sharing when the infant was sleeping

with people other than the parents.”

The researchers also reported that

sleeping with the mother alone did not

reduce infants’ risk of SIDS, as some

researchers have concluded on the

basis of earlier studies.

The researchers noted that sleeping

on the stomach and sleeping on soft

bedding—both known to increase the

risk of SIDS independently—posed a

much greater risk for SIDS when

occurring together than might be

expected. For example, soft bedding

appeared to pose 5 times the risk of

SIDS as firm bedding; sleeping on the

stomach increased the risk of SIDS 2.4

times. Yet infants who slept stomach

down on soft bedding had 21 times

the risk of SIDS as infants who slept

on the back on firm bedding.

Of the SIDS cases, 15 were found to

have slept on a sofa the last time they

were placed to sleep. The researchers

do not know why sleeping on a sofa

would increase the risk of SIDS more

than would sleep on a bed, yet they

warn that the practice appears to be

highly dangerous.

Since the start of the NICHD-led

campaign in 1994, the SIDS rates for

African American infants and white

infants have declined by about 50 per-

cent, but a significant disparity still

remains.

Machismo AffectingMen’s Health

Poor health literacy and machis-

mo are hazards to the health of

Hispanic men, but innovative commu-

nity programs can help overcome that,

according to a report presented March

21, 2003, at the 7th annual conference

of the National Hispanic Medical

Association (NHMA).

By addressing the cultural, linguis-

tic and social barriers to good health,

Latino men can be empowered to live

healthier lives, as shown in one of

many model programs that will be dis-

cussed at the conference of leading

Hispanic health professionals.

NHMA is calling for national

health policy that would:

• Provide more research to understand

the need for integrating culture and

language in health delivery and pre-

ventive medicine

• Advocate for state and federal reim-

bursement for interpreter services in

health care

• Create a State Children’s Health

Insurance Program (SCHIP) as a

federal program and expand it to

include parents

• Expand existing programs to cover

preventive services, including oral

and mental health

• Advocate for employee-based health

insurance for migrant workers

• Support community access pro-

grams, faith-based initiatives, com-

munity health centers and safety net

providers

• Increase recruitment of Hispanic

students and faculty into the health

professions

• Increase support for the Office of

Minority Health at the Department

of Health and Human Services (HHS)

Those initiatives are based on the suc-

cess of programs such as El Circulo De

Hombres (the men’s circle) in El Paso,

TX, which tackles the widening dispro-

portionate disparities in health care for

Latino men and takes into account

societal and cultural barriers to timely

and preventive health care. For exam-

ple, diabetes accounts for 4 percent of

all deaths for Mexican American men,

versus 2.5 percent for non-Hispanic

whites. And 82 percent of Mexican

American men report sexual dysfunc-

tion, yet less than half will discuss it

with their physician because of embar-

rassment. Also, 37 percent of Hispanic

men, versus 21 percent of non-

Hispanic whites, die prematurely of

heart disease.

Many Hispanic men don’t go to the

health care provider, even when access

is not an issue, because of the machis-

mo attitude that seeking health care is

a sign of weakness. El Circulo’s pro-

gram allows men to understand their

illness and to openly discuss the stress-

es and anxieties that affect their well-

being, while respecting their culture

and without the fear of being consid-

ered weak or not macho.

Newborn Brain InjuriesDuring Childbirth

Most newborn brain injury cases

don’t occur during labor and

delivery, rather, most instances of

neonatal encephalopathy and cerebral

palsy are attributable to events occur-

ring before labor begins, according to a

joint report recently released by

experts at the American College of

Obstetricians and Gynecologists

(ACOG) and the American Academy

of Pediatrics (AAP).

The report, Neonatal

Encephalopathy and Cerebral Palsy:

Defining the Pathogenesis and

Pathophysiology, gives evidence that

the vast majority of neonatal

encephalopathy and cerebral palsy

originates from developmental or

metabolic abnormalities, autoimmune

and coagulation defects, infection,

trauma or combinations of these fac-

tors. The report has received the

endorsement of six organizations

including the National Institute of

Child Health and Human

Development of the National Institutes

of Health and the Centers for Disease

Control and Prevention.

Newborn encephalopathy and cere-

bral palsy are associated with signifi-

cant mortality rates and long-term

morbidity and have been central in the

assignment of blame in obstetric liti-

gation. However, the report confirmed

that hypoxia (or insufficient supply of

oxygen) during labor or delivery is not

a significant cause in most of the cases

of neonatal encephalopathy or cerebral

palsy, with less than one-quarter of

June | July 2003 AWHONN Lifelines 213