title: The Impact of Tobacco Smoke Exposure on Childhood Asthma in a Medicaid Managed Care Plan.
abstract: 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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Medical Affairs, Texas Children's Health Plan, Houston, TX; Pulmonary Section, Baylor College of Medicine, Houston, TX. Electronic address: hjfarber@texaschildrens.org.
authors.forename: Harold J
authors.initials: HJ
authors.lastname: Farber
authors.affiliation: Jones Graduate School of Business, Rice University, Houston, TX.
authors.forename: Richard R
authors.initials: RR
authors.lastname: Batsell
authors.affiliation: Information Systems, Texas Children's Health Plan, Houston, TX.
authors.forename: Edwin A
authors.initials: EA
authors.lastname: Silveira
authors.affiliation: Quality and Outcomes Management, Texas Children's Health Plan, Houston, TX.
authors.forename: Rose T
authors.initials: RT
authors.lastname: Calhoun
authors.affiliation: Department of Medical Affairs, Texas Children's Health Plan, Houston, TX; Academic General Pediatrics Section, Baylor College of Medicine, Houston, TX.
authors.forename: Angelo P
authors.initials: AP
authors.lastname: Giardino
mesh_terms: D000293:Adolescent; D000318:Adrenergic beta-Agonists / Q000627:therapeutic use; D001741:Black or African American / Q000706:statistics & numerical data; D001249:Asthma / Q000188:drug therapy / Q000453:epidemiology*; D002648:Child; D002662:Child Health Services / Q000706:statistics & numerical data*; D002675:Child, Preschool; D017047:Cost Sharing; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D005102:Health Expenditures; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008329:Managed Care Programs / Q000191:economics; D008484:Medicaid; D009035:Mothers / Q000706:statistics & numerical data*; D015995:Prevalence; D012907:Smoking / Q000453:epidemiology*; D013781:Texas / Q000453:epidemiology; D014028:Tobacco Smoke Pollution / Q000706:statistics & numerical data*; D014481:United States; D044465:White People / Q000706:statistics & numerical data
chemical_list: D000318:Adrenergic beta-Agonists; D014028:Tobacco Smoke Pollution
keywords: involuntary smoking; pediatric asthma; pediatrics; secondhand smoke; smoke; smoking