Outreach Activities In Specific Communities

Mother holding baby.

Between 1990 and 2015, the SIDS rate dropped across all populations in the United States, with the most significant decrease happening between 1994 to 1998.¹ Today, although the SIDS rate remains relatively low and most caregivers report using the back sleep position, infants in some communities remain at higher risk for SIDS and have higher SIDS rates than infants in other communities.

The table below² shows the breakdown of Sudden Unexplained Infant Deaths (SUID), which includes SIDS, accidental suffocation and strangulation in bed, and unknown causes, for different ethnic groups in the United States.

2017 SUID Deaths and Death Rates by Race/Ethnic Origin of the Mother, 2017

Race	SIDS Deaths	Death Rate Per 100,000 Births
Hispanic	503	57
Non-Hispanic White	1,753	86
Non-Hispanic Black	1,141	194
American Indian or Alaska Native	79	229
Asian or Pacific Islander	74	27
Origin unknown or not stated	34	105
Total	3,584	93

The Safe to Sleep^® campaign uses a variety of approaches and strategies to craft effective messages about reducing the risk of SIDS and other sleep-related causes of infant death and to design effective strategies for delivering these messages to communities around the United States.

Research on health education and SIDS outreach found that response to safe sleep messages differed among different communities and racial/ethnic groups, which may help explain some of the lingering differences in SIDS rates.

For example, NICHD—in partnership with the National Institute on Deafness and Other Communication Disorders and the Centers for Disease Control and Prevention (CDC)—conducted the Chicago Infant Mortality Study to better understand why SIDS risk remained higher in African American infants. The study focused on 260 predominantly African American infants in Chicago who had died of SIDS between November 1993 and April 1996.

The study found that:

African Americans at that time were less likely than other racial/ethnic groups to have been informed by a health care worker to place their babies to sleep on their backs as a way to reduce SIDS risk.
Infants who shared a bed with other children or adults were at a higher risk of SIDS than infants who slept in their own sleep area were.
Sleeping on soft bedding and on the stomach increased the risk for SIDS and posed a far greater risk when they occurred together than the sum of both risk factors would suggest.

These findings provided a foundation for designing outreach to address some of the specific needs of African American communities within the context of SIDS and other sleep-related causes of infant death. Visit https://www.nichd.nih.gov/newsroom/releases/sidsRisk to learn more about this study.

To identify factors that might contribute to high rates of SIDS among American Indians and Alaska Natives (AI/AN), NICHD, the Indian Health Service (IHS), and the CDC funded the Aberdeen Area Infant Mortality Study in 2002. The study of Northern Plains Indian infants revealed that:

Infants were less likely to die of SIDS if their mothers received visits from public health nurses before and after giving birth.
Binge drinking (five or more drinks at one time) during the mother’s first trimester of pregnancy made it eight times more likely that her infant would die of SIDS.
Any maternal alcohol use during the 3 months before pregnancy or during the first trimester was associated with a six-fold increase in the risk of SIDS.
Infants were more likely to die of SIDS if they were dressed in two or more layers of clothing during sleep.

The findings suggested that the risk factors for SIDS among AI/AN communities may be slightly different from those of other communities and provided an evidence-based starting point for outreach programs. To learn more about this study, visit http://www.nichd.nih.gov/news/releases/pages/sids_riskfactors.aspx.

These and other studies, including the National Infant Sleep Position Study and the Collaborative Home Infant Monitoring Evaluation, helped the Safe to Sleep® campaign refine its messages and outreach activities to maximize their effectiveness.

To impact the rates of SIDS and other sleep-related causes of infant death, the Safe to Sleep® campaign not only informs its outreach efforts with data and evidence but also enhances its efforts by working with and within different communities. By relying on the expertise of community members, organizations, and governments, Safe to Sleep® is able to get effective, tailored safe sleep messages into communities in ways that would not be possible without those collaborators.

