Health Sciences Program Student Theses, Dissertations and Capstones

Document Type

Dissertation - NSU Access Only

Degree Name

Doctor of Philosophy (PhD) in Health Science

Copyright Statement

All rights reserved. This publication is intended for use solely by faculty, students, and staff of Nova Southeastern University. No part of this publication may be reproduced, distributed, or transmitted in any form or by any means, now known or later developed, including but not limited to photocopying, recording, or other electronic or mechanical methods, without the prior written permission of the author or the publisher.

Department

College of Health Care Sciences – Health Science Department

First Advisor

Moya Alfonso

Date of original Performance / Presentation

January 2026

Publication Date / Copyright Date

1-1-2026

Abstract

The rate of sudden unexpected infant death (SUID) was on a downward trend in the United States. During 2020, when the COVID-19 pandemic started, the SUID rate significantly increased by 2.8 per 100,000 live births. The purpose of this dissertation study was to explore the association between modifiable (mother’s tobacco use and breastfeeding) and unmodifiable factors (infant’s gender, birth weight and gestational age; mother’s education, income, race, and access to prenatal care) among infants who died of SUID (sudden infant death syndrome, accidental suffocation and strangulation in bed, and unknown cause) between 2019 and 2020. The theoretical framework used was the social ecological model. It integrates individual, interpersonal, institutional, community, and public policy levels to understand the impact of the COVID-19 pandemic on SUID. It involved a quantitative, cross-sectional, retrospective, correlational research design to examine the relationship between variables. Data were collected from the 2020 period/2019 cohort linked birth/infant death data set, publicly available from the Centers for Disease Control and Prevention. Chi-square automatic interaction detector (CHAID) results indicated that tobacco use; underlying cause of death; birth year; death year; gestation; sex; race; and Women, Infants & Children (WIC) had statistically significant interactions. When year of death was forced to enter the CHAID model first, results were suggestive of infants who died in 2019 and whose mother was non-Hispanic Black, Hispanic, origin unknown or not stated, non-Hispanic Asian, or non-Hispanic (AIAN) were more likely to die of an unknown cause. There were no statistically significant interactions with 2020 and study variables. Subsequent pandemics may occur. Understanding its impact may prevent another rise in infant deaths.

Disciplines

Medicine and Health Sciences

Keywords

breastfeeding; COVID-19; infant mortality; sudden infant death syndrome; sudden unexpected infant death; tobacco use

Download
To access this thesis/dissertation you must have a valid nova.edu OR mynsu.nova.edu email address and create an account for NSUWorks.

Free My Thesis

If you are the author of this work and would like to grant permission to make it openly accessible to all, please click the Free My Thesis button.

  Contact Author

Share

 
COinS