Running head: AN INTEGRATIVE REVIEW: SUDDEN INFANT DEATH SYNDROME

An Integrative Review: Sudden Infant Death Syndrome (SIDS) and Socioeconomic Status
LaWanda Dunn
Bon Secours Memorial College of Nursing
Nursing Research
4122

May 4, 2015

On my honor, I have neither given nor received aid on this assignment or test, other than
acknowledged, nor have I seen anyone else do so.

AN INTEGRATIVE REVIEW: SUDDEN INFANT DEATH SYNDROME

Abstract
Since the start of the Back to Sleep Campaign the literature has shown a significant
decrease in the occurrence of SIDS. While there has been a significant decrease in infant deaths
from SIDS, some populations have not seen the same decline. The goal of this integrative review
is to evaluate existing literature surrounding Sudden Infant Death Syndrome (SIDS) and
socioeconomic status (SES). The research design is an integrated review. Search for relevant
literature was conducted through the use of computer-based search engines such as PubMed, the
Nursing Reference Center, and CINHAL. The search yielded 147 results and 5 met the inclusion
criteria of the author. The results and findings showed common connections among the literature.
The main common threads were sleep position and SES, SES and race, and SES and SIDS
awareness/knowledge. Limitations include that the researcher is not an expert in this topic and is
currently in nursing school. The fact that this review was done for a class assignment along with
time constraints may not have yielded the best results for articles. Based on the findings of the
researcher, suggestions for future would be for the Back to Sleep Campaign and healthcare
providers evaluate how to reach low SES and African-Americans to decrease the disparity of
SIDS incidence.

AN INTEGRATIVE REVIEW: SUDDEN INFANT DEATH SYNDROME

An Integrative Review: Sudden Infant Death Syndrome (SIDS) and Socioeconomic Status
The purpose of this integrative review is to review existing literature linking the
occurrence of Sudden Infant Death Syndrome (SIDS) to levels of socioeconomic status. Since
the distribution of the American Academy of Pediatrics (AAP) had released their
recommendations in 1992, there has been a 50% decline in the incidence of SIDS (Moon, Oden,
Joyner, & Ajao, 2010). However despite there being an overall decline of SIDS, there seemed to
be disparities in certain populations with certain modifiable and non-modifiable risk factors.
Identifying the causative agent(s) of these disparities of SIDS incidence is of great value to
pediatric research as a whole and SIDS research. This topic is of interest to the researcher due to
the concern for medically underserved populations. Therefore the proposed PICOT question by
this researcher is: Are children born to parents of lower socioeconomic status (SES) at an
increased risk for developing SIDS when compared to infant born to parents of higher
socioeconomic status?
Search Methods & Search Outcomes
To conduct the search for literature pertinent to the PICOT question, various online
databases and search engines were used. The data bases included PubMed, Nursing Reference
Center, and CINHAL. Keywords used were socioeconomic and SIDS. The search yielded
almost two hundred articles, showing there was a wealth of literature utilizing the key words.
Inclusion criteria for selected articles incorporated articles published between 2010 and 2015,
published and written in English, and peer-reviewed research articles that were quantitative or
qualitative in nature. Articles were selected based on the relevance to the researchers PICOT
question, Are children born to parents of lower socioeconomic status at an increased risk for
developing SIDS when compared to infant born to parents of higher socioeconomic status? The

AN INTEGRATIVE REVIEW: SUDDEN INFANT DEATH SYNDROME

screening process yielded 5 articles, including 3 quantitative and 2 qualitative articles. One
obstacle found by the researcher was there were not many articles that dealt with SES and SIDS
exclusively. Consequently the researcher expanded relevant articles to be inclusive of articles
pertaining to sleep position preferences and perceptions, which is a major contribution to SIDS
incidence (Mathews, Joyner, Oden, Alamo, & Moon, 2014).
Findings & Results
The findings of the five research articles overall indicated a disparity in SIDS
occurrences among vulnerable populations, particularly African-Americans. Since there were no
articles that controlled for socioeconomic status only, conclusions were drawn in relation to other
variables with tight correlations to SIDS (or Sleep Related Infant Death- SRID) inclusive of
positioning, perceptions on positioning, and cultural responses to those perceptions. A summary
of the results of the research are presented in Table 1. The researcher organized the review into
three major themes that emerged in the articles; sleep position/habits as it relates to SES, race
and SES and SES correlation to SIDS awareness and knowledge.
Sleep Position/Habits & Socioeconomic Status
In three of the five articles there was a consensus that SES had some impact on sleep
position directly or indirectly (Mathews et al., 2014, Moon et al., 2010, Robida & Moon, 2012).
In the study done by Matthews et al. (2014), it was noted that often African-Americans and
Hispanics often share the same socioeconomic profile. This researchers study was a multimodal
study using quantitative techniques through surveys, and analyzing demographics of participants.
Additional qualitative techniques included focus groups and individual interviews to look for
reoccurring themes. The survey tool that was used was validated since it was used in previous
research. Grounded theory methodology was utilized to develop themes even further. The

