Infant Sleep Position: A Telephone Survey of Inner-city Parents of Color C. Merle Johnson, PhD*; Margaret M. Borkowski, MS*; Kimberly E. Hunter, MS*; Christie L. Zunker, MA*; Katherine Waskiewicz, BS*; Jason M. Evans, MD‡; Nicholas W. Hether, PhD§; and Frances A. Coletta, PhD, RD§ Abstract. Objective. To assess what positions par- ents were placing their infants to sleep and their opinion about sleep positioning. Design. A prospective telephone survey of parents of 2-month-old infants with repeated measures at 4 months that began during the second wave of the Back to Sleep campaign in 1994. Participants. African-American, Hispanic, Asian, and American Indian parents from inner cities in the north central United States. Results. Preference for prone positioning existed at both 2 and 4 months (over 40%). Twenty-four percent of parents disagreed with the recommendations of the American Academy of Pediatrics regarding supine or lateral positioning. Conclusions. Although prone sleep positioning has decreased over the past 5 years, many inner-city parents of color prefer this over supine. The Back to Sleep campaign appears effective in changing attitudes and medical personnel appear influential in promoting risk reductions associated with sudden infant death syn- drome. More efforts are clearly needed to convince par- ents who disagree with and resist recommendations. Pediatrics 1999;104:1208 –1211; sleep, infants, SIDS, African-Americans, Back to Sleep (campaign). ABBREVIATIONS. SIDS, sudden infant death syndrome; NISP, National Infant Sleep Position (study); AAP, American Acad- emy of Pediatrics. R ecommendations for infant sleep positioning have changed in the United States from back or side in 1992 to supine only in 1996. 1–6 These recommendations were developed from worldwide data demonstrating decreases in rates of sudden infant death syndrome (SIDS) when infants were placed on their backs rather than their sides or stomachs. From 1992 to 1994 we surveyed parents and found that 60% used prone positioning for their 2- and 4-month-old infants. 7 A majority of our sample preferred prone and disliked supine posi- tioning, although lateral positioning was a popular alternative. Simultaneous and subsequent research showed prone sleep positioning in the United States has steadily decreased since 1992. 1–5 Recom- mendations to avoid prone positioning were reaf- firmed in the Back to Sleep campaign in 1994 and revised to supine only in 1996. 6 More recent published data on factors related to infant sleep positioning in the United States 8 –11 found decreases in prone sleep positioning from 70% in 1992 to 24% in 1996. Rates of SIDS have shown a corresponding decrease from 1.2 per 1000 live births in 1992 to .74 in 1996. 8,11 Maternal race, age, socioeconomic status, and geographic loca- tions were some factors related to prone sleeping. African-American and low-income mothers were more likely to place their infants prone in the crib. These findings corroborate other studies 12,13 that also found decreases in the trend of prone sleeping, although African-American and low-income moth- ers were still more likely to continue to use this position. Although the Back to Sleep program 4–8 appears to have made an impact on reducing prone sleep positioning and concomitant SIDS rates, the need for further reductions as well as discovering potential impediments to prone positioning ap- pears warranted. 8 –13 During the genesis of the Back to Sleep cam- paign, we conducted another telephone survey to assess whether inner-city parents were employing recommendations for avoidance of prone sleep po- sitioning for their infants. The survey began in 1994 and continued until 1997. As in our previous study, 7 data were collected from parents of 2-month-old infants and repeated at 4 months. In addition to cohort differences, these families were primarily African-Americans living in cities which differed from the rural, largely Caucasian sample in earlier surveys. 7,14 The purpose of the study was to discover how parents of color learned about infant sleep positioning recommendations, what practices they used for positioning their infants, and what their opinions were regarding various positionings as well as sanctioned recommendations. METHODS Parents of 2-month-old infants were asked to participate in a telephone survey. The methodology, based on the total design system, 15 was approved by the university’s institutional review board and was similar to our previous studies. 7,14 First, expect- ing mothers residing in various north central cities in the United States including Detroit, St Louis, Kansas City, Grand Rapids, Saginaw, Lansing, Benton Harbor, Toledo, and Racine were recruited from databases developed by Metromail, the same marketing firm used in the National Infant Sleep Position (NISP) From the *Central Michigan University, Mount Pleasant, Michigan; ‡Medical College of Wisconsin, Milwaukee, Wisconsin; and §Gerber Products Company, Fremont, Michigan. Received for publication Mar 15, 1999; accepted Jul 21, 1999. Reprint requests to (C.M.J.) Department of Psychology, Central Michigan University, Mount Pleasant, MI 48859. E-mail: carl.johnson@cmich.edu PEDIATRICS (ISSN 0031 4005). 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