Running head: UNINTENTIONAL INFANT DEATHS 1

Unintentional Infant Deaths by Suffocation in Hillsborough County, Florida

Rachael Lewkowiez

University of South Florida

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Unintentional Infant Deaths by Suffocation in Hillsborough County, Florida

This paper was written to address a weakness in the community in Hillsborough County, Florida.

Hillsborough County has a higher rate of unintentional infant suffocation in bed than the rate for

the state of Florida as a whole (Florida Department of Health: Division of Public Health statistics

and Performance Management, 2015). This paper will analyze data related to unintentional infant

deaths by suffocation. It will also discuss impacts that this data have on the community. It will

analyze determinants of health and the literature to create community based nursing interventions

to prevent this problem in the future.

Overview of Hillsborough County

Hillsborough County, FL is located on the east coast of central FL, and contains the cities

of Tampa, Ybor, parts of Brandon, and parts of Town n Country (US Census Bureau: Center

for Economic Studies, 2014).

Hillsborough County is an urban classified county (US Government Accountability

Office, n.d.). Based on the 2015 census, the population of Hillsborough County is 1,349,050

people (US Census Bureau: Center for Economic Studies, 2014). (U.S. Census Bureau, 2016)Of

the workforce; 78% (404977) are white, 16.4% (84,944) are black, 3.6% (18,722) are Asian,

0.5% (2,551) are Native American or Alaskan Natives, 0.1% (636) are Hawaiian or Pacific

Islander, and 1.5% (7,702) belong to two or more racial groups (U.S. Census Bureau, 2016).

The median household income is $50,579; and while 87.5% of the residents in the county have a

high school diploma or higher, 15.8% of the county lives in poverty (US Census Bureau: Center

for Economic Studies, 2014). The top 3 NAICS Industry Sectors are Healthcare and social

assistance (13.6%), retail trade (11.7%), and accommodation and food services (9.4%) (U.S.

Census Bureau, 2016). The three largest employers in the county are SDHC, HCA West Forida,

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and Macdill Airforce Base (Tampa Hillsborough EDC Research, 2016). The top 3 healthcare

systems are HCA, with 12 local hospitals, Baycare with 8 hospitals, and Health Management

Associates with 6 (Florida Agency for Health Care Administration, 2011). Hillsborough county

has many unique characteristics, but is still just a part of the bigger network of the state of

Florida.

Comparison of Local vs. State Populations

There are several demographic and socioeconomic characteristics of a population that

affect health status. Anything from education level to the frequency of fast food locations can

affect the health of a population. Next some of these will be explored and compared between the

county and state level.

The percent of families living below the poverty level for the state of Florida is 16.7%,

but in Hillsborough County alone, that number is higher- 17.2% (Florida Department of Health:

Division of Public Health statistics and Performance Management, 2015). In the state of Florida,

13.5% of people over 25 years of age have not completed a high school diploma or equivalent

education; but the data is slightly better for Hillsborough county, with 12.9% of those over 25

not having a high school education. (Florida Department of Health: Division of Public Health

statistics and Performance Management, 2015). In the state of Florida, 11.7% of the population

over 5 years of age speaks English less than very well, which is higher than the percent for

Hillsborough County of 9.9% (Florida Department of Health: Division of Public Health statistics

and Performance Management, 2015).

The next area of health indicators addressed is access to health care centers/ providers in

Hillsborough County and the state of Florida. One indicator of access to healthcare is the number

of licensed providers per 1000 people in the population. The following are the number per 1000

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in the population of different types of licensed health professionals. For Hillsborough County

and the state of Florida respectively, there are 60 and 55.3 licensed dentists; 319.4 and 249

licensed physicians; 13.6 and 14.3 family practice physicians; 13.6 and 9.8 OBGYNs; and 20.5

and 18.0 licensed pediatricians per 100 people in the population (Florida Department of Health:

Division of Public Health statistics and Performance Management, 2015)

Analysis and Interpretation of Data

The previous data begins to paint a picture of the people living within Hillsborough

County, Florida. Hillsborough County is the fourth largest county by population in the state and

is extremely diverse (United States Census Bureau / American Fact Finder, 2016). There are

very affluent areas and also impoverished areas within Hillsborough county creating a very

diverse population. As with any community, Hillsborough county has its own strengths and

weaknesses that will be further explored below through data provided by FLCharts.

Identified Strengths

A strength of Hillsborough County is having less births to mothers with no prenatal care

than the state of Florida overall (Florida Department of Health: Division of Public Health

statistics and Performance Management, 2015). The 3 year rolling rate for the percentage of

births to mothers with no prenatal care is 0.8% for 2013-2015 for the county, but is 1.5% for the

same years for the state of Florida (Florida Department of Health: Division of Public Health

statistics and Performance Management, 2015). In other words, 99.2% of babies born in

Hillsborough county have had some kind of prenatal care, where as only 98.5% of babies born in

Florida have had some kind of prenatal care before they were born (Florida Department of

Health: Division of Public Health statistics and Performance Management, 2015).

