MCH Alert: Focus on Infant Mortality is developed by the Maternal and Child Health Library in collaboration with the National SUID/SIDS Resource Center at Georgetown University. This and past issues of the MCH Alert are available at http://www.mchlibrary.info/alert/archives.html and http://www.sidscenter.org/alert/archives.html.

1. Michigan Releases Action Plan to Prevent and Reduce Infant Mortality
2. Brief Profiles States' Efforts to Improve Women's Health Through Medicaid Programs
3. Study Determines the Accuracy of Information on Infant Sleep Safety Found on the Internet
4. Authors Examine Factors Influencing Infant Sleep Position by Socioeconomic Status

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1. Michigan Releases Action Plan to Prevent and Reduce Infant Mortality

The State of Michigan Infant Mortality Reduction Plan outlines a strategic approach to reduce the infant mortality disparity that exists between races in Michigan. The plan was developed by the Michigan Department of Community Health with input and guidance from community, health care, academic, public health, and other maternal and child health stakeholders across the state. It addresses social issues and disparities as well as efforts to build an enhanced network of support systems to ensure that nearly all Michigan infants survive to their first birthday. Contents include a call to action, strategies and goals for the period 2012-2015, and a list of partnering organizations. Data, reports, guidelines, matrices, and other resources are provided as appendices. The plan is available at http://www.michigan.gov/documents/mdch/MichiganIMReductionPlan_UPDATED_395151_7.pdf

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2. Brief Profiles States' Efforts to Improve Women's Health Through Medicaid Programs

Addressing Women's Health Needs and Improving Birth Outcomes: Results from a Peer-to-Peer State Medicaid Learning Project examines the work of seven Medicaid agencies to develop the programs, policies, and infrastructure needed to identify and reduce women's health risks either before or between pregnancies. The issue brief, published by the Commonwealth Fund, provides background on the importance of preconception care for women and the role of Medicaid in the health of women of childbearing age. The brief identifies four principal strategies used by Medicaid agencies to improve reproductive health before or between pregnancies. These strategies include the following:

• Maximizing opportunities afforded through Medicaid family-planning waivers and state plan amendments to provide additional services such as preconception risk screening as part of covered family-planning visits.
• Developing Medicaid interconception care demonstration waiver projects that offer extended eligibility to women who have had adverse pregnancy outcomes.
• Using managed care approaches to encourage delivery of prevention and intervention services through well-woman, postpartum, and other visits.
• Using Medicaid data, linked Medicaid and vital records data, and public health survey data to identify gaps in services, monitor outcomes, and drive decision-making.

The brief also identifies five core strategies used by state public health agencies and Title V Maternal and Child Health programs to improve the reproductive health of women, state profiles (California, Florida, Illinois, Louisiana, North Carolina, Oklahoma, and Texas), and a checklist to help leaders in other states identify improvement opportunities that fit within their programs' eligibility requirements, quality-improvement objectives, and health-system resources.

The brief is available online.

Readers: More information is available from the following MCH Library resource:

- Preconception and Pregnancy: Knowledge Path at
http://www.mchlibrary.info/KnowledgePaths/kp_pregnancy.html

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3. Study Determines the Accuracy of Information on Infant Sleep Safety Found on the Internet

"We found that health- and medical-related Web sites frequently contain inaccurate information about infant sleep safety," state the authors of an article published in The Journal of Pediatrics online on August 6, 2012. The American Academy of Pediatrics (AAP) has published recommendations for infant sleep safety to reduce the risk of sudden infant death syndrome, suffocation, strangulation, entrapment, and other accidental sleep-related infant deaths. Recent research has shown that parents and health professionals frequently have questions and concerns about specific recommendations, and the Internet is likely a primary source of additional information. The article presents findings from a study to examine the accuracy and reliability of information on infant sleep safety available on the Internet.

The authors searched for advice with 13 key phrases relating to infant sleep safety, chosen to reflect specific AAP recommendations for infant sleep safety. They categorized websites by type and assessed them for accuracy of information provided, based solely on consistency with AAP recommendations. The researchers analyzed the first 100 websites (8-10 pages of results) for each of the key phrases. They also analyzed the first page of search results (10-12 websites) separately, to evaluate the accuracy of information on the websites that a typical searcher would most likely read. The authors analyzed a total of 1,300 websites (100 for each of the 13 key phrases) in July and August 2011 and re-analyzed for accuracy after the most recent AAP guidelines were published, specifically in relation to the new recommendation against all bumper pad use.

