Safe Sleep Summit 2014 held by Children's Trust of South Carolina. Presentation by: Mike Smith, MSPH, Maternal Child Health Epidemiologist, Director, Division of Research and Planning, South Carolina Department of Health and Environmental Control
8. The Big Picture – IM in 2012
Large racial disparity – national issue
Neonatal mortality: 4.7 deaths per 1,000 births
Postneonatal mortality: 2.9 deaths per 1,000
births
Highest rates in the Pee Dee and Midlands
9.
10. SUIDs = SIDS + Accidental Suffocation + Unknown
In 2012: 33 SIDS + 39 Accidental Suffocation = 72
Mostly full term and in rural counties
11. Causes of IM by Race
White: Birth Defects, LBW/PTB, Accidents, SIDS
Black and Other: LBW/PTB, Birth Defects, SIDS,
Maternal Complications of Pregnancy,
Accidents
19. SC PRAMS Data on Sleep
Provider’s advice about safe sleep?
2009-2011
Sleep positioning?
1996-2011
Co-sleeping?
2004-2011
20. Characteristic No Advice Advised P-value
Race/Ethnicity
NH White 7.0 90.8
NH Black 5.1 94.9
Hispanic 8.5 91.5
Maternal Age
<20 years 7.4 92.6
20-29 years 6.3 93.7
30-39 years 7.8 92.2
40+ years 4.0 96.0
Insurance
Medicaid 6.1 93.9
Other 8.0 92.1
Total 6.9 93.1
0.18
0.73
0.25
Provider's Advice about Safe Sleep Practices,
2009-2011
21. Characteristic No Advice Advised P-value
Race/Ethnicity
NH White 7.0 90.8
NH Black 5.1 94.9
Hispanic 8.5 91.5
Maternal Age
<20 years 7.4 92.6
20-29 years 6.3 93.7
30-39 years 7.8 92.2
40+ years 4.0 96.0
Insurance
Medicaid 6.1 93.9
Other 8.0 92.1
Total 6.9 93.1
0.18
0.73
0.25
Provider's Advice about Safe Sleep Practices,
2009-2011
22. Infant Sleep Positioning
Smith MG et. al. Racial differences in trends and predictors of infant sleep positioning in SC,
1996-2007. MCHJ(2012)16:72-82.
23. Characteristic Not on Back On Back P-value
Race/Ethnicity
NH White 27.1 72.9
NH Black 41.5 58.5
Hispanic 16.1 83.9
Maternal Age
<20 years 34.2 65.8
20-29 years 32.9 67.1
30-39 years 26.8 73.2
40+ years 14.5 85.5
Insurance
Medicaid 34.7 65.3
Other 25.3 74.7
Total 30.7 69.3
<0.0001
0.04
0.001
Placing infants down to sleep on their backs, 2009-
2011
24.
25. Characteristic Co-Sleeping
Never Co-
Sleeping P-value
Race/Ethnicity
NH White 52.8 47.2
NH Black 79.7 20.3
Hispanic 73.3 26.7
Maternal Age
<20 years 77.7 22.3
20-29 years 66.3 33.7
30-39 years 54.5 45.5
40+ years 54.5 45.5
Insurance
Medicaid 71.4 28.6
Other 52.9 47.1
Total 59.1 40.9
<0.0001
Infants never co-sleeping, 2009-2011
<0.0001
<0.0001
28. SC Safe Sleep Coalition
Broad-based coalition facilitated by Children’s
Trust
Provided recommendations to the Joint Citizens
and Legislative Committee on Children
Continues efforts to operationalize
recommendations
29. HRSA Infant Mortality CoIIN
13 states in US DHHS regions IV and VI
Groups organized around several areas to
prevent infant mortality
1. Elective deliveries before 39 weeks
2. Interconception care
3. Smoking cessation
4. Perinatal Regionalization
5. Safe sleep
31. Safe Sleep CoIIN Workgroup
Goals:
Improve sleeping practices to reduce SIDS
and sleep related SUIDs
Consistently and accurately monitor trends
in SIDS and SUIDs
Objectives:
Reduce infant mortality related to SUID by
20% in 24 months
Reduce disparities
32. Safe Sleep CoIIN Workgroup
Shared regional strategies and state-specific
strategies
SC’s Safe Sleep CoIIN Workgroup has adopted
the Safe Sleep Coalition’s recommendations as
the state plan
33. IM CoIIN in the Future
Efforts already expanded to Region V
Plans to expand nationally
Incorporation into Title V Block Grant
Opportunity for leadership
35. Big Finish
Infant mortality creeping back up? Racial
disparity certainly persistent
SUIDs really a leading cause of infant death in
2012. Modifiable?
Best practices – ABC’s of safe sleep
36. Big Finish
Nearly all women are receiving some safe sleep
advice from providers during pregnancy
Correct and consistent advice?
Impact on behavior?
Big gains in back sleeping
Clear disparities by race/ethnicity and
Medicaid status
37. Big Finish
Some recent improvement with respect to
infant co-sleeping
Controversy
Clear disparities in race/ethnicity, maternal
age, and Medicaid status
Synergy between federal and state efforts
Opportunity for national leadership
39. Contact Info
Mike Smith, MSPH
MCH Epidemiologist
Director, Division of Research and Planning
Bureau of Maternal and Child Health
803-898-3740
smithm4@dhec.sc.gov