AN INTEGRATIVE REVIEW: SUDDEN INFANT DEATH SYNDROME

sample group was composed of African-American and Hispanic participants from varied SES.
The sample size for African-Americans was significantly larger than the Hispanic group and
there is no mention of a power analysis being done to establish if these are is an appropriate
sample sizes. Matthews et al. (2014) found that both groups shared the same concerns when it
came to influencing factors for sleep position. The two main concerns were safety and comfort.
While the influencing factors behind sleep position were the same, the actions of AfricanAmericans and Hispanics that mirrored their concerns were very different from each other. The
researcher also noted that both groups shared issues related to limited space and financial
constraints. As previously noted, African-Americans and Hispanics often share similar SES
profiles. This is significant to the body of research since there is very limited research that
compares two ethnicities with similar profiles. Another reason this contributes to the body of
research in SIDS is that this particular study shows that SES was not a factor in the influence of
placing infants in the AAP recommended position.
A separate qualitative study looked at the beliefs and perceptions on sleep position and
SIDS in African-American mothers (Moon et al., 2010). The design of this study is qualitative
description that utilized an initial researcher administered survey as well as focus groups and
interviews. Rigor and its components (credibility, confirmability, goodness, transferability, and
dependability) were present in this study through explicit statement by the researcher or observed
through the nature and process of the study. The participants were of varied SES and were all
African-American. The findings of this study related to SES were that of the three reoccurring
themes influencing sleep habits (lack of plausibility, randomness, and vigilance), vigilance was
most common among mothers with a lower SES. This is significant to the existing body of
research because this study demonstrated that African-American mothers of lower SES from the

AN INTEGRATIVE REVIEW: SUDDEN INFANT DEATH SYNDROME

sample believed that sleep position and location (of the infant) were irrelevant as long as they
were in close proximity and closely watching the infant.
Robida & Moon (2012) did a quantitative, non-experimental correlational study that
utilized a survey tool to ask questions regarding factors influencing infant sleep position. There
was no threat to validity with instrumentation due to the fact that the survey had been used in
other studies and pilot testing was done. The sample composed of 412 African-American
participants from higher SES (n=148) and lower SES (n=264). Descriptive statistics, univariate
analysis, multivariate analysis, and chi-square tests were all methods used to analyze the data.
Results of the data showed that there was no significant difference in infant sleep positon based
on SES. Both groups were more likely to place their infants in a prone position to sleep despite
the AAP recommendations. This study adds to research on SIDS because while parents of higher
SES are more aware of what SIDS is in comparison to parents of lower SES, this does not impact
their practices. Furthermore both parents of higher SES and lower SES were able to identify
supine as the recommended sleep position, even if they did not know the rationale behind it.
Additionally the results showed that when instructed by a healthcare provider about the
recommended sleep position, parents of lower SES still thought prone was the best sleep position
for their child.
Sleep position and culture. In four of the five studies reviewed, there was a connection
or allusion to SES and culture and how that affects position placement. Matthews et al. (2014)
explored African-Americans and Hispanics to compare sleep practices since these two groups
disproportionately experience SIDS. However African-American babies are still twice more
likely to die of SIDS than Hispanic babies (Mathews et al., 2014). As previously mentioned both
groups shared the same concerns of safety and comfort that influenced the sleep position for their

