title: Secondhand smoke and asthma: what are the effects on healthcare utilization among children?
abstract: OBJECTIVE
  This study aims to examine the associations between asthma, secondhand smoke exposure and healthcare utilization in a nationally representative sample of children.
  
  
  METHODS
  Data from 5686 children aged 0-11 years were analyzed. Healthcare utilization, asthma diagnosis and demographic information came from the 2001 and 2006 Medical Expenditure Panel Surveys. Secondhand smoke exposure was measured during the 2000 and 2005 National Health Interview Surveys. Multivariable regression models were used to determine the association between secondhand smoke exposure, asthma diagnosis and healthcare utilization (hospitalizations, emergency department visits, outpatient visits and prescription medication use).
  
  
  RESULTS
  Asthma modified the relationship between secondhand smoke exposure and hospitalizations, as exposure more than doubled the odds of hospitalization among children with asthma but had no effect on children without asthma. Secondhand smoke exposure increased the odds by 37% of emergency room visits (P<0.001), but was not associated with outpatient visits or medication use. Children with asthma had a higher odds of utilizing all healthcare services (P<0.001).
  
  
  CONCLUSIONS
  Secondhand smoke exposure was associated with a greater utilization of hospitals and emergency departments, and the effect on hospitalizations was most pronounced among children with asthma. Reducing secondhand smoke exposure would help to reduce the burden on the healthcare system, especially among children with asthma.
authors.affiliation: The Ohio State University College of Public Health, Division of Epidemiology, Columbus, OH, USA.
authors.forename: Yue
authors.initials: Y
authors.lastname: Jin
authors.forename: Eric E
authors.initials: EE
authors.lastname: Seiber
authors.forename: Amy K
authors.initials: AK
authors.lastname: Ferketich
mesh_terms: D001249:Asthma / Q000453:epidemiology* / Q000209:etiology; D002648:Child; D002675:Child, Preschool; D005260:Female; D005102:Health Expenditures; D006296:Health Services / Q000706:statistics & numerical data*; D006306:Health Surveys; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D012424:Rural Population / Q000706:statistics & numerical data; D012959:Socioeconomic Factors; D014028:Tobacco Smoke Pollution / Q000009:adverse effects*; D014481:United States; D014505:Urban Population / Q000706:statistics & numerical data
chemical_list: D014028:Tobacco Smoke Pollution
keywords: Asthma; Health care services; Secondhand smoke