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

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

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

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

12. Reducing Infant Mortality

13. South Carolina Safe Sleep Data

14. 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

15. Safe Sleep Recommendations

16. Safe Sleep Recommendations
 Alone

17. Safe Sleep Recommendations
 Alone
 Back

18. Safe Sleep Recommendations
 Alone
 Back
 Crib

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

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

26. Mental Vacation

27. Some State and National Efforts

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

30. 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

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

34. Big Finish

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

38. Questions?

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