Epidemiology and Infection

Research Article

Smoking, the environment and meningococcal disease: a case control study

R. E. Stanwella1*, J. M. Stuarta2, A. O. Hughesa3, P. Robinsona2, M. B. Griffina1 and K. Cartwrighta4

a1 Department of Public Health Medicine, Bristol and Weston Health Authority, Manulife House, 10 Marlborough Street, Bristol BS1 3NP

a2 Department of Public Health Medicine, Gloucester Health Authority, Rikenel, Montpellier, Gloucester GL1 1LY

a3 Department of Epidemiology, University of Bristol, Canynge Hall, Whiteladies Road, Bristol BS8 2PR

a4 Public Health Laboratory, Gloucestershire Royal Hospital, Great Western Road, Gloucester GL1 3NN


This case control study investigated environmental factors in 74 confirmed cases of meningococcal disease (MD). In children aged under 5, passive smoking in the home (30 or more cigarettes daily) was associated with an odds ratio (OR) of 7.5 (95% confidence interval (CI) 1.46–38.66). ORs increased both with the numbers of cigarettes smoked and with the number of smokers in the household, suggesting a dose–response relationship. MD in this age group was also significantly associated with household overcrowding (more than 1.5 persons per room) (OR 6.0, 95% CI 1.10–32.8), with kisses on the mouth with 4 or more contacts in the previous 2 weeks (OR 2.46, 95% CI 1.09–5.56), with exposure to dust from plaster, brick or stone in the previous 2 weeks (OR 2.24, 95% CI 1.07–4.65); and with changes in residence (OR 3.0, 95% CI 1.0–8.99), marital arguments (OR 3.0, 95 % CI 1.26–7.17) and legal disputes in the previous 6 months (OR 3.10, 95% CI 1.24–7.78). These associations were independent of social class. Public health measures to lower the prevalence of cigarette smoking by parents of young children may reduce the incidence of MD. The influence of building dust and stressful life events merits further investigation.

(Accepted August 22 1993)


* Communications to: R. E. Stanwell-Smith. PHLS Communicable Disease Surveillance Centre, 61 Colindale Avenue. London NW9 5EQ.