Back to Sleep - Health Canada SIDS Social Marketing Campaign

Using carefully targeted mass media messaging strategies, Back to Sleep taught parents and other primary infant caregivers across Canada how to avoid the risk factors associated with Sudden Infant Death Syndrome (SIDS).

Background

Sudden Infant Death Syndrome (SIDS) refers to the sudden and unexpected death of an apparently healthy infant that remains unexplained even after a full investigation. In Canada, SIDS is the leading cause of death for infants over four weeks old, accounting for about one infant death out of every 1,400 live births. Although there has been a recent decrease in reported cases of SIDS in Canada, it remains a significant public health concern.

In 1998, new research indicated that to reduce the risk of SIDS an infant should be placed to sleep on his or her back. These findings updated existing information that suggested that the back or side sleeping position were safest. To reflect this new finding, Health Canadas existing social marketing strategy was re-tooled, revitalized and re-launched under the banner Back to Sleep, with a corporate partner to bolster its impact.

Setting Objectives

Overall Objective:

To reduce the risk of SIDS by 10% in Canada over the five-year period from 2000 to 2004.

Marketing Objectives:

The objectives for the Back to Sleep campaign were as follows:

• Increase awareness/knowledge of the risks of SIDS in Canada over a five-year period.
• Increase awareness/knowledge of the things that parents can do to reduce the risk of SIDS (over five-year period).
• Reduce the risk of SIDS by 10% in Canada over a five-year period.

Getting Informed

Past research has shown that parents and other caregivers have a strong propensity to adopt behaviours that are demonstrated to be in the best interests of their infants. As explained below, this information was used to determine the primary target audience for Back to Sleep (parents and other caregivers), as well as to develop the campaign strategy (mass media-based, awareness raising.)

Prior to the launch of the campaign in 2000, Health Canada had already conducted an awareness and attitude survey of 600 respondents. Based on that survey, it established benchmarks from which to evaluate the impact of the Back to Sleep campaign, as well as print templates for the campaign. The templates were brought to focus groups in three cities, for testing and input.

Delivering the Program

An awareness-raising mass-media strategy (Mass Media) was adopted because the barriers to behaviour change were low, relative to the motivation to participate (i.e. risk of babys death). The campaign, called Back to Sleep, was targeted primarily at mothers, expectant/new mothers, partners and peers aged 20 to 34, grandparents, and other caregivers. Certain campaign components also reached outside the home to target a secondary audience - people directly involved in the provision of infant health care and the dissemination infant health care information (i.e. public health units, hospitals, physicians, and pre- and post-natal educators).

Each media component was developed by Health Canada in conjunction with three NGO partners (The Canadian Foundation for the Study of Infant Deaths (CFSID), The Canadian Institute for Child Health (CICH), and The Canadian Paediatric Society (CPS)).

The Canadian Paediatric Society is a national advocacy group, which helped to add credibility to the campaigns communications. All of the materials provided clear, consistent messages about reducing the risk of SIDS, and emphasized the four precautions associated with SIDS:

• Back sleeping position
• Avoid second-hand smoke
• Avoid over-bundling the baby
• Breastfeeding can help protect against SIDS.

Implementation of the strategy also involved the use of the following media-backed message delivery tactics.

Summary of Media Tactics Used:

1. 1. Joint Statement - Reducing the Risk of Sudden Infant Death Syndrome in Canada
   Four partners (Health Canada, The Canadian Foundation for the Study of Infant Deaths, The Canadian Institute for Child Health, and the Canadian Paediatric Society), in consultation with key stakeholders, developed a national statement on reducing the risk of SIDS, in both English and French. The objective of this statement was to provide health professionals with clear, consistent messages on this important issue.

2. 2. Back to Sleep Brochure and Back to Sleep Poster
   The poster was packaged with selected Canadian parenting magazines that were bulk shipped directly to healthcare professionals, and to pre- and post-birth newsletters targeted at health professionals. The posters were also displayed in the washrooms at all 176 McDonalds restaurants in Quebec.

3. 3. Back to Sleep Promotional ad
   The one-page ad was included in a variety of magazines, including Today's Parents and Expecting. The magazines in which the ad appeared, were selected based on their reach and fit (the majority were given out free at doctor's offices/ public health units, reaching lower socio-economic segments of the population).

