1,000 Grandmothers Project helps 4 tribes increase knowledge of safe infant sleep practices
Each year, about 3,500 Sudden Unexpected Infant Deaths (SUIDs) occur in the United States.1 SUIDs are defined as deaths among infants under 1 year of age that occur suddenly and unexpectedly.2 The 3 most commonly reported types of SUIDs are: Sudden Infant Death Syndrome (also known as SIDS), accidental suffocation and strangulation in bed, and unknown causes.1 SUIDs are a significant concern among the American Indian/Alaska Native (AI/AN) population, which has the highest rate of SUIDs of any racial/ethnic group in the United States. For 2010–2013, the SUID death rate among AI/AN infants was 190.5 per 100,000 live births. The SUIDs rate for AI/AN infants was over twice that of non-Hispanic white infants (84.4), and over 3 times that of the total United States population.3
The International Association for Indigenous Aging is a nonprofit educational organization working to improve the health and well-being of AI/AN and other indigenous people as they move through the age spectrum. In October 2013, the International Association for Indigenous Aging implemented the 1,000 Grandmothers Project to engage Native elders (grandparents and specifically grandmothers) in reducing the rate of SUIDs by educating and mentoring young Native parents or future parents about safe sleep practices for infants during traditional activities.3 Supported by the Centers for Disease Control and Prevention, the Michigan Public Health Institute, and the National Network of Public Health Institutes, the 1,000 Grandmothers Project used Healthy Native Babies, an evidence-based curriculum on safe infant sleep practices developed by the Eunice Kennedy Shriver National Institute for Child Health and Human Development of the National Institutes of Health. The International Association for Indigenous Aging tailored the existing curriculum specifically for Native populations and implemented the project on a pilot basis in 4 geographically diverse tribes—the Turtle Mountain Band of Chippewa Indians in North Dakota, the Eastern Band of Cherokee Indians in North Carolina, and the Hannahville Indian Community (Potawatomie) and Sault. Ste. Marie Tribe of Chippewa Indians in Michigan.3
As part of the 1,000 Grandmothers Project, each tribe formed a planning committee that included at least 1 Native grandmother, while some tribes included a cultural liaison or cultural resource officer, which helped them choose traditional activities for grandmothers and young mothers. Some of the key activities of the project included recruitment/education sessions, intergenerational mentoring sessions, and media outreach. Recruitment/education sessions consisted of recruiting grandmothers and other elders to the program, educating them on SUIDs and SIDS, and addressing traditional beliefs that were inconsistent with current recommended guidelines.3 During 1 to 5 mentoring sessions, grandmothers shared their own child-raising experiences, while also educating young mothers on safe sleep practices. During the sessions, the elders and young mothers engaged in traditional crafting activities of the tribe. All sessions included meals, prayers, crafts, and gifts for participants. Media outreach included public service announcements, newspaper articles, and newsletters to promote the project.
Overall, the 1,000 Grandmothers Project reached nearly 200 program participants from the 4 tribes.4 Across all tribes, around 90 people participated in mentoring sessions, including grandmothers, grandfathers, young mothers, young fathers, and children. Ninety-six elders and other community members participated in educational sessions. All participants completed a pre- and post-test to assess knowledge of SUIDs, pregnancy health behaviors, and safe sleep practices. On the pre-test, 7% of participants answered all questions correctly. Of individuals who participated in a 5-session program, 97% answered all post-test questions correctly, compared to 46% of those participating in a 1-session program, demonstrating the increased effectiveness of the multi-session programs. In addition to pre- and post-test assessments, focus groups, document reviews, and key informant interviews were used to evaluate the project, and lessons learned were incorporated into a report and implementation resources.4
During the program, staff learned that establishing initial contact with a key tribal liaison and obtaining buy-in from tribal councils was critical to securing agreements with tribes and implementing programs. Asking tribes to plan activities tailored to their specific needs and traditional cultures was also important to the success of the program. Overall, the intergenerational 1,000 Grandmothers Project used an evidence-based and culturally appropriate approach to aid in reducing the disparity in SUID rates among the AI/AN population. The combination of an adapted evidence-based curriculum with flexible program requirements helped to effectively increase knowledge of SUIDs and safe sleep practices among tribal members, while also strengthening relationships between Native elders and young parents and celebrating unique tribal traditions.4
2 Cause of death is determined using the following ICD-9 Codes: SIDS (798.0), unknown cause (799.9), and ASSB (E913.0). For 1999 to 2014, cause of death is determined using the following ICD-10 codes: SIDS (R95), unknown cause (R99), and ASSB (W75). Compressed Mortality File, CDC/NCHS.
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