title: Do parents who smoke underutilize health care services for their children? A cross sectional study within the longitudinal PIAMA study.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: National Institute of Public Health and the Environment (RIVM), Bilthoven, The Netherlands. monique.jacobs@rivm.nl
authors.forename: Monique A M
authors.initials: MA
authors.lastname: Jacobs-van der Bruggen
authors.forename: Alet H
authors.initials: AH
authors.lastname: Wijga
authors.forename: Bert
authors.initials: B
authors.lastname: Brunekreef
authors.forename: Johan C
authors.initials: JC
authors.lastname: de Jongste
authors.forename: Caroline A
authors.initials: CA
authors.lastname: Baan
authors.forename: Marjan
authors.initials: M
authors.lastname: Kerkhof
authors.forename: Henriette A
authors.initials: HA
authors.lastname: Smit
mesh_terms: D000328:Adult; D035841:Behavioral Research; D002662:Child Health Services / Q000706:statistics & numerical data*; D002675:Child, Preschool; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D005260:Female; D006300:Health Services Misuse / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008425:Maternal Behavior; D015999:Multivariate Analysis; D009426:Netherlands / Q000453:epidemiology; D010290:Parents / Q000523:psychology*; D010332:Paternal Behavior; D012141:Respiratory Tract Infections / Q000453:epidemiology* / Q000209:etiology; D012737:Sex Factors; D012907:Smoking / Q000453:epidemiology*; D011795:Surveys and Questionnaires; D014028:Tobacco Smoke Pollution / Q000009:adverse effects*
chemical_list: D014028:Tobacco Smoke Pollution