Relationship of passive cigarette smoking

to otitis media (OM) in children

Zsuzsanna Csákányi1 – Gábor Katona 1 - Antal Czinner2

1Heim Pal Children’s Hospital ENT Department, Budapest, Hungary2Heim Pal Children’s Hospital Pediatric Department, Budapest, Hungary

2011 SRNT Annual Meeting February 16-19, 2011. Westin Harbour Castle Toronto, Canada

Middle ear inflammation (OMMiddle ear inflammation (OM))

The most frequent disease in children Most frequent in childrenMost frequent in children

Serious health problemSerious health problem

HHigh health care costsigh health care costs

Otitis media – multifactorial diseaseOtitis media – multifactorial disease

-viral and bacterial infections

-auditory tube dysfunction

-immun system immaturity

- social and environmental factors

Otitis media – multifactorial diseaseOtitis media – multifactorial disease

Exploration and elimination of factors contribute

to OM pathogenesis

Reduce the OM frequency

Exposure to ETS in children Exposure to ETS in children

Serious public health problemSerious public health problemMany associated pediatric conditionMany associated pediatric condition

Acute and long-term health problemsAcute and long-term health problemsCausal relationship to middle ear diseaseCausal relationship to middle ear disease??

Divergent findingsDivergent findings

Aims of the studyAims of the study

Impact of ETS on OMImpact of ETS on OM

Determinant factors of ETS on OMDeterminant factors of ETS on OM

Parental concern about their child’s Parental concern about their child’s ETS exposureETS exposure

Patients and methodsPatients and methods

Heim Pal Children’s Hospital, Heim Pal Children’s Hospital, ENT ENT DepartmentDepartment, , Budapest, Hungary; (January-December 2009)Budapest, Hungary; (January-December 2009)

218218 children children (6 months(6 months -18 yrs, mean: 5.81 yrs,-18 yrs, mean: 5.81 yrs, SD: 3.87)SD: 3.87)

N=80N=80 with OM with OM & & N=138N=138 without OMwithout OM

Children living in Children living in smoking & non-smoking familysmoking & non-smoking family

Questionnaire method Questionnaire method

QQuestionnaireuestionnaireItems addressing 6 main domains:Items addressing 6 main domains:

Ear problemsEar problemsSmoking habitsSmoking habitsMaternal smoking during pregnancy Maternal smoking during pregnancy SES-socioeconomic status SES-socioeconomic status Maternal education Maternal education Parental concern about their child’s Parental concern about their child’s

ETS exposure ETS exposure

Statistical analysisStatistical analysis

Bivariate analysis:Bivariate analysis: - - frequency of AOM infections and household frequency of AOM infections and household characteristicscharacteristicsMultivariable regression analysis:Multivariable regression analysis: - - expected determinants of OM prevalence expected determinants of OM prevalence (household characteristics, frequency and (household characteristics, frequency and duration of exposure to smokers, parental duration of exposure to smokers, parental employment status)employment status)Statistical significance was set at Statistical significance was set at p<0.05p<0.05Models controlled for age,Models controlled for age, gender,gender, SES and maternal educationSES and maternal education

ResultsResults

Being around a smoker at least once a Being around a smoker at least once a weekweekLess than daily ventilation of house or Less than daily ventilation of house or flatflatUrban residenceUrban residenceFather employment statusFather employment statusChild’s ageChild’s age

Incidence of AOM correlates withIncidence of AOM correlates with::

Incidence of AOM does not correlate with: Incidence of AOM does not correlate with:

Flat sizeSmoking at homeSmoking during pregnancyBeing around a smoker one hour dailyMaternal employmentMaternal educationMean number of persons living in the

household

Model controlled for child’s sex and maternal education.

Number of lifetime AOM episodes(Linear regression model)

Predictors of 4 ≤ episodes of AOM(Logistic regression models)

Age in months (OR 1.02; 95% CI: 1.01-1.03)

Child around a smoker for at least once a week (OR: 3.84; 95% CI: 1.44-10.2)

Models controlled for child’s sex and mother’s education.

Correlates of mean cigarettes smoked per day in the household

36.2% of children had family members who smoked 36.2% of children had family members who smoked at least one cigarette per dayat least one cigarette per day

More episodes of AOM (p=0.059)

Living in the countryside (p<0.05)

Paternal unemployment (p<0.02)

Caregiver’s perception of harm to child Caregiver’s perception of harm to child fromfrom ETS ETS

SummarySummaryExposure to ETS correlated with presence

and increasing number of lifetime AOM episodes

Children being around the smoker at least once a week have fourfold increase in the number of AOM episodes

SummarySummaryMean number of cigarettes smoked per

day increased with rural residence and father’s unemployment status

Frequent occurrence of OM among rural population -- lower living standards and

-- higher unemployment rate

SummarySummarySmoking during pregnancy results in very

low birth weight or premature birth

Nearly half the parents considered their child is not exposed to the harmful effects of ETS

Tobacco control issues

AcknowledgementProf.John Spangler and Prof.Todd Rogers

for statistical analyses and useful advices

This study was supported by the Fogarty Found

Thank you for your attention!

Models controlled for child’s sex and mother’s education.

Predictors of 4 ≤ episodes of AOM(Logistic regression models)

Correlates of mean cigarettes smoked per day in the household

36.2%

Caregiver’s perception of harm to child fromCaregiver’s perception of harm to child from ETS ETS based on level of child’s exposure(s)based on level of child’s exposure(s)

Models controlled for child’s sex and mother’s education.

37%

29%

44%