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Gina Lowell, MD, MPH
Rojin Ahadi, MPH
Sumihiro Suzuki, PhD
Felicia Clark, D-ABMDI
Christie Lawrence, DNP, RNC-NIC, APN/CNS
Meredith Reynolds, MD
Kyran Quinlan, MD, MPH

Sudden Unexpected Infant Death occurs about once a week in Cook County, Illinois, the second largest county in the United States, where SUID disproportionately affects families from high hardship communities. Factors like prematurity, prenatal smoking, and unsafe sleep environments are known risk factors for SUID. The Cook County SUID Case Registry team reviews each SUID following monthly Child Death Review meetings and these data are analyzed annually to identify possible prevention insights.

Cook County SUID Case Registry data from 2019-2023 were analyzed for descriptive characteristics including infant age, race, ethnicity, gestational age, maternal age, prenatal/household smoke exposure, and sleep environment hazards. Case reviews (including narrative review) identified patterns of risk which were quantified to provide proportions of SUID that occurred among families with histories of domestic violence or substance use; and among families whose infant died when they were away from their usual home (“temporary stays”). SUID that occurred among preterm infants during temporary stays were further analyzed to detail risk among this population.

From 2019-2023 there were 220 SUID, of which 206 (94%) were sleep-related. SUID peaked among infants aged 1-2-months old. 55 (27%) SUID were found to be due to accidental suffocation. Nearly all infants (99%) were found in an unsafe sleep environment. Infants were found on their side or stomach (86, 42%); while bedsharing (134, 65%); in a non-approved infant sleep space (172, 83%); and/or with soft bedding (189, 92%). SUID occurred among 154 (75%) Non-Hispanic Black (NHB) infants, 33 (16%) Hispanic infants, and 17 (8%) non-Hispanic White (NHW) infants. SUID occurred in 56 (28%) preterm infants. SUID occurred among 30/166 (15%) infants with prenatal/household smoke exposure, among 31 (15%) families with a history of domestic violence and 49/181 (27%) families with a history of substance use (when these variables were known). SUID occurred among 33 (16%) infants during temporary stays, whose peak age at death was 4-months-old. Thirteen SUID occurred among preterm infants during temporary stays: Amont these infants, all were Non-Hispanic Black (NHB) and 5 (38%) were one of twins. Four (31%) were categorized as suffocation-related SUID. No crib was present in the temporary stay location for 5/11 (45%) infants for whom this information was known. Multiple unsafe sleep factors [non-supine sleep (5/13, 38%), non-approved sleep surface (13/13, 100%), bedsharing (11/12, 92%), soft bedding (13/13, 100%)] were present. Bedsharing occurred on adult beds (12/13) which were shared by adults [10/13 (77%)], siblings [8/13 (62%)], or both adults and siblings [6/13 (46%)]. Ten families (77%) had a history of child welfare involvement. Six infants (46%) were in the care of non-parent supervisors when they died.

SUID in Cook County is closely tied to complex social issues including domestic violence, substance use and temporary stays. Preventing SUID connected to these issues necessitates partnership with the trusted social agencies that address them.

1. SUID epidemiology in Cook County, IL
2. Proportion of SUID associated with complex social circumstances
3. Local SUID epidemiology may drive new prevention partnerships

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Gina Lowell, MD, MPH
Rojin Ahadi, MPH
Felicia Clark, D-ABMDI
Christie Lawrence, DNP, RNC-NIC, APN/CNS
Meredith Reynolds, MD
Kyran Quinlan, MD, MPH

Sudden Unexpected Infant Death (SUID) takes the lives of ~3500 infants each year in the United States and has seen virtually no progress in prevention for more than 2 decades. SUID risk is tied closely to poverty. The relationship between SUID risk and poverty is multilayered and complex which hinders the generation of simple and effective prevention programs. In 2023, an Injury Equity Framework was proposed to aid careful review of child deaths and injuries to generate prevention recommendations.

