Maternal and Child Health Journal

, Volume 9, Issue 2, pp 165–172 | Cite as

Health Departments Do It Better: Prenatal Care Site and Prone Infant Sleep Position

  • Martin B. Lahr
  • Kenneth D. Rosenberg
  • Jodi A. Lapidus


Objectives: Reduction of prone infant sleep position has been the main public health effort to reduce the incidence of Sudden Infant Death Syndrome (SIDS). Methods: Oregon Pregnancy Risk Assessment Monitoring System (PRAMS) surveys a stratified random sample of women after a live birth. In 1998–1999, 1867 women completed the survey (64.0% unweighted response; 73.5% weighted response). Results: Overall, 9.2% of all women “usually” chose prone infant sleep position, while 24.2% chose side and 66.5% chose supine position. Women receiving care from private physicians or HMOs more often chose prone position (10.6%) than women receiving prenatal care from health department clinics (2.5%), hospital clinics (6.1%) or other sites (8.3%). Compared to health department prenatal clinic patients, private prenatal patients were more likely to choose prone infant sleep position, adjusted odds ratio = 4.78 (95% confidence interval [CI] 1.64–13.92). Conclusions: Health Department clinics have done a better job than private physicians in educating mothers about putting infants to sleep on their backs. Providers—especially private providers—should continue to stress the importance of supine sleep position for infants.


