Abstract
STUDY OBJECTIVE: To examine the financial cost of doctor consultations for cough, phlegm, and wheeze in children living in a home where family members smoke compared with those not exposed to environmental tobacco smoke. To model these costs to provide the Territory of Hong Kong with estimates of potentially avoidable health care resource use. DESIGN: Cross sectional questionnaire survey. SUBJECTS AND SETTING: All children (10,615) in classes primary 3 to 6 (aged 8-13 years) attending 27 schools in two districts of Hong Kong in 1992 and their parents. MEASUREMENTS AND MAIN RESULTS: Doctor consultations during the previous three months for symptoms of either cough, phlegm or wheeze were higher in younger children, ranging from 22.9% in 8 year olds to 8.4% in those aged 12 or over. For those children living in homes with one, or more than one, smoker category (there were four categories of smokers: father, mother, siblings, others), the adjusted odds ratios (95% confidence intervals) for a doctor consultation for any of these symptoms were 1.15 (1.01, 1.31) and 1.38 (1.14, 1.67) respectively. Using US$15 as the minimum cost incurred per consultation, the expected direct cost per annum per child of doctor consultations was 14% higher for children living in a one smoker category home and 25% for two or more compared with exposure to no smokers in the home. Using these values on a territory wide basis, the annual avoidable direct cost associated with exposure to tobacco smoke in children from birth to 12 years of age ranged from US$338,042 to US$991,591. CONCLUSIONS: Exposure to environmental tobacco smoke not only provides a respiratory health risk for children but also an avoidable excess cost to the family's financial resources and health service providers.
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- Bruusgaard D., Kise S. A., Nilsson D. Health service consumption and parent reported episodes of illness in children 0-3 years. Scand J Prim Health Care. 1993 Jun;11(2):147–150. doi: 10.3109/02813439308994918. [DOI] [PubMed] [Google Scholar]
- Chen Y., Li W. X., Yu S. Z., Qian W. H. Chang-Ning epidemiological study of children's health: I: Passive smoking and children's respiratory diseases. Int J Epidemiol. 1988 Jun;17(2):348–355. doi: 10.1093/ije/17.2.348. [DOI] [PubMed] [Google Scholar]
- Chen Y., Li W., Yu S. Influence of passive smoking on admissions for respiratory illness in early childhood. Br Med J (Clin Res Ed) 1986 Aug 2;293(6542):303–306. doi: 10.1136/bmj.293.6542.303. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Choi B. C., Nethercott J. R. The economic impact of smoking in Canada. Int J Health Plann Manage. 1988 Jul-Sep;3(3):197–205. doi: 10.1002/hpm.4740030306. [DOI] [PubMed] [Google Scholar]
- Fergusson D. M., Horwood L. J., Shannon F. T., Taylor B. Parental smoking and lower respiratory illness in the first three years of life. J Epidemiol Community Health. 1981 Sep;35(3):180–184. doi: 10.1136/jech.35.3.180. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Harlap S., Davies A. M. Infant admissions to hospital and maternal smoking. Lancet. 1974 Mar 30;1(7857):529–532. doi: 10.1016/s0140-6736(74)92714-7. [DOI] [PubMed] [Google Scholar]
- Lo A. Y., Hedley A. J., Pei G. K., Ong S. G., Ho L. M., Fielding R., Cheng K. K., Daniel L. Doctor-shopping in Hong Kong: implications for quality of care. Int J Qual Health Care. 1994 Dec;6(4):371–381. doi: 10.1093/intqhc/6.4.371. [DOI] [PubMed] [Google Scholar]
- Ong S. G., Liu J., Wong C. M., Lam T. H., Tam A. Y., Daniel L., Hedley A. J. Studies on the respiratory health of primary school children in urban communities of Hong Kong. Sci Total Environ. 1991 Jul 1;106(1-2):121–135. doi: 10.1016/0048-9697(91)90025-a. [DOI] [PubMed] [Google Scholar]
- Peters J., Hedley A. J., Wong C. M., Lam T. H., Ong S. G., Liu J., Spiegelhalter D. J. Effects of an ambient air pollution intervention and environmental tobacco smoke on children's respiratory health in Hong Kong. Int J Epidemiol. 1996 Aug;25(4):821–828. doi: 10.1093/ije/25.4.821. [DOI] [PubMed] [Google Scholar]
- Weitzman M., Gortmaker S., Walker D. K., Sobol A. Maternal smoking and childhood asthma. Pediatrics. 1990 Apr;85(4):505–511. [PubMed] [Google Scholar]
- van Reek J., Adriaanse H. Passive smoking and visits to the general practitioner by schoolchildren. J Public Health Med. 1993 Dec;15(4):368–369. doi: 10.1093/oxfordjournals.pubmed.a042894. [DOI] [PubMed] [Google Scholar]