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Objective: To investigate the effects of exposure to tobacco smoke and of parental consumption of alcohol and illegal drugs as risk factors for the sudden infant death syndrome after a national risk reduction campaign which included advice on prenatal and postnatal avoidance of tobacco smoke.

Design: Two year population based case-control study. Parental interviews were conducted for each infant who died and four controls matched for age and date of interview.

Setting: Three regions in England with a total population of 17 million people.

Subjects: 195 babies who died and 780 matched controls.

Results: More index than control mothers (62.6% v 25.1%) smoked during pregnancy (multivariate odds ratio = 2.10; 95% confidence interval 1.24 to 3.54). Paternal smoking had an additional independent effect when other factors were controlled for (2.50; 1.48 to 4.22). The risk of death rose with increasing postnatal …