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Safe Sleep Data and Efforts in South Carolina

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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 …

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

Published in: Health & Medicine
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  • 1. Some Safe Sleep Data and Efforts in SC
  • 2. Overview  Infant Mortality in South Carolina  South Carolina Safe Sleep Data  Some State and National Safe Sleep Efforts  Big Finish
  • 3. Infant Mortality “The main thing is to keep the main thing the main thing.” -Stephen Covey
  • 4. 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
  • 5.  SUIDs = SIDS + Accidental Suffocation + Unknown  In 2012: 33 SIDS + 39 Accidental Suffocation = 72  Mostly full term and in rural counties
  • 6. 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
  • 7. Reducing Infant Mortality
  • 8. South Carolina Safe Sleep Data
  • 9. Potentially Sleep Related Deaths  SUIDs = SIDS + Accidental Suffocation + Unknown  In 2012: 33 SIDS + 39 Accidental Suffocation = 72  Counties with the highest numbers and rates:  Anderson  Darlington  Horry  Lexington
  • 10. Safe Sleep Recommendations
  • 11. Safe Sleep Recommendations  Alone
  • 12. Safe Sleep Recommendations  Alone  Back
  • 13. Safe Sleep Recommendations  Alone  Back  Crib
  • 14. SC PRAMS Data on Sleep  Provider’s advice about safe sleep?  2009-2011  Sleep positioning?  1996-2011  Co-sleeping?  2004-2011
  • 15. 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
  • 16. 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
  • 17. 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.
  • 18. 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
  • 19. 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
  • 20. Mental Vacation
  • 21. Some State and National Efforts
  • 22. 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
  • 23. 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
  • 24. COIN, COIIN, CoIIN?  Collaborative: shared vision and goals; clear roles; consistent communication  Improvement: Quality Improvement (PDSA cycles, IHI model)  Innovation: seek broad impact, coordinated efforts toward group agenda  Network: leaders, staff, shared workspace provided by HRSA
  • 25. 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
  • 26. 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
  • 27. IM CoIIN in the Future  Efforts already expanded to Region V  Plans to expand nationally  Incorporation into Title V Block Grant  Opportunity for leadership
  • 28. Big Finish
  • 29. 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
  • 30. 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
  • 31. 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
  • 32. Questions?
  • 33. 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

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