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ResourcesThis document serves as a resource for understanding the terms as they are used in the National Action Plan to Promote Safe Infant Sleep: A Blueprint from the National Action Partnership to Promote Safe Sleep.


The following populations experience the highest rates of sleep-related Sudden Unexpected Infant Death (SUID):

  • Non-Hispanic blacks, American Indians, or Alaska Natives 1,2,3,4
  • Adolescent mothers 2,4
  • Mothers with educational level of high school or below 2,4
  • Families living in poverty 4,5


NAPPS defines a conversation as an individualized, interactive way of communicating in which infant caregivers receive sensitive and supportive messages about infant safe sleep and breastfeeding and have opportunities to discuss recommendations to better understand the reasons for them. Infant caregivers can ask questions, express their concerns, and discuss possible solutions to overcoming barriers to implementing safe sleep behaviors and breastfeeding.


Requires that organizations and their members/employees:

  • Have a congruent, defined set of values and principles, and demonstrate behaviors, attitudes, policies, and structures that enable them to work effectively cross-culturally;
  • Have the capacity to (1) value diversity, (2) conduct self-assessment, (3) manage the dynamics of difference, (4) acquire and institutionalize cultural knowledge, and (5) adapt to the diversity and cultural contexts of communities they serve; and
  • Incorporate the above into all aspects of policymaking, administration, practice, and service delivery, and systematically involve consumers, key stakeholders, and communities.

Cultural competence is a developmental process that evolves over an extended period of time. Individuals, organizations, and systems are at various levels of awareness, knowledge, and skills along the cultural competence continuum. 6


  • Respects the cultural values, beliefs, and practices of the intended audience;
  • Is always undertaken within a social, environmental, and political context;
  • Recognizes the family and community as primary systems of support and intervention;
  • Assures that its efforts exist in concert with natural and informal health care support systems; and
  • Assures meaningful involvement of community members and key stakeholders. 7


A system of collectively held values, beliefs, and practices of a group which guides decisions and actions in patterned ways. 8


Interventions that have been deemed effective, based on formal research and systematic investigation. 9


A comprehensive social and political process. It not only embraces actions directed at strengthening the skills and capabilities of individuals, but action directed towards changing social, environmental, and economic conditions so as to alleviate their impact on public and individual health. Health promotion is the process of enabling people to increase control over the determinants of health and thereby improve their health. 10


Individuals who put babies to sleep: mothers, fathers, grandparents, siblings, other relatives, legal guardians, foster parents, babysitters, and child care /early education providers. 11


The capacity of an organization and its personnel to communicate effectively, and convey information in a manner easily understood by diverse groups including persons of limited English proficiency, those who have low literacy skills or are not literate, individuals with disabilities, and those who are deaf or hard of hearing. Linguistic competency requires organizational and provider capacity to respond effectively to the health and mental health literacy needs of populations served. The organization must have policies, structures, practices, procedures, and dedicated resources to support this capacity. 12


Safe sleep practices refers to the most current recommendations of  The American Academy of Pediatrics (AAP)1 as promoted by the Safe to Sleep® campaign’s educational materials and community outreach efforts.


A strengths-based approach is a way of viewing individuals, families, and communities as resourceful and resilient in the face of adversity. It promotes collaborative problem-solving and reflects the belief that people are resourceful and are capable of solving their own problems. 13


SUID is the sudden and unexpected death of an infant (less than one year of age) in which the manner and cause of death are not immediately obvious prior to investigation. Based on diagnostic criteria by the Centers for Disease Control and Prevention, most SUIDs are reported as one of three types of infant deaths: Sudden Infant Death Syndrome (SIDS), unknown cause, and accidental suffocation and strangulation in bed (ASSB). 14

  • Sudden Infant Death Syndrome (SIDS) is the sudden death of an infant less than 1 year of age that cannot be explained after a thorough investigation is conducted, including a complete autopsy, examination of the death scene, and a review of the medical history. 14 SIDS is fourth leading cause of infant deaths in the United States 15 and the leading cause of death in infants 1 to 12 months old. About half of SUIDS are SIDS. 3
  • Unknown Cause is the sudden death of an infant less than 1 year of age that cannot be explained. Often a thorough investigation was not conducted and cause of death could not be determined. 14
  • Accidental Suffocation and Strangulation in Bed is the leading cause of infant injury death. Mechanisms that lead to accidental suffocation or strangulation include
    • Suffocation by soft bedding, such as when a pillow or waterbed mattress covers an infant’s nose and mouth.
    • Overlay—when another person rolls on top of or against the infant while sleeping.
    • Wedging or entrapment—when an infant is wedged between two objects, such as a mattress and wall, bed frame, or furniture.
    • Strangulation, such as when an infant’s head and neck become caught between crib railings. 14

