IMPACT OF OTITIS MEDIA HISTORY ON HEARING LOSS IN SECOND GRADE STUDENTS: THE UNITED STATES EARLY CHILDHOOD LONGITUDINAL STUDY, KINDERGARTEN CLASS OF 2010-11 (ECLS-K:2011) Chuan-Ming Li1 Howard J. Hoffman1, Christa L. Themann2, Gregory A Flamme3, and Le Chen1 1 Epidemiology and Statistics Program, National Institute On Deafness and Other Communication Disorders (NIDCD), National Institutes of Health (NIH), Bethesda, MARYLAND, USA 2 Hearing Loss Prevention Team, National Institute for Occupational Safety and Health (NIOSH), Centers for Disease Control and Prevention (CDC), Cincinnati, OHIO, USA 3 Department of Speech Pathology and Audiology, Western Michigan University, Kalamazoo, MICHIGAN, USA

Disclaimer The findings and conclusions in this presentation are those of the authors and do not necessarily represent the official position of the National Institute on Deafness and Other Communication Disorders (NIDCD), National Institutes of Health (NIH). Financial Disclosure: we have no relevant commercial entity relationships or financial interests to disclose.

Early Childhood Longitudinal Study The ECLS program includes three longitudinal studies that examine child development, school readiness, and early school experiences. ECLS-K:1998-99 The kindergarten class of 1998-99 cohort is a sample of children followed from kindergarten through the eighth grade. ECLS-B:2001 The birth cohort is a sample of children born in 2001 and followed from birth through kindergarten entry. ESCL-K:2011* The kindergarten class of 2010-11 cohort is following a sample of children from kindergarten through the fifth grade. *The Early Childhood Longitudinal Study–Kindergarten Class of 2010-2011.

Sponsoring Agencies The National Center for Education Statistics (NCES) supported the development of the core ECLS-K:2011 design that provides data needed to answer major research and policy questions. However, the study is enriched and supported by the other federal agencies listed below. National Center for Special Education Research (NCSER), Institute of Education Sciences (IES), U.S. Department of Education Economic Research Service (ERS), U.S. Dept. of Agriculture (USDA) Administration for Children and Families (ACF), U.S. Department of Health and Human Services (HHS) National Institute on Deafness and Other Communication Disorders (NIDCD), National Institutes of Health, U.S. Department of Health and Human Services (HHS) National Eye Institute (NEI), National Institutes of Health, U.S. Department of Health and Human Services (HHS)

ECLS–K: 2010-11 Survey Overview Sponsored by National Center for Education Statistics (NCES), U.S. Department of Education Followed longitudinally – from fall kindergarten (2010) through spring, 5th grade (2016) Public & private schools, included both full-day and part-day kindergarten students, and first time & repeat kindergarten students

ECLS-K:2010-2011 Data Collection Schedule School year Grade1 Data collections2 Label Hearing evaluations Sample size 2010-2011 Kindergarten Fall 2010 P1 13,400 Spring 2011 P2 13,620 2011-2012 First Grade Fall 2011 P3 - Spring 2012 P4 12,960 2012-2013 Second Grade Fall 2012 P5 √ 4,370 Spring 2013 P6 12,100 2013-2014 Third Grade Spring 2014 P7 11,090 2014-2015 Fourth Grade Spring 2015 P8 2015-2016 Fifth Grade Spring 2016 P9 1 Grade indicates the modal grade for children who were in kindergarten in the 2010–11 school year. After the kindergarten rounds of data collection, children are included in data collection regardless of their grade level. 2 All but two rounds of data collection include the entire sample of children. The fall first-grade data collection included approximately one-third of the total ECLS-K:2011 sample of children. The fall second-grade data collection included the same subsample selected for the fall of first grade.

ECLS-K Data Sources Children one-on-one academic assessments in reading, math, science, and executive function; measurement of height and weight; hearing evaluations (threshold measurement) Parents phone interview/questionnaires about family demographics, parental involvement in education, and child’s health and development Teachers self-administered questionnaires about their backgrounds and teaching practices, and information about the sampled children they teach School administrators self-administered questionnaires about their background and experience and about the physical, educational, organizational, and fiscal characteristics of their schools

ECLS-K Domains School/ Teacher Child Parent Care/ Education Provider Parent and Child Demographics Parental Health •Physical •Mental •Nutrition Marital/Partner Relationship Childrearing Behavior and Attitudes Family Processes/ Organization Child Care Arrangements Health •Physical Health •Physical Activity •Nutrition Physical Growth Gross and Fine Motor Cognitive Language/ Communication Socioemotional Background and Experience Characteristics of Focal Child’s Development Children’s Learning Environment Teaching Practices School Demographics Children’s Development School Programs Educational Goals and Objectives

Parent Interviews ( K, 1st, 2nd & 3rd Grade) Parent’s Involvement with Child’s School Family Structure Primary Language(s) Spoken Home Environment, Activities, and Cognitive Stimulation Child Care Child’s Health and Well-Being Social Skills, Problem Behaviors, Approaches to Learning Critical Family Processes Parent Education and Human Capital Parent Employment Welfare and Other Public Transfers Mobility and Tracking Updates

