The Impact of Tobacco Smoke Exposure on Childhood Asthma in a Medicaid Managed Care Plan

• Published in: Chest Vol. 149; no. 3; p. 721
• Main Authors: Farber, Harold J, Batsell, Richard R, Silveira, Edwin A, Calhoun, Rose T, Giardino, Angelo P
• Format: Journal Article
• Language: English
• Published: United States 01.03.2016
• Subjects: Adolescent; Adrenergic beta-Agonists - therapeutic use; African Americans - statistics & numerical data; Asthma - drug therapy; Asthma - epidemiology; Child; Child Health Services - utilization; Child, Preschool; Cost Sharing; Emergency Service, Hospital - utilization; European Continental Ancestry Group - statistics & numerical data; Female; Health Expenditures; Hispanic Americans - statistics & numerical data; Humans; Infant; Infant, Newborn; Male; Managed Care Programs - economics; Medicaid; Mothers - statistics & numerical data; Prevalence; Smoking - epidemiology; Texas - epidemiology; Tobacco Smoke Pollution - statistics & numerical data; United States; United States; Texas; smoke; involuntary smoking; secondhand smoke; pediatric asthma; pediatrics; smoking
• ISSN: 1931-3543
• DOI: 10.1378/chest.15-1378

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.