Lauren A. Smith

Infant bed sharing is a common practice in many countries, including the United States.^1,2 In a previous analysis of the National Infant Sleep Position Study (NISP), almost 45% of parents reported sharing a bed with their infants at least some of the time.¹ Strong associations between bed sharing and sudden infant death syndrome^3,4 or unintentional sleep-related death in infants have been established. Occurrences of unintentional sleep-related deaths appear to be increasing.⁵

Objective To determine trends and factors associated with choice of infant sleeping position. Design Annual nationally representative telephone surveys from 1993 through 2007. Setting Forty-eight contiguous states of the United States. Participants Nighttime caregivers of infants born within the last 7 months; approximately 1000 interviews were given each year. Main Outcome Measure Whether infant is usually placed supine to sleep. Results For the 15-year period, supine sleep increased (P < .001) and prone sleep decreased (P < .001) for all infants, with no significant difference in trend by race. Since 2001, a plateau has been reached for all races. Factors associated with increased supine sleep between 1993 and 2007 included time, maternal race other than African American, higher maternal educational level, not living in Southern states, first-born infant, and full-term infant. The effect of these variables was reduced when variables related to maternal concerns about infant comfort, choking, and advice from physicians were taken into account. Between 2003 and 2007, there was no significant yearly increase in supine sleep. Choice of sleep position could be explained almost entirely by caregiver concern about comfort, choking, and advice. Race no longer was a significant predictor. Conclusions Since 2001, supine sleep has reached a plateau, and there continue to be racial disparities. There have been changes in factors associated with sleep position, and maternal attitudes about issues such as comfort and choking may account for much of the racial disparity in practice. To decrease sudden infant death syndrome rates, we must ensure that public health measures reach the populations at risk and include messages that address concerns about infant comfort and choking.

OBJECTIVES. Our aims were (1) to describe rates of suboptimal control and controller medication underuse in a diverse population of children with asthma and (2) to identify potentially modifiable parental behaviors and beliefs associated with these outcomes.METHODS. We conducted telephone interviews with parents of 2- to 12-year-old children with persistent asthma, in a Medicaid plan and a large provider group. Suboptimal control was defined as ≥4 symptom days, ≥1 symptom night, or ≥4 albuterol use days in the previous 2 weeks. Controller medication underuse was defined as suboptimal control and parent report of <6 days/week of inhaled steroid use. Multivariate analyses identified factors that were independently associated with suboptimal control and controller medication underuse.RESULTS. Of the 754 study children, 280 (37%) had suboptimal asthma control; this problem was more common in Hispanic children (51%) than in black (37%) or white (32%) children. Controller medication underuse was present for 133 children (48% of those with suboptimal asthma control and 18% overall). Controller medication underuse was more common among Hispanic (44%) and black (34%) children than white (22%) children. In multivariate analyses, suboptimal control was associated with potentially modifiable factors including low parental expectations for symptom control and high levels of worry about competing household priorities. Controller medication underuse was associated with potentially modifiable factors including parental estimation of asthma control that was discordant with national guidelines and no set time to administer asthma medications.CONCLUSIONS. Deficiencies in asthma control and controller medication use are associated with potentially modifiable parental beliefs, which seem to mediate racial/ethnic and socioeconomic disparities in suboptimal control and controller medication underuse.

To assess the association of childhood asthma with parental employment and welfare receipt, which has not been studied. We analyzed cross-sectional data on 13 371 children younger than 18 from the 1997 National Health Interview Survey, a nationally representative stratified probability sample of the US noninstitutionalized population. Single-parent (n=3,907) and 2-parent families (n=9,464) were analyzed separately. Families with children younger than 6 and families with incomes below the federal poverty level (FPL) were also analyzed separately. The main outcome measures were full-time parental employment and welfare receipt. Compared to single parents of nonasthmatic children younger than 6, single parents of young children with asthma were more likely to be employed less than full time (adjusted odds ratio [OR] 2.1, 95% confidence interval [CI], 1.4-3.2). This relationship was also evident among single-parent families with incomes below FPL (adjusted OR 2.8, 95% CI, 1.2-6.5). Parental employment among 2-parent families with young children was similar regardless of child's asthma status. Two-parent families with young asthmatic children were more likely to have received welfare for at least 1 parent (adjusted OR 2.6, 95% CI, 1.5-4.6). Single-parent families of asthmatic children were also more likely to have received welfare (adjusted OR 1.4, 95% CI, 1.1-1.7). Children's asthma is associated with reduced parental employment among single parents and increased welfare receipt among single- and 2-parent families. These associations with children's asthma may have implications for policy makers interested in increasing employment and decreasing welfare