prenatal care SIDS infant sleep position infant mortality public health 


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  1. 1.
    Murphy SL. Division of Vital Statistics. Deaths: Final Data for 1998. Hyattsville, MD: National Center for Health Statistics; 2000 07/24/00. Table 28, pp. 89–91. Accessed 03/12/04.
  2. 2.
    Oregon Department of Human Services Health Services, Office of Disease Prevention and Epidemiology, Center for Health Statistics. Oregon Vital Statistics Annual Report 1998, Mortality, Fetal and Infant Mortality, Youth Suicide Attempts. Table 7–2. Accessed 03/18/04.
  3. 3.
    Sinha A. Sudden Infant Death Syndrome—United States, 1980–1988. JAMA 1992;268:856–7.CrossRefPubMedGoogle Scholar
  4. 4.
    Martin JA, Hamilton BE, Ventura SJ, et al., Division of Vital Statistics. Births: Final Data for 2001. Hyattsville, MD: National Center for Health Statistics; 2002 12/18/02. Accessed on 03/15/04.
  5. 5.
    National Center for Injury Prevention and Control, Centers for Disease Control and Prevention. WISQARS Leading Causes of Death Reports, 1999–2001. 03/15/04. Rates were calculated by dividing the number of cases in 2001—by region, after adding the individual states’ data for that region-by the number of live-born infants in the calendar year 2001, by region.
  6. 6.
    Mitchell EA, Scragg R, Stewart AW, et al. Results from the first year of the New Zealand cot death study. N Z Med J 1991;104:71–6.PubMedGoogle Scholar
  7. 7.
    Guntheroth WG, Spiers PS. Sleeping prone and the risk of Sudden Infant Death Syndrome. JAMA 1992;267:2359–62.CrossRefPubMedGoogle Scholar
  8. 8.
    Fleming PJ, Blair PS, Bacon C, et al. Environment of infants during sleep and risk of the sudden infant death syndrome: Results of 1993-5 case-control study for confidential inquiry into stillbirths and deaths in infancy. Br Med J 1996;313:191–5.Google Scholar
  9. 9.
    Taylor JA, Krieger JW, Reay DT, et al. Prone sleep position and the sudden infant death syndrome in King County, Washington: a case-control study. J Pediatr 1996;128:626–30.PubMedGoogle Scholar
  10. 10.
    Øyen N, Markestad T, Skjærven R, et al. Combined effects of sleeping position and prenatal risk factors in sudden infant death syndrome: The Nordic Epidemiological SIDS Study. Pediatrics 1997;100:613–21.CrossRefPubMedGoogle Scholar
  11. 11.
    Hauck FR, Herman SM, Donovan M, et al. Sleep environment and the risk of Sudden Infant Death Syndrome in an urban population: the Chicago Infant Mortality Study. Pediatrics 2003;111:1207–14.PubMedGoogle Scholar
  12. 12.
    Kattwinkel J, Brooks J, Myerberg D. AAP Task Force on Infant Positioning and SIDS. Positioning and SIDS. Pediatrics 1992;89:1120–6.PubMedGoogle Scholar
  13. 13.
    Kattwinkel J, Brooks J, Keenan ME, et al. AAP Task Force on Infant Positioning and SIDS. Positioning and sudden infant death syndrome (SIDS): Update. Pediatrics 1996;98:1216–8.PubMedGoogle Scholar
  14. 14.
    Centers for Disease Control and Prevention. Sudden Infant Death Syndrome—United States, 1983–1994. MMWR 1996;45(40):859–63. Accessed on 04/30/03.Google Scholar
  15. 15.
    Kochanek KD, Smith BL, Division of Vital Statistics. Deaths: Preliminary Data for 2002. Hyattsville, MD: National Center for Health Statistics; 2004 02/11/04. Table 8, pp. 30–31. Accessed on 03/12/04.
  16. 16.
    Willinger M, Ko CW, Hoffman HJ, et al. Factors associated with caregiver’s choice of infant sleep position, 1994–1998: The National Infant Sleep Position Study. JAMA 2000;283:2135–42.CrossRefPubMedGoogle Scholar
  17. 17.
    Muhuri PK, MacDorman MF, Ezzati-Rice TM. Racial differences in leading causes of infant death in the United States. Paediatr Perinat Epidemiol 2004;18:51–60.CrossRefPubMedGoogle Scholar
  18. 18.
    Willinger M, Hoffman HJ, Wu KT, et al. Factors associated with the transition to nonprone sleep positions of infants in the United States: The National Infant Sleep Position Study. JAMA1998;280:329–35.CrossRefPubMedGoogle Scholar
  19. 19.
    Pollack HA, Frohna JG. Infant sleep placement after the Back to Sleep Campaign. Pediatrics 2002;109:608–14.CrossRefPubMedGoogle Scholar
  20. 20.
    Saraiya M, Serbanescu F, Rochat R, et al. Trends and predictors of infant sleep position in Georgia, 1990–1995. Pediatrics 1998;102:1–6.PubMedGoogle Scholar
  21. 21.
    Lesko SM, Corwin MJ, Vezina RM, et al. Changes in sleep position during infancy; a prospective longitudinal assessment. JAMA 1998;280:336–40.CrossRefPubMedGoogle Scholar
  22. 22.
    Brenner RA, Simons-Morton BG, Bhaskar B, et al. Prevalence and predictors of the prone sleep position among inner-city infants. JAMA 1998;280:341–6.CrossRefPubMedGoogle Scholar
  23. 23.
    Hauck FR, Moore CM, Herman SM, et al. The contribution of prone sleeping position to the racial disparity in Sudden Infant Death Syndrome: The Chicago Infant Mortality Study. Pediatrics 2002;110:772–80.CrossRefPubMedGoogle Scholar
  24. 24.
    Gibson E, Dembofsky CA, Rubin S, et al. Infant sleep position practices 2 years into the “back to sleep” campaign. Clin Pediatr 2000;39:285–9.Google Scholar
  25. 25.
    Moon RY, Omron R. Determinants of infant sleep position in an urban population. Clin Pediatr 2002;41:569–73.Google Scholar
  26. 26.
    Rainey DY, Lawless MR. Infant positioning and SIDS. Acceptance of the nonprone position among clinic mothers. Clin Pediatr 1994;33:322–4.Google Scholar
  27. 27.
    Ray BJ, Metcalf SC, Franco SM, et al. Infant sleep position instruction and parental practice: Comparison of a private pediatric office and an inner-city clinic. Pediatrics 1997;99:e12. Accessed on 03/27/03.Google Scholar
  28. 28.
    Colson ER, Bergman DM, Shapiro E, et al. Position for newborn sleep: Associations with parents’ perceptions of their nursery experience. Birth 2001;28:249–53.CrossRefPubMedGoogle Scholar
  29. 29.
    Johnson CM, Borkowski MS, Hunter KE, et al. Infant sleep position: A telephone survey of inner-city parents of color. Pediatrics 1999;104:1208–11.PubMedGoogle Scholar
  30. 30.
    Morgan SK, Johnson CM. Infant sleep: Resident recommendations and socioeconomic status differences in patient practices. Fam Med 2001;33:614–20.PubMedGoogle Scholar
  31. 31.
    Rasinski KA, Kuby A, Bzdusek SA, et al. Effect of a Sudden Infant Death Syndrome risk reduction education program on risk factor compliance and information sources in primarily black urban communities. Pediatrics 2003;111:e347–54. Accessed on 04/11/03.Google Scholar
  32. 32.
    Oregon PRAMS First Year Report, 1998–99. Department of Human Services, Health Services, Portland, Oregon: Office of Family Health 2000: Appendix D: Weighting Scheme. Accessed on 03/22/03
  33. 33.
    Mitchell EA, Scragg R. Observations on ethnic differences in SIDS mortality in New Zealand. Early Hum Dev 1994;38:151–7.CrossRefPubMedGoogle Scholar
  34. 34.
    Greenland S. Modeling and variable selection in epidemiologic analysis. Am J Public Health 1989;79:340–9.PubMedGoogle Scholar
  35. 35.
    Kattwinkel J, Brooks JG, Keenan ME, et al. Changing concepts of sudden infant death syndrome: implications for infant sleeping environment and sleep position. Pediatrics 2000;105:650–6.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science + Business Media, Inc. 2005

Authors and Affiliations

  • Martin B. Lahr
    • 1
    • 3
  • Kenneth D. Rosenberg
    • 1
    • 2
  • Jodi A. Lapidus
    • 1
  1. 1.Department of Public Health and Preventive MedicineOregon Health and Sciences UniversityPortland
  2. 2.Office of Family HealthOregon Department of Human ServicesPortland
  3. 3.Disability Determination ServicesSalem

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