The effect of passive smoking on the risk of otitis media in Aboriginal and non-Aboriginal children in the Kalgoorlie–Boulder region of Western Australia

Peter A Jacoby, Harvey L Coates, Ashwini Arumugaswamy, Dimity Elsbury, Annette Stokes, Ruth Monck, Janine M Finucane, Sharon A Weeks and Deborah Lehmann
Med J Aust 2008; 188 (10): 599-603.


Objectives: To determine the risk of otitis media (OM) associated with passive smoking in young children, and any competing effect between passive smoking and childcare attendance.

Design, participants and setting: Prospective cohort study of 100 Aboriginal and 180 non-Aboriginal children born in Kalgoorlie Regional Hospital between 1 April 1999 and 31 January 2003. These children underwent routine clinical examinations by an ear, nose and throat specialist up to three times before the age of 2 years, and tympanometry at routine field follow-up visits from the age of 4 months. Childrens’ mothers were interviewed at 1–3 weeks postpartum to provide sociodemographic data.

Main outcome measures: Associations between OM and exposure to environmental tobacco smoke (ETS) and childcare attendance.

Results: 82 Aboriginal and 157 non-Aboriginal children attended for routine clinical examinations. OM was diagnosed at least once in 74% of Aboriginal children and 45% of non-Aboriginal children; 64% of Aboriginal children and 40% of non-Aboriginal children were exposed to ETS. Exposure to ETS increased the risk of specialist-diagnosed OM in Aboriginal children (OR, 3.54; 95% CI, 1.68–7.47); few attended childcare. Non-Aboriginal children exposed to ETS but not attending childcare were at increased risk of OM (OR, 1.91; 95% CI, 1.07–3.42) while those attending childcare had no increased smoking-related risk. Tympanometry was performed on 87 Aboriginal and 168 non-Aboriginal children; a type B tympanogram (suggesting fluid in the middle ear) was also associated with passive smoking in Aboriginal children.

Conclusions: Reducing the exposure of children to ETS is a public health priority, especially for the Aboriginal population. A smoke-free environment will help reduce the burden of OM.

  • Peter A Jacoby1
  • Harvey L Coates2
  • Ashwini Arumugaswamy1
  • Dimity Elsbury1
  • Annette Stokes1
  • Ruth Monck1
  • Janine M Finucane1
  • Sharon A Weeks3
  • Deborah Lehmann1

  • 1 Telethon Institute for Child Health Research, Centre for Child Health Research, University of Western Australia, Perth, WA.
  • 2 Princess Margaret Hospital for Children, Perth, WA.
  • 3 Professional Hearing Services, Perth, WA.



We thank F Lannigan for his clinical expertise, V Verma and D Hill for audiological assessments. The Eastern Goldfields Division of General Practice, the midwives at Kalgoorlie Regional Hospital, G Stokes and his family, and T Canning, J Doyle and B Scott, Goldfields South East Health Region gave their continuous support to the study. We thank Ann Larson and Michael Alpers for their critical review of an earlier draft of the manuscript. This study was funded through National Health and Medical Research Council (NHMRC) project grant no. 212044 and two Healthway grants (no. 6028 and no. 10564). Deborah Lehmann is currently funded through NHMRC program grant no. 353514. World Vision provided funding for L Dorizzi, R Bonney and P Bonney to assist with fieldwork. Donations from the Lions Club, Kalgoorlie, Kalgoorlie Consolidated Gold Mines, BHP Billiton, the Friends of the Institute, Sands & McDougall and the Lotteries Commission enabled the purchase of essential equipment. We thank all the families who agreed to take part in the study. A complete list of investigators on the Kalgoorlie Otitis Media Research Project is available in reference 25.25

Competing interests:

None identified.

