Relationship of passive cigarette smoking to otitis media (OM) in children
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Transcript of Relationship of passive cigarette smoking to otitis media (OM) in children
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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
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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
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Otitis media – multifactorial diseaseOtitis media – multifactorial disease
-viral and bacterial infections
-auditory tube dysfunction
-immun system immaturity
- social and environmental factors
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Otitis media – multifactorial diseaseOtitis media – multifactorial disease
Exploration and elimination of factors contribute
to OM pathogenesis
Reduce the OM frequency
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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
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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
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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
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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
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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
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ResultsResults
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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::
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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
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Model controlled for child’s sex and maternal education.
Number of lifetime AOM episodes(Linear regression model)
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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.
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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)
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Caregiver’s perception of harm to child Caregiver’s perception of harm to child fromfrom ETS ETS
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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
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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
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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
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AcknowledgementProf.John Spangler and Prof.Todd Rogers
for statistical analyses and useful advices
This study was supported by the Fogarty Found
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Thank you for your attention!
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Models controlled for child’s sex and mother’s education.
Predictors of 4 ≤ episodes of AOM(Logistic regression models)
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Correlates of mean cigarettes smoked per day in the household
36.2%
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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%