AN INTEGRATIVE REVIEW: SUDDEN INFANT DEATH SYNDROME

infant. The results showed that despite concerns being the same in both groups, AfricanAmericans were more likely to place their infants in a prone position while Hispanics were more
likely to place their infants in a supine position in response to these concerns. This is significant
to the body of research regarding SIDS because this study may shed light on the racial/ethnic
disparity and how cultural norms can be protective in nature versus more harmful.
Over all there seemed to be an overwhelming body of evidence that stated that parents
and caregivers that were African-American were more likely to place their infants in a prone
position to sleep (Mathews et al., 2014, Moon et al., 2010, Robida & Moon, 2012, Zachry &
Kitzmann, 2010).
Socioeconomic Status and Race
Hogan (2014) did a quantitative study to evaluate socioeconomic factors, inclusive of
race, poverty, education level, and parity, and their impact on SIDS and sleep-related infant
deaths (SRID) in St. Louis. This author used a non experimental design, case-control study,
using observational studies and secondary analysis. To analyze data the researcher used chisquare analysis and logistic regression to look at relationships between variables and incidence
of SRID. One problem with this study is that the researcher acknowledges higher rates of SIDS
and SRID in the population studies, but in the analysis fails to separate out SIDS in from the
umbrella term SRID. The dependent variables were mothers who experienced infant death while
the independent variables were other socioeconomic factors already listed above. The researcher
did notice that of the case and control group used, 53% of the mothers who experienced SRID
were considered poor, meaning that they qualified for government programs or assistance
(Hogan, 2014). Of the 53% of poor mothers who had experienced SRID, 60% were AfricanAmerican, 35% were Caucasian, and the other 5% made were made up of undisclosed

AN INTEGRATIVE REVIEW: SUDDEN INFANT DEATH SYNDROME

minorities. The chi-square analysis done also reiterated this finding because SES and race were
found to have levels of significance. This finding within the researchers sample group reflects
previous studies done outside of St. Louis that race, particularly African-American, is correlated
to poverty and the occurrence of SRID, which is inclusive of SIDS.
Zachry & Kitzmann (2010) did a quantitative non-experimental correlational study to
investigate disparities in sleep position and compliance in an area of Tennessee where the SIDS
mortality rate is higher than the national average. The sample of 205 participants participated in
the study through the completion of a questionnaire that was made specifically for the study. No
mention of power analysis to see if the sample size was adequate was done however there is
mention of pilot testing being done of the instrument to make sure questions were clear.
Multivariate analysis was done, to look at demographic variables and predictors, along with
descriptive statistics, used to examine primary sources of information for SIDS awareness. The
study only showed income as the only predictor for knowledge of sleep recommendations.
However the researcher did note that while it was not significant in the multivariate analysis,
comparisons discovered that 95% of people of European descent and 80% of minority
responders were aware of sleep recommendations, while only 75% of African-Americans were
aware. These findings also correlated to the breakdown of race by SES. This study is relevant to
SIDS research because it demonstrates that in this particular study, there is a correlation between
SES and race.
Socioeconomic Status & SIDS Awareness/Knowledge
In the qualitative study already referenced by Zachry & Kitzmann (2010), the researchers
examined a population in Tennessee to evaluate knowledge about recommendations for sleep
position and compliance. The results of this study demonstrated that income was the only

AN INTEGRATIVE REVIEW: SUDDEN INFANT DEATH SYNDROME

significant predictor in caregivers awareness of current sleep recommendations. The lower the
income, the less caregivers were aware of the recommendation for supine sleep position. In
addition people with lower income, earning below $20,000 reported the primary source of
information for sleep position recommendations were the hospital staff, whereas people that
earned over $80,000 learned of recommendations through printed materials.
The study done by Robida & Moon (2012) assessed knowledge of African-American
parents of varied SES. Parents who were of higher SES were significantly more likely to report
that they knew what SIDS was compared to people of a lower SES. However when people of a
lower SES did report receiving the supine sleep recommendation from their health care provider,
they were more likely to still place their infant prone. The contribution to this study to the greater
body of work is that it demonstrated a negative correlation as it relates to SES and knowledge
about SIDS and sleep position recommendations.
Discussion/Implications
The finding of this integrative review address the connections between SES and factors
surrounding SIDS. These review findings are related to and support the researchers PICOT
question: Are children born to parents of lower socioeconomic status (SES) at an increased risk
for developing SIDS when compared to infant born to parents of higher socioeconomic status?
Four of the five studies took place in an urban setting in the Washington DC/ Maryland and St.
Louis (Hogan, 2014, Mathews et al., 2014, Moon et al., 2010, Robida & Moon, 2012). The other
study took place in southwest Tennessee which included urban and some rural areas (Zachry &
Kitzmann, 2010).This suggests that the results are not generalizable and that there needs to be
more studies done in different types of geographical areas with different characteristics to see if
the studies yield the same or similar results. There also were direct correlations to socioeconomic

