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

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.