Contraceptive Counseling in the Postpartum Period: Could Pediatricians Have a Role?

INTRODUCTION: Unplanned pregnancies lead to adverse health outcomes and contribute to economic burdens. A lack of continuity and consistency in immediate postpartum care may be a contributor. The most frequent postpartum medical encounters occur with the child's pediatric health care provider, which represents an opportunity to discuss postpartum contraception. Therefore, our objective was to evaluate postpartum family planning knowledge and behavior in women, and to assess the potential acceptability of a pediatrician-delivered intervention to improve knowledge of and convenient access to contraception among postpartum women. METHODS: This was a non-interventional pilot study that employed survey and interview methodology. RESULTS: Women attending pediatric visits for their newborn or infant (N = 346) were surveyed; 35 were interviewed. On average, respondents were 27 years old (SD = 6), 6 months postpartum (SD = 5), and resumed sex 8 weeks after delivery (SD = 6). Of those who had resumed sex, 68% were not using contraception at the time. However, only 18% of survey respondents wanted to have another child. Few exhibited accurate knowledge of birth spacing or long acting reversible contraception. Most interviewees (86%) supported the idea of pediatricians providing contraceptive counseling. Concerns identified included whether it was "allowable" and pediatrician's lack of knowledge of complex maternal health histories. DISCUSSION: This study highlights a gap between contraceptive need and provision in postpartum women. However, the findings suggest women's willingness to engage in conversations with their child's pediatrician about family planning. Future research should assess the feasibility and impact of integrating postpartum counseling into pediatric visits.

Implementation of a Statewide Program to Promote Safe Sleep, Breastfeeding and Tobacco Cessation to High Risk Pregnant Women.

Infant mortality remains a problem in the United States with sleep-related deaths accounting for a significant portion. Known risk reduction strategies include breastfeeding, avoiding tobacco use and following the American Academy of Pediatrics' safe sleep guidelines. The purpose of this project was to evaluate outcomes of Safe Sleep Instructor-led community baby showers, which included safe sleep promotion, breastfeeding promotion and tobacco cessation education. Certified Safe Sleep Instructors (n = 35) were trained on how to plan and host a Community Baby Shower to provide education to pregnant women of low socioeconomic status or with high risk of infant mortality. Eighteen Community Baby Showers were held across two urban and eight rural counties in Kansas. Surveys were administered pre- and post-event to assess participant knowledge, confidence and intentions to follow through with planned action related to safe sleep, breastfeeding and reducing tobacco risk. Matched data were summarized and evaluated for differences using McNemar's and Wilcoxon Signed Rank tests. Significant increases were observed in Baby Shower participants' (n = 845) reported plans to follow the AAP Safe Sleep guidelines (all p < 0.001), likelihood to breastfeed (p < 0.001), confidence in ability to breastfeed for more than 6 months (p < 0.001), knowledge of local breastfeeding support resources (p < 0.001), knowledge of ways to avoid second-hand smoke exposure (p < 0.001) and knowledge of local tobacco cessation services (p = 0.004). Based on the result of the pre- and post-event surveys, certified Safe Sleep Instructors were able to plan and host successful events to increase knowledge and confidence related to risk reduction strategies to reduce sleep-related infant deaths.

PA student assessment of body mass index in children using visual cues.

OBJECTIVE: Pediatric weight or body mass index often is underestimated by providers when relying solely upon visual cues. This study sought to determine physician assistant (PA) students' and recent graduates' ability to accurately assess BMI for age in patients ages 3 to 5 years using visual cues. METHODS: PA students and recent graduates visually assessed pictures of three children ages 3 to 5 years-one obese, one overweight, and one with healthy weight-for BMI categorization via online survey. Responses were scored for accuracy. RESULTS: Ninety-eight PA students and recent graduates completed the assessment. Accuracy for BMI categorization was low, especially in the obese and overweight children for visual assessment alone. Accuracy improved slightly when height and weight data were provided. CONCLUSIONS: PA student and recent graduate visual assessment for categorization of BMI is unreliable, similar to studies with other providers. PAs should be aware of discrepancy and not rely on visual assessment to determine weight-related interventions.

