Promoting Safe Sleep, Tobacco Cessation and Breastfeeding to Rural Women During the COVID-19 Pandemic: Pre-Post Study

Ahlers-Schmidt, Carolyn R; Schunn, Christy; Hervey, Ashley M; Torres, Maria; Nelson, Jill

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 comparing outcomes to previous in-person events. METHODS: Participants from four rural Kansas counties were emailed the pre-survey, provided educational materials (videos, live-stream or digital documents), and completed a post-survey. Those who completed both surveys received a portable crib and wearable blanket. Within group comparisons were assessed between pre- and post-surveys; between group comparisons (virtual vs in-person) were assessed by post-surveys. RESULTS: Based on data from 143 in-person and 74 virtual participants, virtual participants were more likely to be married (p<.001), have private insurance (p<.001), and less likely to report tobacco use (p<.001). Both event formats significantly increased knowledge and intentions regarding safe sleep and avoidance of second-hand smoke (all p≤.001). Breastfeeding intentions did not change. Differences were observed between in-person and virtual regarding confidence in ability to avoid second-hand smoke (in-person, 84% vs virtual, 72%; p=.031), intention to breastfeed ≥6 months (in-person, 62% vs virtual, 79%; p=.008) and confidence in ability to breastfeed ≥6 months (in-person, 47% vs virtual, 64%; p=.02). CONCLUSIONS: While both event formats demonstrated increased knowledge/intentions to follow safe sleep recommendations, virtual events may further marginalize groups who are high-risk for poor birth outcomes. Strategies to increase technology access, recruit priority populations and ensure disparities are not exacerbated will be critical for implementation of future virtual events.