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Background: Sleep-related infant deaths (e.g., SIDS, accidental suffocation, undetermined) are the leading cause of postneonatal mortality. Infants from low income families have higher rates of sleep-related deaths. Other risk factors for sleep-related death include nonsupine sleep position, bedsharing, maternal smoking, sleeping in separate room, soft bedding, and breastfeeding <8 weeks. Little is known about how these risk factors vary by income or if psychosocial stressors, social services, and education of parents from healthcare providers about risk factors influence these risks among low income families.

Objective: Aim 1: Describe differences in risk factors for sleep-related infant death by family income. Aim 2: Among low income families, describe differences in risk factors by psychosocial stressors, services, and risk-factor education.

Design/Methods: We analyzed 2016-2017 CDC Pregnancy Risk Assessment Monitoring Study (PRAMS) data in 47 states. PRAMS questions mothers of infants regarding infant sleep practices, smoking, income, psychosocial stressors (e.g., financial stress, domestic violence), services (e.g., WIC), and risk-factor education. The main predictor for Aim 1 was household income. For Aim 2, the main predictors were psychosocial stressors, services, and risk-factor education. Table 1 details the variables used. The main outcomes were risk & protective factors: (1) sleep position, (2) sleep surface, (3) sleep location, (4) soft objects in sleep area, (5) breastfeeding duration (<8 weeks vs ≥8 weeks), and (6) maternal smoking. We used the X2 test for bivariate analyses and multivariable logistic regression for adjusted analyses.

Results: There were 1.8 million weighted respondents. For Aim 1, mothers with low income mothers had 12x higher odds of roomsharing without bedsharing, 96% lower odds of breastfeeding ≥8 weeks and >99% lower odds of living in a smoke-free household (Tables 2 & 3). For Aim 2, domestic violence during pregnancy and certain stressors were associated with ~50% increased odds of maternal smoking (Table 4). Domestic violence also had 50% decreased odds of using a separate approved sleep surface. Receipt of education on sleep position and sleep location had 2.5x increased odds of a safe sleep position and ~30% increased odds of roomsharing without bedsharing.

Conclusion(s): To decrease income disparities in sleep-related infant deaths, interventions should support breastfeeding and smoking cessation, as well as address domestic violence and specific stressors, in low income families.

Presented at the 2021 PAS Virtual Conference



Household income, psychosocial stressors, and risk factors for sleep-related   infant deaths

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