Exposing Compassion Fatigue and Burnout Syndrome in a Trauma Team: A Qualitative Study.

Compassion fatigue (CF) and burnout syndrome (BOS) are identified in trauma, emergency, and critical care nursing practices. The purpose of this qualitative study was to measure CF and BOS in a trauma team and allow them to share perceptions of related stress triggers and coping strategies. Surveys to measure CF and BOS and a focus group allowed a trauma team (12 practitioners) to share perceptions of related stress triggers and coping strategies. More than half scored at risk for CF and BOS. Stress triggers were described as situation (abuse, age of patient) versus injury-related. Personal coping mechanisms were most often reported. Both CF and BOS can be assessed with a simple survey tool. Strategies for developing a program culturally sensitive to CF and BOS are provided.

The role of cosmetologists as health promoters in the prevention of infant mortality.

Safe sleep practices reduce an infant's risk for sudden infant death syndrome and sleep-related death. While rates of infants placed on their back to sleep are high, other safe sleep practices are less widely implemented. Our objective was to evaluate the feasibility of using cosmetologists as health promoters for infant safe sleep to reduce infant mortality. In this descriptive study, a 27-item survey was mailed to the 405 licensed cosmetologists residing in the five zip codes with the highest infant mortality rates in the county. Of 149 completed surveys (36.8 %), 103 cosmetologists (69.1 %) were currently working. Most were comfortable (68.9 %) promoting health topics with their clients. Popular health-related topics currently discussed included: diet/weight control, healthy eating, and physical activity. Few (≤13 %) were interested in discussing infant mortality prevention or safe sleep promotion. Most respondents were either unsure (56 %) or did not feel infant mortality was a problem in their community (41 %); however, more than half (53 %) knew someone who had experienced an infant death. Cosmetologists were not highly interested in providing safe sleep education; however they engaged in diet and exercise talk already. Cosmetologists may be more appropriate for obesity-prevention programs to reduce infant mortality than safe sleep promotion.

Low-income urban Latino parents' perceptions of immunization text reminders.

OBJECTIVE: Identify perceptions regarding benefits of and barriers to receiving text messages for immunization reminders and preferred content for such text messages. DESIGN: Structured interviews. SETTING: Outpatient pediatric resident and faculty clinic. PARTICIPANTS: A convenience sample of 54 low-income urban Latino parents of children aged < or = 2 years. MAIN OUTCOME MEASURES: Parent perspectives on text message reminders. RESULTS: Most respondents were female (70%), married (63%), and fluent only in Spanish (89%). Most (83%) had a health literacy score in the adequate range. All (100%) reported being interested in receiving immunization reminders by text message, and 81% reported being willing to receive general appointment reminders by text message. Parents made 72 comments regarding benefits of text message immunization reminders. The most common sub-category was usefulness of the reminders (53%). These comments reflected participants' busy schedules and the beneficial nature of text messages in reminding parents of appointments. Fifty-six comments were provided regarding barriers to receiving text message reminders. Most comments (77%) indicated no identifiable barriers. Twenty percent described barriers related to technology, such as costs or lack of text messaging service. Parents generated 108 comments regarding preferred content of reminders. The topics most frequently identified were appointment date and time (32%), names of the vaccines (19%), and the child's name (11%). CONCLUSIONS: Low-income Latino parents perceive text message immunization reminders as a feasible alternative to more traditional forms of communication.

Text messaging to motivate exercise among Latino adults at risk for vascular disease: a pilot study, 2013.

In 2013, we administered a 15-item survey to determine the extent of text message usage among Latino adults in Kansas; for a subset of the survey participants, we also conducted a 6-week pilot trial to determine the effect of text messaging on exercise behaviors. Among the 82 survey participants, 78% had unlimited text messaging. At baseline, all trial participants were at the stage of contemplation; at 6 weeks, one (9%) trial participant remained at the contemplation stage and the other 10 (91%) participants progressed to the action/maintenance/termination stage. Use of text messaging to motivate exercise is feasible and potentially efficacious among Latinos.

