Data to Action Success Story: Hawaii

Hawaii PRAMS Data Used to  Support  Comprehensive Safe Sleep Education

Problem Overview

In the United States, about 4,000 infants die suddenly and unexpectedly each year. The cause of these deaths is not immediately known before investigation, and after investigation the cause often remains unexplained. About half of these sudden unexpected infant deaths (SUID) are reported as SIDS (Sudden Infant Death Syndrome). SIDS is the leading cause of death among infants between the age of 1 month and 1 year, and the third leading cause of infant mortality (death among children younger than 1 year) overall in the United States.1 In Hawaii, SIDS accounts for 41% of all post-neonatal deaths.

Maintaining both a safe sleep position and a safe sleep environment can reduce the risk of SUID/SIDS. For infants up to 1 year of age, the American Academy of Pediatrics (AAP) recommends that caregivers  a) place an infant on their back for every sleep; b) use a firm sleep surface; c) sleep in the same room, but not in the same bed, as an infant sleeps; and, d) keep soft objects and loose bedding out of the sleep area.2

Program Activity Description

Healthy Mothers Healthy Babies Coalition of Hawaii (HMHB) was interested in expanding their SUID prevention program, Hawaii Cribs for Kids, to include comprehensive, family-oriented safe sleep education. Hawaii Cribs for Kids is a program for low-income, high-risk pregnant women and their families that aims to give participants information on safe sleep environments for infants, as well as a free portable crib. To better understand and quantify the need for safe sleep education in Hawaii, HMHB requested information on local infant sleep practices from  Hawaii Health Department staff who gather this information using  PRAMS (Pregnancy Risk Assessment Monitoring System). Hawaii PRAMS developed the Hawaii Safe Sleep Quick Facts publication using data from the Hawaii PRAMS 2009-2010 survey years. This publication incorporated extensive input from local perinatal stakeholders, including HMHB, and was released to the public in April 2012. In 2013, it was updated and released again to incorporate an additional year of Hawaii PRAMS data.3. The publication shows that for infants born in Hawaii in 2009-2010, approximately one-quarter (24.3%) were most often laid to sleep in high-risk sleep positions (either on their side or stomach), one third (33.9%) “always” or “often” slept in the same bed with someone else, and nearly two-thirds (65.8%) usually slept in an environment with one or more of the following risk factors: pillows, bumper pads, plush blankets, or stuffed toys; not sleeping in a crib or portable crib; and not sleeping on a firm or hard mattress.

Program Activity Outcomes

In December of 2012, HMHB included Hawaii PRAMS prevalence estimates related to infant sleep practices from the Hawaii Safe Sleep Quick Facts in a mini-grant application for the CJ Foundation for SIDS. The goal of this grant application was to secure funds to support comprehensive, family-oriented safe sleep education as part of the Hawaii Cribs for Kids program. The application was successful, and in early 2013, HMHB was awarded $5,000 to support the inclusion of comprehensive family-oriented safe sleep education into the Hawaii Cribs for Kids Program. Hawaii PRAMS data was essential to demonstrating the need for safe sleep education in Hawaii.

To monitor and evaluate the effectiveness of the ongoing Hawaii Cribs for Kids program, HMHB plans to follow up with participants when their infants turn 3 months old, and again when their infants turn 1 year old. Based on the popularity of the program, it is being expanded from its current location on the island on Oahu to also include the island of Maui in 2015.


  1. Centers for Disease Control and Prevention. Sudden Unexpected Infant Death and Sudden Infant Death Syndrome website. Accessed November 3, 2014.
  2. American Academy of Pediatrics. SIDS and Other Sleep-Related Infant Deaths: Expansion of Recommendations for a Safe Infant Sleeping Environment website. icon. Accessed February 11, 2015.
  3. Hawaii State Department of Health. Hawaii Safe Sleep Quick Facts website. pdf icon[PDF -211KB]external icon. Accessed February 11, 2015.