The Black and White of Infant Back Sleeping and Infant Bed Sharing in Florida, 2004–2005

Not using the infant back sleep position is an established risk factor for sudden unexpected infant death (SUID). Infant bed
sharing may also increase SUID risk, particularly under certain circumstances. Both of these infant sleeping behaviors are
disproportionately higher among Black mothers. We explored the relationship between not using the infant back sleeping and
infant bed sharing, developed separate risk factor profiles for these behaviors, and identified maternal characteristics contributing
to racial differences in their practice. Merged 2004–2005 birth certificate and Pregnancy Risk Assessment Monitoring System
data for 2,791 non-Hispanic Black and White Florida women were evaluated using univariable and multivariable analyses to develop
risk factor profiles for infrequent back sleeping and frequent bed sharing. Cross-product interaction terms were introduced
to identify factors contributing to racial differences. Infrequent back sleeping and frequent bed sharing were reported by
two-thirds of Black women and one-third of White women. There was no association between the infant sleeping behaviors when
adjusted for race (adjusted odds ratio [aOR], 1.04; 95% CI, 0.83–1.31). The infant sleeping behaviors shared no common independent
maternal characteristics. Father acknowledgement on the birth certificate was a strong contributor to racial differences in
infrequent back sleeping while breastfeeding, trimester of entry to prenatal care, and maternal depression revealed notable
racial differences for bed sharing. Behavior-specific and race-specific public health messages may be an important public
health strategy for reducing risky infant sleeping behaviors and decreasing SUIDs.