A 4-year-old child is diagnosed with otitis media. The parent asks the nurse about the causes of this illness. Which risk factors would the nurse include in response to this parent? Select all that apply.

A. Household smoking increases the risk of otitis media by irritating the respiratory tract and impairing immune function. B. A history of urinary tract infections is not a risk factor for otitis media. C. Exposure to illness in daycare centers or schools increases the likelihood of respiratory infections, which can lead to otitis media. D. Native American ethnicity has a higher incidence of otitis media, likely due to genetic and environmental factors. E. Absence of breastfeeding increases the risk of otitis media because breastfeeding provides immune protection. F. Craniofacial anomalies (e.g., cleft palate) increase the risk of otitis media due to poor Eustachian tube function and chronic ear infections.