April 2001

From University of Michigan Health System

Back to Sleep campaign not as successful for African-Americans

But campaign correlates with large decrease in SIDS among Hispanics and non-Hispanic whites

Baltimore - The national Back to Sleep campaign, which recommends that caretakers place healthy babies on their backs to sleep, has been credited with recent declines in Sudden Infant Death Syndrome, or SIDS.

But a new study from the University of Michigan Health System and the U-M School of Public Health, presented today at the 2001 Pediatric Academic Societies and American Academy of Pediatrics joint meeting in Baltimore, shows that the Back to Sleep campaign, started in 1994, has been more successful for some racial and ethnic groups than for others.

"The Back to Sleep campaign was successful in terms of getting children to sleep on their backs, but there are still disparities between African-American children and white children," says John Frohna, M.D., M.P.H., clinical assistant professor, Departments of Pediatrics and Internal Medicine, U-M Medical School, and author of the study. Harold A. Pollack, Ph. D., assistant professor of health management and policy at the U-M School of Public Health, co-authored the study.

"We found that the overall prevalence of putting infants in the prone, or face-down, position decreased from 27 percent in 1996 to 19 percent in 1998," Frohna says. "But, although adherence to the American Academy of Pediatrics' recommended sleep position increased among African-Americans, it increased at a slower rate than was observed in other large racial or ethnic groups."

The Back to Sleep campaign promotes infant placement on the back to reduce the risk of SIDS. The syndrome, characterized as the unexplainable death of an infant, is the leading cause of death in babies between one month and 1 year of age. Most SIDS deaths occur when a baby is between one and four months of age. African-American children are more than twice as likely as white babies to die of SIDS. Much of this disparity appears linked with parental education, infant birth weight and other factors. Although certain factors may make some babies more susceptible to SIDS, researchers are still studying the precise causes.

In the U-M study, Frohna and Pollack gathered data from the Pregnancy Risk Assessment Monitoring System of the Centers for Disease Control and Prevention. The CDC's national database was developed from a population-based survey of women and collects information regarding their experiences and behaviors before, during and shortly after pregnancy. The U-M team used PRAMS data from 15 states that totaled 55,263 women.

Overall, Hispanic/Latinos were more likely than non-Hispanic whites to position their babies on their backs for sleeping, but also showed a propensity for positioning babies on their sides.

"Adherence to recommendations increased sharply among Hispanic and Latino families," Frohna says. "In 1996, 27 percent of these babies were placed face-down to sleep compared to 13 percent in 1998. SIDS incidence among Hispanics and Latinos declined by 23 percent, more than twice the rate of decline observed among African-Americans or among non-Hispanic whites."

Frohna says this study did not examine reasons why certain racial and ethnic groups responded differently to the Back to Sleep campaign. The Back to Sleep campaign - sponsored by the National Institute of Child Health and Human Development, the Maternal and Child Health Bureau, the American Academy of Pediatrics, the SIDS Alliance, and the Association of SIDS and Infant Mortality Program - has already begun to look into finding new ways to get its message to more people and to caregivers in daycare centers and other settings.

Frohna says hopes the information from this study sparks more discussion about culturally appropriate means of communication.

"I think this information will do a few things. First, it shows there is still a need for additional focused efforts to inform African-American parents about the benefits of placing babies on their backs to sleep," Frohna says. "At the same time, the study shows the success of simple messages like that promoted by the Back to Sleep campaign. Perhaps there are ways to mount similar campaigns for other important messages that are in the interest of the public."












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