Vital Signs

Trends and Disparities in Infant Safe Sleep Practices — United States, 2009–2015

Jennifer M. Bombard, MSPH; Katherine Kortsmit, PhD; Lee Warner, PhD; Carrie K. Shapiro-Mendoza, PhD; Shanna Cox, MSPH; Charlan D. Kroelinger, PhD; Sharyn E. Parks, PhD; Deborah L. Dee, PhD; Denise V. D'Angelo, MPH; Ruben A. Smith, PhD; Kim Burley; Brian Morrow, MA; Christine K. Olson, MD; Holly B. Shulman, MA; Leslie Harrison, MPH; Carri Cottengim, MA; Wanda D. Barfield, MD

Disclosures

Morbidity and Mortality Weekly Report. 2018;67(1):39-46. 

In This Article

Results

In 2015, the overall prevalence of nonsupine sleep positioning was 21.6%, ranging from 12.2% in Wisconsin to 33.8% in Louisiana (Table 1). Nonsupine sleep positioning varied by maternal characteristics, and was highest among respondents who were non-Hispanic blacks. Nonsupine sleep positioning prevalence was higher among respondents aged <25 years compared with ≥25 years and those who had completed ≤12 years compared with >12 years of education, and who were WIC participants. Among the 15 states examined during 2009–2015, nonsupine sleep positioning decreased significantly from 27.2% in 2009 to 19.4% in 2015 overall (p<0.001) (Supplementary Table https://stacks.cdc.gov/view/cdc/50001) and in 13 of 15 states (except for Maryland and Washington). Nonsupine sleep positioning decreased significantly among all age, education, WIC participation and most race/ethnicity groups except among respondents who were American Indians/Alaska Natives (Figure).§§

Figure.

Trends in prevalence of nonsupine (on side or stomach) sleep positioning of infants, by mother's race/ethnicity — 15 states,* Pregnancy Risk Assessment Monitoring System, 2009–2015
*Delaware, Hawaii, Illinois, Maryland, Massachusetts, Missouri, Nebraska, New Jersey, Oklahoma, Pennsylvania, Utah, Vermont, Washington, West Virginia and Wyoming.

In 2015, more than half (61.4%) of respondents reported any bed sharing with their infant, with 37.0% reporting "rarely or sometimes" and 24.4% responding "often or always" bed sharing (Table 2). Self-report of any bed sharing varied by state, ranging from 49.0% in West Virginia to 78.9% in Alaska. The prevalence of bed sharing varied by maternal characteristics, gestational age at birth, and breastfeeding at 8 weeks postpartum. Bed sharing prevalence was higher among respondents who were American Indians/Alaska Natives, non-Hispanic blacks, or Asians/Pacific Islanders compared with non-Hispanic whites or Hispanics, aged <25 years compared with ≥25 years, who had completed ≤12 years compared with >12 years of education, who were WIC participants, and who reported any breastfeeding at 8 weeks postpartum (Table 2).

Use of at least one type of soft bedding was reported by 38.5% of respondents, ranging from 28.7% in Illinois to 52.6% in New York City (Table 3). The most frequently reported types of soft bedding were bumper pads (19.1%) and plush or thick blankets (17.5%), followed by pillows (7.1%), infant positioners (6.2%), and stuffed toys (3.1%). Use of at least one type of soft bedding varied by maternal characteristics and breastfeeding at 8 weeks postpartum. The prevalence of soft bedding use was higher among respondents who were Asians/Pacific Islanders or Hispanics compared with members of other race/ethnicity groups, aged <25 years compared with ≥25 years, who had completed ≤12 compared with >12 years of education, who were WIC participants, and who were not breastfeeding at 8 weeks postpartum (Table 3).

§§Alaska Native information available for Alaska only.

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