Auswirkungen des Aktiv- und Passivrauchens auf die Gesundheit von Kindern und Jugendlichen

Zusammenfassung

Der Tabakkonsum betrifft in Deutschland in erheblicher Weise auch Kinder und Jugendliche. Während vor 10 Jahren kaum jeder fünfte Jugendliche (18 %) rauchte, haben in dieser Altersgruppe 2001 über 30 % der 12 – 17-jährigen selbst geraucht. Das ist prekär, da die Peer Group einen wichtigen Einfluss auf die Entwicklung der Rauchgewohnheiten hat und darüber hinaus die Tabakabhängigkeit hauptsächlich vor dem 20. Lebensjahr entsteht (80 % der Erwachsenen, die regelmäßig rauchen, haben vor dem 20. Lebensjahr mit dem Rauchen begonnen). Ein früher Beginn ist aufgrund der Summationseffekte und der Unreife der Organe außerdem besonders gesundheitsgefährdend. Erfreulicherweise nimmt der Anteil der rauchenden Jugendlichen in den letzten Jahren wieder ab.
Neben dieser direkten Schädigung durch das aktive Rauchen besteht auch eine Gefahr durch das passive Rauchen. Schon vorgeburtlich wird der Fetus durch die Rauchexposition geschädigt. Vorzeitiger Blasensprung, Frühgeburtlichkeit, verlangsamtes fetales Wachstum und vermindertes Lungenvolumen lassen sich auf einen mütterlichen Tabakkonsum zurückführen. Die Passivrauchexposition führt jedoch nicht nur bei Säuglingen zu einer gesundheitlichen Beeinträchtigung. Typische Gesundheitsfolgen der Tabakexposition bei Kindern sind Atemwegserkrankungen, aber auch verlangsamtes Wachstum und andere Auffälligkeiten. Der mütterliche Zigarettenkonsum zeigt dabei die stärkste Korrelation mit Erkrankungen der kindlichen Atemwege. Daher müssen Präventionsbemühungen unter Einbeziehung von Kindern und Jugendlichen intensiviert werden.

Abstract

Tobacco abuse is especially a public health problem among children and teenagers in Germany. While the proportion of adolescents smoking regularly was 18 % in 1997, this has increased to more than 30 % in 2001. The high impact of peer groups in young people aggravates the development of smoking habits. Furthermore, an addiction to nicotine develops mainly before the age of 20 (80 % of all adults smokers have started as teenagers). Early and continued damage to health will result in long-term sequelae due to immaturity of the organs. Fortunately, the proportion of smoking adolescents has decreased in the last few years. Besides the well known effects of active smoking, children are especially endangered by environmental tobacco smoke (ETS). Exposure to cigarette smoke during pregnancy is directly correlated to premature rupture of the membranes, premature birth, delayed foetal development, and reduced lung function. Children are suffering from impairments of their health not only due to ETS exposure in utero but also after birth (e. g., diseases of upper and lower airways, delayed physical and mental development). Therefore, the prevention of active and passive smoking must be intensified and should consider the special situation of children and adolescents.

Literatur

• 1 Laucht M, Schmid B. Early onset of alcohol and tobacco use-indicator of enhanced risk of addiction?.  Z Kinder Jugendpsychiatr Psychother. 2007;  35 137-143
• 2 DiFranza J R, Rigotti N A, McNeill A D. et al . Initial symptoms of nicotine dependence in adolescents.  Tob Control. 2000;  9 313-319
• 3 Bray F, Parkin D M. Lung cancer in Europe in 2000: epidemiology, prevention, and early detection. Tyczynski JE.  Lancet Oncol. 2003;  4 45-55
• 4 US Department of Health and Human Services .Preventing Tobacco Use Among Young People: A Report of the Surgeon General Atlanta, Georgia: US Department of Health and Human Services, Public Health Service, Centres for Disease Control, Centre for Health Promotion and Education. Office on Smoking and Health 1994
• 5 Robert Koch Institut .Epidemiologisches Bulletin 22/2000. 31.05.2000