4. 4. Back to Sleep Television Public Service Announcement
   A 30-second PSA, describing the four precautions parents can take, was sent out to broadcasters across Canada. This was essential in targeting at-risk parents with lower literacy levels, who might have had trouble reading print materials.

5. 5. Partnership with Procter and Gamble (Pampers)
   Procter & Gambles Pampers division included the key Back to Sleep message on their two smallest sized diapers in English, French, and Spanish. They also created a promotional door-hanger, distributed the existing educational pamphlet to new mothers through the majority of hospitals in Canada, and promoted SIDS awareness through their own advertising campaigns.

6. 6. Partnership with The Canadian Foundation for the Study of Infant Deaths
   CFSID promoted the campaign through Babys Breath, a newsletter developed by CFSID that is distributed to people wishing to gain information about SIDS. CFSID included copies of the Back to Sleep promotional material with the distribution of the newsletter.

Measuring Achievements

A post-campaign tracking survey (replicating the pre-campaign benchmark survey) was conducted in the spring of 2001, to test awareness and attitude shifts and to suggest any necessary modifications to the campaign. The survey involved 605 respondents.

Results

• An increase in awareness from 44% (in 1999) to 66% (in 2001), that the proper position to place a baby during sleep is on his/her back.
• An increase in the number of professionals (from 21% to 67%) who advised putting the child to sleep on his/her back.
• Among caregivers or parents that have taken action to reduce the risk of SIDS, 69% said that they lay their babies on their backs to sleep, up from 41% in 1999.

Comparisons (From the benchmark survey conducted in 1999):

1999: 47% said side sleeping position reduces risk, 44% said back sleeping position
2001: 45% said side sleeping position reduces risk; 66% said back position reduces risk

1999: 84% were aware that secondhand smoke or smoking in household increases risks of SIDS and 82% said smoking during pregnancy increases risk
2001: 89% said secondhand smoking in the household increases risk of SIDS and 81% said smoking during pregnancy increases risk

1999: 71% had seen information on SIDS before
2001: 79% had seen info on SIDS before

1999: 94% top-of-mind awareness about SIDS
2001: 97% top-of-mind awareness about SIDS

1999: 61% of health professionals had given advice to place child on its side to sleep and 21% said put child on back
2001: 21% had advised a side position while 67% of health professionals had advised a back position for the baby to sleep

Contacts

Shelley Cotroneo
Senior Marketing Consultant, Health Canada
Jeanne Mance Building Room 1092D
Ottawa, Ontario
K1A 0K9
Ph: (613)941-5356
Fax: (613)957-1395
shelley_cotroneo@hc-sc.gc.ca

Notes

PARTNERS:

Non-Governmental Organizations:

The three non-government organizations that Health Canada partnered with include:

1. 1. The Canadian Foundation for the Study of Infant Deaths (CFSID)
   CFSID is dedicated to solving the mystery of sudden and unexpected infant deaths, and to the emotional support of those who are affected. Their goals include the promotion and support of high quality and innovative research into the causes of SIDS and its effects on families, the implementation of public education and awareness programs about issues relating to SIDS, and the provision of current and accurate information and emotional support to families who have experienced an infant death due to SIDS.

2. 2. The Canadian Institute for Child Health (CICH)
   The role of the CICH in child and family health involves working with the federal government to ensure that relevant child's family policies are developed; working with professionals and educators to equip them with the best in research and programs; and, reaching out to families to help with the crucial task of nurturing, protecting, educating, and empowering our children. The CICH vision is to give all Canadian children the best possible future by making them a top priority.

3. 3. The Canadian Paediatric Society (CPS)
   The Canadian Paediatric Society is a national advocacy association committed to the health needs of children and youth. Since 1922, the CPS has worked to advocate for the health and well-being of children and youth; promote quality health care for all Canadian children and youth; provide professional development opportunities for paediatricians; establish Canadian standards and guidelines for paediatric care and practice; and promote the interests of children and youth and their physicians. As a voluntary professional association, the CPS represents more than 2,000 paediatricians, paediatric sub?specialists, paediatric residents, and other child health care.

Private Sector Partner:

Procter & Gamble (Pampers)
The Procter and Gamble company markets over 300 products to more than five billion consumers in 140 countries. Health Canada has entered a partnership specifically with Pampers, which is a product of Proctor and Gamble. The Pampers division has included the key message Back to Sleep on the waistband of their two smallest diapers.

Last updated: July 2004. This case study was written in 2002 by Jay Kassirer.