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LETTERS TO THE EDITOR SOCIAL FACTORS INFLUENCING DISEASE INCIDENCE Ber (11 sutes.,'. .g pathways linking socioen- vironmen condiuonI and social .upport to physical health ouuo need to be more thotlghtfully e:- plored " Thie sta ent i~ parucularly applicable to Native Americans on rvauons where attitudn of the population toward th ealth care systems on the reservation have a profoun the ' pad on the ability of physicians and other he we providers to deliver a quality of inediul eare eo en.urate with their degree of espertise. Mott specificallg, as a pediatricien who nt two years on a resetvation. I was imptes.ed by the " known~ high incidence of acute and recurrent o media among the Native American children (2) 0 ®a the too often associated hearing deficita wit ubae- quent learning disabilities (3). Too often n ~ waa a lack of' parental compliance with prsesc ' medical regimens and routine follbw-up care mmendations for acute and recurrent otitis I believe a cause and effect relation esista betw the degree of paren- tal noneompilance with presatEibed medicaliregimens/ routine follow-up care creased incidence of turn, is known to disabilities secon heari.ng defici be achieved, media, it,i feel th mmendationa and an in- nt otitis media which, in related to subsequent laarning to significant,,terurrent, chronic If better parental compliance could e deleterious sequelae of recurrent otitu hoped, could be significantly eeduced'I1 the attitudes of any population toward  give •'health care system piay a significant role in det~rmining the ability of highly competent health care providers within a health care system to achieve  noteworthy frequency of paren piiance. Positive attitudes of given health care syatem increased patient and' turn, would~help dec of treatable patho ln tronclusio factors im likdih 541 d patient com- pulation toward a d probably result in ntal compliance which, in the frequency and seveeity es. he more one understands how social on disese incidence, the greater the that health care providers will be able to have~{more positive impact on a given population thus, generate a higher degree of patient/parental mpilance resulting in reduced' morbidity and' mor- tality. Rsrots>rcas 1'. IDan LF. Social net.wrk.. support, and health: takttt~ tFie t step dor.~ard' Am J Epidemiol 1986:123:559-62. :... Blue~to ~ CD:.. Reeent~ ad'vances inn the patbogensia, di- atnos~. an anaRement of otitis m.dLL Padutr Clia Ivon.h Am 1 :727~55. 3~ Paradise JL. Ou ' during early life: bow harardous to development'' P trw 198t:68iafiS-73. Albert F. icola Dwision oJ P rac Endocrirtology Statt/ord Uhitxrs Medical Center StattJord, CA 9+t,405 Editor's note: In aecordonee uriah Journal yolicy. Berk- nlan nVt aa*d'{)/ she WYhef to Rtpond to Dr, DiNieolo'i r, but.she chose not~~.to do so.~ RE: `EFFECTS OF PASSIVE SMOKING ON ISCHEJ1iIC HEART DISEASE MORTALITY' OF NONSMOKERS: A PROSPECTIVE STUDY' Garland et al. (1) reported initially that as a restllt of a near 10-year prospective study, with data analyzed by highly sophisticated statistical methods allowing adjustment for various factors, it was found that wives of current or former smokers hZ an increased relative risk for death from iscbemic beart disease of 14.9, highly suggestive if not nominally significant (p s 0.10). A subsequenterntum (2) states that the relative risk of 14.9 was erroneous and should have been 2.7,, p remaining at s0:10. Conclusions in the report were stated not to be affected, other valuss in the tables and elsewhere to be correct. However it was the 14:9'relative riak which was at the beart of the initial report. No other relative riska were cited in the neport. The 14.9 relative risk was repeated several times in the report and motivated the suggestion tbat legialation might be needed A nomig- nificant relative risk of only 2:7 hardly conveys the authority, for such action. Furtbermon:, I note that the authors give some justification for using one-sided p levela on the basis that they were testing previous findings. Yet in their final'.paragraph they state that to their knowledge, their report was the first to relate inereased' mortality from ischemic heart disease to involuntary smoking. In that case, p should be 50.20, not significant at all, and even less supportive of the naed'for action. Rncamcr, 1. Gsriand C. Banest-Connor E. Suarez L, at aL Eff.cn of pasnve smoking on ~ ucEemic bsut . dia.aae mortaltty of non.moken: a pro.p.eu.e study... Am JEpidemiol 1'985:121:645-50. 2. Erratum..Am J Epidemiol 1965:122:1112 Nathan Mantel i Nlathematiu, Stotistiu and' Computer Science The Americon UniuersiEy 8ethesdA MD 2081y N 0 T I C E This material may be protected by copyright law (Title 17 UiS. Cod4 t1Q ~M,°1. 1z~ 8 s4i' r °1 B 'z