FACTORS ASSOCIATED WITH THE TRANSITION TO NONPRONE SLEEP POSITIONS OFINFANTS IN THE UNITED-STATES - THE NATIONAL-INFANT-SLEEP-POSITION-STUDY

Context.-Studies have demonstrated strong associations between the pro ne sleep position (on the stomach) and sudden infant death syndrome (S IDS), In 1992, the American Academy of Pediatrics recommended that inf ants be placed to sleep laterally (on their side) or supine (on their back) to reduce SIDS risk, and in 1994, the national public education campaign ''Back to Sleep'' was launched.Objective.-To determine the ty pical sleep position of infants younger than 8 months in the United St ates, the changes that occurred after these recommendations, and the f actors associated with the placement of infants prone or supine.Design .-Annual nationally representative telephone surveys. Setting.-The 48 contiguous states of the United States. Participants.-Nighttime caregi vers of infants born within the last 7 months between 1992 and 1996, A pproximately 1000 interviews were conducted per year. Main Outcome Mea sures.-The position the infant was usually placed in for sleep, and th e position the infant was most commonly found in when checked during t he night's sleep. Results.-Ninety-seven percent of respondents in each wave of the survey usually placed their infant to sleep in a specific position. Infants were placed in the prone position by 70% of caregiv ers in 1992, prior to the campaign, but only 24% in 1996, Supine and l ateral placements increased during this time period, from 13% in 1992 to 35% in 1996 and from 15% in 1992 to 39% in 1996, respectively. Sign ificant predictors of prone placement included maternal race reported as black (odds ratio [OR], 2.34; 95% confidence interval [CI], 1.68-3. 26), mother's age 20 to 29 years (OR, 1.28; 95% CI, 1.09-1.50), region reported as the mid-Atlantic (OR, 1.41; 95% CI, 1.12-1.78) or souther n states (OR, 1.47; 95% CI, 1.22-1.70), mothers with a previous child (OR, 1.68; 95% CI, 1.43-1.97), and infants younger than 8 weeks (OR, 0 .63; 95% CI, 0.46-0.85), Infants aged 8 to 15 weeks were significantly more likely to be placed nonprone over time compared with the other a ge groups. Most of the risk factors for prone were significantly relat ed in the opposite direction to supine placement. Conclusions.-The pre valence of infants placed in the prone sleep position declined by 66% between 1992 and 1996, Although causality cannot be proved, SIDS rates declined approximately 38% during this period. To achieve further red uction in prone sleeping, efforts to promote the supine sleep position should be aimed at groups at high risk for prone placement.