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Another strength for Hillsborough County is that there are more mothers who initiate

breastfeeding in the county than in the state of Florida overall (Florida Department of Health:

Division of Public Health statistics and Performance Management, 2015). The 3 year rolling rate

for the percentage of births to mothers who initiate breastfeeding is 89.5% for Hillsborough

county for 2013-2015, but only 84% for the same years for the state (Florida Department of

Health: Division of Public Health statistics and Performance Management, 2015). Both the

county and state meet the target for healthy people 2020 of 81.9% of babies who are ever

breastfed, but Hillsborough county has exceeded the goal by much more than the state alone

(Healthy People 2020, 2017).

A third strength for Hillsborough is there are less maternal deaths per 1000 live births

than in the state (Florida Department of Health: Division of Public Health statistics and

Performance Management, 2015). The 3 year rolling rate for the maternal deaths per 1,000 live

births was 23.5 for Hillsborough county for the years 2013-2015, but was 24.1 for the state of

Florida for those same years (Florida Department of Health: Division of Public Health statistics

and Performance Management, 2015). This is the first year that Hillsborough county had less

maternal deaths per 1000 live births than the state since the 2004-2006 data (Florida Department

of Health: Division of Public Health statistics and Performance Management, 2015). In fact, for

the 2012-2014 years, the 3 year rolling rate for the maternal deaths per 1,000 live births was 28.1

for Hillsborough county and 23.8 for Florida (Florida Department of Health: Division of Public

Health statistics and Performance Management, 2015).

Identified Weaknesses

A big weakness is that there are more neonatal deaths to African Americans than to

Caucasians in Hillsborough County (Florida Department of Health: Division of Public Health

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statistics and Performance Management, 2015). The three year rolling rate for African

Americans in Hillsborough county is 9.6 neonatal infant deaths per 1,000 live births for the years

2013-2015, while the rate for the same years in Caucasians is only 4.0 neonatal infant deaths per

1000 live births (Florida Department of Health: Division of Public Health statistics and

Performance Management, 2015). This gap in neonatal outcomes between the different racial

groups is indicative of a huge health disparity in Hillsborough county. This is evidence of a huge

opportunity for improvement in Hillsborough county.

Hillsborough county has another weakness in that this county has a higher rate of total

gonorrhea, chlamydia, and infectious syphilis than in the state of Florida overall (Florida

Department of Health: Division of Public Health statistics and Performance Management, 2015).

In 2015, Hillsborough county had a rate of 740.3 per every 1,000 for the previously mentioned

sexually transmitted infections, while the state of Florida in 2015 had a rate of 588.7 per 1,000

(Florida Department of Health: Division of Public Health statistics and Performance

Management, 2015). This is an ongoing problem, and Hillsborough countys rate have been

above the state average for as far back as 1996, which demonstrates a huge opportunity for

improvement on the public health front (Florida Department of Health: Division of Public Health

statistics and Performance Management, 2015).

Hillsborough county also has a higher 3-year rolling rate of infant deaths from

unintentional suffocation and strangulation in bed per 1,000 live births than that of the state of

Florida overall (Florida Department of Health: Division of Public Health statistics and

Performance Management, 2015). The 2013-2015 rolling rate for Hillsborough county was 0.5

infant deaths from unintentional suffocation and strangulation in bed per 1,000 live births, and

the rate for the state was 0.4 per 1,000 (Florida Department of Health: Division of Public Health

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statistics and Performance Management, 2015). This poses another huge opportunity for

improvement in the public health of Hillsborough County because it is 100% preventable by

using safe sleep practices.

Identification of a Priority Health Issue

The priority health issue is that Hillsborough county also has a higher 3-year rolling rate

of infant deaths from unintentional suffocation and strangulation in bed per 1,000 live births than

that of the state of Florida overall (Florida Department of Health: Division of Public Health

statistics and Performance Management, 2015). Accidental suffocation or strangulation in bed is

one cause of Sudden Infant Death Syndrome, or SIDS, which is the number 1 cause of death for

infants under 1 year of age (Florida Department of Health: Division of Public Health statistics

and Performance Management, 2015). Prematurity, soft beds, heavy blankets, obese parents,

tired parents, and intoxicated parents increase a babys risk for Infant suffocation in bed (Byard,

2015). Infant suffocation mortality rates were increased by non-Hispanic black and American

Indian/Alaskan Native mothers who smoked during pregnancy, had less than 12 years of

education, and had no prenatal care (Byard, 2015).

Discussion and Application of Community Health Models

Social determinants of health are different aspects of peoples lives that can affect their

health and quality of life in a variety of ways (Center for Disease Control, 2017). Healthy

People 2020 puts a big emphasis on social determinants of health and includes it in one of their

four main goals (Centers for Disease Control, 2015). Examples of social determinants of health

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include income, employment, education, environments, access to healthy food, access to

healthcare and safe living place, etc. (Center for Disease Control, 2017).

Population Diagnosis

Infants in Hillsborough County have a higher risk of unintentional death by suffocation

and strangulation in bed than infants in the rest of the state of Florida because unsafe sleep

practices.