TXT@WORK: pediatric hospitalists and text messaging.

BACKGROUND: Many studies assess provider-patient communication through text messaging; however, minimal research has addressed communication among physicians. The purpose of this study was to evaluate the use of text messaging by pediatric hospitalists. MATERIALS AND METHODS: A brief, anonymous, electronic survey was distributed through the American Academy of Pediatrics Section on Hospital Medicine Listserv in February 2012. Survey questions assessed work-related text messaging. RESULTS: Of the 106 pediatric hospitalist respondents, 97 met inclusion criteria. Most were female (73%) and had been in practice <10 years (67%). Ninety-one percent of responders used a smartphone. More than half sent (60%) and received (61%) work-related text messages, some (12%) more than 10 times per shift. More than half (53%) received work-related text messages when not at work. When asked to identify all potential work recipients, most often sent work-related text messages to other pediatric hospitalists (64%), fellows or resident physicians (37%), and subspecialists/consulting physicians (28%). When asked their preferred mode for brief communication, respondents' preferences varied. Many (46%) respondents worried privacy laws can be violated by sending/receiving text messages, and some (30%) reported having received protected health information (PHI) through text messages. However, only 11% reported their institution offered encryption software for text messaging. CONCLUSIONS: Physicians were using text messaging as a means of brief, work-related communication. Concerns arose regarding transfer of PHI using unsecure systems and work-life balance. Future research should examine accuracy and effectiveness of text message communication in the hospital, as well as patient privacy issues.

Parent intention to use a patient portal as related to their children following a facilitated demonstration.

OBJECTIVE: To describe parent feedback and intention to use the patient portal related to their children's health records after a facilitated learning session. Patient portals are Internet-based, self-service models for health account information and records that allow patients or parents to be more proactive in their healthcare. MATERIALS AND METHODS: A navigator demonstrated the patient portal to parents using on-site kiosks at a pediatric clinic. Parents ≥18 years of age completed an institutional review board-approved survey. RESULTS: Of those approached, 171 (54%) parents participated in the demonstration; 64 (37%) completed surveys. Average age was 28 years (standard deviation 7), and most were white (26, 40%) or Hispanic (14, 22%). Most (46, 72%) did not know about the patient portal prior to demonstration; of those who did, only five (28%) had used it. Following demonstration, the majority (59, 92%) thought the patient portal was easy to use. Parents planned to view medical records and laboratory results but disliked having separate accounts for each child and the lack of a "symptom checker." Many (44, 69%) planned for future use. The majority (62, 97%) found the navigator helpful, and (37, 58%) wanted access to the patient portal via on-site kiosks. CONCLUSIONS: Although most parents had no prior experience with the patient portal, they were satisfied overall with ease of use and offered features. Clinics should consider (1) hands-on demonstrations of the patient portal to encourage understanding and use and (2) alternative access venues if home computers are not available.

Evaluating opportunities for text message communication: a survey of parents and teens.

BACKGROUND: Text messaging is a widespread, cost-effective method for communicating. It is widely used by both parents and teens. The study objective was to survey teens and their parents to assess the capability and willingness of teens to receive healthcare-related text messages from their physician. SUBJECTS AND METHODS: Parents and teens (12-17 years old) at an adolescent clinic were asked to complete surveys. Surveys were available in hard copy or electronically (via Survey Monkey) using computer kiosks in the waiting room. Approval was received from two local Institutional Review Boards. RESULTS: Of the 93 pairs who began the survey, 47 pairs (51%) qualified and completed both the teen and parent surveys. Over 85% of teens were willing to receive texts from their doctor. Teens were most interested in appointment reminders (81%), immunization reminders (53%), and general test results (for example, strep [53%]). Parents' willingness to allow teens to receive text messages directly varied by content. Many parents preferred to also receive a copy of any text message sent to their teen. CONCLUSIONS: Both parents and teens endorse using text messages for appointment reminders. Parents appear willing for their teens to receive some health information directly. Future research should evaluate the efficacy of using text messages for communication with teens to improve care and utilization of services for adolescents.

