# Social Media and Risk-reduction Training for Preterm Infant Care Practices (SMART Preemie)

> **NIH NIH R01** · UNIV OF MASSACHUSETTS MED SCH WORCESTER · 2024 · $804,485

## Abstract

SMART Preemie Project Summary
Sudden and unexpected infant death (SUID) occurs 2-3-fold more often among preterm infants (<37 weeks’
gestation) compared to healthy, term infants (≥ 37 weeks) and 2-fold more often among non-Hispanic Black
compared to non-Hispanic white infants. SUID rates have not changed in over 2 decades despite widespread
public health efforts targeting the general population. We conducted a national prevalence study to ascertain
adherence to American Academy of Pediatrics recommended SUID-reducing safe sleep practices (supine
sleep, room sharing but not bedsharing, and nonuse of soft bedding) among preterm infants in our R01, “Study
of Attitudes and Factors Effecting PREterm infant care Practices” (SAFE PREP; HD095060). Among 834
preterm infants recruited from 30 hospitals across the US, we found alarming rates of unsafe sleep practices at
4-8 weeks after hospital discharge, including 51% with non-supine sleep, 24% with bedsharing, and 59% with
loose objects in the sleep space. Further, non-Hispanic Black mothers had lower rates of exclusive supine
sleep compared to non-Hispanic white mothers (34% vs. 64%). We also found that attitudes about safety and
vulnerability of preterm infants and messaging and modeling behaviors by health care providers were
modifiable determinants of safe sleep practices among mothers of preterm infants. To address this urgent
problem, in this R01 renewal application, we propose a type 1 hybrid implementation-effectiveness, cluster
randomized trial, “SMART Preemie”, at 16 hospitals that participated in SAFE PREP. Leveraging our past
experience, we will conduct two safe sleep interventions specifically targeting the factors we identified in SAFE
PREP that influenced maternal decision-making about infant sleep practices: 1) a hospital-based intervention
focused on safe sleep modeling and education; and 2) a post-discharge mobile health (“mHealth”) intervention
where short, engaging videos and queries about safe sleep or shared reading (attention-matched control) will
be delivered through text messaging. We will test the effectiveness of the hospital and post-discharge mHealth
interventions individually and synergistically at changing maternal adherence to safe sleep practices by
randomizing 16 NICUs into 4 groups (4 per group): (1) Safe Sleep hospital and Shared Reading post-
discharge; (2) Shared Reading hospital and Safe Sleep post-discharge; (3) Safe Sleep hospital and Safe Sleep
post-discharge; or (4) Shared Reading hospital and Shared Reading post-discharge. In Aim 1, we will test the
effectiveness of the safe sleep interventions vs. control on adherence to safe sleep practices (supine sleep,
room sharing without bedsharing, and avoidance of loose objects) and compare effectiveness across
racial/ethnic groups. In Aim 2, we will test the extent that mediating factors identified in SAFE PREP, including
attitudes and social norms, explain intervention effects on safe sleep practices. In Aim 3, using ...

## Key facts

- **NIH application ID:** 10802495
- **Project number:** 2R01HD095060-06
- **Recipient organization:** UNIV OF MASSACHUSETTS MED SCH WORCESTER
- **Principal Investigator:** Sunah S Hwang
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $804,485
- **Award type:** 2
- **Project period:** 2018-08-17 → 2029-06-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10802495

## Citation

> US National Institutes of Health, RePORTER application 10802495, Social Media and Risk-reduction Training for Preterm Infant Care Practices (SMART Preemie) (2R01HD095060-06). Retrieved via AI Analytics 2026-05-27 from https://api.ai-analytics.org/grant/nih/10802495. Licensed CC0.

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