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Healthy People 2020 is a national effort that sets goals and objectives to improve the health and well-being of all people in the United States. One of the crucial topic goals and objectives for 2020 is to reduce the incidence of fetal and infant deaths that occur from Sudden Infant Death Syndrome (SIDS). The magnitude of fetal mortality related to SIDS is considerable; in 2017 there were 3,600 sudden unexpected infant deaths (SUID) in the United States (Centers for Disease Control [CDC], 2018). SUID include several subcategories such as SIDS, accidental suffocation in a sleeping environment, as well as other deaths from unknown causes. SIDS is the most prevalent of these categories, occurring mostly among infants less than 1 year of age and often during the second and third month of life (CDC, 2018). By identifying the specific disparities that correlate with the high number of SIDS cases, Healthy People 2020 aims to create awareness, improve population health and achieve health equity in the United States.
SIDS is a complex, multifactorial disorder where often infants appear to be healthy before succumbing to it. Due to its unknown cause and unpredictable sudden nature, SIDS has a particularly devastating toll on new mothers, caregivers and families as a whole. The two major disparities that have been identified by Healthy People 2020 as contributors to SIDS are both race/ethnicity as well as age. In 2016, it was found that per 1,000 live births, deaths occurred in 1.1 American Indian/Alaskan native infants and 0.77 African American infants as compared to 0.13 in Asian or Pacific Islander infants (Healthy People, 2020). It is incredibly important that disparities and risk factors related to the onset of SIDS are identified and promptly managed in order to lessen the overall occurrence, as well as promote inclusive safety in newborns. In order to properly tailor healthcare toward eliminating these disparities, reduce the overall risk factors for SIDS and common causes of mortality, it’s vital to develop and implement sound health promotion practices within these specific populations.
The first step to implement a successful health promotion program within a community is to understand the factors that make theses populations have the largest disparity. Minority groups in the United States such as African Americans, Asian or Pacific Islander and Hispanic populations who are also under 25 years of age experience a higher degree of health disparities when compared to the perceived majority groups such as the Caucasian Americans (Rice, Goldfarb, Brisendine, Burrows, and Wingate, 2017). Notably, the authors assert that the socially disadvantaged populations mentioned above carry the highest degree of likelihood to experience health disparities such as disease or pandemic burden, SIDS, and violence coupled with limited opportunities to access optimal healthcare services. It is believed that within these populations, SIDS may occur as a result from both their environmental and physical factors and therefore make infants more susceptible.
In recent decades, Sudden Unexpected Infant Deaths (SUID) was a common experience in the United States. However, recent studies have indicated a drop in the statistics although the rates have remained comparatively constant since the turn of 2000. For instance, Parks, Lambert, and Shapiro-Mendoza, (2017) sought to examine ethnic and racial trends in SUID in the US between 1995 and 2013 where they established that the disparity rates have been consistently high for American Indians or the Alaska Natives compared to other social groups, that is an average of 2.6%). The authors further assert that the infant mortality rate decreased significantly down the infant age starting from the age gap of 1-2 months. For instance, the age of death for infants between 0-4 months ranged from 76% to 86% with the lowest death rate occurring between 2011 and 2013, which stood at 76%. Precisely, Hispanic American women experience the highest prevalence of SIDS with infant death rate common for the age of 1-4 months. Given this assertion, the underlying objectives include raising awareness about fetal mortality and infant mortality with the aim of reducing SIDS and SUID prevalence, especially among Hispanic, American Indians and non-Hispanic black women.
A recent study by Mathews, Joner, Oden, Alamo, Moon (2015) showed that socioeconomic factors between ethnicities could also account for the disparity between ethnicities. The study compared infant care practices that impact risk for sleep-related infant death in African–American and Hispanic families. The goal of this study was to compare infant care practices relevant to sleep related infant deaths, including sleep position, bed-sharing, room-sharing, parental smoking and breastfeeding. Findings showed that African American women were significantly more likely to bed-share with their infants than Hispanic women (Mathews et.al., 2015). A similar study was done by Gaydos et al. (2015) to compare decision making regarding sleep practices for low-income, African-American women. and counseling practices of their providers to better understand how to effectively mitigate SIDS/SUID risk for this population. This study was intended to better understand how low-income, African-American mothers under 25 years of age understand and act upon safe sleep recommendations for newborns and how providers counsel these mothers. The large majority of mothers reported understanding, but not following, the safe-sleeping recommendations. None of the providers actively counsel their patients on risk-mitigating techniques if they decide to bed share.
Another contributing factor to the disparity may be related to provider teachings. A study exploring physicians’ knowledge, attitudes, and behaviors related to Sudden Infant Death Syndrome and infant safe sleep and identified barriers as well as enabling and/or reinforcing factors associated with providing infant safe sleep education in the prenatal environment. Out of 418 physicians, approximately half (55%) indicated via survey that it was important for them to discuss SIDS risk factors and/or infant safe sleep with prenatal patients. Physicians can influence the infant safe sleep choices that women make and therefore it is important to know whether they are providing education on this topic and what they are recommending [1] Providing information and embodying cultural completence are two of the main factors which contribute to a positive intervention strategy for African American women under 25.
The overarching research reveals that the socially underprivileged groups in the United States experience the highest degree of mortality. Therefore, it is necessary for relevant for health care promotions in conjunction with both federal and governments of respective states to design a means to eradicate or limit chances for infant and fetal mortality in the US. One of the feasible means of reducing SIDS-related mortality cases involves evaluation of the basics of bedtime aspects for babies and related behavior code for mothers. According to Hauck, Tanabe, McMurry, and Moon, (2015), rates of newborn deaths from sleep-related causes have remained constant in recent years. The authors add that lack of access to safer cribs, which could enhance adherence to sleep recommendations, have persisted despite awareness of sleep recommendations among mothers. To tackle this discourse, the Bedtime Basics for Babies (BBB) program was developed. The prime objective of the program is to distribute cribs to families that experience the highest degree of fetal and infant mortality, as in the case of Hispanic and non-Hispanic black women; this will contribute significantly towards reducing mortality-related cases.
The program stands to produce the greatest desired result when it is executed in an appropriate manner. Therefore, nurses should be sought after for the execution of the BBB program for maximum benefit. Loan et al. (2018) observe that nurses exhibit the highest degree of literacy discharge, that is, nurses provide excellent work when it comes to patient engagement, empowerment, and activation. Moreover, the authors indicate that healthcare-related programs or initiatives may not be achieved unless nurses are fully engaged. On this note, nurses come handy for the BBB program where they will be expected to create awareness of the program among the socially disadvantaged groups mentioned above. The nurses will assess and identify the most susceptible families, which require cribs and related Safe Sleep Kit that contain wearable blankets and pacifiers. This program is greatly important for the socially disadvantaged groups, especially the Hispanic and non-Hispanic black women. Most importantly, nurses remain privy to this program since they exhibit the necessary knowledge and experience for the success of this kind of program.
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