COVID-19 Impact on Group Prenatal Education: A Comparison of Virtual and In-Person Formats.

This retrospective study compared knowledge, intention, and satisfaction outcomes between pregnant women who attended prenatal education in person (n = 202; 55%) prior to the COVID-19 pandemic or virtually (n = 166; 45%) during the pandemic. Results identified increases in knowledge and intention for a healthy pregnancy and safe infant care for both groups. Virtual participants were less likely to endorse developing a birth plan (p = 0.035), knowledge of breastfeeding resources (p = 0.006), confidence in the ability to breastfeed (p = 0.033), and plans to use only a safe infant sleep location (p = 0.045). Important education was provided by continuing Baby Talk during the pandemic. However, topics with activities/demonstrations during in-person learning that were discontinued for virtual learning had significantly lower increases for virtual participants. Virtual education should incorporate more demonstrations/activities.

Characteristics Associated with Sudden Unexpected Infant Death in a Rural Hispanic Population: A Case-Control Study.

INTRODUCTION: Sudden unexpected infant death (SUID) is the leading cause of death among U.S. infants aged 28 days to 1 year. In Kansas, Hispanic infant mortality is nearly 50% higher than non-Hispanic White. Further, the SUID rate did not change between 2005-2018, while rates for non-Hispanic Black and White infants decreased significantly. This study sought to identify characteristics and behaviors of Hispanic birthing persons related to SUID. METHODS: Linked Kansas birth/death vital statistics data (2005-2018) identified Hispanic birthing persons with a singleton birth who experienced SUID. To reduce confounding effects, greedy nearest neighbor matching paired each SUID case sequentially with the four nearest controls based on age, race, payor source and parity. Matching procedures, likelihood-ratio χ2, Fisher exact test and multiple logistic regression model with Firth's penalized maximum likelihood estimation were computed. RESULTS: Of 86,052 Hispanic singleton births, 66 involved SUID and were matched with 264 controls. No differences were related to marital status, population density of residence, education level, language spoken, prenatal BMI, weight gained during pregnancy, adequacy of prenatal care, enrollment in WIC, or state immunization registry participation (all p>0.05). However, tobacco use during pregnancy contributed to a three times greater risk of SUID (OR=3.208; 95% CI=1.438 to 7.154). Multivariable models for behavioral variables revealed low predictive accuracy with area under the ROC curve=0.6303. CONCLUSION: This study suggests SUID deaths to rural Hispanic families are likely multifaceted. Study results inform educational programs on the importance of addressing tobacco cessation in SUID risk reduction interventions for Hispanic families.

Parent opinions about use of text messaging for immunization reminders.

