Child care arrangements and repeated ear infections in young children. AM Hardy, MG Fowler. Am .1 Public Health 1993 Sep;83(9):13?1-1325. Based on the 1988 Natinnal Heslth Intervi.ew Surve , with 1005 repeated ear infections in children under 6 years old, versus controls 4122 without them.

"Results of many previous studies of recurrent ear infections are difficult to interpret because potential risk factors have been assessed only with univariate statistical analyses, withnot controlling for other important variables. Studies in the United States have not been population based and have used selected samples; thus, the results have not been generalizable."

"'Two major strengths of this study are the use of a population-based survey to examine the associations of child care and repeated infections and the use of multivariate techniques to control for other risk factors. Because the survey was nationally representative, the findings are more broadly generalizable than those of many previous studies."

"Multiple logistic regression analysis showed that factors significantly associated with repeated ear infections were age (1 to 2 years) race (White) sex (male), and medical history repeated tonsillitis, enlarged adenoids, or asthma. Risks fr 1-2 year olds were 2.8 (2.1- 3 , and 3-5 year olds 1.5 l.l-2.3), versus <1 year olds; for males versus females, 1.3 (1.1-1.5). With respect to non-Hispanic blacks, non-Hispanic whites' risk was 2.1 (1.7-2.6), and Hispanics 1.6 ( 1.1-2.3 ). With history of repeated tonsillitis/enlarged adenoids 3.5 (2.5-5.1), and history of asthma 2.3 (2.1-2.6.)

"Although single or occasional episodes of otitis media are relatively easy to manage, recurrent episodes present a greater clinical challenge..... Because children with single or infrequent ear infections were included in the comparison group of children who never had repeated ear infections, the statistical associations noted may have been weakened somewhat and are thus on the conservative side.

(In the NHIS, "Among households with a child with asthma, 417 of households had at least one member who smoked, which was the same as among households with no child with asthma." (WR Taylor, PW Newacheck. Pediatrics 1992;90(5):657-6 2.)

After multiple logistic regression, day care kids had 509 higher rates of repeated ear infections. Exposure to passive smoke was not significantly related to repeated ear infections after controlling for age, race, and sex.

This is no so-called tobacco industry study. Here are the authors:

"Ann M. Hard is with the Illness and Disability Statistics Branch, Division of Health Interview Statistics, National Center for Health Statistics, Hyattsville, Md. At the time of the study, Mary Glenn Powler was with the Division of Analysis, Office of Analysis and Epidemiology, National Center for Health Statistics." It's interesting to note how the media selectively annoint government workers with anti-smoking opinions as official voices of the U.S. government, and then look the other way and censor the findings when they don't serve their agenda.

And what does the EPA tell us? "Recent studies also solidify the evidence for the conclusion of a causal association between parental smoking and increased middle ear infection in young children. Yet it also says, Snme evidence suggests that the incidence of acute upper respiratory tract illnesses and acute middle ear infections may be more common in children exposed to PTS. However, several studies failed to show any effect. In addition the possible role of confounding factors, the lack of studies showing clear dose-response relationship, and the absenc e of a plausible biological mechanism preclude more definitive conclusions. EPA Respiratory Health Effects of Passive Smoking : Lung Cancer and Other Disorders. Section 1, Summary and Conclusions )1.3.2.; nearly verbatim with section 7.4.2 Summary and Discussion of Middle Ear Diseases

Of the 8859 subjects of studies examined by the EPA, 3290 were aged 10 to 20; 1615 were aged 6-13 and the outcome of interest was merely snoring; and 736 were aged 6 1/2 to 7 1/2. Barely 3000 were in the most important age group: Over 80% of episodes of otitis media occur in 0-6 year olds; fewer than 8% of 7 year olds experience it, and it virtually disappears with increasing age (Lundgren K Ingvarsson L. Scand J Infect Dis 1983;39 (suppl):19-25.)

But EPA finessed this difficulty: "Iverson and coworkers .. suggested that the risk associated with passive smoking increased with age This may explain the negative results nf several studies based on preschool children. The validity of projecting a dubious "ETS effect from school-age children to pre-schoolers is not addressed.

And, EPA's speculations on biological effects of ETS ought to include the observation that Hemophilus influenzae and Streptococcus pneumoniae, bacteria linked tn acute otitis media, are reported tn be very sensitive to growth inhibition by cigarette smoke in vitro (ar 8 ug ml). (Ertel A et al. Chest 1991;100(3):628-630).