0881 Maternal Homelessness and Infant Safe Sleep in California: Trends and Inequities from the MIHA Survey, 2013–2021

Abstract Introduction Safe infant sleep practices reduce sleep-related deaths, yet disparities persist across demographic and socioeconomic groups. Maternal homelessness is a compounding risk. We examined trends and disparities in California using Maternal and Infant Health Assessment (MIHA) data from 2013 to 2021. Methods We calculated weighted prevalences with 95% confidence intervals (CIs) overall and by subgroups defined by race/ethnicity, maternal age, education, household income, and neighborhood poverty level. For each outcome- maternal homelessness, infant bedsharing, and back-to-sleep placement- we used binary logistic regression models that included the subgroup domain and time period to assess associations and temporal trends. Results Statewide, homelessness remained 3% across periods (2013–2015: 3.0%, 95% CI 2.6–3.4; 2016–2018: 3.4%, 3.1–3.7; 2019–2021: 3.4%, 3.1–3.7). Bedsharing declined from 34.6% (33.3–35.9) to 28.9% (28.0–29.7), while back-to-sleep rose from 80.3% (79.2–81.4) to 86.0% (85.3–86.7). In race/ethnicity domain models for bedsharing, odds in 2013–2015 were substantially higher in American Indian/Alaska Native OR 2.74 (95% CI 2.35–3.20), Black OR 2.99 (2.86–3.12), Asian/Pacific Islander OR 2.25 (2.18–2.33), and Hispanic OR 1.78 (1.73–1.83). Homelessness odds were lower in older groups: 20–34 y OR 0.42 (95% CI 0.33–0.54) and ≥35 y OR 0.25 (0.18–0.36). Bedsharing was less likely in older mothers (20–34 y OR 0.73, 0.69–0.78; ≥35 y OR 0.69, 0.65–0.74), whereas back-to-sleep was more likely (20–34 y OR 1.90, 1.81–1.99; ≥35 y OR 2.24, 2.13–2.35). Conclusion Conclusions: From 2013 to 2021, California showed improvement in safe sleep practices with reductions in bedsharing and increased adherence to back-to-sleep recommendations. However, pronounced disparities persisted across racial/ethnic groups and age-related categories. These inequities underscore the need for targeted, culturally responsive strategies to address the preventable burden of sleep-related infant deaths in California and similar settings. Support (if any)