• 6 Conrad K M, Flay B R, Hill D. Why children start smoking cigarettes: predictors of onset.  Br J Addiction. 1992;  87 1711-1724
• 7 Chassin L, Presson C C, Rose J S. et al . The natural history of cigarette smoking from adolescence to adulthood: demographic predictors of continuity and change.  Health Psychol. 1996;  15 478-484
• 8 Lando H A, Thai D T, Murray D M. et al . Age of initiation, smoking patterns, and risk in a population of working adults.  Prev Med. 1999;  29 590-598
• 9 Breslau N, Peterson E L. Smoking cessation in young adults: age at initiation of cigarette smoking and other suspected influences.  Am J Pub Health. 1996;  86 214-220
• 10 Paavola M, Vartiainen E, Puska P. Predicting adult smoking: the influence of smoking during adolescence and smoking among friends and family.  Health Educ Res. 1996;  11 309-315
• 11 United Nations Childrenaposs Fund .The State of the Worldaposs Children. New York, NY: United Nations Childrenaposs Fund 2002
• 12 The Global Youth Tobacco Survey Collaborative Group . Tobacco use among youth: a cross country comparison.  Tob Control. 2002;  11 252-270
• 13 World Bank .Curbing the epidemic: governments and the economics of tobacco control. 1999. PEDIATRICS 2006; 118: e899 www1.worldbank.org/tobacco/reports.asp Accessed December 20 2005
• 14 KiGGS .Studie des Robert Koch-Institutes. (www.kiggs.de) Mai 2003 bis Mai 2006
• 15 Statistische Bundesamt .Mikrozensus 1992 Fachserie 12 Reihe S.3 Fragen zur Gesundheit. 
• 16 Currie C. et al .Young people's health in context. Health Behaviour in School-aged Children (HBSC) study: international report from the 2001/2002 survey, WHO.
• 17 Lampert T. Tabakkonsum und Passivrauchbelastung von Jugendlichen. Ergebnisse des Kinder- und Jugendgesundheitssurveys (KiGGS).  Dtsch Arztebl. 2008;  105 265-271
• 18 Castles A, Adams E K, Melvin C L. et al . Effects of smoking during pregnancy. Five Meta-Analyses.  Am J Prev Med. 1999;  16 208-215
• 19 Nabet C, Lelong N, Ancel P Y. et al . Smoking during pregnancy according to obstetric complications and parity: results of the EUROPOP study.  Eur J Epidemiol. 2007;  22 715-721 Epub 2007 Aug 29
• 20 US Department of Health and Human Services .The Health Consequences of Smoking: A Report of the Surgeon General. Atlanta, GA: US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health 2004
• 21 Svanes C, Omenaas E, Jarvis D. et al . Parental smoking in childhood and adult obstructive lung disease: results from the European Community Respiratory Health Survey.  Thorax. 2004;  59 295-302
• 22 Edwards C A, Osman L M, Godden D J. et al . Relationship between birth weight and adult lung function: controlling for maternal factors.  Thorax. 2003;  58 1061-1065
• 23 Moshammer H, Hoek G, Luttmann-Gibson H. et al . Parental smoking and lung function in children: an international study.  Am J Respir Crit Care Med. 2006;  173 1255-1263
• 24 Cunningham J, Dockery D W, Speizer E F. Maternal smoking during pregnancy as a predictor of lung function in children.  Am J Epidemiol. 1994;  139 1139-1152
• 25 Tager I B, Ngo L, Hanrahan J P. Maternal smoking during pregnancy: effects on lung function during the first 18 months of life.  Am J Respir Crit Care Med. 1995;  152 977-983
• 26 Cunningham J, O'Connor G T, Dockery D W. et al . Environmental tobacco smoke, wheezing, and asthma in children in 24 communities.  Am J Respir Crit Care Med. 1996;  153 218-224
• 27 Wang X, Wypij D, Gold D R. et al . A longitudinal study of the effects of parental smoking on pulmonary function in children 6 – 18 years.  Am J Respir Crit Care Med. 1994;  149 1420-1425
• 28 Stick S M, Burton P R, Gurrin L. et al . Effects of maternal smoking during pregnancy and a family history of asthma on respiratory function in newborn infants.  Lancet. 1996;  348 1060-1064
• 29 Cook D G, Strachan D P, Carey I M. Parental smoking and spirometric indices in children.  Thorax. 1998;  53 884-893
