Factors associated with caregivers' choice of infant sleep position, 1994-1998 - The National Infant Sleep Position Study
Factors associated with caregivers' choice of infant sleep position, 1994-1998 - The National Infant Sleep Position Study
复制标题
DOI：
10.1001/jama.283.16.2135
复制
发表时间：
2000-04-26
影响因子：
120.7
通讯作者：
Corwin, MJ
中科院分区：
文献类型：
--
作者：
Willinger, M;Ko, CW;Corwin, MJ
背景1994年旨在减少婴儿猝死综合症的全国“恢复睡眠”运动的成功和简单提供了一个机会，可以研究哪些因素决定一种行为是否会在公共卫生干预下朝着预期的方向改变。目的研究社会人口学特征、动机和信息暴露，以确定哪些因素影响了运动实施后护理人员对婴儿睡姿的选择。设计1994年至1998年间进行的年度全国代表性电话调查。48个相邻的美国。参与者是1994年至1998年访谈前7个月内出生婴儿的夜间看护人。每年进行约1000次访谈。主要结局指标婴儿通常的睡眠姿势，从特定来源获得的睡眠姿势建议，以及报告的选择姿势的原因。结果1994 - 1998年间，白人婴儿俯卧位率从44%下降到17%，黑人婴儿俯卧位率从53%下降到32%。仰卧位在白人婴儿中从27%增加到58%，在黑人婴儿中从17%增加到31%。在此期间，来自至少一个来源的仰卧建议的报告从38%增加到79%。从1995年到1998年，86%让婴儿俯卧的看护人只收到了不俯卧的建议。82%的护理人员将婴儿舒适作为俯卧放置的原因。在多因素分析中，医生推荐的“仰卧位而非俯卧位”影响最大，并与俯卧位减少（比值比[OR]， 0.25[95%可信区间{CI}， 0.16-0.39]）和仰卧位增加（OR, 3.37 [95% CI, 2.38-4.76]）相关。所有4个来源（医生、新生儿护士、阅读材料和广播/电视）的推荐进一步增加了仰卧位的可能性（OR, 6.01 [95% CI, 4.57-7.90]）。其他与俯卧位增加和仰卧位减少独立相关的因素包括母亲为黑人，胎次大于1，居住在南部或中大西洋州。根据我们的研究，截至1998年，大约五分之一的婴儿仍然俯卧，只有一半的婴儿仰卧。在婴儿健康检查时，医生和新生儿托儿所工作人员以及印刷和广播媒体建议婴儿仰卧位，这增加了婴儿仰卧位的比例。护理人员对于俯卧睡姿的感知优势的信念应该得到解决，以进一步减少俯卧睡姿。
Context The success and simplicity of the 1994 national "Back to Sleep" campaign to reduce sudden infant death syndrome provides an opportunity to study which elements determine whether a behavior will change in the desired direction in response to a public health intervention.Objective To examine sociodemographic characteristics, motivation, and message exposure to ascertain which factors influenced a caregiver's choice of infant sleep position after implementation of the campaign.Design Annual nationally representative telephone surveys conducted between 1994 and 1998.Setting The 48 contiguous United States.Participants Nighttime caregivers of infants born within the 7 months prior to interview between 1994 and 1998. Approximately 1000 interviews were conducted each year.Main Outcome Measures The position the infant was usually placed in for sleep, sleep position recommendations received from specific sources, and reasons reported for position choice.Results Between 1994 and 1998, prone placement declined from 44% to 17% among white infants and from 53% to 32% among black infants. Supine placement increased from 27% to 58% among white infants and from 17% to 31% among black infants. During this period, reports of supine recommendations from at least 1 source doubled from 38% to 79%. From 1995 to 1998, 86% of caregivers who placed the infant prone reported receiving only nonprone recommendations. Infant comfort was given as a reason for prone placement by 82% of these caregivers. In multivariate analysis, physician recommendation of "supine not prone" had the strongest influence and was associated with decreased prone placement (odds ratio [OR], 0.25 [95% confidence interval {CI}, 0.16-0.39]) and increased supine placement (OR, 3.37 [95% CI, 2.38-4.76]). Recommendations from all 4 sources (the physician, neonatal nurse, reading materials, and radio/television) further increased the probability of supine placement (OR, 6.01 [95% CI, 4.57-7.90]). Other factors independently associated with increased prone and decreased supine placement included maternal black race, parity of more than 1, and living in a southern or mid-Atlantic state.Conclusions According to our study, as of 1998, approximately one fifth of infants were still placed prone, and only half were placed supine. Recommendations of supine placement during infancy by physicians at well-baby checks and by neonatal nursery staff and print and broadcast media have increased the proportion of infants placed supine. Caregiver beliefs regarding perceived advantages of prone sleeping should be addressed to attain further reduction in prone placement.