safe sleep data and efforts in south carolina

Some Safe Sleep Data and Efforts in SC

Overview

Infant Mortality in South Carolina

South Carolina Safe Sleep Data

Some State and National Safe Sleep

Efforts

Big Finish

Infant Mortality

“The main thing is to keep the main

thing the main thing.”

-Stephen Covey

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

SUIDs = SIDS + Accidental Suffocation + Unknown

In 2012: 33 SIDS + 39 Accidental Suffocation = 72

Mostly full term and in rural counties

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

Reducing Infant Mortality

South Carolina Safe Sleep Data

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

Safe Sleep Recommendations

Safe Sleep Recommendations

Alone

Safe Sleep Recommendations

Alone

Back

Safe Sleep Recommendations

Alone

Back

Crib

SC PRAMS Data on Sleep

Provider’s advice about safe sleep? 2009-2011

Sleep positioning? 1996-2011

Co-sleeping? 2004-2011

Characteristic No Advice Advised P-valueRace/Ethnicity NH White 7.0 90.8 NH Black 5.1 94.9 Hispanic 8.5 91.5Maternal 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 96.0Insurance Medicaid 6.1 93.9 Other 8.0 92.1Total 6.9 93.1

0.18

0.73

0.25

Provider's Advice about Safe Sleep Practices, 2009-2011

Characteristic No Advice Advised P-valueRace/Ethnicity NH White 7.0 90.8 NH Black 5.1 94.9 Hispanic 8.5 91.5Maternal 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 96.0Insurance Medicaid 6.1 93.9 Other 8.0 92.1Total 6.9 93.1

0.18

0.73

0.25

Provider's Advice about Safe Sleep Practices, 2009-2011

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.

Characteristic Not on Back On Back P-valueRace/Ethnicity NH White 27.1 72.9 NH Black 41.5 58.5 Hispanic 16.1 83.9Maternal 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 85.5Insurance Medicaid 34.7 65.3 Other 25.3 74.7Total 30.7 69.3

<0.0001

0.04

0.001

Placing infants down to sleep on their backs, 2009-2011

Characteristic Co-SleepingNever Co-Sleeping P-value

Race/Ethnicity NH White 52.8 47.2 NH Black 79.7 20.3 Hispanic 73.3 26.7Maternal 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 45.5Insurance Medicaid 71.4 28.6 Other 52.9 47.1Total 59.1 40.9

<0.0001

Infants never co-sleeping, 2009-2011

<0.0001

<0.0001

Mental Vacation

Some State and National Efforts

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

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 weeks2. Interconception care3. Smoking cessation4. Perinatal Regionalization5. Safe sleep

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

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

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

IM CoIIN in the Future

Efforts already expanded to Region V

Plans to expand nationally Incorporation into Title V Block Grant

Opportunity for leadership

Big Finish

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

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

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

Questions?

Contact Info

Mike Smith, MSPHMCH EpidemiologistDirector, Division of Research and PlanningBureau of Maternal and Child Health

803-898-3740smithm4@dhec.sc.gov