BACKGROUND: Adherence to childhood immunization schedules is a function of various factors. Given the increased use of technology as a strategy to increase immunization coverage, it is important to investigate how parents perceive different forms of communication, including traditional means and text-message reminders. OBJECTIVE: To examine current forms of communication about immunization information, parents' satisfaction levels with these communication modes, perceived barriers and benefits to using text messaging, and the ideal content of text messages for immunization reminders. METHODS: Structured interviews were developed and approved by two Institutional Review Boards. A convenience sample of 50 parents was recruited from two local pediatric clinics. The study included a demographics questionnaire, the shortened form of the Test of Functional Health Literacy for Adults (S-TOFHLA), questions regarding benefits and barriers of text communication from immunization providers, and preferred content for immunization reminders. Content analyses were performed on responses to barriers, benefits, and preferred content (all Cohen's kappas > 0.70). RESULTS: Respondents were mostly female (45/50, 90%), white non-Hispanic (31/50, 62%), between 20-41 years (mean = 29, SD 5), with one or two children (range 1-9). Nearly all (48/50, 96%) had an S-TOFHLA score in the "adequate" range. All parents (50/50, 100%) engaged in face-to-face contact with their child's physician at appointments, 74% (37/50) had contact via telephone, and none of the parents (0/50, 0%) used email or text messages. Most parents were satisfied with the face-to-face (48/50, 96%) and telephone (28/50, 75%) communication. Forty-nine of the 50 participants (98%) were interested in receiving immunization reminders by text message, and all parents (50/50, 100%) were willing to receive general appointment reminders by text message. Parents made 200 comments regarding text-message reminders. Benefits accounted for 63.5% of comments (127/200). The remaining 37.5% (73/200) regarded barriers; however, no barriers could be identified by 26% of participants (13/50). Parents made 172 comments regarding preferred content of text-message immunization reminders. The most frequently discussed topics were date due (50/172, 29%), general reminder (26/172, 26%), and child's name (21/172, 12%). CONCLUSIONS: Most parents were satisfied with traditional communication; however, few had experienced any alternative forms of communication regarding immunizations. Benefits of receiving text messages for immunization reminders far outweighed the barriers identified by parents. Few barriers identified were text specific. Those that were, centered on cost if parents did not have unlimited texting plans.

Collaborating with Culturally Competent Prenatal Education among Hispanic Communities.

INTRODUCTION: Hispanics represent the largest minority group in the United States. In Kansas, the population of Hispanics has been increasing; unfortunately, their infant mortality rate has increased as well. Baby Talk is a prenatal education program promoting maternal and infant health through risk-reduction strategies and healthy decision-making. The aim of this pilot project was to develop and evaluate a Spanish curriculum for Baby Talk. METHODS: A collaborative partnership between bilingual community members and health professionals from different origins, nationalities, and Spanish dialects was formed to create a culturally and linguistically appropriate Spanish Baby Talk curriculum. This interventional pilot mixed methods research study employed quantitative and qualitative methods to evaluate participant knowledge, intentions, satisfaction, and perceptions of the new curriculum. RESULTS: Fifteen pregnant women participated in Spanish Baby Talk. Of those, 12 participated in either phone interviews (n = 6) or a focus group (n = 6). All respondents described their experience with the Spanish Baby Talk program as "excellent". Significant increases in knowledge were seen related to topics such as benefits of full-term pregnancy and benefits of breastfeeding. Four themes were identified from the focus group and interviews: 1) lack of accessible community resources; 2) sense of community; 3) Spanish Baby Talk strengths; and 4) areas for improvements. CONCLUSIONS: Findings suggested that the Spanish Baby Talk curriculum was linguistically appropriate and resulted in increases in knowledge and intentions related to health and safety behaviors. Areas for improvement were related to marketing the program and referring to resources that provide material supports (i.e., diapers) to continue the move towards a culturally competent program.

Qualitative Assessment of Access to Perinatal Mental Health Care: A Social-Ecological Framework of Barriers.

Introduction: Psychological distress affects up to 25% of pregnant women and contributes to poor birth outcomes. Screening with appropriate referral or treatment is critical, yet many women do not access services. This project aimed to identify knowledge of and barriers to mental health services in the perinatal period. Methods: Interviews with low-income pregnant or postpartum women, primary care providers (PCPs), and mental health care providers were conducted in Sedgwick County, Kansas. Interviews were transcribed, independently reviewed using grounded theory, and stratified using a social-ecological model framework. Results: Thirty-three interviews were conducted with 12 (36%) pregnant or postpartum women, 15 (45%) PCPs, and 6 (18%) mental health care providers. Barriers were categorized into three levels: individual, social, and society. Individual level barriers, including cost or lack of insurance and transportation, were consistent across groups, however, women identified barriers only at this level. Provider groups identified barriers at all levels, including lack of support, poor communication between providers, and Medicaid limitations. Conclusions: Multi-level interventions are needed to improve access to mental health care for low-income women in the perinatal period.