AN INTEGRATIVE REVIEW: SUDDEN INFANT DEATH SYNDROME

10

status and race in some of these studies (Hogan, 2014, Zachry & Kitzmann, 2010). When there
was not a correlation drawn, the African-American population was the chosen ethnicity for the
sample and thus the focus of the article (Mathews et al., 2014, Moon et al., 2010, Robida &
Moon, 2012). This speaks the wide body of literature that demonstrates the disparity of SIDS in
the African-American community. Of the five articles, only one specifically looked at SES as the
main focus (Hogan, 2014) while the other studies looked at SES as one of many variables. This
reflects that there is a gap in epidemiological studies of SIDS that stratify risk factors by
ethnicity and race (Mathews et al., 2014). Based on the findings, it is worth noting that health
care providers need to do further investigation particularly with low SES patients and AfricanAmerican patients to assist with compliance in maintaining the AAP recommendations for sleep
position to reduce SIDS. Additionally it is suggested that the Back to Sleep Campaign make
more valiant efforts in targeting populations where SIDS is prevalent.
Limitations
This integrative review has several limitations recognized by the researcher. The
researcher is a current nursing student. The fact that the researcher is a nursing student promotes
time constraints in which limited the time spent on the research. The assignment was limited to 5
articles which thus limited the body of research available to the researcher. In addition the intent
behind the research was for a final assignment versus an organic spirit of inquiry. The researcher
is a novice a writing an integrative review and also has limited depth of knowledge in the subject
matter.
Conclusion
The findings of this integrative review corroborate that there is some connection between
SES, Race, Sleep positon, and SIDS awareness. Worthy findings include African-American

AN INTEGRATIVE REVIEW: SUDDEN INFANT DEATH SYNDROME

11

caregivers believing sleep position recommendations do not carry as much weight and influence
as them being vigilant caregivers. Other findings include that the execution of cultural norms my
give rise to the explanation of the SIDS disparity among certain cultures and sleep practices/
decisions to not vary a great deal within the African-American community when it comes to
SES, and lastly, knowledge of SIDS or recommendations does not necessarily dictate behavior.
Healthcare providers and initiatives such as the Back to Sleep Campaign have to evaluate these
concerns and connections to decrease the incidence of SIDS in certain populations.

AN INTEGRATIVE REVIEW: SUDDEN INFANT DEATH SYNDROME

12

References
Hogan, C. (2014, January/February). Socioeconomic factors affecting infant sleep-related deaths
in St. Louis. Public Health Nursing, 31(1), 10-18. http://dx.doi.org/10.111/phn.12052
Mathews, A., Joyner, B. L., Oden, R. P., Alamo, I., & Moon, R. Y. (2014). Comparison of infant
sleep practices in African-American and US Hispanic families: Implications for sleeprelated infant death. Journal of Immigrant and Minority Health.
http://dx.doi.org/10.1007/s10903-014-0016-9
Moon, R. Y., Oden, R. P., Joyner, B. L., & Ajao, T. I. (2010, July). Qualitative analysis of
beliefs and perceptions about Sudden Infant Death Syndrome in African-American
mothers: Implications for safe sleep recommendations. The Journal of Pediatrics, 157(1),
92-97. http://dx.doi.org/10.1016/j.jpeds.2010.01.027
Robida, D., & Moon, R. Y. (2012). Factors influencing infant sleep position: Decisions do not
differ by SES in African-American families. Arch Dis Child, 97, 900-905.
http://dx.doi.org/10.1136/archdischild-2011-301360
Zachry, A. H., & Kitzmann, K. M. (2010). Disparities in sleep position awareness and
compliance. Southern Medical Journal, 103(4), 311-315. http://dx.doi.org/0038-4348/02000/10300-0

AN INTEGRATIVE REVIEW: SUDDEN INFANT DEATH SYNDROME

First
Conceptual Design/
Author Framework Method
(Year)

None
aparent
Moon,
2010

Sample/
Setting

Major
Variables
Studied
(and their
definition)
qualitative AA
SES
description parents
determined
(QD)
w/ infants w/ parental
research
0-6 mo of education
design
age in
level,
Method:
DC, &
Medicaid
surveys,
MD, with eligibility,
15-min
wide
eligibility for
staff
range of
Special
administere SES
Supplementa
d
l Nutrition
Purposef Program for
ul
Women, &
sampling WIC
for
interview
s & focus
groups

13

Measure
ment

Data Analysis

Findings

Appraisal:
Worth to
practice

Qualitative
study
using
focus
group
interviews,
individual
in-depth
(semistructured
interviews,
to examine
parental
beliefs/
perception
s about
SIDS

