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Barriers to Following the Back-to-Sleep Recommendations: Insights From Focus Groups With Inner-City Caregivers

  • Eve R. Colson
    Correspondence
    Address correspondence to Eve R. Colson, MD, Yale University School of Medicine, 333 Cedar Street, PO Box 208064, New Haven, CT 06520
    Affiliations
    From the Department of Pediatrics (Dr Colson), Yale University School of Medicine, New Haven, Conn; Department of Pediatrics (Dr McCabe), University of California-San Francisco, San Francisco, Calif; Department of Pediatrics (Dr Fox), Northwestern University, Evanston, Ill; Data Coordinating Center (Ms Levenson) and Department of Epidemiology (Dr Colton), Boston University School of Public Health, Boston, Mass; Department of Pediatrics (Dr Lister), University of Texas Southwestern, Dallas, Tex; and Departments of Pediatrics and Epidemiology (Dr Corwin), Boston University Schools of Medicine and Public Health, Boston, Mass
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  • Liana K. McCabe
    Affiliations
    From the Department of Pediatrics (Dr Colson), Yale University School of Medicine, New Haven, Conn; Department of Pediatrics (Dr McCabe), University of California-San Francisco, San Francisco, Calif; Department of Pediatrics (Dr Fox), Northwestern University, Evanston, Ill; Data Coordinating Center (Ms Levenson) and Department of Epidemiology (Dr Colton), Boston University School of Public Health, Boston, Mass; Department of Pediatrics (Dr Lister), University of Texas Southwestern, Dallas, Tex; and Departments of Pediatrics and Epidemiology (Dr Corwin), Boston University Schools of Medicine and Public Health, Boston, Mass
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  • Kenneth Fox
    Affiliations
    From the Department of Pediatrics (Dr Colson), Yale University School of Medicine, New Haven, Conn; Department of Pediatrics (Dr McCabe), University of California-San Francisco, San Francisco, Calif; Department of Pediatrics (Dr Fox), Northwestern University, Evanston, Ill; Data Coordinating Center (Ms Levenson) and Department of Epidemiology (Dr Colton), Boston University School of Public Health, Boston, Mass; Department of Pediatrics (Dr Lister), University of Texas Southwestern, Dallas, Tex; and Departments of Pediatrics and Epidemiology (Dr Corwin), Boston University Schools of Medicine and Public Health, Boston, Mass
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  • Suzette Levenson
    Affiliations
    From the Department of Pediatrics (Dr Colson), Yale University School of Medicine, New Haven, Conn; Department of Pediatrics (Dr McCabe), University of California-San Francisco, San Francisco, Calif; Department of Pediatrics (Dr Fox), Northwestern University, Evanston, Ill; Data Coordinating Center (Ms Levenson) and Department of Epidemiology (Dr Colton), Boston University School of Public Health, Boston, Mass; Department of Pediatrics (Dr Lister), University of Texas Southwestern, Dallas, Tex; and Departments of Pediatrics and Epidemiology (Dr Corwin), Boston University Schools of Medicine and Public Health, Boston, Mass
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  • Theodore Colton
    Affiliations
    From the Department of Pediatrics (Dr Colson), Yale University School of Medicine, New Haven, Conn; Department of Pediatrics (Dr McCabe), University of California-San Francisco, San Francisco, Calif; Department of Pediatrics (Dr Fox), Northwestern University, Evanston, Ill; Data Coordinating Center (Ms Levenson) and Department of Epidemiology (Dr Colton), Boston University School of Public Health, Boston, Mass; Department of Pediatrics (Dr Lister), University of Texas Southwestern, Dallas, Tex; and Departments of Pediatrics and Epidemiology (Dr Corwin), Boston University Schools of Medicine and Public Health, Boston, Mass
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  • George Lister
    Affiliations
    From the Department of Pediatrics (Dr Colson), Yale University School of Medicine, New Haven, Conn; Department of Pediatrics (Dr McCabe), University of California-San Francisco, San Francisco, Calif; Department of Pediatrics (Dr Fox), Northwestern University, Evanston, Ill; Data Coordinating Center (Ms Levenson) and Department of Epidemiology (Dr Colton), Boston University School of Public Health, Boston, Mass; Department of Pediatrics (Dr Lister), University of Texas Southwestern, Dallas, Tex; and Departments of Pediatrics and Epidemiology (Dr Corwin), Boston University Schools of Medicine and Public Health, Boston, Mass
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  • Michael J. Corwin
    Affiliations
    From the Department of Pediatrics (Dr Colson), Yale University School of Medicine, New Haven, Conn; Department of Pediatrics (Dr McCabe), University of California-San Francisco, San Francisco, Calif; Department of Pediatrics (Dr Fox), Northwestern University, Evanston, Ill; Data Coordinating Center (Ms Levenson) and Department of Epidemiology (Dr Colton), Boston University School of Public Health, Boston, Mass; Department of Pediatrics (Dr Lister), University of Texas Southwestern, Dallas, Tex; and Departments of Pediatrics and Epidemiology (Dr Corwin), Boston University Schools of Medicine and Public Health, Boston, Mass
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      Background.—African American infants have a higher incidence of SIDS and increased risk of being placed in the prone position for sleep.
