Support via Online Social Networks to Promote Safe Infant Care Practices Toward Reducing Racial Disparities in Infant Mortality (SUPERSONIC)

The focus of this renewal application is to build upon the findings from the Influence of Social Networks on Infant Care and Disparities in Postneonatal Infant Mortality (SONIC) study by conducting a 4-armed pragmatic randomized controlled trial (RCT) using online social networks (OSNs) to promote safe infant care practices and reduce Black/White disparities in adherence to these practices. In SONIC, we described characteristics of the social networks of mothers of young infants and demonstrated the influence of these networks and social norms on parental decisions about infant sleep practices, and particularly how differences in social networks and norms contribute to racial disparities in these practices. These disparities contribute to disparities in postneonatal infant deaths, a large proportion of which are from sudden infant death syndrome (SIDS) and unintentional injury-related infant deaths associated with the sleep environment. These deaths, known as sleep-related deaths (SRDs), remain the leading cause of postneonatal death in the US, with ~3700 deaths each year. Many of the risk factors for these deaths can be modified by changes in parental practice, particularly where and how the infant sleeps. A key finding from SONIC was that mothers for whom the social norm was to place infants nonsupine, to bedshare and to use soft bedding were all themselves more likely to use the associated unsafe sleep practice. Black mothers and first time mothers in particular were more influenced by the negative norm of soft bedding use. This reinforces that mothers rely heavily on advice from trusted sources in their social network when deciding which infant care practices to adopt. Thus, the influence of social networks and norms, if contrary to recommended infant care practices, is a major barrier to acceptance of these practices. Online social networks (OSNs) have become a powerful tool for establishing social norms and influencing behavior, and data suggest that this is equally or more so for Blacks. Thus, our proposed SUPERSONIC (Support via Online Social Networks to promote Safe Infant Care practices Toward Reducing Racial Disparities in Infant Mortality) study is the natural next step after SONIC. We plan to test, through a 4-armed pragmatic RCT, an intervention strategy that uses OSNs (closed Facebook groups) to change social norms. Mothers in each study arm will participate in an OSN and receive one of the following 4 messaging interventions: 1) safe sleep alone, 2) breastfeeding alone, 3) both safe sleep and breastfeeding, and 4) routine health messages (control). We will disseminate information through OSNs that will address common myths and misconceptions to ultimately impact attitudes and social norms regarding infant sleep practices and breastfeeding. We anticipate that impacting the social network and norms will lead to improved safe sleep and breastfeeding practices, which in turn should lead to a significant reduction in the incidence of SRDs, particularly in Black infants. Additionally, this research may provide important insights that can be applied in other areas of pediatric health, including vaccine acceptance and nutrition/obesity