Perceived Barriers to Clinical Trials Participation: A Survey of Pediatric Caregivers.

Introduction: Pediatric clinical trials are difficult to conduct, leading to off-label use of medication in children based on results of trials with adults. As a unique population, children deserve to have appropriately tested therapies. The purpose of this study was to evaluate pediatric caregivers' beliefs and perceived barriers to participation in clinical trials. Methods: The study was completed within the Sunflower Pediatric Clinical Trials Research Extension (SPeCTRE), an affiliate of the IDeA States Pediatric Clinical Trials Network (ISPCTN). This was a cross-sectional survey, adapted from the Pediatric Research Participation Questionnaire. A convenience sample of pediatric caregivers was recruited in three areas of a highly rural Midwestern state between 2017 and 2018. Results: A total of 159 caregivers completed surveys; the majority (72.3%) were previously familiar with clinical trials, but less than 20% had ever been invited to participate. Caregivers were willing to consider enrolling their child if a physician in whom they had high trust recommended the trials (H = 10.1, p = 0.04) and if there were perceived benefits, such as access to tests and medications not covered by insurance (correlation coefficient [CC] = 0.4, p < 0.01) and compensation for time and travel (CC = 0.3, p = 0.04). Conclusions: Trust in their physician highly influences likelihood of a caregiver consenting to have their child participate in a clinical trial. Therefore, to facilitate opportunities for children to participate in clinical trials, physicians need to be trained so they can offer trials locally. In addition, trials need to offer benefits, such as increased access to tests and medications as well as appropriate compensation.

Perceived Barriers to Pediatric Clinical Trials Implementation: A Survey of Health Care Staff.

Introduction: Clinical trials are the gold standard for assessing the effectiveness and safety of treatments. The objective of this study was to assess provider opinions regarding implementing pediatric clinical trials in various practice settings across Kansas. Methods: The study was completed within the Sunflower Pediatric Clinical Trials Research Extension (SPeCTRE), an affiliate of the IDeA States Pediatric Clinical Trials Network (ISPCTN). A cross-sectional, 36-item survey was administered to a state-wide convenience sample targeting health care providers and clinic staff. Results: A total of 115 health care providers and clinic staff completed surveys; 31% were physicians. Physicians were more likely than other clinic staff to have experience with clinical trials (correlation coefficient [CC] = 0.270, p = 0.004). When compared to urban respondents, rural providers were less supportive of recruitment for clinical trials in their practices (CC = -0.251, p = 0.008) and more likely to feel comfortable referring patients for clinical trials involving treatments that their insurance did not cover (CC = 0.302, p = 0.001). Conclusions: A range of rural and urban health care professionals supported conducting pediatric clinical trials but identified several barriers as well. These results will support future pediatric clinical trials across the country including Kansas.

Physician impressions of using text message technology to increase vaccination compliance.

INTRODUCTION: Immunization schedules are complicated and difficult for parents to remember. Parents are willing to receive text message reminders. However, it is unknown whether physicians are willing to implement such a system. The purpose of this study was to evaluate the feasibility of a text messaging reminder system from the physician's perspective. MATERIALS AND METHODS: Surveys were distributed in the winter of 2009-2010 by e-mail, facsimile, and telephone interview to 149 family physicians and pediatricians who provide immunizations in Sedgwick County, Kansas. RESULTS: A 69% response rate was achieved. Nearly all (92%) respondents reported that they currently communicate information about immunization schedules to parents using traditional methods such as verbal reminders or appointment cards; however, none (0%) currently use text or email to generate reminders to parents. Even when asked to assume they had all of the necessary resources, almost one-third (31%) reported that they were "very unwilling" or "unwilling" to use a general text-messaging program, 43% were "neutral" or "undecided," and only 27% were "willing" or "very willing." Physician willingness to use a text-messaging program was not related to their reported gender (χ²(2)=0.224, p=0.894), specialization (χ² (2)=4.363, p=0.113), years in practice (F(2, 91)=0.435, p=0.149), or comfort level with technology (χ²(4)=1.861, p=0.761). CONCLUSIONS: There is a hesitancy to implement a text message reminder system for childhood vaccine schedules. This may be due to the lack of empirical evidence supporting the use of this technology for health reminders or the lack of willingness to implement another system. Further investigation is needed to determine why few physicians are willing to implement text messaging for immunization reminders.