Experience with African American Communities

In 1999, NICHD, First Candle (formerly SIDS Alliance), and the National Black Child Development Institute hosted a meeting with representatives from national African American organizations as a first step in capitalizing on these organizations’ experience and knowledge in reaching members of their communities. Representatives from various groups participated, including:

Alpha Kappa Alpha Sorority, Inc. (AKA)
Chi Eta Phi Sorority
Chicago Department of Health
D.C. Department of Health
National Association of Black Owned Broadcasters
National Association for the Advancement of Colored People (NAACP)
National Medical Association
National Coalition of 100 Black Women (NCBW)
Pampers Parenting Institute
Zeta Phi Beta Sorority

Participants proposed messaging and outreach strategies that had proven successful with their constituents, and NICHD and other campaign sponsors incorporated these ideas into a broad outreach strategy for reaching African American communities. The campaign created a suite of resources tailored to African American communities, a collection of materials and training modules intended to help users educate people in their communities about SIDS risk reduction.

In 2001, then–U.S. Surgeon General Dr. David Satcher debuted the Resource Kit at a meeting in Atlanta, with members of AKA, Women in the NAACP (WIN), the NCBW, and other groups. This first national training workshop on SIDS risk reduction was followed by more than 40 regional train-the-trainer sessions.

In 2003, the AKA, WIN, and the NCBW hosted “Journey for Our Children” summits in Tuskegee, AL; Los Angeles, CA; and Detroit, MI. The summits featured training on how to use the Resource Kit and other Back to Sleep efforts related to SIDS risk reduction. These summits proved to be effective in mobilizing communities to take action to spread safe sleep messages and get people excited about SIDS risk reduction activities. They also served as a primary impetus for many local outreach efforts conducted by summit participants.

To learn more about the summits, select a link below:

Since the summits, the Safe to Sleep® campaign has supported a variety of additional activities to help revise safe sleep messages appropriately and to spread them across African American communities. These activities include focused efforts in Arkansas, Alabama, the District of Columbia, Illinois, Mississippi, and Ohio.

In 2015, NICHD and Kappa Alpha Psi® Fraternity, Inc., began collaborating on an outreach initiative to teach fathers, grandfathers, uncles, brothers, and other community members about the ways to reduce the risk of SIDS and other sleep-related causes of infant death.

Experience with American Indian and Alaska Native Communities

In 2002, informed by the findings from the Aberdeen Study described above, NICHD hosted a meeting with members of AI/AN communities to discuss infant mortality and SIDS in the Northwest and Northern Plains regions of the United States. In addition to learning general information about SIDS, infant mortality statistics, and outreach methods that have been successful, participants discussed potential responses for their own areas of Indian Country with high SIDS rates.

At a follow-up meeting in Rapid City, SD, in 2003, participants discussed community-driven strategies designed to increase awareness of SIDS risk reduction, as well as how to reach people with these messages while preserving cultural traditions. In addition, participants established the Healthy Native Babies Workgroup to advise NICHD and its partners on the development of messages, materials, and outreach strategies specific for AI/AN audiences.

To further define the needs of these communities, NICHD and members of the workgroup held a series of discussions in five IHS regions in the Northern Tier: Aberdeen, SD; Bemidji, MN; Billings, MT; Portland, OR; and Alaska. The results of these discussions helped the workgroup define safe sleep messages and identify strategies for disseminating information.

Partners in AI/AN outreach and the workgroup include:

Aberdeen Area Tribal Chairmen’s Health Board
Association of American Indian Physicians
Bemidji Area Indian Health Service
Billings Area Indian Health Service
Inter-Tribal Council of Michigan
Minnesota Department of Health
National Indian Women’s Health Resource Center
Northwest Portland Area Indian Health Board
Red Lake Tribal Council (Minnesota)

The result of this unique collaboration is a suite of materials and outreach activities specifically tailored for AI/AN communities. The workgroup continues revising existing materials and messages and refining outreach strategies to ensure effective dissemination of this important information.

Guided by research and the expertise of leaders from different racial/ethnic communities, Safe to Sleep^®offers materials tailored for specific audiences.

Materials for African American Audiences

Materials for American Indian and Alaska Native Audiences

Materials for Spanish-Speaking Audiences

Centers for Disease Control and Prevention. Sudden Unexpected Infant Death and Sudden Infant Death Syndrome. (April, 2019). Retrieved April 24, 2018, from https://www.cdc.gov/sids/data.htm.
Centers for Disease Control and Prevention. CDC WONDER. Linked birth/infant death records for 2007–2017 with ICD 10 codes. Infant deaths: Linked birth/infant death records. Retrieved August 28, 2019, from http://wonder.cdc.gov/lbd-current.html.