Background Interventions to prevent sudden unexpected infant death (SUID) typically include education to increase knowledge, thereby improving parenting practice. However, health decision-making is based on a complex interplay of knowledge, attitudes, and beliefs related to intent to initiate behaviors. Further, based on the Health Belief Model, self-efficacy and locus of control are also linked to behavior change. Objective: This study examined the link between pregnant teens’ report on several safe sleep constructs thought to influence parent’s safe sleep behaviors and prenatal knowledge of safe sleep practices.

Design/methods We recruited pregnant teens (13–19 years old) into a trial of an educational intervention for safe sleep during second trimester in a US state with high sleep-related SUID rates. A self-administered survey was completed before intervention. The survey included safe sleep constructs: attitudes (3 items), beliefs (4), self-efficacy (3), intentions (4), knowledge (3), and a standardized measure of knowledge of infant development (KIDI).

Results 115 subjects completed baseline surveys, including 27 white (20%), 103 black (76%), and 5 other (4%) teens with median age 18 y±2. In regression analyses, the KIDI predicted safe sleep knowledge (R²=0.05, F(1, 112)=6.24, p<0.014). Controlling for KIDI, we regressed safe sleep factors on safe sleep knowledge (R²=0.26, F(1, 108)=7.41, p<0.000). Safe sleep knowledge was significantly correlated (p<0.01) with attitudes (r=0.28), intent to act (r=0.30), and safe sleep self-efficacy (r=0.37).

Conclusions The prenatal period presents an important opportunity for educational intervention, as women develop knowledge and form beliefs that may shape early parenting behavior. The link between key safe sleep-related constructs may inform interventions before the birth. Our results suggest that safe sleep knowledge is associated with both key beliefs and with knowledge of general infant development. Interventions that target these beliefs may be more successful.