Safe sleep community baby showers to reduce infant mortality risk factors for women who speak Spanish.

OBJECTIVES: In the United States, sleep-related deaths are one of the primary causes of death for infants age 28 days to one year. The American Academy of Pediatrics (AAP) developed Safe Sleep Recommendations which provide risk reduction strategies for sleep-related infant deaths. Interventions such as Safe Sleep Community Baby Showers have increased knowledge and intentions to engage in these safe sleep behaviors for women who speak English. This study assessed the feasibility, acceptability and initial outcomes of Safe Sleep Community Baby Showers for women who speak Spanish. METHODS: Six Spanish Safe Sleep Community Baby Showers were held in Sedgwick County, Kansas. One hundred forty-six pregnant or recently delivered women who spoke Spanish completed pre- and post-assessments. Univariate comparisons were made using McNemar's test for paired dichotomous variables. RESULTS: Participants had a high school diploma/General Educational Diploma (GED) or less (75.3%), and were uninsured (52.1%) or had Medicaid (n = 49; 33.6%). The majority reported being very satisfied (n = 130; 89.0%) or satisfied (n = 8; 5.5%). Compared to baseline, significant increases in intentions and confidence to follow the AAP Safe Sleep Recommendations were observed following the events. The majority of participants reported intending to place their infant on the back to sleep (98.6%), use only a safe surface (crib, portable crib, bassinet; 99.3%), and only include safe items (firm mattress, fitted sheet; 93.5%) (all p < .001). CONCLUSIONS: Study findings support both feasibility and acceptability of modifying Safe Sleep Community Baby Showers to provide culturally and linguistically appropriate education for women who speak Spanish. Initial outcomes suggest increased intentions to follow safe sleep recommendations.

Promoting Safe Sleep, Tobacco Cessation, and Breastfeeding to Rural Women During the COVID-19 Pandemic: Quasi-Experimental Study.

BACKGROUND: Safe Sleep Community Baby Showers address strategies to prevent sleep-related infant deaths. Due to the COVID-19 pandemic, these events transitioned from in-person to virtual. OBJECTIVE: This study describes outcomes of transitioning Safe Sleep Community Baby Showers to a virtual format and compares outcomes to previous in-person events. METHODS: Participants from four rural Kansas counties were emailed the presurvey, provided educational materials (videos, livestream, or digital documents), and completed a postsurvey. Those who completed both surveys received a portable crib and wearable blanket. Within-group comparisons were assessed between pre- and postsurveys; between-group comparisons (virtual vs in-person) were assessed by postsurveys. RESULTS: Based on data from 145 in-person and 74 virtual participants, virtual participants were more likely to be married (P<.001) and have private insurance (P<.001), and were less likely to report tobacco use (P<.001). Both event formats significantly increased knowledge and intentions regarding safe sleep and avoidance of secondhand smoke (all P≤.001). Breastfeeding intentions did not change. Differences were observed between in-person and virtual meetings regarding confidence in the ability to avoid secondhand smoke (in-person: 121/144, 84% vs virtual: 53/74, 72%; P=.03), intention to breastfeed ≥6 months (in-person: 79/128, 62% vs virtual: 52/66, 79%; P=.008), and confidence in the ability to breastfeed ≥6 months (in-person: 58/123, 47% vs virtual: 44/69, 64%; P=.02). CONCLUSIONS: Although both event formats demonstrated increased knowledge/intentions to follow safe sleep recommendations, virtual events may further marginalize groups who are at high risk for poor birth outcomes. Strategies to increase technology access, recruit priority populations, and ensure disparities are not exacerbated will be critical for the implementation of future virtual events.