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Correlates of prone infant sleeping position by period of birth
A L Ponsonby1, T Dwyer, S V Kasl
1Menzies Centre for Population Health Research, Hobart, Tasmania, Australia.
Insights
Public health interventions successfully shifted infant sleeping practices away from the prone position, reducing sudden infant death syndrome (SIDS) risks. Post-intervention, the prone sleeping position became more associated with socioeconomic and behavioral risk factors.
Area of Science:
- Public Health
- Epidemiology
- Pediatrics
Background:
- The prone sleeping position in infancy is a known risk factor for sudden infant death syndrome (SIDS).
- Public health campaigns worldwide have aimed to reduce the incidence of infants sleeping in the prone position.
Purpose of the Study:
- To investigate changes in the correlates of the prone sleeping position before and after a public health intervention.
- To determine if the risk factors associated with prone sleeping have clustered after the intervention.
Main Methods:
- Analysis of cohort data comparing two periods: before intervention (May 1988-April 1991) and after intervention (May 1991-April 1992).
- Statistical examination of factors associated with the prone sleeping position in both time periods.
Main Results:
- After the intervention, the prone sleeping position was more strongly associated with teenage motherhood, low maternal education, paternal unemployment, unmarried motherhood, non-specialist antenatal care, lack of preparation for a baby, poor smoking hygiene, and bottle feeding.
- The association between unmarried motherhood and prone sleeping shifted significantly, with an odds ratio increasing from 0.54 (before) to 1.92 (after) intervention.
- These clustered risk factors were not evident before the intervention period.
Conclusions:
- The study demonstrates that 'modifiable' risk factors for disease can become associated with each other following increased public awareness of a specific risk.
- The findings support the theoretical concept of risk factor clustering around a recognized health hazard.
- Public health interventions can alter the demographic and behavioral correlates of infant sleep position.
Abstract:
Intervention to avoid the prone sleeping position during infancy has occurred in various countries after evidence that it increases the risk of sudden infant death syndrome (SIDS). This study examined cohort data to determine if correlates of the prone position differed by period of birth, before intervention (1 May 1988 to 30 April 1991) compared with after intervention (1 May 1991 to 30 April 1992). The usual prone sleeping position was more closely associated with the following factors after intervention: teenage motherhood, low maternal education, paternal unemployment, unmarried motherhood, non-specialist antenatal care, not reading books to prepare for a baby, poor smoking hygiene, and bottle feeding. For example, the association of usual prone position with being unmarried shown by the odds ratio (95% confidence interval) was 0.54 (0.47 to 0.63) in the period before intervention and 1.92 (1.18 to 3.15) in the period after intervention. The alteration in correlates of the prone position reported here provide an example to support the theoretical concept that well known 'modifiable' risk factors for disease tend to be associated with each other in both populations and individuals. This phenomenon was not evident in the population before intervention, that is, before the prone sleeping position became a well known SIDS risk factor.