Based on the 1988 National Health Interview Survey, 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, without 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 for 1-2 year olds were 2.8 (2.1-3.8), and 3-5 year olds 1.5 (1.1-2.3), 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..... [B]ecause 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, 41% of house-holds had at least one member who smoked, which was the same as among house-holds with no child with asthma." WR Taylor, PW Newacheck. Pediatrics 1992;90 (5):657-662.)

After multiple logistic regression, day care kids had 50% 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. Hardy 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 Fowler was with the Division of Analysis, Office of Analysis and Epidemiology, National Center for Health Statistics."

Observations and Comments

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 effusion in young children." Yet it also says, "Some evidence suggests that the incidence of acute upper respiratory tract illnesses and acute middle ear infections may be more common in children exposed to ETS. However, several studies failed to show any effect. In addition, the possible role of confounding factors, the lack of studies showing clear dose-response relationships, and the absence of a plausible biological mechanism preclude more definitive conclusions." (US 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« to 7«. 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 of 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 to acute otitis media, are reported to be very sensitive to growth inhibition by cigarette smoke in vitro (at 8 ęg/ml). (Ertel A et al. Chest 1991;100(3):628-630).

In this two-faced, double-talking, schizophrenic document, the evidence is simultaneously strong and conclusive, and weak and inconclusive and riddled with methodological defects. Its clear intent is that the scientific issue be settled by their demagogues and media lynch mob braying "There is no longer any doubt! There is no longer any doubt!", while its authors (FD Martinez and Steven Bayard), use their strategic equivocations to present a facade of scientific respectability. But their real aim is to defame us and deprive us of our liberty, in the name of health goals toward which they're actually accomplishing nothing.

Courtesy of Carol Thompson 08/23/93
Smokers' Rights Action Group
P.O. Box 259575
Madison, WI 53725-9575
Phone: 608-249-4568