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Maternal Assessment of Physician Qualification to Give Advice on AAP-Recommended Infant Sleep Practices Related to SIDS

  • Lauren A. Smith
    Correspondence
    Address correspondence to Lauren A. Smith, MD, MPH, Massachusetts Department of Public Health, 250 Washington Street, 2nd Floor, Boston, Massachusetts 02108.
    Affiliations
    Department of Pediatrics, Boston University School of Medicine, Boston, Mass (Dr Smith and Dr Corwin); Department of Pediatrics, School of Medicine, Yale University, New Haven, Conn (Dr Colson and Ms Margolis); Data Coordinating Center (Mr Rybin) and Department of Epidemiology (Dr Colton and Dr Corwin), Boston University School of Public Health, Boston, Mass; Department of Pediatrics, University of Texas, Southwestern Medical Center, Dallas, Tex (Dr Lister); and Massachusetts Department of Public Health, Boston, Mass (Dr Smith)
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  • Eve R. Colson
    Affiliations
    Department of Pediatrics, Boston University School of Medicine, Boston, Mass (Dr Smith and Dr Corwin); Department of Pediatrics, School of Medicine, Yale University, New Haven, Conn (Dr Colson and Ms Margolis); Data Coordinating Center (Mr Rybin) and Department of Epidemiology (Dr Colton and Dr Corwin), Boston University School of Public Health, Boston, Mass; Department of Pediatrics, University of Texas, Southwestern Medical Center, Dallas, Tex (Dr Lister); and Massachusetts Department of Public Health, Boston, Mass (Dr Smith)
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  • Denis Rybin
    Affiliations
    Department of Pediatrics, Boston University School of Medicine, Boston, Mass (Dr Smith and Dr Corwin); Department of Pediatrics, School of Medicine, Yale University, New Haven, Conn (Dr Colson and Ms Margolis); Data Coordinating Center (Mr Rybin) and Department of Epidemiology (Dr Colton and Dr Corwin), Boston University School of Public Health, Boston, Mass; Department of Pediatrics, University of Texas, Southwestern Medical Center, Dallas, Tex (Dr Lister); and Massachusetts Department of Public Health, Boston, Mass (Dr Smith)
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  • Amy Margolis
    Affiliations
    Department of Pediatrics, Boston University School of Medicine, Boston, Mass (Dr Smith and Dr Corwin); Department of Pediatrics, School of Medicine, Yale University, New Haven, Conn (Dr Colson and Ms Margolis); Data Coordinating Center (Mr Rybin) and Department of Epidemiology (Dr Colton and Dr Corwin), Boston University School of Public Health, Boston, Mass; Department of Pediatrics, University of Texas, Southwestern Medical Center, Dallas, Tex (Dr Lister); and Massachusetts Department of Public Health, Boston, Mass (Dr Smith)
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  • Theodore Colton
    Affiliations
    Department of Pediatrics, Boston University School of Medicine, Boston, Mass (Dr Smith and Dr Corwin); Department of Pediatrics, School of Medicine, Yale University, New Haven, Conn (Dr Colson and Ms Margolis); Data Coordinating Center (Mr Rybin) and Department of Epidemiology (Dr Colton and Dr Corwin), Boston University School of Public Health, Boston, Mass; Department of Pediatrics, University of Texas, Southwestern Medical Center, Dallas, Tex (Dr Lister); and Massachusetts Department of Public Health, Boston, Mass (Dr Smith)
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  • George Lister
    Affiliations
    Department of Pediatrics, Boston University School of Medicine, Boston, Mass (Dr Smith and Dr Corwin); Department of Pediatrics, School of Medicine, Yale University, New Haven, Conn (Dr Colson and Ms Margolis); Data Coordinating Center (Mr Rybin) and Department of Epidemiology (Dr Colton and Dr Corwin), Boston University School of Public Health, Boston, Mass; Department of Pediatrics, University of Texas, Southwestern Medical Center, Dallas, Tex (Dr Lister); and Massachusetts Department of Public Health, Boston, Mass (Dr Smith)
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  • Michael J. Corwin
    Affiliations
    Department of Pediatrics, Boston University School of Medicine, Boston, Mass (Dr Smith and Dr Corwin); Department of Pediatrics, School of Medicine, Yale University, New Haven, Conn (Dr Colson and Ms Margolis); Data Coordinating Center (Mr Rybin) and Department of Epidemiology (Dr Colton and Dr Corwin), Boston University School of Public Health, Boston, Mass; Department of Pediatrics, University of Texas, Southwestern Medical Center, Dallas, Tex (Dr Lister); and Massachusetts Department of Public Health, Boston, Mass (Dr Smith)
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      Abstract

      Objective

      The American Academy of Pediatrics (AAP) strongly recommends the supine-only sleep position for infants and issued 2 more sudden infant death syndrome (SIDS) reduction recommendations: avoid bed sharing and use pacifiers during sleep. In this study, we investigated the following: 1) if mothers from at risk populations rate physicians as qualified to give advice about sleep practices and 2) if these ratings were associated with reports of recommended practice.

      Methods

      A cross-sectional survey of mothers (N=2355) of infants aged <8 months was conducted at Women, Infants, and Children (WIC) Program centers in 6 cities from 2006 to 2008. The predictor measures were maternal rating of physician qualification to give advice about 3 recommended sleep practices and reported nature of physician advice. The dependent measures were maternal report of usage of recommended behavior: 1) “infant usually placed supine for sleep,” 2) “infant usually does not share a bed with an adult during sleep,” and 3) “infant usually uses a pacifier during sleep.”

      Results

      Physician qualification ratings varied by topic: sleep position (80%), bed sharing (69%), and pacifier use (60%). High ratings of physician qualification were associated with maternal reports of recommended behavior: supine sleep (adjusted odds ratio [AOR] 2.1, 95% confidence interval [CI], 1.6–2.6); usually no bed sharing (AOR 1.5, 95% CI, 1.2–1.9), and usually use a pacifier during sleep (AOR 1.2, 95% CI, 1.0–1.5).

      Conclusions

      High maternal ratings of physician qualification to give advice on 2 of the 3 recommended sleep practices targeted to reduce the risk of SIDS were significantly associated with maternal report of using these behaviors. Lower ratings of physician qualification to give advice about these sleep practices may undermine physician effectiveness in promoting the recommended behavior.

      Keywords

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