• 30 U.S. Environmental Protection Agency .Respiratory health effects of passive smoking: lung cancer and other disorders. Washington, DC: U.S. Environmental Protection Agency 1992
• 31 Li Y F, Gilliland F D, Berhane K. et al . Effects of in utero and environmental tobacco smoke exposure on lung function in boys and girls with and without asthma.  Am J Respir Crit Care Med. 2000;  162 2097-2104
• 32 Sherrill D L, Martinez F D, Lebowitz D. et al . Longitudinal effects of passive smoking on pulmonary function in New Zealand children.  Am Rev Respir Dis. 1992;  145 1136-1141
• 33 Hanrahan J P, Tager I B, Segal M R. et al . The effect of maternal smoking during pregnancy on early infant lung function.  Am Rev Respir Dis. 1992;  145 1129-1135
• 34 Strachan D, Cook D. Health effects of passive smoking 6: parental smoking and childhood asthma: longitudinal and case-control studies.  Thorax. 1998;  53 204-212
• 35 Tager I B, Hanrahan J P, Tosteson T D. et al . Lung function, pre and post natal smoke exposure, and wheezing in the first year of life.  Am Rev Respir Dis. 1993;  147 811-817
• 36 Wright A L, Holberg C, Martinez F D. et al . Relationship of parental smoking to wheezing and nonwheezing lower respiratory tract illnesses in infancy. Group Health Medical Associates.  J Pediatr. 1991;  118 207-214
• 37 Law B J, Carbonell-Estrany X, Simoes E A. An update on respiratory syncytial virus epidemiology: a developed country perspective.  Respir Med. 2002 Apr;  96 Suppl B 1-7
• 38 Rantakallio P. Relationship of maternal smoking to morbidity and mortality of the child up to the age of five.  Acta Paediatr Scand. 1978;  67 621-631
• 39 Huang S W, Giannoni C. The risk of adenoid hypertrophy in children with allergic rhinitis.  Ann Allergy Asthma Immunol. 2001;  87 350-355
• 40 Corbo G M, Fuciarelli F, Foresi A. et al . Snoring in children: association with respiratory symptoms and passive smoking.  BMJ. 1989;  299 1491-1494
• 41 Stahlberg M R, Ruuskanen O, Virolainen E. Risk factors for recurrent otitis media.  Pediatr Infect Dis. 1986;  5 30-32
• 42 Strachan D, Cook D. Health effects of passive smoking 4: parental smoking, middle ear disease, and adenotonsillectomy in children.  Thorax. 1998;  53 50-56
• 43 Franklin P J, Turner S, Mutch R. et al . Parental smoking increases exhaled nitric oxide in young children.  Eur Respir J. 2006;  28 730-733
• 44 Tepper R S, Williams-Nkomo T, Martinez T. et al . Parental smoking and airway reactivity in healthy infants.  Am J Respir Crit Care Med. 2005;  171 78-82
• 45 Fleming P, Blair P S. Sudden Infant Death Syndrome and parental smoking.  Early Hum Dev. 2007;  83 721-725
• 46 Eliot J, Vullermin P, Robinson P. Maternal Cigarette Smoking Is Associated with Increased Inner Airway Wall Thickness in Children Who Die from Sudden Infant Death Syndrome.  AJRCCM. 1998 Sep;  158 (3) 802-806
• 47 California Environmental Protection Agency .Health effects of exposure to environmental tobacco smoke. Sacramento, CA: Office of Environmental Health Hazard Assessment; 1997. Available at: www.oehha.org/pdf/exec.pdf
• 48 Bascom R. Environmental factors and respiratory hypersensitivity: the Americas.  Toxicol Lett. 1996;  86 115-130
• 49 Magnusson C G. Maternal smoking influences cord serum IgE and IgD levels and increases the risk for subsequent infant allergy.  J Allergy Clin Immunol. 1986;  78 898-904
• 50 Henderson F W, Henry M M, Ivins S S. et al . Correlates of recurrent wheezing in school-age children. The Physicians of Raleigh Pediatric Associates.  Am J Respir Crit Care Med. 1995;  151 1786
• 51 Johnson J D, Houchens D P, Kluwe W M. et al . Effects of mainstream and environmental tobacco smoke on the immune system in animals and humans: a review.  Crit Rev Toxicol. 1990;  20 369-395
• 52 Ownby D R, McCullough J. Passive exposure to cigarette smoke does not increase allergic sensitization in children.  Allergy Clin Immunol. 1988;  82 634-638
