title: Risk factor changes for sudden infant death syndrome after initiation of Back-to-Sleep campaign.
abstract: OBJECTIVE
  To test the hypothesis that the profile of sudden infant death syndrome (SIDS) changed after the Back-to-Sleep (BTS) campaign initiation, document prevalence and patterns of multiple risks, and determine the age profile of risk factors.
  
  
  METHODS
  The San Diego SIDS/Sudden Unexplained Death in Childhood Research Project recorded risk factors for 568 SIDS deaths from 1991 to 2008 based upon standardized death scene investigations and autopsies. Risks were divided into intrinsic (eg, male gender) and extrinsic (eg, prone sleep).
  
  
  RESULTS
  Between 1991-1993 and 1996-2008, the percentage of SIDS infants found prone decreased from 84.0% to 48.5% (P < .001), bed-sharing increased from 19.2% to 37.9% (P < .001), especially among infants <2 months (29.0% vs 63.8%), prematurity rate increased from 20.0% to 29.0% (P = .05), whereas symptoms of upper respiratory tract infection decreased from 46.6% to 24.8% (P < .001). Ninety-nine percent of SIDS infants had at least 1 risk factor, 57% had at least 2 extrinsic and 1 intrinsic risk factor, and only 5% had no extrinsic risk. The average number of risks per SIDS infant did not change after initiation of the BTS campaign.
  
  
  CONCLUSIONS
  SIDS infants in the BTS era show more variation in risk factors. There was a consistently high prevalence of both intrinsic and especially extrinsic risks both before and during the Back-to-Sleep era. Risk reduction campaigns emphasizing the importance of avoiding multiple and simultaneous SIDS risks are essential to prevent SIDS, including among infants who may already be vulnerable.
authors.affiliation: New England Research Institutes, Watertown, Massachusetts, USA.
authors.forename: Felicia L
authors.initials: FL
authors.lastname: Trachtenberg
authors.forename: Elisabeth A
authors.initials: EA
authors.lastname: Haas
authors.forename: Hannah C
authors.initials: HC
authors.lastname: Kinney
authors.forename: Christina
authors.initials: C
authors.lastname: Stanley
authors.forename: Henry F
authors.initials: HF
authors.lastname: Krous
mesh_terms: D005260:Female; D006293:Health Promotion; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009035:Mothers; D015995:Prevalence; D016684:Prone Position; D012189:Retrospective Studies; D012307:Risk Factors; D012890:Sleep; D013398:Sudden Infant Death / Q000453:epidemiology* / Q000209:etiology; D014028:Tobacco Smoke Pollution / Q000009:adverse effects; D014481:United States / Q000453:epidemiology
chemical_list: D014028:Tobacco Smoke Pollution