Date of Award

December 2012

Degree Type

Dissertation

Degree Name

Doctor of Philosophy

Department

Health Sciences

First Advisor

Mary K. Madsen

Committee Members

Ron A. Cisler, Paul Florsheim, Jennifer Doering, Emmanuel Ngui

Keywords

Bed-Sharing, Co-Sleeping, Infant Sleep, Infant Sleep Position, Prams

Abstract

Since 2005, the American Academy of Pediatrics has recommended a separate but proximate sleep surface for infants (AAP, 2005). However, racial differences in the prevalence of bed-sharing and infant mortality (especially as a result of SIDS or unsafe sleep) continue. Limited research has examined predictors of bed-sharing by racial group, especially the AAP's 2005 policy statement against it. The purpose of this study was to explore maternal-infant bed-sharing and infant sleep position for African-Americans and Whites in a sample of 2,530 respondents (822 African-American and 1,708 Whites) to the Wisconsin Pregnancy Risk Assessment and Monitoring System (PRAMS), a stratified sample of linked survey and birth certificate data between 2007 and 2010. Significantly more African-Americans (70.5%) reported bed-sharing than Whites (53.5%), z = 56.67, SEM = 0.005, p < .001 (one-tailed). Factors associated with bed-sharing varied by race. In the final models, for African-Americans, a higher likelihood of bed-sharing was associated with ≥ 16 years of education (Odds Ratio[OR]: 2.540, 95% CI: 1.098-5.875), 13-15 years of education (OR: 1.924, 95% CI: 1.129-3.278), partner-related stress (OR: 1.859, 95% CI: 1.272-2.715), currently breastfeeding (OR: 1.598, 95% CI: 1.012-2.522), non-supine infant sleep (OR: 1.573, 95% CI: 1.077-2.297), and maternal age (OR: 0.963, 95% CI: 0.931-0.995). When Medicaid as method of payment was included, it reduced the likelihood of bed-sharing (OR: 0.550, 95% CI: 0.372-0.814). For Whites, bed-sharing was associated with currently breastfeeding (OR: 2.444, 95% CI: 1.939-3.081), income of $10,000-$14,999 (OR: 1.833, 95% CI: 1.004-3.344), income of $35,000-$49,999 (OR: 1.704, 95% CI: 1.234-2.351), being unmarried (OR: 1.667, 95% CI: 1.184-2.346), non-supine infant sleep (OR: 1.407, 95% CI: 1.069-1.852), and partner-related stress (OR: 1.381, 95% CI: 1.058-1.802). Needing money for food was also associated with bed-sharing (OR: 1.575, 95% CI: 1.158-2.143). Overall, subtle differences in the factors at play for African-American and White families who bed-share were demonstrated. Practice implications include culturally-relevant discussions and interventions. In-depth investigation of the family level context of bed-sharing, the ecology of infant sleep, and information received by families is suggested. These results help inform development of a targeted, culturally sensitive approach to educating families on sleep-related infant safety.

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