An Examination of the Father's Name on the Birth Certificate and SUID in Georgia Infants Open Access

Rossetti, Annie Eugenia (2014)

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Objective: Sudden unexpected infant deaths (SUID) are defined as deaths in infants less than 1 year of age that occur suddenly and unexpectedly, and whose cause of death are not immediately obvious prior to investigation. Maternal, prenatal care, and infant risk factors have been identified for SUID; however, paternal involvement has not been sufficiently studied in past literature. As guided by the Precede-Proceed framework, this study examines if the absence of a father's name on the birth certificate is associated with an increased odds ratio of SUID among Georgia infants.

Methods: Linked birth-infant death files from 1998-2008 were used to obtain a final analysis population of 1,188 SUID cases and 12,246 controls. The primary independent variable of interest was coded as father absent on birth certificate or father present on birth certificate. Odds ratios were examined across three logistic regressions: 1) all cases and controls; 2) infants born to white mothers; and, 3) infants born to black or African-American mothers.

Results: Eighty one percent of infants in the final analysis population listed a father's name on the birth certificate. The absence of a father's name on the birth certificate was associated with a significantly greater odds ratio of SUID among both unmarried and married women, notably married mothers aged 20-34. The absence of a father on the birth certificate was protective among married mothers aged 35 or older. When stratified by race, the absence of a father's birth certificate was only associated with an increase in the risk of SUID among white mothers who were married, 20-34 years of age, and did not list a father on the birth certificate.

Discussion: The results of this study suggest that the absence of a father's name on the birth certificate is a risk factor for SUID. The findings from this study encourage continued support for state- and community-based programs and policies to improve paternal involvement during pregnancy and after birth. Future research should explore the predisposing, reinforcing, and enabling factors that influence the absence of a father's name on a birth certificate, in an attempt to identify potential causes.

Table of Contents

Chapter 1. Introduction - 1

Figure 1. Precede-Proceed Planning Framework - 3

Chapter 2. Literature Review - 4

Sudden Unexpected Infant Death - 4

Risk Factors - 5

Family Stability and SUID - 7

Paternal Involvement - 8

SUID in Georgia - 10

Child Fatality Review Program - 11

SUID Demographics in Georgia - 12

The Current Study - 13

Chapter 3. Methodology - 15

Study Design and Participants - 15

Data Collection Procedures - 16

Measures - 16

Analyses - 19

Chapter 4. Results - 20

Description of Analysis Population - 20

Variable Categories - 20

Results of the Bivariate Analyses - 21

Interaction, Confounding, and Collinearity Assessment - 22

Results of Multivariate Analyses - 23

Results of Stratified Multivariate Analyses - 25

Chapter 5. Discussion - 26

Summary of Findings - 26

Strengths - 27

Limitations - 28

Future Directions - 30

References - 33

Tables - 39

Table 1. Descriptive Characteristics of Analysis Population - 39

Table 2. Chi-Square Tests of Independence - 41

Table 3. Collinearity Assessment of Independent Variables - 43

Table 4. Stratified Analysis of Covariates and SUID - 44

Table 5. Logistic Regression Analysis Predicting SUID - 45

Table 6. Adjusted Odds Ratios Stratified by Race - 47

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