Community/Population-based Interventions

The wheel of public health interventions is a way to classify public health interventions to

get all aspects of the population. It separates interventions and classifies them based on where

they are focused. They can be focused on the individual, the community, or the system (Nursing,

2009).

Primary Level of Prevention

The level of recipient for primary prevention could be the community level, and an

intervention for this level could be to put a commercial on tv educating people of the community

about safe sleep practices. Primary prevention could also be mandatory education about safe

sleep practices prior to discharge from delivering a baby. Stakeholders include members of the

community, whether they have infant children of their own or have people they care about with

infants, the loss of a baby is devastating to many. Stakeholders would also include health care

providers and legislators, because if a baby is resuscitated that baby will likely require intensive

care and also drain financial resources. Funding sources could include grants or could be

included in the CDCs Safe to sleep campaign. The community health nurse would be

involved in education to new mothers of safe sleep practices as a part of the discharge plan.

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Secondary Level of Prevention

For the secondary level of prevention, it will address the systems level recipient. All

sudden infant deaths must be reported to coroners by the coroners act, 1962, and this intervention

will expand on that. This intervention will be a database categorizing the prevalence of the

different causes of Infant suffocation in bed. This will give a better reporting of the specific most

common causes of this infant suffocation in bed for each county/state. This will help to tailor

future community interventions to each countys needs. For example, one county may have high

levels of infant suffocation in bed because of bed sharing, while another county may have high

drug use levels, and intoxicated parents are causing a higher level of infant deaths. Having more

specific data on the deaths could lead to more effective and relevant education for different

populations based on their needs. Stakeholders would be legislators and researchers because their

future policies and interventions would be more effective with less wasted resources.

Tertiary Level of Prevention

The tertiary level of prevention is focused on the individual who has lost his/her baby due

to infant suffocation in bed. If this individual has other children, an investigation into the home

will need to be conducted by DCF. This will ensure that if the home or caregivers are not safe

that the other childrens safety can be protected. Secondly, any parent who loses a baby in this

way should have resources given to them for counseling, as well as support groups in their area.

There are significant links to depressive symptoms and PTSD in parents who have lost an infant

(Christiansen, 2017). More readily available treatment and support for the grief following this

event could help get parents back to their baseline functioning after a traumatic loss.

Development of Health Policy

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Health policy ensures that there is a standard level of care, and that the care provided

meets the needs of the people. It is constantly evolving and changing as the needs of a given

population change, problems are improved, and new problems arise. This proposed policy is a

method of primary prevention, and targets the community level of the intervention wheel. The

intervention is that education on safe sleep practices will be required before any patient can be

discharged after delivery of a baby at a hospital in Hillsborough County. The desired outcome is

to reduce the number of unintentional infant deaths due to suffocation in bed in Hillsborough

County to below the state average. Stakeholders affected by this new policy will be healthcare

providers, because they will need a standardized training on the education they should be giving

their patients as a part of the discharge plan. This education should be based off of the CDCs

safe to sleep program. Everyone will support this proposal because it is low cost- the only cost

would be training staff nurses on womens health floors in hospitals about the CDC safe sleep

program. No one should oppose this policy because unexpected infant suffocation in bed is a

preventable loss, and educating parents on safe sleep is all thats required to stop the number one

killer of infants under 12 months. This policy can begin in just one hospital system. After a year

review the percentage of babies born in those hospitals who have dies from suffocation in bed

and compare that data to other hospital systems in the same area. If the policy has reduced the

number of deaths then it can be expanded to other systems and hospitals. This policy will

improve health in Hillsborough county by reducing infant mortality, which is a huge predictor of

health for any given population. It will improve the health of the adult population by reducing

the cases of depression and PTSD from parents who have lost an infant to this tragedy.

Here I will delve into how this topic personally affects my future career in nursing. It is

extremely relevant to me because I have always loved babies. My whole life I have worked with

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young children, and as I have learned more and more in nursing school, I have developed a

passion for maternal and newborn health. I plan to pursue a career in labor and delivery and the

topic of unexpected infant suffocation in bed is extremely important in that regard. I bond very

quickly to the patients I get to care for on L&D, and I feel very privileged to be able to be present

and involved in such a special moment in their lives- the birth of a child. Even when there are

less happy moments in L&D it is still a privilege to be a part of such a vulnerable time of a

persons life. Education on preventing accidental suffocation of infants in bed could save the

lives of some children that I will help bring into this world. I also view it as a completely

preventable cause of death for innocent babies and there is no reason for children to die this way.

I think we can work towards a goal of completely ending infant suffocation in bed through safer

sleep practices.

Conclusion

Hillsborough County has a very large and diverse population. In Hillsborough County,

there is a higher 3-year rolling rate of infant deaths from unintentional suffocation and

strangulation in bed per 1,000 live births than that of the state of Florida overall (Florida

Department of Health: Division of Public Health statistics and Performance Management, 2015).

More effective education at discharge from having a baby could prevent this tragedy by

encouraging safe sleep practices. The CDC recommends the safe to sleep campaign and more

effective promotion of this policy could save many infant lives.

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References

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