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Original Research: Asthma |

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

Harold J. Farber, MD; Richard R. Batsell, PhD; Edwin A. Silveira, BS; Rose T. Calhoun, RN, MEd; Angelo P. Giardino, MD, PhD
Author and Funding Information

FUNDING/SUPPORT: In kind support provided by Texas Children’s Health Plan.

CORRESPONDENCE TO: Harold J. Farber, MD, Pulmonary Section, Baylor College of Medicine and Texas Children’s Hospital, 6701 Fannin St, Ste 1040, Houston, TX 77030


Copyright 2016, American College of Chest Physicians. All Rights Reserved.


Chest. 2016;149(3):721-728. doi:10.1378/chest.15-1378
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Background  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.

Methods  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.

Results  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).

Conclusion  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.


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