media release refuting expert testimony in one uk case, in which the conviction was subsequently overturned. prevention a number of measures have been found to be effective in preventing sids, including changing the sleeping position to supine, breastfeeding, limiting soft bedding, immunizing the infant and using pacifiers. the use of electronic monitors has not been found to be useful as a preventative strategy. the effect that fans might have on the risk of sids has not been studied well enough to make any recommendation about them. evidence regarding swaddling is unclear regarding sids. a 2016 review found tentative evidence that swaddling increases the risk of sids, especially among babies placed on their bellies or sides while sleeping. measures not shown to be useful include positioning devices and baby monitors. in the united states, companies that sell the monitors do not have fda approval for them as medical devices. sleep positioning sids rate from 1988 to 2006 (u.s.) sleeping on the back has been found to reduce the risk of sids. it is thus recommended by the american academy of pediatrics and promoted as a best practice by the us national institute of child health and human development (nichd) "safe to sleep" campaign. the incidence of sids has fallen in a number of countries in which this recommendation has been widely adopted. sleeping on the back does not appear to increase the risk of choking, even in those with gastroesophageal reflux disease. while infants in this position may sleep more lightly, this is not harmful. sharing the same room as the parents but in a different bed may decrease the sids risk by half. pacifiers the use of pacifiers appears to decrease the risk of sids, although the reason is unclear. the american academy of pediatrics considers pacifier use to prevent sids to be reasonable. pacifiers do not appear to affect breastfeeding in the first four months, even though this is a common misconception. bedding product safety experts advise against using pillows, overly soft mattresses, sleep positioners, bumper pads (crib bumpers), stuffed animals, or fluffy bedding in the crib, and recommend instead dressing the child warmly and keeping the crib "naked." blankets or other clothing should not be placed over a baby's head. the use of a "baby sleep bag" or "sleep sack", a soft bag with holes for the baby's arms and head can be used as a type of bedding that warms the baby without covering its head. vaccination infants typically receive several vaccinations between the ages of 2 and 4 months, which is also the peak age for sids. due to this coincidence, a number of studies have investigated the possible role of vaccinations as a cause of sids. these have found either no relation between vaccinations and sids, or a reduction of the risk of sids following vaccination. a 2007 meta-analysis found that vaccinations were associated with a halving of the risk of sids, and argued that immunisation should be a part of sids prevention campaigns. epidemiology arcutio, a device designed to prevent infant death by suffocation, philosophical transactions 422 (1732) globally, sids resulted in about 22,000 deaths as of 2010, down from 30,000 deaths in 1990. rates vary significantly by population from 0.05 per 1000 in hong kong to 6.7 per 1000 in native americans. sids was responsible for 0.54 deaths per 1,000 live births in the us in 2005. it is responsible for far fewer deaths than congenital disorders and disorders related to short gestation, though it is the leading cause of death in healthy infants after one month of age. sids deaths in the us decreased from 4,895 in 1992 to 2,247 in 2004, a 54% decrease. during a similar time period, 1989 to 2004, sids as the cause of death for sudden infant death (sid) decreased from 80% to 55%, a 31% decrease. according to john kattwinkel, chairman of the centers for disease control and prevention (cdc) special task force on sids "a lot of us are concerned that the rate (of sids) isn't decreasing significantly, but that a lot of it is just code shifting". race rates of sids by race/ethnicity in the u.s., 2009, cdc, 2013 in 2013, there were persistent disparities in sids deaths among racial and ethnic groups in the u.s. in 2009, the rates of death range from 20.3 per 100,000 live births for asian/pacific islander to 119.2 per 100,000 live births for native americans/alaska native. african american infants have a 24% greater risk of having a sids-related death, compared to the u.s. population as a whole, and experience a 2.5 greater incidence of sids than in caucasian infants. rates are calculated per 100,000 live births to enable more accurate comparison across groups of different total population size. research suggests that factors which contribute more directly to sids risk—maternal age, exposure to smoking, safe sleep practices, etc.—vary by racial and ethnic group and therefore risk exposure also varies by these groups. risk factors associated with prone sleeping patterns of african american families include mother's age, household poverty index, rural/urban status of residence, and infant's age. more than 50% of african american infants were placed in non-recommended sleeping positions, according to a 2012 study completed in south carolina, indicating that cultural factors can be protective as well as problematic. the rate of sids per 1000 births varies among ethnic groups in the united states: central americans and south americans: 0.20 asian/pacific islanders: 0.28 mexicans: 0.24 puerto ricans: 0.53 whites: 0.51 african americans: 1.08 native american: 1.24 society and culture the rate of sids varies vastly among different cultures and countries around the world, with sids rates lowest among asian and pacific islander infants. some evidence supports the hypothesis that sids is not an ancient phenomenon and that it appears more commonly in western societies. much of the popular media portrayals of infants shows them in non-recommended sleeping positions.