Online Program

Assessing disparities in infant safe sleep practice by maternal WIC status in Massachusetts

Tuesday, November 5, 2013

Nicole Krellenstein, B.A., Injury Prevention Center, Boston Medical Center, Boston, MA
Hafsatou Diop, MD, MPH, Bureau of Family Health and Nutrition- Pregnancy Risk Assessment Monitoring System (PRAMS), Massachusetts Department of Public Health, Boston, MA
Emily Lu, MPH, Bureau of Family Health and Nutrition- Pregnancy Risk Assessment Monitoring System (PRAMS), Massachusetts Dept. of Public Health, Boston, MA
Holly Hackman, MD, MPH, Massachusetts Department of Public Health, Boston, MA
Jonathan Howland, PhD, MPH, Injury Prevention Center, Boston Medical Center, Boston, MA
Background/Purpose: Non-supine infant sleep positions increase risk for sudden unexpected infant death (SUID). Disparities in safe sleep practices are associated with maternal income and race/ethnicity. WIC is a nutrition supplement program for low-income (185% Federal poverty line) pregnant and post-partum women and children up to age 5. Currently in Massachusetts (MA) ≈ 40% of pregnant/post-partum women are WIC clients. To inform development of a SUID intervention strategy, the MA Department of Public Health (MDPH) investigated the association between WIC status and infant safe sleep practices among post-partum MA mothers using data from the Pregnancy Risk Assessment Monitoring System (PRAMS) survey. Methods: PRAMS is an annual statewide survey of mothers of infants conducted by the MDPH in conjunction with the CDC that includes questions about infant sleep position and mothers' prenatal WIC status. We used aggregate (2007-2010) data to estimate the relative risk (RR) of infant safe sleep position by WIC enrollment. Results/Outcomes: The weighted aggregate sample included 276,252 women (≈ 69,063 women/year; mean response rate 68%). The crude RR that WIC (vs. non-WIC) mothers most often placed their infants in supine sleeping positions was 0.81 (95% CI: 0.77, 0.84; p= .0001). Significant differences were found for each year, although convergent trends were observed. Conclusion: MA WIC mothers more frequently reported placing their babies in non-supine positions compared with non-WIC mothers. Given the statewide infrastructure and large proportion of MA pregnant/post-partum women enrolled in WIC, these findings indicate the potential effectiveness of WIC-based safe sleep interventions as a SUID reduction strategy.

Learning Areas:

Planning of health education strategies, interventions, and programs
Public health or related research

Learning Objectives:
Describe disparities in maternal behaviors pertaining to infant safe sleep by participation in the Women Infants and Children (WIC) program in Massachusetts; Design intervention strategies for reducing Sudden Unexpected Infant Death (SUID) using disparity findings.

Keyword(s): SIDS, Infant Mortality

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: As a core staff member of the Boston Medical Center Injury Prevention Center I have received training and have worked closely alongside experts in injury prevention research. I also have significant experience collaborating with the MA Department of Public Health, developing implementation and evaluation strategies for various injury-related interventions, including falls prevention, sports injury prevention, and safe sleep promotion programs. I graduated summa cum laude with high honors in experimental psychology from Vanderbilt University.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.