Office of Epidemiology and Research, Division of Research

Advancing Applied MCH Research

(SDAS) MCH Research Program: Sleep-related circumstances of sudden unexpected infant deaths

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Project Number: R40 MC 17177-01
Grantee: Michigan Public Health Institute
Project Date: 2/01/2010

Final Report

(SDAS) MCH Research Program: Sleep-related circumstances of sudden unexpected infant deaths Final Report (PDF) Exit Disclaimer

Principal Investigator

Theresa Covington, MPH
Principal Investigator
2436 Woodlake Circle
Okemos, MI  48864-6002
Phone: Washington, DC 20005 517-927-1527


  • Perinatal/Infancy (0-12 months)


  • African American


Since 1999 most of the decline in sudden infant death syndrome (SIDS) rates may be explained by a shift in how these deaths are classified and reported. Sudden unexpected infant deaths (SUID) rates have increased dramatically, including those classified as accidental suffocation or strangulation in bed (ASSB), and unknown or unspecified cause, resulting in a relatively stable cumulative SUID rate. None of these cause classifications have any information on the infant sleep environment or circumstances at the time of death. Lack of sleep circumstance information hinders provision of services to families, targeted prevention efforts, and SUID systems integration approaches identified by the Maternal and Child Health Bureau as strategic priorities. Small epidemiologic studies, usually with fewer than 200 cases, have demonstrated common risk factors among SIDS deaths, but they have not been evaluated in ASSB or other deaths of unknown or unspecified cause. Other than risk factors intrinsic to the underlying health of an infant, modifiable sleep-related circumstances include factors such as sleep position, bed-sharing, sleep surfaces, and location of death (own home or away from home). Evidence on sleep-related circumstances during death for these and other risk factors have been documented in 11 states through their multidisciplinary child death review (CDR) programs that submit findings from their reviews of deaths to a web-based CDR case reporting system. This system, funded through a HRSA MCHB cooperative agreement for the National Center for Child Death Review, a project of the Michigan Public Health Institute, was developed to support program and policy prevention efforts at the local, state, and national level. Non-identifiable aggregated 2005-08 death incident data on circumstances for about 4,000 SUID cases in this system will be used in three secondary data analyses, including information obtained at the reviews from medical examiners (ME) or coroners, death scene investigations and other sources. The objectives of this research are to: 1) compare sleep-related circumstances among different cause classifications of SUID cases; 2) identify racial/ethnic differences in the sleep environment for infants who die; and 3) identify the factors needed to improve and target safe sleep and crib distribution campaigns. Both descriptive and multi-variable analysis techniques will be applied to the aggregated death circumstance data already collected and maintained on the web-based CDR case reporting system. Research relevance for infant survival through application of our findings on sleep-related circumstances in SUID cases includes: better evidence about sleep-related safety for clinical and community program counseling in the pre- and post-natal settings for women and their families; organization of services for families experiencing SUID; and public health prevention initiatives to improve the sleep environment, such as distribution of cribs to care-takers of infants in various locations (own homes, homes of babysitters, licensed child care settings, etc.).


Listed is descending order by year published.

Schnitzer PG, Covington TM, Dykstra HK. Schnitzer et al. respond. Am J Public Health. 2013 May;103(5):e2-3. doi: 10.2105/AJPH.2013.301244. Epub 2013 Mar 14. PubMed PMID: 23488518.

Somers RL. An overlooked hazard of crib design skews our perception of sudden unexpected infant deaths. Am J Public Health. 2013 May;103(5):e2. doi: 10.2105/AJPH.2012.301192. Epub 2013 Mar 14. PubMed PMID: 234885

Schnitzer PG, Covington TM, Dykstra HK. Sudden unexpected infant deaths: sleep environment and circumstances. Am J Public Health. 2012 Jun;102(6):1204-12. Epub 2012 Apr 19. PubMed PMID: 22515860.


SIDS/SUID, Sleep, Mortality, Health Disparities, Safety & Injury Prevention

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