      Objective.—To determine new barriers and more information about previously identified barriers that interfere with adherence to the Back-to-Sleep recommendations among inner-city, primarily African Americans.
      Design/Methods.—We conducted 9 focus groups with caregivers of infants and young children from women, infants, and children centers and clinics in New Haven and Boston. Themes were identified using standard qualitative techniques.
      Results.—Forty-nine caregivers participated, of whom 86% were African American, 6% were Hispanic, 4% were white, and 4% were other. Four themes were identified: 1) Safety: Participants chose the position for their infants based on which position they believed to be the safest. Some participants did not choose to put their infants in the supine position for sleep because they feared their infants would choke; 2) Advice: Participants relied on the advice of more experienced female family members. Health care providers were not uniformly a trusted source of advice; 3) Comfort: Participants made choices about their infants sleeping positions based on their perceptions of whether the infants appeared comfortable. Participants thought that their infants appeared more comfortable in the prone position; 4) Knowledge: Some participants had either limited or erroneous knowledge about the Back-to-Sleep recommendations.
      Conclusions.—We identified multiple barriers to adherence to recommendations regarding infant sleep position. Data obtained from these focus groups could be used to design educational interventions aimed at improving communication about and adherence to the Back-to-Sleep recommendations.

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      REFERENCES

        • Kochanek KD
        • Murphy SL
        • Anderson R
        • Scott C
        Deaths: Final data for 2002. National Vital Statistics Report. Volume 53. Number 2. National Center for Health Statistics, Hyattsville, Md2004
        • Mitchell EA
        • Scragg R
        • Stewart AW
        • et al.
        Results from the first year of the New Zealand cot death study.
        N Z Med J. 1991; 104: 71-76
        • Dwyer T
        • Ponsonby AB
        • Newman NM
        • Gibbons LE
        Prospective cohort study of prone sleeping position and sudden infant death syndrome.
        Lancet. 1991; 337: 1244-1247
        • Lesko SM
        • Corwin MJ
        • Venzina RM
        • et al.
        Change in sleep position during infancy: a prospective longitudinal assessment.
        JAMA. 1998; 280: 336-340
        • Willinger M
        • Ko CW
        • Hoffman HJ
        • et al.
        Factors associated with caregivers' choice of infant sleep position, 1994–1998: the National Infant Sleep Position Study.
        JAMA. 2000; 283: 2135-2142
        • Pollack HA
        • Frohna JG
        A competing risk model of sudden infant death syndrome incidence in two US birth cohorts.
        J Pediatr. 2001; 138: 661-667
        • Pollack HA
        • Frohna JG
        Infant sleep placement after the back to sleep campaign.
        Pediatrics. 2002; 109: 608-614
        • Brenner RA
        • Simons-Morton BG
        • Bhaskar B
        • et al.
        Prevalence and predictors of the prone sleep position among inner-city infants.
        JAMA. 1998; 280: 341-346
        • Hauck FR
        • Moore CM
        • Herman SM
        • et al.
        The contribution of prone sleeping position to the racial disparity in sudden infant death syndrome: the Chicago Infant Mortality Study.
