Study of SIDS, which has evaluated sleep position practices since 1992 (Willinger et al., 1998). These ongoing assessments have allowed for the identification of high-risk populations and existing barriers to behavior change (National Institute for Child Health and Human Development, 1998; 2000).
Intermediate outcomes indicated that between 1994 and 1998, twice as many child caregivers (38 versus 79 percent) reported receiving the Back to Sleep recommendation from at least 1 of 4 sources (physician, nurse, reading materials, or radio and television) (NISP, 1998). Outcome measures have revealed a drop in prone sleep positioning among the general population, from 70 percent in 1992 to only 21 percent in 1997, with a corresponding drop in the incidence of SIDS rates of nearly 40 percent since 1992.
Between 1994 and 1998, stomach placement decreased 27 percentage points among whites but only 21 percentage points among African-Americans (Centers for Disease Control and Prevention, 1999). Overall, prone infant sleeping placement was 32 percent for African-Americans compared with 17 percent of whites in 1998 (Nagourney, 2000). Indeed, the gap between whites and African-Americans increased from a 9-percent difference in 1994 to a 17-percent difference in 1998. Lower rates of reduction in the incidence of SIDS have been noted among southern states and population groups of lower socioeconomic status, those living in either rural or inner-city environments, African-Americans, and Native Americans/Alaskan Natives. However, rates of change in sleep positioning behaviors have differed between Native Americans/Alaskan Natives and whites, suggesting that the continued high incidence of SIDS among the former group may be because of a higher prevalence of environmental risk factors (e.g., household smoke) in this population (Centers for Disease Control and Prevention, 1999).
Mammography is among the few areas of health behavior where there is impressive evidence for a clear narrowing of the gap