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Disproportionate Enforcement of a Hospital's Safe Sleep Policy for Racial and Ethnic Minority Families
Lauren Titus1,2, Natalie Yass3, Anika Nelson1,2
1Department of Pediatrics, Section of Hospital Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin.
Insights
Enforcement of safe sleep policies in children's hospitals revealed racial disparities. Non-Hispanic Black infants experienced more unsafe sleep events and escalated consequences, suggesting systemic racism. Policy changes are recommended to support families.
Area of Science:
- Pediatric Health
- Health Equity
- Public Health Policy
Background:
- Safe sleep policies are crucial for infant well-being.
- Systemic racism may impact healthcare policy enforcement.
- Previous research indicates racial disparities in child safety outcomes.
Purpose of the Study:
- To investigate potential systemic racism in the enforcement of a children's hospital safe sleep policy.
- To evaluate disparities in the documentation and escalation of unsafe sleep events (USEs) among different demographic groups.
Main Methods:
- Retrospective medical record review of infants aged 12 months or younger.
- Logistic regression analysis to compare infants with and without USEs.
- Survival analysis to assess time to escalation of USEs.
Main Results:
- Non-Hispanic Black (NHB) infants had disproportionately more USEs (52%) compared to non-USE infants (23%) (P < .01).
- NHB infants were 2.42 times more likely to have a USE than Non-Hispanic White (NHW) infants (P < .01).
- NHW infants experienced longer delays in warnings and escalations compared to NHB infants; only NHB infants had USEs escalate to security.
Conclusions:
- The study identified disparities in safe sleep policy enforcement, suggesting systemic racism.
- Hospitals should carefully consider the impact of safe sleep policies on marginalized families.
- Replacing punitive measures with supportive interventions is recommended to facilitate behavior change.
Objective:
We aimed to evaluate the enforcement of a staff-initiated children's hospital safe sleep policy for evidence of systemic racism.
Patients And Methods:
Retrospective medical record review of staff-initiated safe sleep policy enactments was performed. Demographic data of infants aged 12 months or younger with an unsafe sleep event (USE) documented in the electronic health record were compared with logistic regression to infants without USEs. Time to escalation of USEs was analyzed using survival analysis. Descriptive statistics were used to compare median number of warnings and outcomes of escalation for each demographic group.
Results:
Of 233 infants with USEs, a disproportionate number were Non-Hispanic Black (NHB) (52%) compared with infants without USEs (23% NHB) (P < .01). When adjusting for confounding variables, NHB infants were 2.42 times more likely to have an USE compared with Non-Hispanic white (NHW) infants (OR, 2.42; 95% CI, 1.63-3.58; P < .01). NHW infants had a significantly longer median time between first and second warnings compared with all other groups (P < .01), and the time to fourth warning for NHW infants was over 6 times that for NHB infants. The only instances of USEs that escalated to hospital security involved NHB infants.
Conclusion:
Disparities suggestive of systemic racism were identified in the enforcement of a children's hospital safe sleep policy. For hospitals looking to adopt or revise safe sleep policies, the authors suggest careful consideration of potential impacts on already systemically marginalized families. We suggest replacing punitive consequences of policy nonadherence with interventions to facilitate behavior change in the hospital and after discharge.
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