Differential Media Reporting of Unintentional Child Deaths in Chicago, 2011–2015

In the United States, sudden unexpected infant death (SUID) is the leading classification of death in the postneonatal period.¹ In 2016, more than 3600 American infants had their death classified as a SUID.¹ SUIDs include sudden infant death syndrome (SIDS), accidental suffocation or strangulation in bed, and other ill-defined and unspecified causes of mortality among those younger than one year.²

After an initial decline in sleep-related infant deaths in the 1990s following the American Academy of Pediatrics’ policy statement and the National Institutes of Health–led Back to Sleep Campaign, efforts to keep safe sleep in the spotlight have dwindled and there has been minimal progress in decreasing infant sleep-related deaths.¹ Most SUID cases occur in unsafe sleep environments, but efforts to promote safe infant sleep behaviors (e.g., using a crib or bassinet, avoiding soft bedding, placing the infant in the supine position) have had little effect and vary substantially across families of all cultures. For instance, recent research suggests low rates of compliance with recommended safe sleep practices across the US population, but especially among Blacks, whose SUID rate is twice as high as that of non-Hispanic Whites.^2,3

According to the health belief model, people must feel threatened by their current behavioral patterns to be motivated to change behavior, and one’s environment plays a critical role.⁴ The magnitude of the perceived risk of SUID likely influences caregiver decisions regarding safe sleep behaviors, and this risk perception is at least in part influenced by learning of events, such as through media reports.^5,6 In addition, focus groups of Black mothers showed they felt that the relationship between SIDS and sleep position was implausible and that SIDS was a random phenomenon.⁷ It is not known whether the media reporting of SUID reflects the magnitude of the problem.

CASE STUDY OF CHILD DEATHS IN CHICAGO

We examined how rates of media reporting reflect the actual mortality risk for SUID in addition to two major causes of child mortality in Chicago, Illinois, between 2011 and 2015. We collected data regarding motor vehicle–related deaths (younger than 21 years), fire-related deaths (younger than 21 years), and SUIDs (younger than 12 months) that occurred in the city of Chicago from January 1, 2011, to December 31, 2015. All motor vehicle–related deaths were captured from the Fatality Analysis Reporting System and shared by the Illinois Department of Transportation. We obtained all fire-related deaths from the Office of the Illinois State Fire Marshal. We obtained all SUIDs from the Center for Health Statistics of the Illinois Department of Public Health.

The source of data for media coverage of these three mechanisms of death was Google News, which captures any media that is posted online. Search parameters included quarantining coverage to Chicago during the stated timeframe, isolating results from the six largest local media outlets, and using 25 search terms that we generated for motor vehicle–related deaths (i.e., teen crash, fatal crash, traffic death, teen driver, fatal accident, motor vehicle crash, pedestrian, bicycle, cyclist, hit-and-run), fire-related deaths (i.e., fire, inhalation, arson), and SUIDs (i.e., SIDS, SUID, crib death, cot death, suffocate, suffocation, strangle, strangulation, asphyxia, entrapment, sudden infant death, infant death). For the media case to be valid, the event must have occurred in the city of Chicago during the study window.

From 2011 to 2015 in Chicago, there were 71 motor vehicle–related and 45 fire-related deaths among young persons as well as 221 SUIDs. Non-Hispanic Black infants accounted for 77% of all SUIDs (n = 169), Hispanic infants accounted for 14% of SUIDs (n = 31), and non-Hispanic White infants accounted for 8% (n = 17). Non-Hispanic Blacks had approximately 10 times the number of SUIDs than did non-Hispanic Whites. During the study period, Chicago media covered 42 (59.2%) of the motor vehicle–related deaths, 17 (37.8%) of the fire-related deaths, and none of the SUIDs (Figure 1).

FIGURE 1—

Child Deaths and Media Reporting Rates by Mechanism: Chicago, IL, 2011–2015

Note. MV = motor vehicle.

Source. Total deaths taken from Vital Statistics (http://dph.illinois.gov).

USING THESE FINDINGS TO PROTECT OUR CHILDREN

During the investigation period, there was a complete lack of media coverage of SUIDs in Chicago, which likely diminishes the public’s perception of SUID risk and motivation to adopt safe sleep practices. This is despite the fact that SUIDs are far more common than child deaths attributable to other injury mechanisms. In fact, even though SUIDs only occur in the first year of life, SUIDs accounted for approximately twice the number of deaths of young persons between 2011 and 2015 in Chicago from motor vehicle crashes and fires combined.

This distorted representation in the media has implications for interest and motivation of parents and caregivers to follow safe sleep recommendations. Parents fear allowing their adolescents to begin driving independently, partly because the media reports on most adolescent traffic deaths. However, if parents never read a story about a SUID, their risk perception of SUIDs may be falsely low, and parents may be unknowingly endangering their infants by choosing unsafe sleep behaviors by incorrectly presuming the risk is minimal.

Work to have the media coverage of SUIDs better align with the true number of cases will require addressing hurdles as to why these tragic deaths are not routinely reported in the first place. For example, reporters and editors may be uncomfortable with, wary about, or particularly sensitive to the issue. Additionally, by the time the medical examiner or coroner declares a cause of death, the story may be old. However, failure to cover these cases may have contributed to the lack of progress toward preventing infant sleep-related deaths over the past two decades. In addition to reporting on the frequency of unsafe sleep-related deaths, the media should report on the steps caregivers can take to make the infant sleep environment safer and tailor their messaging for those at greatest risk. The public’s health would be advanced by stories that include accurate prevention messaging, discussing room sharing without bed sharing, supine positioning, breastfeeding, and avoiding soft bedding and exposure to alcohol, smoke, and drugs.

We found a far greater racial disparity among SUID cases in Chicago than the United States overall.² In Chicago, non-Hispanic Black infants have a SUID risk approximately 10 times that of non-Hispanic White infants. Nationally, the Black rate is twice that of Whites. The reasons for this exaggerated local disparity are not immediately clear. Further work is necessary to investigate the reasons behind this finding and their possible implications for prevention of SUIDs in this high-risk group.

Despite efforts to identify all media reporting, some may have been missed (e.g., media outlets with smaller reach), but there is no reason to believe that those missed would have a dramatically different distribution of reports by injury type. Although the absolute level of media coverage for these injury types may be somewhat greater than we found, the relative rates of reporting would be unlikely to change.

We found that despite SUIDs being a major contributor to mortality, SUIDs have been entirely absent in Chicago media. This void likely contributes to parents and caregivers grossly underestimating their infant’s risk of SUID. Although the unexpected death of an infant is a sensitive issue, the public would be better served by media reporting on SUID cases in which risk perception is better aligned with reality.