Beginning in July 2023 the Kendi-Macy Injury Equity Framework was applied to review SUID in Cook County, Illinois which includes Chicago where racial disparity of SUID is highest among the most populous cities in the country. The original framework was tailored to work best for SUID and for a resource-limited setting. The Cook County SUID Case Registry team used this process in monthly meetings to carefully review how social influences of health directly contributed to each death and to generate practical SUID prevention recommendations addressing contributing factors in high-risk populations of Cook County. For each death, the grid of the matrix was filled with contributions from all team members. Recommendations were generated and efforts to act on these recommendations were taken.

From July 2023 to May 2025, a total of 64 SUID were reviewed using the Cook County-modified injury equity matrix (IEM). IEM review surfaced 52 ideas among 5 categories of further pursuit: 1) data discovery (7), 2) messaging lessons (14), 3) advocacy opportunities (8), 4) actionable prevention (19), and 5) policy recommendations (4). Of these ideas, all data discovery was completed; 4/8 advocacy opportunities were pursued; 13/19 prevention programming efforts were completed or are ongoing, and 2/4 policy recommendations were adopted. Data discovery included further analysis of SUID related to temporary stay situations, domestic violence, substance use history, and child welfare involvement. Prevention programming included outreach to relevant support agencies (e.g. domestic violence, substance use, shelters), safe sleep training tailored to local agency needs (e.g. WIC/home visiting/doulas), and a combined SIDS and DV awareness resource fair. Adopted policy recommendations included developing Guidance for Safe Sleep in Shelters, including advocacy to ensure infants in Chicago shelters have a bassinet or portable crib for sleep; and a collective advocacy effort eliminating the prenatal visit requirement for families to receive a portable crib from a Medicaid managed care plan. Pending policy recommendations include work to require hotels/motels to provide safe sleep spaces for infants, and advocacy to have all SUID in Cook County receive equitable evaluation by the Illinois Department of Children and Family Services. At times, IEM review generated questions that led to rich discussion without an actionable outcome (4).

The Kendi-Macy framework modified for SUID was fruitful to identify innovative prevention measures to address the complex interplay between poverty and SUID risk.

1. SUID review using a methodical approach deepens understanding of the association between poverty and SUID risk.
2. A multidisciplinary review team allows for diverse perspectives and generates multiple avenues to further SUID prevention.
3. SUID surveillance is enhanced by methodical case review.

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Kathleen McDonough, MPA

In Oregon, sleep-related deaths account for the highest percentage of infant deaths behind perinatal conditions and congenital malformations. To address this issue, a local county government agency traditionally not associated with public health has partnered with public health organizations and local hospitals to provide free safe sleep kits (portable crib and sheet, sleep sack, safe sleep book, pacifier and educational materials) along with in-person safe sleep education to income eligible families in either English or Spanish. The program’s objectives include a reduction in sleep related deaths for infants in the county through increased access to culturally appropriate in-person education and the distribution of free safe sleep kits to income eligible families. AAP approved bassinets are available for transient families or those whose living space won’t accommodate a full-sized portable crib to ensure the caregivers needs are appropriately met.

Public health nurses from the local county health department and injury prevention specialists from local hospitals meet with families individually to assess their needs around safe sleep. This 1:1 education is targeted to meet the family where they are and provide the resource in safe and familiar setting such as their home, local community baby shower, 1:1 appointment, or when inpatient at local hospital. Safe sleep education, including hands on portable crib set up, is provided to caregivers in either English or Spanish, however, every attempt is made to provide the safe sleep education and instruction in the caregiver’s native language. To be eligible, families must be a resident of the county and must qualify for public benefits or demonstrate a financial need. The program is managed by the county government agency, which has designated state funding available to support local child fatality prevention initiatives. Prior to program implementation, local public health agencies and hospitals struggled to find funding for safe sleep resources for families in need.

Since program inception in July 2021, more than 1300 safe sleep kits and 1:1 education has been provided for income eligible families in the county.

Fatalities related to an unsafe sleep environment are the number one cause of preventable death for infants in this Oregon county. Our non-traditional safe sleep program utilizes a multidisciplinary approach to better identify and reach more families in need of safe sleep resources and education.

1. The benefits of utilizing a multidisciplinary and non-traditional approach to address a public health issue.
2. How to leverage community partnerships to implement an upstream prevention program.
3. A different approach to reducing sleep related deaths for infants.

