www.rwjms.rutgers.edu/sids/] In addition to its long-standing programs and services, noted under Available Services, the SCNJ's newest initiatives include a [https://news.rutgers.edu/news/new-rutgers-app-seeks-reduce-infant-mortality/20180418#.W3Wkf85KiUm mobile phone app for safe sleep] and a public health initiative to address racial and ethnic disparities. The SCNJ has released a free safe sleep mobile phone app for Android and iPhone systems which can be accessed by placing the words "SIDS Info" into the search bar of the appropriate app store. The content is available in English and Spanish and contains voice-over to overcome challenges related to literacy. The SCNJ's app has received a Public Health Innovator Award from the New Jersey Department of Health. The app contains content for providers as well as the public. Hospitals and other provider systems are using the app as an efficient tool for reviewing safe sleep practices with parents. Providers are asked to then help parents download it to review at home and to share with family members and other caregivers. Disparity in outcomes among racial/ethnic groups is associated in part with disparities in social determinants of health, including economic resources, access to healthcare, access to healthy food, lifespan health, smoking, prematurity, low birth weight, and neighborhood crime, as well as disparities in safe sleep practices. The SCNJ partnered with other public health and healthcare organizations in New Jersey to present a Black Infant Mortality Conference in June 2017 and provided testimony to the NJ State Senate Health Committee to bring greater awareness to the disparities in social determinants that contribute to disparities in infant mortality and to facilitate efforts to address these. In a related project, the SCNJ developed a Student Safe Sleep Ambassador program whereby students in high infant mortality communities learn about safe sleep and educate caregivers in their neighborhoods. The program has proven to be effective in increasing awareness.
Evidence-based PracticesThe most recent safe infant sleep guidelines were published by the American Academy of Pediatrics in 2016 and include research conducted by the SIDS Center of New Jersey. The campaign describes the safest sleep environment for infants from birth to 12 months of age. In addition to placing infants on their backs to sleep, the guidelines recommend avoidance of an infant bed sharing with a sleeping adult or child, avoidance of a sofa or chair for infant sleep, removal of loose bedding, pillows, quilts, soft objects, and bumpers from the infant's sleep area, use of a firm mattress that fits the crib space, is intended for the product, and is covered only with a tightly fitted sheet, avoidance of overheating the infant, and avoidance of exposure to tobacco smoke. In place of bed sharing, room sharing with the baby is advised so that the parent can be close by the infant. Breastfeeding is also recommended. While parents may bring the infant into bed for feeding and comforting, the AAP recommends that the infant be returned to the near-by crib, bassinet, portable crib, or play yard that meets current safety standards, once the parent is ready to sleep. These standards can be obtained from the Consumer Product Safety Commission ([https://www.cpsc.gov/Safety-Education/Safety-Education-Centers/cribs online] or 800-638-2772). Parents should consider offering a pacifier but should wait one month if breastfeeding and should avoid the use of clips or strings to attach a pacifier to the infant's clothing as these pose a strangulation risk. Tummy time when the infant is awake and supervised is also recommended to facilitate motor development. The AAP urges all caregivers to discuss these guidelines and any challenges to achieving them with their infant's health care providers. The policy statement can be accessed through the following link provided by the AAP: [http://pediatrics.aappublications.org/content/early/2016/10/20/peds.2016-2938].
Available ServicesSudden Infant Death Syndrome Center of New Jersey (SCNJ) Hotline: 800-545-7437 Visit [http://www.rwjms.rutgers.edu/sids/] or call the hotline to obtain additional bereavement services, hospital Safe Sleep Tool Kits, the American Academy of Pediatrics safe infant sleep guidelines, and SIDS Center safe sleep flyers, videos, information on its free mobile phone app, and related material. Examples of three of the SCNJ's long-standing educational programs are *Nurses LEAD the Way, which is presented at birthing hospitals and has resulted in improvements in knowledge about safe sleep and in education policies and procedures related to the provision of this information to families, *Neighborhoods LEAD the Way, which reaches into communities at highest risk to address the challenges of racial disparity often in collaboration with local clergy, and *Presentations to the New Jersey Division of Child Protection and Permanency. [[br]] The SCNJ provides educational materials in English, Spanish, Arabic, Haitian Creole, and Hindi with other languages available as requested. Educational videos, hospital tool kits, webinars, and other message facilitating material are distributed and also available on the SCNJ website. In addressing the major risk of household smoke exposure, the SCNJ collaborated with [http://momsquit.com/ Mom's Quit Connection] to extend the penetration of knowledge and interventions. The SCNJ also targets specific groups of caregivers, such as grandparents, and works with faith-based communities to reach caregivers at community levels. The free SIDS Center of New Jersey [https://news.rutgers.edu/news/new-rutgers-app-seeks-reduce-infant-mortality/20180418#.W3WoAc5KiUm safe sleep mobile phone app] can be accessed through the app stores for Android and iPhones by typing "SIDS Info" into the search bar. To arrange an education program, call the hotline: 800-545-7437
Health Program InformationNJDOH Sudden Infant Death Syndrome (SIDS) information: [http://www.nj.gov/health/fhs/maternalchild/outcomes/] NJ Department of Children and Families: [http://njsafesleep.com/main/]
Page Content Updated On 08/16/2018, Published on 08/17/2018