safe sleep data and efforts in south carolina
DESCRIPTION
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 ControlTRANSCRIPT
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
