Use of health services by children of smokers and nonsmokers in a health maintenance organization

Am J Public Health. 1998 Jun;88(6):897-902. doi: 10.2105/ajph.88.6.897.


Objectives: Use of health services by children of smokers and nonsmokers was compared to assess whether exposure to environmental tobacco smoke resulted in greater use of health services among children of smokers.

Methods: Primary care and emergency room visits, asthma-related prescriptions, and inpatient stays over the 42-month study period were compared for children of smokers (n = 498) and nonsmokers (n = 1062) who were enrolled in a health maintenance organization. Parents of children aged 1 through 11 years were identified from participants in 2 randomized smoking cessation trials.

Results: After adjustment for parental age, education, and health status and for child's age, there were no differences between children of smokers and children of nonsmokers in use of primary care or emergency room visits, asthma-related prescriptions, or inpatient stays. However, among those with any preventive care visits, children of smokers had significantly fewer visits than children of nonsmokers.

Conclusions: Further study is needed to elucidate whether parents who smoke underutilize health services for their children or use services differently from nonsmoking parents and whether these differences have cost implications.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Ambulatory Care / statistics & numerical data
  • Asthma / epidemiology*
  • Asthma / etiology
  • Asthma / prevention & control
  • Child
  • Child Health Services / statistics & numerical data*
  • Child, Preschool
  • Female
  • Health Maintenance Organizations / statistics & numerical data*
  • Humans
  • Infant
  • Male
  • Patient Admission / statistics & numerical data
  • Primary Health Care / statistics & numerical data
  • Randomized Controlled Trials as Topic
  • Smoking Cessation
  • Tobacco Smoke Pollution / adverse effects*


  • Tobacco Smoke Pollution