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Outreach Activities in Specific Communities

Mother holding baby. 

During the 1990s1, the SIDS rate dropped by more than 50% across all populations in the United States. Today, although the SIDS rate remains relatively low and most caregivers report using the back sleep position, the infants in some communities remain at higher risk for SIDS and have higher SIDS rates than do infants in other communities.

The table below2 shows the breakdown of SIDS deaths for different ethnic groups in the United States.

SIDS Deaths/Death Rates by Race/Ethnic Origin of the Mother per 1,000 Births, 2013

Race SIDS Deaths Death Rate Per 1,000 Births
Hispanic 443 .49
Non-Hispanic White 1,799 .84
Non-Hispanic Black 1,007 1.72
American Indian or Alaska Native 69 1.79
Asian or Pacific Islander 70 .28
Origin unknown or not stated 33 1.20
Total 3,422 .87

Outreach for the Safe to Sleep® campaign uses a variety of approaches and strategies to craft effective messages about reducing the risk of SIDS and other sleep-related causes of infant death and to design effective strategies for getting these messages into communities around the United States.

Outreach Informed by Research

To understand the lingering differences in SIDS rates, research on health education and SIDS outreach found that response to safe sleep messages differed among different communities and racial/ethnic groups

For example, the NICHD—in partnership with the National Institute on Deafness and Other Communication Disorders and the Centers for Disease Control and Prevention (CDC)—conducted the Chicago Infant Mortality Study to better understand why SIDS risk remained higher in African American infants. The study focused on 260 predominantly African American infants in Chicago who had died of SIDS between November 1993 and April 1996.

The study found that:

  • African Americans at that time were less likely than other racial/ethnic groups to have been informed by a health care worker to place their babies to sleep on their backs as a way to reduce SIDS risk.
  • Infants who shared a bed with other children or other adults were at a higher risk of SIDS than were infants who slept in their own sleep area.
  • Sleeping on soft bedding and sleeping on the stomach increased the risk for SIDS and posed a far greater risk of SIDS when they occur together than the sum of both risk factors added together would suggest.

The findings provided a foundation for designing outreach to address some of the specific needs of African American communities within the context of SIDS and other sleep-related causes of infant death. Visit to learn more about this study.

To determine factors that might contribute to high rates of SIDS among American Indians and Alaska Natives (AI/AN), the NICHD, the Indian Health Service (IHS), and the CDC funded the Aberdeen Area Infant Mortality Study in 2002. The study of Northern Plains Indian infants revealed that:

  • Infants were less likely to die of SIDS if their mothers received visits from public health nurses before and after giving birth.
  • Binge drinking (five or more drinks at one time) during the mother's first trimester of pregnancy made it eight times more likely that her infant would die of SIDS.
  • Any maternal alcohol use during the 3 months before pregnancy or during the first trimester was associated with a six fold increased risk of SIDS.
  • Infants were more likely to die of SIDS if they were dressed in two or more layers of clothing during sleep.

The findings suggested that the risk factors for SIDS among AI/AN communities may be slightly different from those of other communities and provided an evidence-based starting point for outreach programs. To learn more about this study, visit

These and other studies, including the National Infant Sleep Position Study and the Collaborative Home Infant Monitoring Evaluation, helped the Safe to Sleep® campaign to refine its messages and outreach activities to maximize effectiveness.

Outreach Informed by Experience

To make an impact on SIDS and other sleep-related causes of infant death rates, the Safe to Sleep® campaign not only informs its outreach efforts with data and evidence, but also enhances its efforts by working with and within different communities. By relying on the expertise of community members, organizations, and governments, Safe to Sleep® is able to get effective, tailored safe sleep messages deep into communities in ways that would not be possible for the campaign working alone.

Experience with African American Communities

In 1999, the NICHD, First Candle (formerly SIDS Alliance), and the National Black Child Development Institute hosted a meeting with representatives from national African American organizations as a first step in capitalizing on the experience and knowledge of these organizations in reaching members of their communities. Representatives from various groups participated, including:

  • Alpha Kappa Alpha Sorority, Inc. (AKA)
  • Chi Eta Phi Sorority
  • Chicago Department of Health
  • D.C. Department of Health
  • National Association of Black Owned Broadcasters
  • National Association for the Advancement of Colored People (NAACP)
  • National Medical Association
  • National Coalition of 100 Black Women (NCBW)
  • Pampers Parenting Institute
  • Zeta Phi Beta Sorority

Participants proposed messaging and outreach strategies that had proven successful with their constituents, and the NICHD and other campaign sponsors incorporated these ideas into a broad outreach strategy for reaching African American communities. The campaign created a suite of materials tailored to African American communities, a collection of materials and training modules intended to help individuals educate people in their communities about SIDS risk reduction.

In 2001, then U.S. Surgeon General Dr. David Satcher debuted the Resource Kit at a meeting in Atlanta, GA, with members of AKA, Women in the NAACP (WIN), the NCBW, and other groups. This first national training workshop on SIDS risk reduction was followed by more than 40 regional train-the-trainer sessions.

In 2003, the AKA, WIN, and the NCBW hosted "Journey for Our Children" summits in Tuskegee, AL; Los Angeles, CA; and Detroit, MI. The summits featured training on how to use the Resource Kit and other Back to Sleep efforts related to SIDS risk reduction. These summits proved to be effective in mobilizing communities to take action in spreading safe sleep messages and in getting people excited about SIDS risk reduction activities. They also served as a primary impetus for many local outreach efforts conducted by summit participants.