        Pediatrics. 2002; 110: 772-780
        • Ottolini MC
        • Davis BE
        • Patel K
        • et al.
        Prone infant sleeping despite the “Back to Sleep” campaign.
        Arch Pediatr Adolesc Med. 1999; 153: 512-517
        • Willinger M
        • Hoffman HJ
        • Wu KT
        • et al.
        Factors associated with the transition to nonprone sleep positions of infants in the United States: The National Infant Sleep Position Study.
        JAMA. 1998; 280: 329-335
        • Fox K
        Cultural issues in pediatric care.
        in: Behrman RE Kliegman RM Jenson HB Nelson Textbook of Pediatrics. 16th ed. WB Saunders Co, Philadelphia, Penn2000 (Chapter 3)
        • Kleinman A
        The Illness Narratives: Suffering, Healing, and the Human Condition. Basic Books, New York, NY1988
        • Kleinman A
        Local worlds of suffering: an interpersonal focus of illness experience.
        Qualitative Health Res. 1992; 2: 127-134
        • Yang L
        • Fox K
        Ethnography in health research and practice.
        Ambul Child Health. 1999; 4: 339
        • Morgan DL
        Planning Focus Groups. Sage Publications, Thousand Oaks, Calif1997
        • Glazer BG
        • Strauss AL
        The Discovery of Grounded Theory. Aldine, New York, NY1999
        • Denzin NK
        • Lincoln YS
        Strategies of Qualitiative Inquiry. Sage Publications, Thousand Oaks, Calif2003
        • Krueger RA
        • Casey MA
        Focus Groups: Practical Guide for Applied Research. Sage Publications, Thousand Oaks, Calif2000
        • Tucker C
        • Herman K
        • Pedersen T
        • et al.
        Cultural sensitivity in physician-patient relationships: perspectives of an ethnically diverse sample of low-income primary care patients.
        Medical Care. 2003; 41: 859-870
        • Kahn A
        • Groswasser J
        • Sottiaux M
        • et al.
        Prone or supine body position and sleep characteristics in infants.
        Pediatrics. 1993; 91: 1112-1115
        • Gerald CM
        • Harris KA
        • Thach BT
        Spontaneous arousals in supine infants while swaddled and unswaddled during rapid eye movement and quiet sleep.
        Pediatrics. 2002; 110: e70
        • Gerald CM
        • Harris KA
        • Thach BT
        Physiologic studies on swaddling: an ancient childcare practice, which may promote the supine position for infant sleep.
        J Pediatr. 2003; 141: 398-404
        • Horne RSC
        • Ferens D
        • Watts A
        • et al.
        The prone sleep position impairs arousability in term infants.
        J Pediatr. 2001; 138: 811-816
        • Corbie-Smith G
        • Thomas SB
        • St. George DMM
        Distrust, race and research.
        Arch Intern Med. 2002; 162: 2458-2468
      1. The NICHD Community Connection: Advancing the Health of Families in Your Community. Issue 1, June 2004. Publication: 04-5514. National Institute of Child Health and Human Development

        • NICHD
        Back-to-Sleep initiatives.
        (Accessed September 8, 2005)
        • Moon RY
        • Oden RP
        • Grady KC
        Back to sleep: educational intervention with women, infants and children program clients.
        Pediatrics. 2004; 113: 542-547
        • Moon RY
        • Oden RP
        Back to sleep: can we influence child care providers?.
        Pediatrics. 2003; 112: 878-882
        • Colson ER
        • Joslin SC
        Changing nursery practice gets inner-city infants in the supine position for sleep.
        Arch Pediatr Adolesc Med. 2002; 156: 717-720
        • Hein HA
        • Petit SF
        Back to sleep: good advice for parents but not for hospitals?.
        Pediatrics. 2001; 107: 537-539
        • Ray BJ
        • Metcalf SC
        • Franco SM
        • Mitchell CK
        Infant sleep position instruction and parental practice: comparison of a private pediatric office and an inner-city clinic.
        Pediatrics. 1997; 99: e12
        • Wise PH
        The anatomy of disparity in infant mortality.
        Ann Rev Public Health. 2003; 24: 341-362