Abstract
BackgroundA 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.MethodsData 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.ResultsThe 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.ConclusionMothers 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.
Highlights
A higher prevalence of respiratory symptoms and an associated increase in health care utilization among children with parents who smoke is to be expected
About 23% of the children (805 children) had at least one parent who smoked at home; 473 children had a mother who smoked at home and 613 children had a father who smoked at home
The results for respiratory symptoms and health care use in relation to parental smoking are summarized in table 2
Summary
A higher prevalence of respiratory symptoms and an associated increase in health care utilization among children with parents who smoke is to be expected. It is fairly well established that exposure to environmental tobacco smoke (ETS) is associated with an increased prevalence of respiratory symptoms in young children [1,2,3,4,5,6,7]. It is unclear whether this increased frequency of symptoms translates into higher use of different health care services. In a study among asthmatic children, maternal smoking as compared to paternal smoking only, was independently related to fewer physician visits for asthma for the children [18] This association was independent of adjustment for asthma severity. Crombie et al [18] suggest a possible lack of awareness of asthma symptoms among heavy smokers or a reluctance of parents who smoke to visit the physician for asthmarelated symptoms
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