Variability of Safe Sleep Practices Among Missouri PRAMS Participants 2016-2022.

introductionPublic health efforts have led to a decline in infant sleep-related deaths since 1990. Yet 3,700 infant sleep-related deaths occurred in the United States (U.S) in 2022, including sudden infant death syndrome (SIDS), accidental suffocation in bed, and other unknown causes. Understanding variances in maternal characteristics and the influence on infant sleep practices, may allow for the use of targeted interventions to assist in addressing preventable infant deaths.

objectiveThis study aims to identify demographic groups among mothers in the 2016–2022 Missouri PRAMS cohort, self-reported information about infant safe sleep practices and their likelihood of adherence to safe sleep guidelines.

methodsMothers who answered the infant sleep questions in the phase 8 PRAMS questionnaire were included in the sample. A scoring system was created to assess adherence to the American Academy of Pediatrics recommendations for infant safe sleep. Associations with maternal demographic characteristics and healthcare provider advice for safe sleep practice were analyzed. Multiple linear regression models were computed using the continuous safe sleep variable, including and excluding back-to-sleep provider recommendation and breastfeeding status.

resultsMost mothers (49.2%) reported always/almost always practicing infant safe sleep recommendations. Those significantly less likely to adhere included those who reported not being married (36.3%), < 20 years of age (30.3%), never breastfed (43.8%), living in a rural area (42.5%), and attaining less than a high school diploma (33.3%). Provider advice for “back to sleep” was a significant predictor for safe sleep score across regression models, along with marital status, education, and regional residence. DISCUSSION: Understanding the demographic characteristics of mothers who reported less likely practicing safe sleep habits can allow providers and public health messaging to modify their messaging for an impactful change in reducing infant mortality. It is evident from this study that widespread messaging to all mothers is essential. Results show that most mothers of infants report receiving safe sleep education, yet a significant number report not following the guidelines. Future public health efforts to promote safe sleep need to focus on incorporating ways to encourage a change in behavior by understanding perceived barriers and social norms around infant sleep practices. LIMITATIONS: Declining response rate among PRAMS participants’ unwillingness or inability to respond to the survey is a limiting factor to this study. Self-reporting information may lead to answers based on what is socially acceptable rather than the truth.