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Leah Nelson, RCP
Nick Marinelli, MPA
Isabella Baldino
Kevin Borrup, DrPH, JD, MPA
Kristen Volz-Spessard, MS
Steven C. Rogers, MD, MS

Suicide is the second leading cause of death among teens and college-aged young adults and 12.2% of people aged 18-25 experiencing serious thoughts of suicide in the past year. This data highlights the urgent need for prevention efforts tailored to this high-risk population. Fresh Check Day (FCD), designated in the Suicide Prevention Resource Center’s Best Practices Registry, is a peer-driven mental health promotion and suicide prevention program developed by the Jordan Porco Foundation to support student mental health needs on college campuses. The program aims to reduce stigma, increase awareness of available mental health resources, and encourage help-seeking behavior through interactive booths, campus-wide collaboration, and student engagement. The rate of 18–25-year-olds experiencing mental, behavioral, or emotional health issues has been increasing significantly over the past several years so hospital- and campus-based programs play a critical role in promoting mental health and connecting individuals with resources.

Following the FCD programs, anonymous post-event participant surveys were administered to assess student perceptions, knowledge gains, and changes in attitudes toward mental health. Scaled, and open-ended items were included, focusing on key metrics such as preparedness to support peers, awareness of mental health resources, and comfort discussing mental health. Survey responses and demographic information were analyzed using Microsoft Excel and Tableau to visualize trends and examine the program’s utilization across diverse student populations. Qualitative feedback was thematically analyzed to understand the personal impact of the program, identify common themes, and highlight areas for improvement.

From January 2014 to May 2025, 1,517 FCDs took place at colleges in 46 states; Over 300,000 students participated in FCD programs and 119,803 (40%) students completed the post-event surveys. 83.7% reported feeling more prepared to help a friend exhibiting warning signs of suicide; 87.4% were more aware of mental health resources available to them; 83.7% were more likely to ask for help if experiencing emotional distress themselves; 82% felt more comfortable talking about mental health and suicide. Data collected from community colleges showed equal or greater impact across all effectiveness indicators when compared to all FCD campuses. Hispanic/Latinx, Black/African American, and Asian/Asian American respondents averaged equal to or greater than White/Caucasian respondents across all effectiveness indicators.

Data collected over the past decade supports FCD’s quality, efficacy, and vital importance to college communities across the country and justifies further expansion of the program. Results indicate a significant increase in student awareness of mental health resources and services available on campus and in the broader community, enhanced student capacity to recognize and respond to mental health crises among peers, and increased willingness among students to seek out mental health support for themselves. These impacts may prevent young adult suicide deaths.

1)Understand the importance of effective primary suicide prevention programs for college-aged young adults.
2) Describe Fresh Check Day participants’ reported perceptions, knowledge gains, and changes in attitudes toward mental health.
3) Illustrate comparisons across campus demographics and student identities.

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Ky Renshaw, Undergraduate
Nicholas Stange, MD MPH
Cole Wymore, MD
Parker Sternhagen, Undergraduate
Brooke Askelsen, Undergraduate
Sarah Nichols, BS
Kareem Shoukih, BS
Alec Marticoff, BS
Mikayla Gibson, BS
Brenda Vergara, AA
Pam Hoogerwerf, BA
Charles Jennissen, MS

The number of infants <1 year of age that die of Sudden Unexpected Infant Death (SUID) in the U.S. each year is similar to that of the number of motor vehicle-related deaths in those <20 years. By following safe sleep practices, the risk of SUID can be decreased. Our study objectives were to: 1) determine the proportion of rural Iowa adolescents that take care of infants <1 year of age and in what capacity, and 2) identify the proportion that have placed infants <1 year of age to sleep and whether they always followed basic infant safe sleep practices.

An anonymous survey was performed of 2025 Iowa FFA (formerly Future Farmers of America) Leadership Conference attendees at the University of Iowa Stead Family Children’s Hospital safety booth. Surveys were completed either electronically on Qualtrics via phone or on paper which were later entered into Qualtrics. Data were exported and descriptive and bivariate (chi-square) analyses were performed using Excel and Vassarstats (http://vassarstats.net/).