• 53 Kulig M, Luck W, Lau S. et al . Effect of pre- and postnatal tobacco smoke exposure on specific sensitization to food and inhalant allergens during the first 3 years of life. Multicenter Allergy Study Group, Germany.  Allergy. 1999;  54 220-228
• 54 Kulig M, Luck W, Wahn U. The association between pre- and postnatal tobacco smoke exposure and allergic sensitization during early childhood. Multicentre Allergy Study Group, Germany.  Hum Exp Toxicol. 1999;  18 241-244
• 55 Lannerö E, Wickman M, van Hage M. et al . Exposure to environmental tobacco smoke and sensitisation in children.  Thorax. 2008;  63 172-176
• 56 Menzies D, Nair A, Williamson P A. et al . Respiratory symptoms, pulmonary function, and markers of inflammation among bar workers before and after a legislative ban on smoking in public places.  Jama. 2006;  296 1742-1748
• 57 Skogstad M, Kjaerheim K, Fladseth G. et al . Cross shift changes in lung function among bar and restaurant workers before and after implementation of a smoking ban.  Occup Environ Med. 2006;  63 482-487
• 58 Goodman P, Agnew M, McCaffrey M. et al . Effects of the Irish smoking ban on respiratory health of bar workers and air quality in Dublin pubs.  Am J Respir Crit Care Med. 2007;  175 840-845
• 59 Genuneit J, Weinmayr G, Radon K. et al . Smoking and the incidence of asthma during adolescence: results of a large cohort study in Germany.  Thorax. 2006;  61 572-578 Epub 2006 Mar 14
• 60 Gilliland F D, Islam T, Berhane K. et al . Regular smoking and asthma incidence in adolescents.  Am J Respir Crit Care Med. 2006;  174 1094-1100
• 61 Strachan D P, Butland B K, Anderson H R. Incidence and prognosis of asthma and wheezing illness from early childhood to age 33 in a national British cohort.  BMJ. 1996;  312 1195-1199
• 62 Barrett E G, Wilder J A, March T H. et al . Cigarette smoke-induced airway hyperresponsiveness is not dependent on elevated immunoglobulin and eosinophilic inflammation in a mouse model of allergic airway disease.  Am J Respir Crit Care Med. 2002;  165 1410-1418
• 63 Lau S, Nickel R, Niggemann B. et al . The development of childhood asthma: lessons from the German Multicentre Allergy Study (MAS).  Paediatr Respir Rev. 2002;  3 265-272
• 64 Hancox R J, Welch D, Poulton R. et al . Cigarette smoking and allergic sensitization: a 32-year population-based cohort study.  J Allergy Clin Immunol. 2008;  121 38-42.e3
• 65 Linneberg A, Nielsen N H, Madsen F. et al . Factors related to allergic sensitization to aeroallergens in a cross-sectional study in adults: The Copenhagen Allergy Study.  Clin Exp Allergy. 2001;  31 1409-1417
• 66 Tsoumakidou M, Elston W, Zhu J. et al . Cigarette smoking alters bronchial mucosal immunity in asthma.  Am J Respir Crit Care Med. 2007;  175 919-925
• 67 Adler S, Rosewich M, Rose M A. et al .Untersuchung der Lungenfunktion bei jugendlichen Rauchern. Zürich: GPP 2008
• 68 Franklin P J, Turner S, Mutch R. et al . Parental smoking increases exhaled nitric oxide in young children.  Eur Respir J. 2006;  28 730-733
• 69 Maniscalco M, Vatrella A, Sofia M. Passive smoke and exhaled nitric oxide.  Am J Respir Crit Care Med. 2002;  165 1188
• 70 Kharitonov S A, Robbins R A, Yates D. et al . Acute and chronic effects of cigarette smoking on exhaled nitric oxide.  Am J Respir Crit Care Med. 1995;  152 609-612
• 71 Sato S, Nishimura K, Koyama H. et al . Optimal cutoff level of breath carbon monoxide for assessing smoking status in patients with asthma and COPD.  Chest. 2003;  124 1749-1754
• 72 Pearce M S, Hayes L. Newcastle Heart Project; Newcastle Thousand Families Study. Self-reported smoking status and exhaled carbon monoxide: results from two population-based epidemiologic studies in the North of England.  Chest. 2005;  128 1233-1238
