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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 Department of Health and Environmental Control

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Safe Sleep Data and Efforts in South Carolina

  1. 1. Some Safe Sleep Data and Efforts in SC
  2. 2. Overview  Infant Mortality in South Carolina  South Carolina Safe Sleep Data  Some State and National Safe Sleep Efforts  Big Finish
  3. 3. Infant Mortality “The main thing is to keep the main thing the main thing.” -Stephen Covey
  4. 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. 5.  SUIDs = SIDS + Accidental Suffocation + Unknown  In 2012: 33 SIDS + 39 Accidental Suffocation = 72  Mostly full term and in rural counties
  6. 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. 7. Reducing Infant Mortality
  8. 8. South Carolina Safe Sleep Data
  9. 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. 10. Safe Sleep Recommendations
  11. 11. Safe Sleep Recommendations  Alone
  12. 12. Safe Sleep Recommendations  Alone  Back
  13. 13. Safe Sleep Recommendations  Alone  Back  Crib
  14. 14. SC PRAMS Data on Sleep  Provider’s advice about safe sleep?  2009-2011  Sleep positioning?  1996-2011  Co-sleeping?  2004-2011
  15. 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. 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. 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. 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. 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. 20. Mental Vacation
  21. 21. Some State and National Efforts
  22. 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. 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. 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. 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. 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. 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. 28. Big Finish
  29. 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. 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. 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. 32. Questions?
  33. 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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