1641 adolescents 13-18 years of age completed the survey. Nearly three-fifths (59%) were 16-18 years old and over three-fifths (61%) were female. Nearly half (48%) lived on a farm, 23% lived in the country, but not on a farm and 29% lived in a town. The vast majority (95%) were non-Hispanic White. Overall, nearly three-quarters (72%) had taken care of a child <1 year of age; of these, 55% had done so as a babysitter, 43% did so for a relative’s infant (not a sibling) and 35% had taken care of a sibling <1 year of age. Overall, 57% stated they had placed a baby <1 year of age down for a nap or nighttime sleep. Of adolescents that had placed a baby <1 year of age down for sleep, 45% only reported places that would be considered safe (i.e., bassinet, baby’s own crib, pack and play/portable crib). As far as the sleep position, 78% stated they only placed babies <1 year of age down to sleep on their back. There were no significant differences by sex regarding proportions that had taken care of a baby <1 year of age, that had babysat, taken care of a relative’s child or had taken care of a sibling, that had placed a baby <1 year of age down to sleep, or that had reported always placing a baby in a safe place and a safe position to sleep.

Most rural adolescents in the study had placed a baby <1 year of age down to sleep with most having placed an infant in an unsafe place and one-fifth having placed infants not on their back. Adolescents should be targeted for infant safe sleep education, for example, in school and during babysitting classes.

Attendees will be able to:
1) Discuss the proportion of rural adolescents that take care of babies less than 1 year of age and their relationship to those children.
2) State the proportion of adolescents that report always placing an baby less than 1 year of age for a nap or nighttime sleep in a safe place and in a safe position.
3) Identify at least two ways in which adolescents could be educated regarding infant safe sleep practices.

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Lorrie Lynn, MA, CPSTI

Every three years, for over 30 years, the Injury Prevention Coalition created the Childhood Unintentional Injuries Report to the Community. The report provides data trends on unintentional injury deaths, hospitalizations and emergency department discharges for children 0 to 14 years of age for the across the county. Throughout the years leading injuries tables informed other county report cards and organizational programs throughout the county. The Report stood as a resource for organizations throughout the county and a guide to injury prevention practices.

The 2025 report is distinctly different than the previous reports. Influenced by three separate events, the Report changed from a resource document to a call to action. The first shift was in an injury prevention mindset. The Coalition members, charged with keeping children safe and healthy met and began action planning, building specific and achievable programs and collaborations that would begin to move the needle on intractable injuries for kids, drowning, roadway crashes, and safe sleep for infants. The second event occurred when the state changed its injury data reporting process. Although easily accessible, the data for injuries is not available if the number of incidents met a threshold of 11 or more individuals. This change impacted the data and trend analysis historically included in the report. This change created challenges in comparing data year-over-year and resulted in an incomplete unintentional fatalities table. Despite the changes, the table on unintentional injury death still aligned data to show the three leading causes, drowning/submersion, suffocation and motor vehicles. The final influence in the context of a changing world was seeking the input of a community voice, the Injury Prevention Advisory Committee, to confirm and guide our work and this report. We invited a group of diverse leaders and parents to share their insights about child injuries that will lead to designing programs building on the communities’ strengths.

When Simon Sinek speaks of starting with “Why” it is because there is familiarity and comfort in describing the “How” and the “What”. This report is in the wake of a pandemic that changed our world. Starting with “Why” was critical to understanding the new reality of childhood injury. The result of this new perspective on the Community Report shows in the language, the structure, and the promise to report back to the community in 3 years with the progress and challenges. These are commitments through words, data and action plans calling for equity for all children.

Bringing community voice to the design and discussions about unintentional injury puts children in the context of family and culture. The Action Plans, built with the community voice, are measurable and accountable. Sharing the latest data trends and proven practices we can make the lives of children safer and healthier

• By combining data, action plans and community voice you expand your perspective on solutions
• Taking the time to develop Action Plans with measurable outcomes holds a coalition of individuals accountable.
• Data challenges are inevitable and seeking out other sources of data, like community voice can build the richness of lived experience.