摘要：Objectives. We examined relationships between otitis media risk factors, sociodemographic characteristics, and maternal knowledge and attitudes and early onset of otitis media. Methods. Pregnant women from Minnesota American Indian reservations and an urban clinic were enrolled in our study between 1998 and 2001. Follow-up was performed on enrollees’ infants until the children were 2 years old. Research nurses collected data by ear examination, from interviews and questionnaires given to enrolled mothers, and otitis media episodes that were abstracted from medical records. Results. Sixty-three percent of infants had experienced an otitis media episode by 6 months of age. Logistic regression analyses showed that maternal otitis media history, infant history of upper respiratory infection, and compliance with study visits were significantly related to early otitis media onset. Although high percentages of infants were exposed to cigarette smoke and other children and were formula fed, these factors were not related to otitis media. Mothers’ prenatal awareness of otitis media risks associated with environmental tobacco smoke exposure and formula feeding did not predict their postpartum behaviors. Conclusions. We found that infant history of upper respiratory infection and maternal otitis media history are risk factors for early otitis media in American Indian infants. Mothers’ prepartum knowledge and attitudes regarding otitis media did not predict their postpartum avoidance of risk behaviors. Otitis media (OM) affects nearly all preschool children, and onset in the first few months of life predicts later chronic and recurrent OM. 1 – 4 Data from the Indian Health Service (IHS) and the National Center for Health Statistics revealed that, during the 1990s, OM-associated outpatient visit and hospitalization rates among American Indian and Alaska Native children aged younger than 5 years were 2.3- and 2.9-times higher, respectively, than among US children in the same age group. 5 Also in the 1990s, Northern Plains American Indians, including residents of the Bemidji Area IHS in Minnesota, had the second highest rates of IHS outpatient visits and hospitalizations for OM. 5 Although OM rates are higher among American Indians/Alaska Natives than among other groups, little is known about specific factors that could affect their OM risk. Potentially modifiable risk factors for early OM identified in other populations include upper respiratory infections (URIs), 6 , 7 early colonization with OM pathogens, 8 day care attendance or sibling day care attendance, 2 , 7 , 9 short breast-feeding duration, 6 , 10 prone sleeping, 11 and heavy maternal smoking. 12 Family history is also an important risk factor, 1 , 7 , 13 one that may be attributed to shared environmental or genetic factors. A substantial heritable component has been demonstrated in twin studies, 14 – 16 and evidence for links between chronic and recurrent OM and regions on chromosomes 10q and 19q was recently demonstrated in a group of Minnesota families. 17 Racial and ethnic differences in OM incidence may arise from disparities in socioeconomic status, access to and use of health care, and variations in the prevalence of environmental and genetic risk factors. For example, in a study of Black and White children, Paradise et al. showed that race was no longer predictive of time with middle ear effusion after control for socioeconomic status. 18 The aim of the Little Ears Study, described here, was to investigate OM epidemiology in American Indian children from birth to age 2 years, including OM incidence in the first 6 months of life (hereafter, “early OM”), as well as relationships between early OM onset and sociodemographic characteristics, OM risk factors, and maternal knowledge and attitudes.
