Factors associated with caregivers' choice of infant sleep position, 1994-1998 - The National Infant Sleep Position Study

Context The success and simplicity of the 1994 national "Back to Sleep" cam paign to reduce sudden infant death syndrome provides an opportunity to stu dy which elements determine whether a behavior will change in the desired d irection in response to a public health intervention. Objective To examine sociodemographic characteristics, motivation, and mess age exposure to ascertain which factors influenced a caregiver's choice of infant sleep position after implementation of the campaign. Design Annual nationally representative telephone surveys conducted between 1994 and 1998. Setting The 48 contiguous United States. Participants Nighttime caregivers of infants born within the 7 months prior to interview between 1994 and 1998. Approximately 1000 interviews were con ducted each year. Main Outcome Measures The position the infant was usually placed in for sle ep, sleep position recommendations received from specific sources, and reas ons reported for position choice. Results Between 1994 and 1998, prone placement declined from 44% to 17% amo ng white infants and from 53% to 32% among black infants. Supine placement increased from 27% to 58% among white infants and from 17% to 31% among bla ck infants. During this period, reports of supine recommendations from at l east 1 source doubled from 38% to 79%. From 1995 to 1998, 86% of caregivers who placed the infant prone reported receiving only nonprone recommendatio ns. Infant comfort was given as a reason for prone placement by 82% of thes e caregivers. In multivariate analysis, physician recommendation of "supine not prone" had the strongest influence and was associated with decreased p rone placement (odds ratio [OR], 0.25 [95% confidence interval {CI}, 0.16-0 .39]) and increased supine placement (OR, 3.37 [95% CI, 2.38-4.76]). Recomm endations from all 4 sources (the physician, neonatal nurse, reading materi als, and radio/television) further increased the probability of supine plac ement (OR, 6.01 [95% CI, 4.57-7.90]). Other factors independently associate d with increased prone and decreased supine placement included maternal bla ck race, parity of more than 1, and living in a southern or mid-Atlantic st ate. Conclusions According to our study, as of 1998, approximately one fifth of infants were still placed prone, and only half were placed supine. Recommen dations of supine placement during infancy by physicians at well-baby check s and by neonatal nursery staff and print and broadcast media have increase d the proportion of infants placed supine. Caregiver beliefs regarding perc eived advantages of prone sleeping should be addressed to attain further re duction in prone placement.