Keep It Simple: The Success of Using the ABCs of Safe Sleep

Background: Sleep related infant deaths remain an alarming public health issue. Since 1992, the American Academy of Pediatrics has recommended that infants sleep on their backs to reduce the risk of SIDS. Following the recommendation, the National Institute of Child Health and Human Development launched the Safe to Sleep (formerly the Back to Sleep) campaign. The campaign emphasized placing infants alone on their back in a safe sleep environment. The campaign resulted in a more than a 50% decline in infant sleep related deaths. However, since 2001, adherence to supine sleep recommendations has plateaued. African American infants are twice as likely to die from SIDS as infants from other races. Despite the perceived simplicity of infant safe sleep recommendations, data indicates that African American mothers are less likely to follow infant safe sleep recommendations. Most sleep-related infant deaths are largely preventable. Thus, investigating methods to increase adherence to infant safe sleep recommendations, especially among families at highest risk for death, is an important public health priority.

Program background: The Georgia Department of Public Health received funding to implement a safe sleep training and crib distribution program in Fulton County, Georgia. The overall goal of the program was to educate mothers about the importance of following the ABCs (Alone, Back, and Crib) of Safe Sleep. Program participants also received a portable crib. The term “ABCs of Safe Sleep” is a form of chunking. Chunking consists of assigning an acronym or a summary slogan to enhance memory and increase knowledge. 

Evaluation Methods and Results: This study is a prospective, matched pre- and post-test survey design cohort study with a follow-up. Participants were recruited through local health departments and met the following criteria: women who (1) were between 32-40 weeks pregnant or within 3 months postpartum, and (2) demonstrated financial need. Participants attended a 1 1/2 - 2-hour group training session; and completed a pre-test survey prior to the start of the session and a post-test survey upon program completion. For those who agreed, a follow-up phone survey was conducted ten weeks after program completion or after the infant’s birth. The proportion of participants who correctly identified the back only sleep position as the recommended position significantly increased from pre-test (58.8%) to post-test (96.2%). The proportion remained high (93.4%) at follow-up. The proportion of participants who identified the recommended sleep location as alone on a separate surface in the mothers’ room increased significantly from pre-test (53.4%) to post-test (74.8%) at post-test. The proportion remained high (85.1%) at follow-up.

Conclusions: The results suggest that using short concise infant safe sleep messaging is effective in increasing participant knowledge on infant safe sleep recommendations. 

Implications for research and/or practice: Future campaigns should focus on using chunking or concise messaging to reinforce other safe sleep protective factors, such as using pacifiers, room sharing and breastfeeding. This presentation will highlight the strengths of using effective infant safe sleep messages and the potentially important role that chunking can play in reinforcing messages.