Statement of Purpose To pilot a protocol that evaluates the safety of an infant’s sleep environment using photographs taken with a smartphone.

Methods Participants were a convenience sample of teen mothers aged 13 to 19 years who owned a smartphone and who had an infant younger than 4 months of age. A safe sleep environment survey was administered during a postnatal home visit. During the visit, teen mothers were trained to take and submit standard photographs of their infant’s sleep environment. One month after the home visit, teen mothers were prompted via text message to send photographs of the infants’ current sleep environment. Study staff independently assessed the photographs across five domains of infant sleep safety, including sleep location, surface, position, presence of soft items, and hazards near the sleep area. The primary outcome was inter-rater reliability between coders, measured using Cohen’s Kappa coefficient (æ∼).

Results Three coders assessed photographs from nine participants. The inter-rater reliability was strong for four of the five domains assessed: sleep location Kappa (æ∼)=0.74, sleep position æ∼=1.00 and sleep surface æ∼=1.00. The inter-rater reliability for recognition of various soft items in the sleep area varied from æ∼=0.69 for loose bedding to æ∼=1.00 for pillows. Identification of other hazards near the sleep area (cords, blinds, etc) had a lower inter-rater reliability (æ∼=0.42).

Conclusions Using photographs, coders can reliably categorise some key safety aspects of infant sleep areas, but further study is needed to fully characterise sleep environments using photographs alone. Development of a detailed coder guide is planned for use in a larger study.

Significance and Contributions to Injury and Violence Prevention Science Photography has potential utility in the evaluation of injury prevention interventions as an alternative to labour intensive and intrusive home visits.