Aortopulmonary septal defect due to staphylococcal endocarditis.

In the Child Chest Clinic of the Medical College of Virginia Hospitals, 300 teenagers (13 through 19 years of age) were questioned as to their smoking habits, and 127 (42 percent) admitted the smoking habit. Among a control group chosen as a random sample from three local high schools and one junior high school in which students are, in general, of a similar socioeconomic background, 32 percent were smokers. Although the dangers of smoking are well recogn i ~ e d , ' ~ teenagers and college students have accepted the smoking habit; the results of the present study emphasize this fact. However, the large percentage of smokers in this particular study group (no one was a "heavy smoker," since daily consumption was less than one pack in all cases) was unexpected. It should be emphasized that all of the children in this study have been observed in the Medical College of Virginia Child Chest Clinic for more than ten years because of infection with tuberculosis. There is no evidence that smoking is more likely to be harmful to teenagers who have healed primary tuberculosis than to those in the general population. However, the adolescents themselves were certainly not aware of this fact and smoking is discouraged by the Chest Clinic. It would appear that knowledge of the existence of any earlier pulmonary infection, in this case tuberculosis, and the need for an annual follow-up examination should be a deterrent to the acquisition of the smoking habit. This is apparently not the case. A recent report by the Committee on Environmental Hazards of the American Academy of Pediatrics' has listed aspects of the smoking problem which relate directly to children and teenagers. The first of these is the shortterm effect of smoking by teenagers and children, and in this regard it has been adequately shown that children who smc~ke have more respiratory symptorn~,~ cough, phlegm, breathlessness, wheezing and colds than do nonsmoker^.^-^ The second aspect is the effect of tobacco smoke on nonsmokers. Cigarette smoke, inhaled from either end of the cigarette, suppresses pulmonary defense mechanisms in uiuo, and mucociliary activity and alveolar macrophage activity in uitro. Therefore, the pulmonary defense mechanisms of children are impaired from breathing smoke from ciga~ettes.~ Further, Cameron's studies"J~l1 indicate the children from homes where the parents smoked had a higher incidence of respiratory disease than did the children of nonsmokers.