• Overall, 566 websites (43.5 percent) provided accurate information, 365 (28.1 percent) provided inaccurate information, and 369 (28.4 percent) were not relevant to the key phrase. Among the relevant websites, 60.8 percent provided accurate information.
• The key phrases associated with the highest percentage of websites with accurate information were "infant cigarette smoking" (82 percent accurate), "infant sleep position" (74 percent accurate), and "infant sleep surface" (73 percent accurate).
• The key phrases yielding the highest percentage of websites with inaccurate information were "pacifier infant" (14 percent accurate), "infant home monitors" (18 percent accurate), and "infant co-sleeping" (20 percent accurate).
• In general, government websites had the highest rates of accurate information (80.9 percent), followed by organization websites (72.5 percent). The websites with the highest rates of inaccurate information were retail product review sites, blogs, and websites created by individuals.

"It is disturbing that less than one-half (43.5 percent) of the Web sites found in Google searches for key phrases related to infant sleep safety provided accurate information," conclude the authors. They suggest that providers "consider offering URLs of specific Web sites that they have identified as accurately reflecting the AAP guidelines and educating families on how to evaluate health-related Web sites for trustworthiness."

Chung M, Oden RP, Joyner BL, et al. 2012. Safe infant sleep recommendations on the Internet: Let's Google it. The Journal of Pediatrics [published online on August 6, 2012]. Abstract available at http://dx.doi.org/10.1016/j.jpeds.2012.06.004

Readers: More information is available from the National SUID/SIDS Resource Center as follows:

- Safe Sleep at
http://sidscenter.org/SafeSleep/index.html

- For Families at
http://sidscenter.org/families.html

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4. Authors Examine Factors Influencing Infant Sleep Position by Socioeconomic Status

"Sleep position practices among African-American parents do not differ by SES [socioeconomic status]," write the authors of an article published in Archives of Disease in Childhood online on August 17, 2012. The incidence of sudden infant death syndrome (SIDS) in the United States has declined by 50 percent since 1992, when the American Academy of Pediatrics (AAP) first recommended that infants be placed in a non-prone position for sleep. However, African-American infants remain twice as likely to be placed prone for sleep and also twice as likely to die from SIDS as white infants. This racial disparity exists across all educational and income categories. The primary aim of the study described in this article was to better understand factors contributing to the comparatively high incidence of prone sleep positioning in African-American infants and how these factors may vary by SES.

Between April 2006 and May 2010, researchers enrolled a cross-sectional sample of African-American parents with infants ages 6 months or younger. Parents were recruited from primary care pediatric clinics and private practices in Washington, DC, and suburban Maryland. There were 412 participants, 264 of lower SES and 148 of higher SES.

The authors found that

• Overall, 62.9 percent, 8.5 percent, and 9.5 percent of parents exclusively used the supine, side, and prone positions for sleep, respectively; the remaining 19.1 percent did not place their infant consistently in one position.
• There was no significant difference between African-American parents of higher vs. lower SES in the use of supine, side, and prone positions, either exclusively or occasionally.
• There were no differences in the use of any sleep positions, either exclusively or occasionally, when African-American parents with college degrees were compared with those with high school diplomas or who did not complete high school.
• Parents of higher SES were significantly more likely to report that they knew what SIDS was (94.6 percent vs. 86.0 percent, p=0.01). However, there was no significant difference between those of higher vs. lower SES in identifying the supine sleep position as the recommended sleep position for infants (83.1 percent vs. 79.5 percent, p=0.38), in the belief that prone sleeping definitely or possibly places infants at an increased risk of dying from SIDS (61.2 percent vs. 60.6 percent, p=0.86), or in identifying that the supine sleep position is the best way, in the parent’s own opinion, to place an infant to sleep (62.8 percent vs.. 54.2 percent, p=0.09).
• Compared to those who had not, parents who had received an exclusive supine sleep position recommendation from a health professional were more likely to demonstrate increased knowledge; they were more likely to state that they knew what SIDS was, believe that the prone sleep position increases the risk of SIDS, and identify the supine sleep position as the position recommended by AAP. However, receiving such a recommendation was not associated with increased positive parental attitudes about the supine sleep position.

The authors conclude that "improved attitudes toward positioning and increased use of supine positioning [among African-American parents] may result if healthcare providers address common concerns and misconceptions about sleep position."

Robida D, Moon RY. 2012. Factors influencing infant sleep position: Decisions do not differ by SES in African-American families. Archives of Disease in Childhood [published online on August 17, 2012]. Abstract available at http://dx.doi.org/10.1136/archdischild-2011-301360

Readers: More information is available from the following MCH Library resource:

- Racial and Ethnic Disparities in Health: Knowledge Path
http://www.mchlibrary.info/KnowledgePaths/kp_race.html

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