Farber Harold J, Batsell Richard R, Silveira Edwin A, Calhoun Rose T, Giardino Angelo P
Department of Medical Affairs, Texas Children's Health Plan, Houston, TX; Pulmonary Section, Baylor College of Medicine, Houston, TX.
Jones Graduate School of Business, Rice University, Houston, TX.
Chest. 2016 Mar;149(3):721-8. doi: 10.1378/chest.15-1378. Epub 2016 Jan 6.
Tobacco smoke exposure increases breathing problems of children. Texas Children's Health Plan is a Managed Medicaid and Children's Health Insurance Program (CHIP) managed care provider. The aim of this study is to determine associations among tobacco smoke exposure, asthma prevalence, and asthma health-care utilization.
Texas Children's Health Plan conducts an annual survey of members who have a physician visit. Questions were added to the survey in March 2010 about asthma and tobacco smoke exposure. Survey results for children < 18 years of age were matched to health plan claims data for the 12 months following the date of the physician visit.
A total of 22,470 parents of unique members/patients from birth to < 18 years of age participated in the survey. More whites than African Americans or Hispanics report that the child's mother is a smoker (19.5% vs 9.1% and vs 2.3%, respectively; P < .001). Compared with children whose mother does not smoke, parent report of asthma diagnosis and claims for dispensing of short-acting beta agonist medication are greater if the mother is a smoker (adjusted OR, 1.20 [95% CI, 1.03-1.40] and 1.24 [95% CI, 1.08-1.42], respectively). In contrast to Medicaid, in which there are no out-of-pocket costs, the CHIP line of business requires copays for ED visits. ED visits are influenced by maternal smoking only in the CHIP line of business (adjusted OR, 4.40; 95% CI, 1.69-11.44).
Maternal smoking increases risk for asthma diagnosis and prescription of asthma quick relief medication. Maternal smoking predicted asthma-related ED visits only for the CHIP line of business.
接触烟草烟雾会增加儿童的呼吸问题。德克萨斯儿童健康计划是一家管理式医疗补助和儿童健康保险计划（CHIP）的管理式医疗服务提供商。本研究的目的是确定烟草烟雾暴露、哮喘患病率和哮喘医疗保健利用之间的关联。
德克萨斯儿童健康计划对有过就诊经历的会员进行年度调查。2010年3月在调查中增加了有关哮喘和烟草烟雾暴露的问题。将18岁以下儿童的调查结果与就诊日期后12个月的健康计划理赔数据进行匹配。
共有22470名从出生到18岁以下的独特会员/患者的家长参与了调查。报告孩子母亲吸烟的白人比非裔美国人或西班牙裔更多（分别为19.5%、9.1%和2.3%；P <.001）。与母亲不吸烟的儿童相比，如果母亲吸烟，家长报告的哮喘诊断以及短效β受体激动剂药物配药的理赔情况更多（调整后的比值比分别为1.20 [95%置信区间，1.03 - 1.40]和1.24 [95%置信区间，1.08 - 1.42]）。与无需自付费用的医疗补助不同，CHIP业务线要求急诊就诊需支付自付费用。急诊就诊仅在CHIP业务线受母亲吸烟影响（调整后的比值比为4.40；95%置信区间，1.69 - 11.44）。
母亲吸烟会增加哮喘诊断和哮喘快速缓解药物处方的风险。母亲吸烟仅对CHIP业务线的哮喘相关急诊就诊有预测作用。
