Date of Award

January 2019

Document Type

Open Access Thesis

Degree Name

Medical Doctor (MD)



First Advisor

Jaspreet Loyal


Some US hospitals are giving out cardboard boxes as a way to address behaviors associated with Sudden Infant Death Syndrome (SIDS). Our goal was to evaluate the cardboard box for this purpose by quantifying current practices and qualitatively assessing caregivers’ perceptions of the cardboard box. Study participants were English or Spanish-speaking caregivers of 2-16 week old infants presenting to primary care clinics in New Haven, CT. Caregivers completed a survey asking about demographic data and SIDS risk factors, such as non-supine positioning and bed-sharing. Some caregivers also participated in a semi-structured interview about the cardboard box, created used a grounded theory approach. Of 120 survey respondents, 38% of all participants and 63% of Spanish-speaking participants reported bed-sharing at least some of the time. Factors associated with bed-sharing included Spanish as the primary language (OR: 4.3 [95% CI: 1.9-9.9]). Factors associated with non-supine positioning included Hispanic ethnicity (OR: 2.6 [95% CI 1.2-5.8]), caregiver born outside the US (OR: 4.2 [95% CI: 1.8-9.6]), Spanish as the primary language (OR: 6.3 [95% CI: 2.7-14.7]), and less than high school education (OR: 3.4 [95% CI: 1.3-8.9]). Of 50 interview participants, 52% said they would use the cardboard box for their infant to sleep in compared with 48% who said they would not. The following 3 themes emerged from the data: (1) safety of the cardboard box; (2) appearance and (3) variation in planned use. In conclusion, bed-sharing rates were higher in our study population compared to the national average, highlighting the need for better resources; however, participants were divided about whether they would actually use the cardboard box, indicating it may not be a successful intervention in our community.


This is an Open Access Thesis.

Open Access

This Article is Open Access