The effects of environmental tobacco smoke on health services utilization in the first eighteen months of life

Objective. To examine the effects of environmental tobacco smoke (ETS) on h ealth services use in Chinese infants with nonsmoking mothers. Design. Prospective, population-based birth cohort. Setting. General population of Hong Kong in 1997-1998. Participants. A total of 8327 parent-infant pairs who were followed up for 18 months. Main Outcome Measures. Doctor consultations and hospitalizations. Results. After adjusting for the age, education level, and employment statu s of mothers-as well as infants' birth weight, method of delivery, breastfe eding status, and birth order-ETS exposure through the mother in utero was positively associated with higher consultation (adjusted odds ratio [OR]: 1 .26; 95% confidence interval [CI]: 1.14, 1.39) and hospitalization (OR: 1.1 8; 95% CI: 1.05, 1.31) use in infants with nonsmoking mothers attributable to any illness. In addition, postnatal exposure to ETS at home was linked t o higher rates of hospitalizations for any illness compared with nonexposed infants (OR: 1.12; 95% CI: 1.00, 1.25), although the relationship did not hold for outpatient consultation visits. The OR for higher hospital use in infants exposed to 2 or more smokers at home was 1.30 (95% CI: 1.08, 1.58). Conclusions. The use of tobacco products by household members, even among n onsmoking mothers, has an enormous adverse impact on the health of children , as well as increases health services use and cost. The present data suppo rt the revision of public policy to reflect an evidence-based approach to t he promotion of smoking cessation in all household members during and after pregnancy.