Evidence Base for Safe Sleep Interventions


Many interventions can increase knowledge about factors that may contribute to sleep-related death in infants and improve the application of this knowledge to reduce the impact of these factors. Evaluations of these interventions in the published literature look at increases in target audiences’ knowledge and at changes in behavior. Some evaluations look at the association between the intervention and subsequent rates of SUID. This page links to the evidence base of interventions that have had an effect on increasing safe sleep behaviors and thus reducing sleep-related infant deaths.

There are multiple examples of innovative approaches that impact safe sleep behaviors reported in both the peer-reviewed literature and through national level resource centers help to inform the methodology of this project.

The evidence is summarized below, based on three sources: (1) What Works: Changing Knowledge and Behavior to Reduce Sudden Unexpected Infant Death developed by NCEMCH and housed in the MCH Library’s SUID/SIDS Gateway; (2) Promising Practices for Cultural and Linguistic Competence in Addressing SIDS and Other Infant Death developed by NCCC; and (3) ASTHO’s promising practices summary of states addressing SUID/SIDS within the CoIIN for Infant Mortality activities.

Interventions within single formal infant care service related sectors.

Hospital Safe Sleep Initiative
Franklin County, OH Infant Safe Sleep Task Force. 
 Provided training and monitoring of safe sleep practices in birthing hospitals in county. Also provided training for child care provider. 
Service Sector: 
Birthing hospitals. 
Hospital audits showed supine placement increased from 50% to 96%; cribs with blankets decreased from 22% to 1%; cribs with toys from 13% to 1%. Evaluations of trainings were positive.1

Model Behavior: The Most Important Modeling Job of Your Life
First Candle, funded by NICHD.
Description: Training for nurses in Missouri NICUs and well-baby nurseries for CEUs. Presentations made at 22 national and 23 regional nursing conferences.
Service Sector: Birthing hospitals. 
80% of the participants scored 90% or better on the post-test.2 Percent of nurses reporting using back-only position in first 24 hours for healthy newborns increased from 26% to 50.2% and those who endorsed supine sleep increased from 45% to 70.8%.3

Safe Sleep Nursing Policy
Wesley Medical Center community teaching hospital, Wichita, KS. 
Developed a nursing policy on safe sleep that required education of families during post-partum room orientation, not at discharge.
Service Sector: 
Birthing hospitals.
Findings: Supine placement increased from 25% to 58%. 91% families reported having viewed the video, 95% planned to place their baby supine to sleep, and 0% reported plans to co-sleep.4

Michigan Demonstration Project
Tomorrow’s Child/Michigan SIDS and 7 urban hospitals in MI.
Description: Project drafted new policies/procedures and provided in-service trainings to nurses. Monitored implementation with audits on units.
Service Sector: Birthing hospitals.
Findings: Increase from 84.8% to 94.2% of nurses who knew AAP recommendations. Nurses who held the opinion that back sleep is safest increased from 79.5% to 89.2%. Infants sleeping supine increased from 80.7% to 91.9%. Mothers told about infant safe sleep increased from 62.7% to 91.4%.5

Healthy Childcare America Back to Sleep Campaign
AAP Healthy Childcare America.
Description: A new childcare curricula focused on child care settings was evaluated with unannounced observations and questionnaires.
Service Sector: Childcare.
Findings: 3 months after the intervention exclusive use of supine sleep position increased from 65% to 70.4% in control group and 87.8% in the intervention group. Childcare provider awareness of AAP recommendations increased from 59.7% to 64.8% in control group and 80.5% in intervention group.6

WIC Education Study
Children’s Hospital National Medical Center in Washington, DC.
Description: In local WIC program a health educator-led short educational interventions to discuss safe sleep practices with African American families as a prerequisite to obtaining food vouchers.
Service Sector: WIC.
Findings: Pre-training, 90% of parents co-slept, 21% planned to bed share, and 57.7% placed infant supine. After intervention, 85.3% planned to use supine position.7

Interventions within single sectors that are part of caregivers natural networks of support.

Church Peer Educators
County public health department of Alameda, CA
Description: Project recruited peer health educators from African American churches to demonstrate safe sleep messages at church events and at caregiver service centers.
Service Sector: Faith-based organizations.
Findings: Increased delivery of safe sleep messages by trusted, culturally concordant messengers.8

Culturally Competent Media Messages
The North Carolina Healthy Start Foundation.
Description: Developed a series of media messages and training materials with a focus on grandmothers. Approach not only to inform grandmothers but to support parents’ sense of self-efficacy.
Findings: The overall campaign of which this was a part resulted in an increase on PRAMS data of supine sleeping from 43% to 76% over 5 years.9

Always Right Program
Medical and Health Research Association and NYC Department of Health.
Description: Project worked with high schools for pregnant/parenting teens, using discussion and peer interaction that respected parents’ power to make their own decisions about safe sleep.
Service Sector: Schools.
Findings: Changed policy and implementation in schools’ childcare settings, safe sleep messages integrated into various lessons/classroom discussions.10

Sisters United Initiative
Arkansas Office of Minority Health and Arkansas Children’s Hospital.
Description: African American sororities trained members for their chapters and communities about rates of SUID in their communities and safe sleep.
Service Sector: Culturally specific community organizations.
Findings: Sorority chapters have websites and Facebook accounts to promote safe sleep; chapters leveraged funding from NICHD grants to host 22 safety showers for at-risk pregnant women.11

Interventions where an organization with the goal of promoting safe sleep engages multiple partners to deliver safe sleep messages.

SIDS Risk Reduction Education
The SIDS Alliance of Illinois in partnership with the Chicago Department of Public Health, and the CJ Foundation for SIDS.
Description: Provided SIDS risk reduction education to largely black neighborhoods in Chicago. Education for family members and caregivers took place at partner sites.
Service Sectors: Community locations.
Findings: Increases in knowledge and reported use of some safe sleep practices from a pre to post survey within the community.12

Upstate Community Partners Program
Greenville, South Carolina Department of Health.
Description: Trained community partners to talk with families to help assess caregivers safe sleep knowledge and practices and refer caregivers for education or for eligibility for a pack n play.
Service Sectors: Childcare, disability services, schools, early intervention, home visitors, literacy organizations, parent support organizations, faith-based organizations, coroner’s office, and Department of Social Services.
Findings: Partners check in with families over the course of the first year. The program reports that all babies involved in the program survived to their first birthdays.13

Interventions that create an integrated systems approach.

Public/Private Safe Sleep Initiative
Tomorrow’s Child/Michigan SIDS and MI Department of Health.
Description: State-wide public/private safe sleep initiative to create better coordination to promote safe sleep and to engage community members in creation of materials and messages.
Service Sectors: state and local agencies with full set of public and private safe sleep partners.
Findings: An official positive safe sleep message for use in all public agencies with support from the breastfeeding community, and governor; legislative appropriations; private philanthropy; ongoing structure to meet new challenges and sustain efforts.1

Also Read: How To Fall Asleep Fast