BACKGROUND: Mississippi has the highest rate of infant mortality in the nation. Although prior research indicated that infant supine sleep position has a vital role in preventing sudden infant death, little is known about its trend and associated factors in Mississippi. Our study estimated the proportion and identified characteristics associated with infant supine sleeping position using a large population-based sample.
METHODS: We analyzed Mississippi Pregnancy Risk Assessment Monitoring System (PRAMS). PRAMS is an on-going national surveillance system designed to identify and monitor maternal behaviors and experiences before, during and after pregnancy among women delivering a live birth. We assessed linear trends for infant supine sleeping position during 2003-2011 using logistic regression (n=9,131). To assess characteristics associated with infant supine sleeping position, we aggregated data from the most recent PRAMS (2009–2011) (n = 3,836). Proportions and 95% CIs for infant supine sleeping position by levels of selected characteristics were calculated, and differences were assessed using chi-square tests. In order to assess characteristics associated with infant supine sleeping position, we used multiple logistic regression. Variables were included in the multiple logistic regression model if their p-value was less than 0.20 on bivariate analysis. All analyses accounted for the complex sample design and unequal selection probabilities.
RESULTS: There was significant change overall in the linear trend for annual proportions of infant supine sleeping position from 2003 to 2011 (linear trend p<0.0001). The prevalence of infant supine sleeping position significantly increased from 46.5% in 2003 to 62.7% in 2011. For the aggregated data from 2009 to 2011, 60.2% of women placed their infant in a supine position for sleep. In unadjusted analyses, the subgroups with the highest proportion of infant supine sleeping position were white (64.8%), married (64.9%), 25-29 years of age (65.5%), those who had college education (67.8%), annual income $35,000 or more (67.1%), intended pregnancy (67.0%), and those who started prenatal care in the first trimester of their pregnancy (62.3%). Based on the multiple logistic regression, intended pregnancy (aOR= 1.5, 95% CI 1.2-1.8, reference=unintended pregnancy) and being white (aOR=1.4, 95% 1.2-1.8, reference=black) were independently associated with infant supine sleeping position.
CONCLUSIONS: The findings indicate that infant supine sleeping position rate is low and very far behind the Healthy People 2020’s target of 75.9%, highlighting a strong need to identify effective interventions to change unsafe practices and reduce disparities regrading infant sleep position in Mississippi.