To learn more about the summits, select a link below:

Since the summits, the Safe to Sleep® campaign has supported a variety of additional activities to help revise safe sleep messages appropriately and to spread them across African American communities. These activities include focused efforts in Arkansas, Alabama, the District of Columbia, Illinois, Mississippi, and Ohio.

In 2015, the NICHD and Kappa Alpha Psi® Fraternity, Inc., began collaborating on an outreach initiative to teach fathers, grandfathers, uncles, brothers, and other community members about the ways to reduce the risk of SIDS and other sleep-related causes of infant death.

Experience with American Indian and Alaska Native Communities

In 2002, informed by the findings from the Aberdeen Study described earlier, the NICHD hosted a meeting with members of American Indian and Alaska Native (AI/AN) communities to discuss infant mortality and SIDS in the Northwest and Northern Plains regions of the United States. In addition to learning general information about SIDS, infant mortality statistics, and outreach methods that have been successful, participants discussed potential responses for their own areas of Indian Country with high SIDS rates.

At a follow-up meeting in Rapid City, SD, in 2003, participants identified community-driven strategies designed to increase awareness of SIDS risk reduction, as well as how to reach people with these messages while preserving cultural traditions. In addition, participants established the Healthy Native Babies Workgroup to advise the NICHD and its partners on the development of messages, materials, and outreach strategies specific for AI/AN audiences.

To further define the needs of these communities, the NICHD and members of the workgroup held a series of discussions in five IHS regions in the Northern Tier: Aberdeen, SD; Bemidji, MN; Billings, MT; Portland, OR; and Alaska. The results of these discussions helped the workgroup define safe sleep messages and identify strategies for disseminating information.

Partners in American Indian/Alaska Native outreach and the workgroup include:

  • Aberdeen Area Tribal Chairmen's Health Board
  • Association of American Indian Physicians
  • Bemidji Area Indian Health Service
  • Billings Area Indian Health Service
  • Inter-Tribal Council of Michigan
  • Minnesota Department of Health
  • National Indian Women's Health Resource Center
  • Northwest Portland Area Indian Health Board
  • Red Lake Tribal Council (Minnesota)

The result of this unique collaboration is a suite of materials and outreach activities specifically tailored for AI/AN communities. The workgroup's activities continue, revising existing materials and messages and refining outreach strategies to ensure effective dissemination of this important information. Learn more about the Healthy Native Babies Project.

Safe to Sleep® Champions Initiative

Safe to Sleep® Champions, an effort launched in 2012, enlisted spokespersons who helped share safe sleep messages in their local areas. The Champions served as the voice of the Safe to Sleep® campaign by speaking with local media and community members to raise awareness about the campaign and key messages about SIDS and other sleep-related causes of infant death.

In the pilot phase of this initiative, the NICHD recruited Champions from states with the highest rates of SIDS and other sleep-related infant deaths. The Institute selected and trained 36 Champions from 21 states to disseminate the key messages of the campaign through their local media. The Champions engaged both traditional and social media outlets. In total, they achieved 81 media placements, spreading the word about the Safe to Sleep® campaign and safe infant sleep practices to a potential audience of more than 4.8 million people.

During its second phase in 2013, the Safe to Sleep® Champions initiative engaged community leaders and stakeholders nationwide to conduct both media and community outreach. From 2012 to 2014, approximately 1,000 individuals, representing every state and two U.S. territories, volunteered to be Champions. This initiative helped to encourage health professionals and community stakeholders across the country to use consistent messaging to educate the public about safe infant sleep.

Safe to Sleep® Champions were diverse; they included:

  • Mothers, fathers, grandparents, and relatives
  • Parents and family members who lost an infant to SIDS or other sleep-related cause of infant death
  • Physicians and other health care providers
  • Health educators and public health workers
  • Representatives from local organizations and coalitions on infant or family health
  • Trusted community leaders who are dedicated to reducing the risk of SIDS and other sleep-related causes of infant death.

Safe to Sleep® Champions were expected to:

  • Become familiar with the updated American Academy of Pediatrics recommendations and the Safe to Sleep® campaign.
  • Educate parents and other caregivers, childcare providers, health care providers, and other community members about safe infant sleep through work with local media and/or conducting community outreach to highlight the public health issue of SIDS and other sleep-related causes of infant death with a focus on the Safe to Sleep® campaign.
  • Serve as a liaison to the NICHD for ongoing communication, tracking, and evaluation.

Each Champion was tasked with completing at least two outreach activities to educate the media and/or their local communities about safe infant sleep. The Safe to Sleep® Champions Initiative concluded in 2014 and the campaign continues to work with local departments of health to train groups on safe infant sleep.

Tailored Materials for Specific Audiences

Guided by research and the expertise of leaders from different racial/ethnic communities, Safe to Sleep® offers materials tailored for specific audiences.

Materials for African American Audiences

Materials for American Indian and Alaska Native Audiences

Materials for Spanish-Speaking Audiences

  2. Source: Centers for Disease Control and Prevention, HHS. (2015). CDC WONDER. Linked birth/infant death records for 2007–2013 with ICD 10 codes. Infant deaths: Linked birth/infant death records. Retrieved September 10, 2015, from
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