SUID is defined by the following ICD codes: R95, R99, and W75. 3


An organized, purposeful structure that consists of a complex network of interrelated stakeholders that continually influence one another to maintain activities to achieve the goal of making safe infant sleep a national norm. The systems approach entails creating relationships, building infrastructure to sustain the system and its activities, assuring consistent, sustainable resources, and creating an inclusive process to achieve goals. 12, 16


1. Task Force on Sudden Infant Death Syndrome, Moon RY. 2011. SIDS and other sleep-related infant deaths: Expansion of recommendations for a safe infant sleeping environment. Pediatrics 128(5):1030-1039 (policy statement); e1341-e1367 (technical report).

2. Shapiro-Mendoza CK, Colson ER, Willinger M, Rybin DV, Camperlengo L, Corwin MJ. 2014. Trends in infant bedding use: National Infant Sleep Position Study, 1993–2010. Pediatrics 135(1):10-17.

3. Centers for Disease Control and Prevention. Sudden Unexpected Infant Death and Sudden Infant Death Syndrome: Data and Statistics [website]. http://www.cdc.gov/sids/data.htm

4. Hauck FR, Tanabe KO, McMurry T, Moon RY. 2014. Evaluation of Bedtime Basics for Babies: A national crib distribution program to reduce the risk of sleep-related sudden infant deaths. Journal of Community Health DOI: 10.1007/s10900-014-9957-0.

5. Malloy MH, Eschbach K. 2007. Association of poverty with Sudden Infant Death Syndrome in metropolitan counties of the United States in the years 1990 and 2000. Southern Medical Journal 100(11):1107-1113.

6. National Center for Cultural Competence. Cultural competence: Definition and conceptual framework. In National Center for Cultural Competence, Georgetown University Center for Child and Human Development. Conceptual Frameworks/Models, Guiding Values and Principles [website].

7. Bronheim S, Sockalingam S. 2003. A Guide to Choosing and Adapting Culturally and Linguistically Competent Health Promotion Materials. Washington, D.C.: National Center for Cultural Competence, Georgetown University Center for Child and Human Development.

8. Wenger AFZ. 1993. Cultural meaning of symptoms. Holistic Nursing Practice 7(2):22.

9. Smith BJ, Tang KC, Nutbeam D. 2006. WHO Health Promotion Glossary: New Terms. Oxford, United Kingdom: Oxford University Press. http://www.who.int/healthpromotion/about/HP%20Glossay%20in%20HPI.pdf?ua=1

10. Nutbeam D. 1998. Health Promotion Glossary. Geneva, Switzerland: World Health Organization. http://www.who.int/healthpromotion/about/HPR%20Glossary%201998.pdf?ua=1

11. Bronheim S. 2015. National Action Partnership to Promote Safe Sleep (NAPPSS) Social-Ecological Model. Washington, DC: Georgetown University.

12. Goode T, Jones W. 2009. Linguistic competence: Definition (rev. ed.). In National Center for Cultural Competence, Georgetown University Center for Child and Human Development. Conceptual Frameworks/Models, Guiding Values and Principles [website].

13. Corcoran J. 2011. Strengths-based Models in Social Work (rev. ed.). Oxford Bibliographies [website].

14. Centers for Disease Control and Prevention. About SUID and SIDS [website]. http://www.cdc.gov/sids/aboutsuidandsids.htm 

15. Kochanek KD, Murphy SL, Xu J, Arias E. 2014. Mortality in the United States, 2013. Atlanta, GA: Centers for Disease Control and Prevention. http://www.cdc.gov/nchs/data/databriefs/db178.htm

16. WebFinance, Inc. System. In WebFinance, Inc. BusinessDictionary.com [website]. http://www.businessdictionary.com/definition/system.html#ixzz3MHThQyYt

March 2015; Updated September 2015