Ear Infections and Hearing Trouble Has {CHILD} had an ear infection since last [spring]? Has {CHILD} had an ear ache since last [spring]? Since last spring, how many times did a doctor, nurse, or other medical professional tell you that {CHILD} had an ear infection? Hearing Trouble (HT) Which best describes {CHILD}’s hearing? If {CHILD} has a hearing aid or other assistive device, please consider {his/her} hearing without the hearing aid or assistive device. Would you say {CHILD} has… Excellent hearing Good hearing A little trouble hearing Moderate trouble hearing A lot of trouble hearing, or Is {CHILD} deaf? Any Hearing Trouble (HT)

(Fall / Spring – K & 1st Grade through 5th Grade) Child Assessments (Fall / Spring – K & 1st Grade through 5th Grade) Direct: Children’s cognitive, socio-emotional, and physical development assessed with test batteries and measurements Stage 1 assessments cover a broad range of difficulty Stage 2 assessments vary by low, middle, or high difficulty for: Reading Mathematics Science Executive function Height and weight measured each data collection round Air-conduction Hearing exams and tympanograms collected on subset (n ≈ 3,500 or ≈ 35%) in Fall 2nd Grade [completed], Spring 3rd Grade [completed], and Spring 5th Grade [planned] Indirect: Child assessments by parent’s and teacher’s ratings

Hearing Exam Components (2nd, 3rd, & 5th Grade) Pre-test questions Otoscopy Middle ear evaluation Tympanometry Static wideband reflectance (3rd and 5th grade only) Pure tone air conduction audiometry Language screening (5th grade only)

Three-parameter Item Response Theory (IRT) logistic function for a hypothetical test item NOTE: a = parameter for discrimination; b = parameter for difficulty; and c = parameter for guessing. The discrimination parameter is proportional to the slope (tangent) of the function at the point of inflection.

Prevalence of Ear Infections

Prevalence of Any Hearing Trouble

Hearing Trouble Prevalence (%) by Frequent Ear Infection (EI) Scale 16

Multivariable Odds Ratios (95% Confidence Intervals) for Risk Factor Associations   N Any Hearing Trouble OR (95% CI) sex 4,720 1.1 (0.9-1.4) Race/ethnicity (9,240) NH Asian 580 0.3 (0.1-0.8)** NH Native American/Pacific Islander 110 1.6 (0.6-3.9) NH White 5,070 1.0 — NH Black 960 0.9 (0.6-1.5) Hispanic 2,070 0.9 (0.7-1.3) Multi-race 460 0.9 (0.4-1.8) Low birth weight, <2500 g 800 1.4 (0.8-2.4) Complications at birth or delivery 1,230 1.2 (0.8-1.6) Special care nursery (NICU) at birth 1,090 0.8 (0.5-1.3) Ever had tympanostomy ear tubes 870 2.6 (1.5-4.5)** Ear infections (EI) None 2,300 1.0 — 1 or 2 EI, any period 4,150 1.8 (1.01-3.1)* 3+ EI, but not in 12 months, any period 970 2.3 (1.2-4.5)** Frequent [3+] EI in 12 months, one period 1,350 2.3 (1.2-4.7)** Frequent [3+] EI in 12 months, multiple periods 490 5.0 (2.3-10.8)**

Reading Scores by Age and History of Any Ear Infection Results: Ever ear infection is significantly associated with decreased reading scores (p=0.04).

Reading Scores by Age and History of Ear Infection p value 3+ EIs vs 0: <.0001 3+ EIs vs 1-2 EIs: 0.0004 1-2 EIs vs 0: 0.1411 Model reading scores = age, sex, time, ever ear infection, time*ever ear infection

Math Scores by Age and History of Any Ear Infection Results: Ever ear infection is significantly associated with decreased math scores (p=0.024). No interaction between ever ear infection and time (semester).

Math Scores by Age and History of Ear Infection p value 3+ EIs vs 0: 0.0003 3+ EIs vs 1-2 EIs: 0.0034 1-2 EIs vs 0: 0.0778 Model math scores = age, sex, time, ever ear infection, time*ever ear infection

Science Scores by Age and History of Ear Infection Results: Ever ear infection was not significantly associated with decreased science scores (p=0.6751).

Science Scores by Age and History of Ear Infection p value 3+ EIs vs 0: 0.0102 3+ EIs vs 1-2: 0.0155 1-2 EIs vs 0: 0.8035 Model science scores = age, sex, time, ever ear infection, time*ever ear infection

Reading Scores by Age and Any Hearing Trouble (HT) p <.0001

Math Scores by Age and Any Hearing Trouble (HT) p <.0001

Science Scores by Age and Any Hearing Trouble (HT) p<.0001

[also for math and science scores] Significant Time-Lag Pattern for reading performance scores (P value < 0.05) [also for math and science scores] EI2 EI4 EI6 EI7 + + + HT2 HT4 HT6 HT7

Conclusion Frequent medically-diagnosed ear infection was associated with parent-reported hearing trouble Repeated ear infections were associated with decreasing academic scores in reading , math, and science Hearing trouble (HT) was associated with decreasing academic scores in reading , math, and science

Thanks. Contact Information: Epidemiology and Statistics Program Division of Scientific Programs NIDCD/NIH Chuan-Ming.Li@nih.gov 301-435-1351