Sudden infant death syndrome (SIDS) remains to be the leading cause of death from one month to one year of age. There have been numerous public education programs such as back to sleep initiated to help reduce the national SIDS rate. However, it is speculated that many SIDS cases still occur in specific regions or areas in the state. To test this hypothesis, a chart review of all SIDS cases occurring in a 4 year period, 1993 to 1996, in Utah was done. Demographic and epidemologic factors were recorded from birth and death certificates, state medical examiner, and public health nurse records. In evaluating the SIDS cases by place of residence, the postal Zip code was used to track the number of cases occurring in Utah. For this four year period, there were 179 SIDS cases from 156,960 births in Utah for a SIDS rate of 1.14 cases/1000 births. A clustering of cases were noted in 4 neighboring postal codes. These neighboring areas had a SIDS rate of 2.37 which was twice the state average. These neighboring areas could not be differentiated from other areas by population size, number of births or social economic factors. Most of the SIDS cases were term gestation, Caucasian race, and had mean age of 13 weeks. Majority of the SIDS cases were found in the morning from October to March. Usually the infants were found prone (70% cases) and discovered by individuals other than the parents (70%). Only 56% of the cases were in a standard crib. Parent smoking was also noted in many cases. In conclusion, cases of SIDS in Utah were associated with specific postal Zip codes with known risk factors of race, gender, positioning, non-parent caregivers, sleeping environment, and smoking. An education program directed to these specific areas has been started and is hoped to reduce the SIDS rate in these areas in future years.