Trends and Predictors of Infant Sleep Positions in Georgia, 1990 to 1995

Abstract

Background. In recent years, the prone sleeping position has emerged as the strongest modifiable risk factor for sudden infant death syndrome, the leading cause of infant mortality between 1 month and 1 year of age in the United States. Since April 1992, sudden infant death syndrome risk-reduction strategies have included the promotion of the back or side sleeping position (nonprone) for healthy infants younger than 1 year of age. Most recently, the back position has been advocated as the best sleeping position and the side position as an alternative. Methods. To evaluate trends in prevalence of the prone position from 1990 to 1995, we used data available from the Georgia Women's Health Survey, a random digit-dialed telephone survey of 3130 women 15 to 44 years of age. We examined the position in which women put their infant to sleep in the first 2 months of life for their most recent live birth (N = 868) and determined independent predictors of prone sleep position among women who consistently used the prone or the back/side position (n = 636) using multiple logistic regression. Results. The prevalence of mothers who put their infant to sleep in the prone position significantly decreased, from 49% in 1990 to 15% in 1995. This decrease is primarily attributable to a major shift to the side position rather than to the back. Using multiple logistic regression, we found the prone sleeping position to be significantly higher among women who entered prenatal care after the first trimester (odds ratio [OR], 3.6; 95% confidence interval [CI], 1.4–9.2), were black (OR, 2.1; 95% CI, 1.4–3.1), had less than a high school education (OR, 2.2; 95% CI, 1.4–3.4), and were living in rural Georgia (OR, 1.9; 95% CI, 1.3–2.7). For the period after April 1992, women who had previous children were 2.6 (OR, 95% CI, 1.7–4.1) times more likely to use the prone sleep position than were first-time mothers. Conclusions. The prevalence of the use of the prone sleep position for infants decreased significantly over the study period. This decrease coincided with national efforts to promote the back or side sleeping position. Increased efforts should target groups who are more likely to use the prone position to attain the national goal of ≤10% of prone position prevalence by the year 2000, with emphasis on placing the infant on the back.