Martin B. Lahr, MD, MPH, Department of Public Health & Preventive Medicine, Oregon Health & Science University, P.O. Box 12853, Salem, OR 97309, 503-947-5117, mlahr@canby.com, Kenneth D. Rosenberg, MD, MPH, Office of Family Health, Oregon Department of Human Services, 800 NE Oregon Street, Suite 850, Portland, OR 97232, and Jodi Lapidus, PhD, Department of Public Health & Preventive Medicine, Oregon Health Sciences University, 3181 SW Sam Jackson Park Road, CB669, Portland, OR 97201-3098.

Objective. Reduction of prone infant sleep position has been the preeminent public health effort to reduce the incidence of Sudden Infant Death Syndrome (SIDS), the number one cause of postneonatal mortality.

Methods. Oregon Pregnancy Risk Assessment Monitoring System (PRAMS) surveys a stratified random sample of women after a live birth. In 1998-1999, 1867 women completed the survey (64.0% response).

Results: Prenatal care site was identified as a significant predictor of choice of prone infant sleep position. Overall, 9.2% of all women “usually” chose prone infant sleep position, while 24.2% chose side and 66.5% chose supine positioning. Women receiving prenatal care from private physicians or HMOs more often chose prone position (10.6%) than women receiving care from health department clinics (2.5%), hospital clinics (6.1%) or other types of sites (8.3%). Women receiving care from private physicians or HMOs were more likely to choose prone infant sleep position ORa 4.24 (95% CI 1.53 – 11.77) than women receiving care from health department clinics, after controlling for type of insurance at delivery, mother’s education, breast-feeding duration, parity, co-sleeping status, family income, race/ethnicity, and smoking status before pregnancy.

Conclusions: Women receiving prenatal care from private physicians or HMOs were at significantly higher risk of choosing prone infant sleep positioning. These women should be targeted for enhanced efforts to promote supine infant sleep position. Prenatal care providers at health departments seem to communicate the back-to-sleep message better than private physicians.

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