Date of Award

January 2017

Document Type

Thesis

Degree Name

Medical Doctor (MD)

Department

Medicine

First Advisor

Eve R. Colson

Abstract

DIFFERENCES IN INFANT CARE PRACTICES AND SMOKING AMONG HISPANIC MOTHERS LIVING IN THE UNITED STATES

Lauren E Provini, Michael J Corwin, Nicole L Geller, Timothy C Heeren, Rachel Y Moon, Denis V Rybin, Carrie K Shapiro-Mendoza, and Eve R Colson. Section of General Pediatrics, Department of Pediatrics, Yale University, School of Medicine, New Haven, CT.

Given that data assessing the heterogeneity of infant care practices among Hispanics are lacking, the objective of this study was to assess the association between maternal birth country and adherence to the American Academy of Pediatrics (AAP) safe sleep recommendations in a national sample of Hispanic mothers. We used a stratified, 2-stage, clustered design to obtain a nationally representative sample of mothers from 32 U.S. intrapartum hospitals. 907 completed follow-up surveys (administered 2-6 months postpartum) were received from mothers who self-identified as Hispanic/Latina, forming our sample, which we divided into 4 subpopulations by birth country (U.S., Mexico, Central/South America, and Caribbean). Prevalence estimates and aORs were determined for infant sleep position, location, breastfeeding, and maternal smoking. When compared with U.S.-born mothers, we found that: mothers born in the Caribbean (aOR 4.56, 95% CI 1.07-19.5) and Central/South America (aOR 2.68, 95% CI 1.38-5.22) were more likely to room share without bed sharing. Caribbean-born mothers were less likely to place infants to sleep supine (aOR 0.41, 95% CI 0.22-0.77). Mothers born in Mexico (aOR 1.67, 95% CI 1.03-2.72) and Central/South America (aOR 2.57, 95% CI 1.09-6.07) were more likely to exclusively breastfeed; Caribbean-born mothers (aOR 0.13, 95% CI 0.03-0.63) were less likely to do so. Foreign-born mothers were significantly less likely to smoke before and during pregnancy. In conclusion, among U.S. Hispanics, adherence to AAP safe sleep recommendations varies widely by maternal birth country. These data illustrate the importance of examining behavioral heterogeneity among ethnic groups and have potential relevance for developing targeted interventions for safe infant sleep.

Comments

This thesis is restricted to Yale network users only. This thesis is permanently embargoed from public release.

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