Abstract â–¡ 150

Epidemiological studies have repeatedly demonstrated an association of infant prone sleeping and an increased risk of SIDS. As such, "Back to Sleep" campaigns have been become standard public health recommendations and reduction of SIDS rates has generally paralleled a reduction in prone sleep rates. Compliance to these recommendations has, unfortunately, varied, with the inevitable consequences as to SIDS incidence. We thus prospectively studied the Jerusalem population to ascertain the rate compliance of mothers to such a "Back to Sleep" program and to analyze the factors that affected compliance.

Methods: Recommendations for supine sleep position were instituted in Israel in September 1993. Base line sample data as to sleep position were obtained from 827 mothers in July 1993. Repeat cross sectional data were obtained from 549 mothers in January 1995, from 841 mothers in July 1996, and from 418 mothers in March 1998. All mothers were sampled from the population attending the Municipality of Jerusalem MCH clinics that serve 85% of the new born infants.

Results: Prior to the institution of the Back to Sleep policy 78% of the mothers placed their infant in the prone position. In 1995 this fell to 43%, in 1996 to 37% and in 1998 it rose to 42%. Conversely, the supine sleep position was utilized by 7% of mothers in 1993, rose to 37% in 1995 and 40% in 1996 and fell to 38% in 1998. Significant correlates of compliance to the supine sleep recommendation, over the entire period of the study, were hospital of birth, maternal education (i.e., lower the level the higher the degree of compliance) and birth order (i.e., the lower the parity the higher the degree of compliance) and practice with previous child. Additionally, in a given individual study year maternal age and specific MCH clinic correlated with compliance (i.e., the younger the mother the higher the compliance).

Discussion: Following initial improvement in supine sleep position rates a plateau occurred at a disappointing rate of 40%. Analysis of population noted that a major influence on subsequent infant sleep practices was the birth hospital, apparently related to the quality of the discharge information provided. Older more experience and higher educated mothers were more noncompliant to recommendations. This suggests that a major focus on this sub population with a concerted health campaign utilizing the public media is necessary to overcome the traditional reluctance of individuals to change longstanding habits of childcare.