• 73 Sundy J S, Hauswirth D W, Mervin-Blake S. et al . Smoking is associated with an age-related decline in exhaled nitric oxide.  Eur Respir J. 2007;  30 1074-1081
• 74 Franklin P J, Turner S, Mutch R. et al . Parental smoking increases exhaled nitric oxide in young children.  Eur Respir J. 2006;  28 730-733
• 75 Malinovschi A, Janson C, Holmkvist T. et al . Effect of smoking on exhaled nitric oxide and flow-independent nitric oxide exchange parameters.  Eur Respir J. 2006;  28 339-345 Epub 2006 Apr 26
• 76 Chambers D C, Tunnicliffe W S, Ayres J G. Acute inhalation of cigarette smoke increases lower respiratory tract nitric oxide concentrations.  Thorax. 1998;  53 677-679
• 77 Kharitonov S A, Robbins R A, Yates D. et al . Acute and chronic effects of cigarette smoking on exhaled nitric oxide.  Am J Respir Crit Care Med. 1995;  152 609-612
• 78 Balint B, Donnelly L E, Hanazawa T. et al . Increased nitric oxide metabolites in exhaled breath condensate after exposure to tobacco smoke.  Thorax. 2001;  56 456-461
• 79 Beißwenger C. Modulation der angeborenen Immunität der Lunge durch Umwelteinflüsse und allergische Entzündung. Uni Marburg: Innere Medizin 2005 http://archiv.ub.uni-marburg.de/diss/z2005/0424/
• 80 Aronson M D, Weiss S T, Ben R L. et al . Association between cigarette smoking and acute respiratory tract illness in young adults.  JAMA. 1982;  248 181-183
• 81 Birrell M A, Wong S, Catley M C. et al . Impact of tobacco-smoke on key signaling pathways in the innate immune response in lung macrophages.  J Cell Physiol. 2008;  214 27-37
• 82 Hurd S. The impact of COPD on lung health worldwide: epidemiology and incidence.  Chest. 2000;  117 1S-4S
• 83 Teramoto S. 1. COPD pathogenesis from the viewpoint of risk factors.  Intern Med. 2007;  46 77-79 Epub 2007 Jan 15. Review
• 84 Gold D R, Wang X, Wypij D. et al . Effects of cigarette smoking on lung function in adolescent boys and girls.  N Engl J Med. 1996;  335 931-937
• 85 Hasday J D, Bascom R, Costa J J. et al . Bacterial endotoxin is an active component of cigarette smoke.  Chest. 1999Mar ;  115 (3) 829-835
• 86 Kitz R, Rose M A, Borgmann A. et al . Systemic and bronchial Inflammation following LPS inhalation in asthmatic and healthy subjects.  J Endotox Res. 2006;  12 367-374
• 87 Andreas S, Batra A, Behr J. et al . Guidelines for Smoking Cessation in Patients with COPD Issued by the Deutsche Gesellschaft für Pneumologie und Beatmungsmedizin.  Pneumologie. 2008;  62 255-272
• 88 DiFranza J R. et al . Tobacco Promotion and the Initiation of Tobacco Use: Assessing the Evidence for Causality.  Pediatrics. 2006;  117 e1237-1248
• 89 DiFranza J R. et al . Measuring the loss of autonomy over nicotine use in adolescents: the DANDY (Development and Assessment of Nicotine Dependence in Youths) study.  Arch Pediatr Adolesc Med. 2002;  156 397-403
• 90 Hanewinkel R, Sargent J D. Exposure to smoking in internationally distributed American movies and youth smoking in Germany: a cross-cultural cohort study.  Pediatrics. 2008;  121 e108-117
• 91 Gervais A. et al . Milestones in the natural course of onset of cigarette use among adolescents.  CMAJ. 2006;  175 255-261
• 92 Wiborg G, Hanewinkel R. Effectiveness of the “Smoke-Free Class Competition” in delaying the onset of smoking in adolescence.  Prev Med. 2002;  35 241-249
• 93 Hanewinkel R. “Be smart-don't start”. Results of a non-smoking competition in Germany 1997 – 2007.  Gesundheitswesen. 2007;  69 38-44
• 94 Thomas R, Perera R. School-based programmes for preventing smoking. Cochrane Database of Systematic Reviews 2002, Issue 4. Art. No.: CD001293. DOI: 10.1002/14 651 858.CD001293.pub2
• 95 Peto R. et al . Mortality from tobacco in developed countries: indirect estimation from national vital statistics.  Lancet. 1992;  339 1268-1478
• 96 Doll R, Peto R, Boreham J. et al . Mortality in relation to smoking: 50 years' observations on male British doctors.  BMJ. 2004;  328 1519