Date of Award


Document Type

Open Access Thesis

Degree Name

Medical Doctor (MD)

First Advisor

Eve Colson


Purpose: The purpose of this project was to examine the associations between maternal child-rearing experience, choice of infant sleeping position, and the source, nature and trust of advice received about infant sleeping position in a high-risk, primarily African-American population. Background: The number of deaths attributed to Sudden Infant Death Syndrome (SIDS) has decreased since the initiation of the Back to Sleep campaign in 1994. Although this change has benefited all ethnic groups, African-American infants are still twice as likely to succumb to SIDS as Caucasian infants. Design/Methods: We conducted 668 face-to-face standardized interviews with mothers of infants in Connecticut, Georgia and Texas. Mothers were included in the interviews if they were the primary caregivers for an infant younger than eight months. Mothers with children aged 10 years or older and mothers of younger children were compared with regard to the following variables: sleep position with current infant, advice received about sleep position, sources of advice and trust in advice received. Univariate analysis was used to compare the two groups of mothers. Odds ratios and 95% CI were calculated to determine relationship between sleep position and maternal characteristics such as age, race and education. Results: Mothers of older children differed from mothers with younger children in two ways. Women with children aged 10 or older were less likely to receive sleep position advice from their families than were women with younger children (12/87 or 14% versus 249/581 or 43%, p<0.0001). Of the multiparous women, mothers with older children were more likely than women with younger children to have placed a previous child in the prone position for sleep (55/87 or 63% versus 100/282 or 36%, p<0.0001). Having placed a previous child in the prone position has been found in other studies to be associated with an increased risk of placing the current infant in the prone position, and our data duplicate this finding. However, the mothers of older children in this sample were not found to use the prone position with the current infant more than mothers of younger children. Conclusions: Mothers with children born before or near the initiation of the Back to Sleep campaign have different sources of advice about sleep position than women with younger children. They are also more likely to have placed a previous child in the prone position for sleep, and so may constitute a group whose children are at increased risk of SIDS.