Jacobs-van der Bruggen Monique A M, Wijga Alet H, Brunekreef Bert, de Jongste Johan C, Baan Caroline A, Kerkhof Marjan, Smit Henriette A
National Institute of Public Health and the Environment (RIVM), Bilthoven, The Netherlands.
BMC Health Serv Res. 2007 Jun 12;7:83. doi: 10.1186/1472-6963-7-83.
A higher prevalence of respiratory symptoms and an associated increase in health care utilization among children with parents who smoke is to be expected. From previous studies however, it appears that parents who smoke may underutilize health services for their children, especially with respect to respiratory care. This study explores the validity and generalizability of the previous assumption.
Data were obtained from a Dutch birth-cohort study; the Prevention and Incidence of Asthma and Mite Allergy (PIAMA) project. Information regarding parental smoking, the child's respiratory symptoms and health care use and potential confounders were obtained by postal questionnaires. Multivariate logistic models were used to relate parental smoking to the child's respiratory symptoms and health care use.
The study comprised 3,564, 4-year old children. In the crude analysis, respiratory symptoms were more frequent among children with a parent who smoked, while health care utilization for respiratory symptoms was not significantly different between children with or without a parent who smoked. In the multivariate analyses, maternal smoking had a larger impact on the child's respiratory symptoms and health care use as compared to paternal smoking. Maternal smoking was positively associated with mild respiratory symptoms of the child, adjusted odds ratio [AOR] 1.50 (1.19-1.91), but not with severe respiratory symptoms AOR 1.03 (0.75-1.40). Among children with mild respiratory symptoms, children with a mother who smoked were less likely to be taken to the general practitioner (GP) for respiratory symptoms, than children with mothers who did not smoke, AOR 0.58 (0.33-1.01). This finding was less pronounced among children with severe respiratory symptoms AOR 0.86 (0.49-1.52). Neither GP visits for non-respiratory symptoms nor specialized care for respiratory disease were significantly associated with parental smoking.
Mothers who smoke appear to underutilize health care for their children with mild respiratory symptoms. Health care workers should be informed about this phenomenon. Inquiring after the respiratory health of the children during regular visits to healthy baby clinics may help to track potential underutilization of care.
父母吸烟的儿童出现呼吸道症状的患病率较高，且医疗保健利用率相应增加，这是可以预期的。然而，从以往的研究来看，吸烟的父母可能没有充分利用针对其子女的医疗服务，尤其是在呼吸道护理方面。本研究探讨了先前假设的有效性和普遍性。
数据来自荷兰一项出生队列研究；哮喘与螨类过敏的预防与发病率（PIAMA）项目。通过邮政问卷获取有关父母吸烟情况、儿童呼吸道症状、医疗保健使用情况以及潜在混杂因素的信息。使用多变量逻辑模型将父母吸烟与儿童呼吸道症状及医疗保健使用情况相关联。
该研究纳入了3564名4岁儿童。在粗分析中，父母吸烟的儿童呼吸道症状更为常见，而有或没有吸烟父母的儿童因呼吸道症状的医疗保健利用率并无显著差异。在多变量分析中，与父亲吸烟相比，母亲吸烟对儿童呼吸道症状及医疗保健使用的影响更大。母亲吸烟与儿童轻度呼吸道症状呈正相关，调整后的优势比[AOR]为1.50（1.19 - 1.91），但与重度呼吸道症状无关，AOR为1.03（0.75 - 1.40）。在有轻度呼吸道症状的儿童中，母亲吸烟的儿童因呼吸道症状被带去看全科医生（GP）的可能性低于母亲不吸烟的儿童，AOR为0.58（0.33 - 1.01）。这一发现在有重度呼吸道症状的儿童中不太明显，AOR为0.86（0.49 - 1.52）。无论是因非呼吸道症状看全科医生，还是呼吸道疾病的专科护理，均与父母吸烟无显著关联。
吸烟的母亲似乎没有充分利用针对其有轻度呼吸道症状子女的医疗保健服务。医护人员应了解这一现象。在定期前往健康婴儿诊所就诊时询问儿童的呼吸道健康状况，可能有助于追踪潜在的医疗服务利用不足情况。