Qualitative
analysis software
(NVivo 7)
*themes were
developed from
transcribed audio
& video
interviews
* additionally
findings were
confirmed via
child health
professionals, and
SIDS researchers,

* three major
themes
emerged:
lack of
plausibility,
randomness,
and vigilance
* themes
were
consistent
within all
interviews
regardless of
SES (w/ the
exception of
vigilance that
was common
in LSES)

* Addresses
skepticism of
AA parents
regarding
AAP
recommenda
tions
*addresses
need to
create buy
in from AA
parents and
the need to
address
concerns

-no
specifics
on the tool
or
questions
asked

*perceptions
cross SES
*BSC needs
plausible
link btwn
recommenda
tions & SIDS
*needs to be
consistency
w/ HCP
practices and

AN INTEGRATIVE REVIEW: SUDDEN INFANT DEATH SYNDROME

Matthew
s, 2014

None
apparent

multimod
al study
using
qualitative
&
quantitative
techniques:
Surveys,
individual
interviews,
and focus
group
interviews
*grounded
theory
methodolo
gy was
used to
develop
themes

Hispanic
(90) &
AA (422)
mothers
of infants
<6 mo
old.
Mothers
18 yo.
Live in
DC &
MD.
Recruited
from
newborn
nurseries,
urban
pediatric
centers,
private
peds
practices,

Mothers selfidentified as
AA or
Hispanic.
Wanted
varied SES
so
determined
this by
eligibility for
Medicaid,
and WIC
(b/c
verifiable).
SES
defined as
having
commercial
health
insurance &
no govt
assistance.
er SES
defined as
Medicaid or
WIC benefits

*Survey
(instrumen
t validated
because it
was used
in past
studies) &
qualitative
interviews
*outcome
measures
based on
parent
report
infant
sleep
position,
bed
sharing,
breast
feeding,
smoke
exposure
&
knowledge
of SIDS

14

*83 AA/9 Hispanic

moms participated
in qualitative
interviews
*Data (quotes)was
coded using NVio
8
* Matrix analysis
used to determine
distribution of
themes among
participants w/
certain
characteristics.

*While both
had same
concerns
(comfort and
safety), both
responded
differently
(ex. comfort
is prone in
AA but
supine in
Hispanic)
* Both AA &
Hispanic
families
shared issues
w/ lack of
space r/t
financial
constraints
and living w/
large
families.
* both said
room sharing
was
convenient
r/t vigilance
& feeding

sleep
messages
*not many
studies done
to stratify
risk factors
by race. To
researchers
knowledge,
no study has
looked @
Hispanic vs
AA families
* draws
relationship
to cultural
norms and
responses
*rationale
behind sleep
positions but
actions
different
*Cultural
norms may
be a
protective
factor.
* knowledge
of SIDS
doesnt
necessarily
mean AAP

AN INTEGRATIVE REVIEW: SUDDEN INFANT DEATH SYNDROME

15
recommenda
tion
followed

First
Conceptual Design/
Author Framework Method
(Year)

None
apparent
Zachry,
2010

Study from
2005-2006
(retrospecti
ve)
Quantitativ
e non
experiment
al
(correlatioa
l)

Sample/
Setting

Caregiver
s of 205
infants
form
birth to
24 mo
*urban
private
practice
(serving
EA
upper&
middle
class
househol
ds)
*urban
private
practice
(serving
AA of
low &
middle
income)

Major
Variables
Studied
(and their
definition)
urban &
rural
defined by
report on
infant
mortality by
TN DPT of
Health p.
312

2 urban
private & 2
rural private
practices in
SW TN.
Income and
discretion of
Drs and
practices

Measure
ment

Data Analysis

Findings

Appraisal:
Worth to
practice

*questionn
aire in the
waiting
rooms of
each clinic
(complete
d onsite or
@ hm and
returned it)
*
questionna
ire was
developed
and pilot
testing
done

* Multivariate
analysis, used to
analyze awareness
& compliance of
sleep positions
* descriptive stats
to examine
primary sources of
information &
reasons for noncompliance

*income was
the only
significant
predictor for
awareness of
positioning
recommendat
ions.
* no single
demographic
was
statistically
significant
* while not
significant
analysis by
race revealed
EA 95%
informed vs
78% AA
informed,
remaining
minority 80%
informed

* In addition
to previous
research
identifying
AA more
likely to
place
pronethis
study says
caregivers w/
lower
incomes also
at risk for
prone
sleeping
*Lower
income and
AA reported
hospital staff
as the
primary
sources of
information
for sleep

