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Trends and factors associated with infant bed sharing, 1993-2010: the National Infant Sleep Position Study
Eve R Colson1, Marian Willinger, Denis Rybin
1Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut.
Insights
Infant bed sharing increased from 1993 to 2010, particularly among Black and Hispanic populations. Physician advice significantly influences bed-sharing practices, with negative attitudes decreasing it and neutral attitudes increasing it.
Area of Science:
- Pediatrics
- Public Health
- Sleep Medicine
Background:
- Infant bed sharing is strongly linked to sudden infant death syndrome (SIDS) and unintentional sleep-related deaths.
- Trends indicate an increase in infant sleep-related deaths, highlighting the importance of safe sleep practices.
Purpose of the Study:
- To analyze trends in infant bed sharing from 1993 to 2010.
- To identify factors associated with infant bed sharing.
- To examine the impact of physician advice on bed-sharing behaviors.
Main Methods:
- Utilized data from the National Infant Sleep Position study, employing annual telephone surveys.
- Included approximately 1000 nighttime caregivers of infants per year across the contiguous United States.
- Defined infant bed sharing as a usual practice for outcome measurement.
Main Results:
- Infant bed sharing as a usual practice increased from 6.5% in 1993 to 13.5% in 2010.
- Significant increases in bed sharing were observed among Black and Hispanic populations throughout the study period.
- Factors associated with increased bed sharing included lower maternal education, minority race/ethnicity, lower household income, specific US regions, younger infant age, and premature birth.
- Physician attitudes influenced bed-sharing: negative attitudes decreased it, while neutral attitudes increased it.
Conclusions:
- The continuous rise in bed sharing among Black and Hispanic infants suggests current recommendations are not universally followed.
- Understanding the factors associated with infant bed sharing is crucial for developing effective behavioral interventions.
- Physician communication and attitudes play a significant role in parental sleep-sharing decisions.
Importance:
A strong association between infant bed sharing and sudden infant death syndrome or unintentional sleep-related death in infants has been established. Occurrences of unintentional sleep-related deaths among infants appear to be increasing.
Objectives:
To determine the trends and factors associated with infant bed sharing from 1993 through 2010, including the association of physician advice on bed sharing.
Design:
National Infant Sleep Position study conducted with annual telephone surveys.
Setting:
The 48 contiguous states.
Participants:
Nighttime caregivers of infants born within 7 months of each survey administration. Approximately 1000 interviews were completed annually.
Main Outcomes And Measures:
Infant bed sharing as a usual practice.
Results:
Of 18 986 participants, 11.2% reported an infant sharing a bed as a usual practice. Bed sharing increased from 1993 (6.5%) to 2010 (13.5%). Although bed sharing increased significantly among white respondents from 1993 to 2000 (P < .001), the increase from 2001 to 2010 was not significant (P = .48). Black and Hispanic respondents reported an increase in bed sharing throughout the study period, with no difference between the earlier and later periods (P = .63 and P = .77, respectively). After accounting for the study year, factors associated with increase in infant bed sharing as a usual practice included maternal educational level of less than high school compared with college or greater (adjusted odds ratio, 1.42 [95% CI, 1.12-1.79]); black (3.47 [2.97-4.05]), Hispanic (1.33 [1.10-1.61]), and other (2.46 [2.03-2.97]) maternal race or ethnicity compared with white race; household income of less than $20,000 (1.69 [1.44-1.99]) and $20,000 to $50,000 (1.29 [1.14-1.45]) compared with greater than $50,000; living in the West (1.61 [1.38-1.88]) or the South (1.47 [1.30-1.66]) compared with the Midwest; infants younger than 8 weeks (1.45 [1.21-1.73]) or ages 8 to 15 weeks (1.31 [1.17-1.45]) compared with 16 weeks or older; and being born prematurely compared with full-term (1.41 [1.22-1.62]). Almost 46% of the participants reported talking to a physician about bed sharing. Compared with those who did not receive advice from a physician, those who reported their physicians had a negative attitude were less likely to have the infant share a bed (adjusted odds ratio, 0.66 [95% CI, 0.53-0.82]), whereas a neutral attitude was associated with increased bed sharing (1.38 [1.05-1.80]).
Conclusions And Relevance:
Our finding of a continual increase in bed sharing throughout the study period among black and Hispanic infants suggests that the current American Academy of Pediatrics recommendation about bed sharing is not universally followed. The factors associated with infant bed sharing may be useful in evaluating the impact of a broad intervention to change behavior.
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