  • 1. Klein JO. The burden of otitis media. Vaccine 2000; 19 Suppl 1: S2-S8.
  • 2. Rovers MM, Schilder AG, Zielhuis GA, Rosenfeld RM. Otitis media. Lancet 2004; 363: 465-473.
  • 3. Boswell JB, Nienhuys TG. Onset of otitis media in the first eight weeks of life in Aboriginal and non-Aboriginal Australian infants. Ann Otol Rhinol Laryngol 1995; 104: 542-549.
  • 4. Couzos S, Murray R. Aboriginal primary health care. An evidence-based approach. Oxford: Oxford University Press, 1999.
  • 5. Lehmann D, Tennant MT, Silva DT, et al. Benefits of swimming pools in two remote Aboriginal communities in Western Australia: intervention study. BMJ 2003; 327: 415-419.
  • 6. Morris PS, Leach AJ, Silberberg P, et al. Otitis media in young Aboriginal children from remote communities in Northern and Central Australia: a cross-sectional survey. BMC Pediatr 2005; 5: 27.
  • 7. Kum-Nji P, Meloy L, Herrod HG. Environmental tobacco smoke exposure: prevalence and mechanisms of causation of infections in children. Pediatrics 2006; 117: 1745-1754.
  • 8. Arcavi L, Benowitz NL. Cigarette smoking and infection. Arch Intern Med 2004; 164: 2206-2216.
  • 9. Daly KA. Definition and epidemiology of otitis media. In: Roberts JE, Wallace IF, Henderson FW, editors. Otitis media in young children. Baltimore: Paul H Brookes Publishing Co, 1997: 3-41.
  • 10. Daly KA, Pirie PL, Rhodes KL, et al. Early otitis media among Minnesota American Indians: the Little Ears Study. Am J Public Health 2007; 97: 317-322.
  • 11. Kero P, Piekkala P. Factors affecting the occurrence of acute otitis media during the first year of life. Acta Paediatr Scand 1987; 76: 618-623.
  • 12. Logan S, Spencer N. Smoking and other health related behaviour in the social and environmental context. Arch Dis Child 1996; 74: 176-179.
  • 13. Uhari M, Mäntysaari K, Niemelä M. A meta-analytic review of the risk factors for acute otitis media. Clin Infect Dis 1996; 22: 1079-1083.
  • 14. Di Franza JR, Lew RA. Morbidity and mortality in children associated with the use of tobacco products by other people. Pediatrics 1996; 97: 560-568.
  • 15. Strachan DP, Cook DG. Health effects of passive smoking. 4. Parental smoking, middle ear disease and adenotonsillectomy in children. Thorax 1998; 53: 50-56.
  • 16. United States Department of Health and Human Services. Respiratory effects in children from exposure to secondhand smoke. In: United States Department of Health and Human Services. The health consequences of involuntary exposure to tobacco smoke: a report of the Surgeon General. (accessed Feb 2007).
  • 17. Australian Institute of Health and Welfare. Australia’s health 2002. Canberra: AIHW, 2002.
  • 18. de Costa C, Child A. Pregnancy outcomes in urban Aboriginal women. Med J Aust 1996; 164: 523-526.
  • 19. Eades SJ, Read AW. Infant care practices in a metropolitan Aboriginal population Bibbulung Gnarneep Team. J Paediatr Child Health 1999; 35: 541-544.
  • 20. Gilchrist D. Smoking prevalence among Aboriginal women. Aboriginal Islander Health Worker J 1998; 22: 4-6.
  • 21. Dewey C, Midgeley E, Maw R. The relationship between otitis media with effusion and contact with other children in a British cohort studied from 8 months to 3 1/2 years. The ALSPAC Study Team. Avon Longitudinal Study of Pregnancy and Childhood. Int J Pediatr Otorhinolaryngol 2000; 55: 33-45.
  • 22. Fleming DW, Cochi SL, Hightower AW, Broome CV. Childhood upper respiratory tract infections: to what degree is incidence affected by day-care attendance? Pediatrics 1987; 79: 55-60.
  • 23. Greenberg D, Givon-Lavi N, Broides A, et al. The contribution of smoking and exposure to tobacco smoke to Streptococcus pneumoniae and Haemophilus influenzae carriage in children and their mothers. Clin Infect Dis 2006; 42: 897-903.
  • 24. Leach A, Boswell JB, Asche V, et al. Bacterial colonization of the nasopharynx predicts very early onset and persistence of otitis media in Australian Aboriginal infants. Pediatr Infect Dis J 1994; 13: 983-989.
  • 25. Lehmann D, Arumugaswamy A, Elsbury D, et al. The Kalgoorlie Otitis Media Research Project: rationale, methods, population characteristics and ethical considerations. Paediatr Perinat Epidemiol 2008; 22: 60-71.
  • 26. Morris P, Ballinger D, Leach A, et al. Recommendations for clinical care guidelines on the management of otitis media in Aboriginal and Torres Strait Islander populations. Canberra: Indigenous and Public Health Media Unit, Commonwealth Department of Health and Aged Care, 2001.
  • 27. McNutt LA, Wu C, Xue X, Hafner JP. Estimating the relative risk in cohort studies and clinical trials of common outcomes. Am J Epidemiol 2003; 157: 940-943.
  • 28. Greenland S. Applications of stratified methods. In: Rothman KJ, Greenland S, editors. Modern epidemiology. 2nd ed. Philadelphia: Lippincott Williams & Wilkins, 1998: 295.
  • 29. Adams K, Briggs V. Galnya angin (good air): partnerships in Indigenous tobacco control. Melbourne: Centre for Excellence in Indigenous Tobacco Control, 2005.
  • 30. Ivers RG. A review of tobacco interventions for Indigenous Australians. Aust N Z J Public Health 2003; 27: 294-299.
  • 31. Mark A, McLeod I, Booker J, Ardler C. The Koori Tobacco Cessation Project. Health Promot J Aust 2004; 15: 200-204.
  • 32. Greenberg RA, Strecher VJ, Bauman KE, et al. Evaluation of a home-based intervention program to reduce infant passive smoking and lower respiratory illness. J Behav Med 1994; 17: 273-290.
  • 33. Matt GE, Quintana JE, Hovell MF, et al. Households contaminated by environmental tobacco smoke: sources of infant exposures. Tob Control 2004; 13: 29-37.
  • 34. Australian Government Department of Families, Housing, Community Services and Indigenous Affairs. 2004 census of child care services summary booklet. (accessed Apr 2007).
  • 35. Silburn SR, Zubrick SR, De Maio JA, et al. The Western Australian Aboriginal Child Health Survey: strengthening the capacity of Aboriginal children, families and communities. Perth: Curtin University of Technology and Telethon Institute for Child Health Research, 2006.
  • 36. Ilicali OC, Keles N, Deger K, et al. Evaluation of the effect of passive smoking on otitis media in children by an objective method: urinary cotinine analysis. Laryngoscope 2001; 111: 163-167.


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