AN INTEGRATIVE REVIEW: SUDDEN INFANT DEATH SYNDROME

16

*2 rural
private
peds
clinics
serving
EA &
AA of
middle &
lower
class)

* of the
caregivers
that were
aware, 19%
were noncompliant

position
recommenda
tions
*SES and
Race
correlation
(but not
shown as
significant in
the study)

*characte
ristics of
the
populatio
n in
general
(low edu,
poverty,
black)
First
Conceptual Design/
Author Framework Method
(Year)

Hogan,
2014

No
conceptual
framework
or
theoretical
framework
mentioned

Design:
Quantitativ
e case
control,
Non
experiment
al-using

Sample/
Setting

Sample:
26,211
infants
studied
from
2005-

Major
Variables
Studied
(and their
definition)
Two groups,
ones that
died vs ones
that survived
past 1 year in
above time
frame.

Measure
ment

Data Analysis

Findings

Appraisal:
Worth to
practice

*no
instrument
of
measurem
ent was
described.
Just that

Descriptive
statistics-frequency
distributions to
ensure each
category was
represented
equally. Purpose of

*Logistical
regression:
no
significance
w/ education
& parity

*author finds
conflicting
views with
logistic
regression
only
showing

AN INTEGRATIVE REVIEW: SUDDEN INFANT DEATH SYNDROME

observation 2009 in
al studies
St. louis.
secondar
y analysis
(retrospecti
ve)

*Demograph
ic variables
studied:
Dependent
variableinfant death.
Independentmothers race,
education,
parity &
poverty

data was
gathered
from a
data base

17
descriptive
statistics is to
report what is
there.NOT TO
DRAW
CONCLUSIONS
*Logistic
regression
*Chi-square
analysis to
determine
relationships/signif
icance in the
independent
variables
*Validity &
Reliability:
historical threat
(no information
regarding historical
environmental
issues that could
have let to SRIDbed sharing) &
instrumentation
threat (no way to
verify initial
instrument used to
collect data that
researcher is
currently using)
present.

BUT
significance
w/ race w/
Caucasian
mothers less
likely to
experience
SRID
*Chi-squarerace & SES
(poor) found
significant
*mothers of
infant death
group more
likely to be
on
government
programs

significance
w/ race THIS
CONFLICT
S WITH
PAST
STUDIES,
more studies
need to be
done vs Chisquare
showed
significance
w/ race &
being poor*Race &
poverty have
a significant
relationship
in SRID

AN INTEGRATIVE REVIEW: SUDDEN INFANT DEATH SYNDROME

Conceptual
framework

Robida, None
2012
apparent

Design/me
thod

Survey of
attitudes,
knowledge
and
practice
Quantitativ
e: nonexperiment
al
correlation
al

Sample/s
etting

Major
Variables
Studied
(and their
definition
Cross
SESsectional determined
sample of by parental
412
educational
parents
attainment
w/ infants and
6mo
eligibility for
264Medicaid &
lower
WIC
SES
*HC
148provider
higher
recommenda
SES
tions of
supine
*parental
decisions on
sleep
positions
*presence of
senior
caregiver in
the home
*observation
of baby
being put
prone in
hospital

18

Measure
ment

Data analysis

findings

Appraisal:
Worth to
practice

15 min
staff
administer
ed survey
that asked
about
knowledge
, attitudes
and
practices
regarding
infant care
and sleep
environme
nt and
family
demograp
hics

Descriptive stats
for the study
group:
(frequencies, % for
categorical
variables, SD, &
means).
*Univariate &
multivariate
analysis, using x2
test to assess if
sleep position
associates w/
predictor variables.

*parents of
higher SES
more likely to
know what
SIDS is
*no
significant
difference
btwn LSES
and HSES in
identifying
supine as
recommende
d sleep
position, in
believing
prone places
baby @ risk
for dying of
SIDS, or
parents
OPINION
that supine is
the best way
for baby to
sleep
* LSES think
prone is best

* in AA
sleep
position
practice does
not differ by
SES
*HCP
recommenda
tions of
supine
sleeping
increased
knowledge
but not
increased
positive
attitudes
about supine
sleep
position
*alludes to
the need to
HCP need to
address
parental
concerns and
misconceptio
ns about

AN INTEGRATIVE REVIEW: SUDDEN INFANT DEATH SYNDROME

19
despite
knowledge of
Supine
position
through edu
w/ HCP

sleep
positions