[Prevention of atherosclerosis by enforcing non-smoking behavior]

Cigarette smoking is the single most important cause for avoidable diseases. Malignancies, pulmonary diseases, and the different manifestations of coronary artery disease (CAD) are either caused or developed significantly earlier with cigarette smoking. Even in the young-adult-age, smokers have more raised lesions in the abdominal aorta or in the coronary arteries. The analysis of more than 800 patients with myocardial infarction at young age showed that cigarette smoking is the dominant risk factor up until myocardial infarction. In male patients with CAD myocardial infarction is the first clinical manifestation. Therefore, the potential for primary prevention is small in traditional medical practice. Based on these experiences, we tried to support nonsmoking behavior in the 7th grade in school. Knowledge about the cardiovascular system and the acute effects of cigarette smoking were taught. In addition, role plays were performed by the children to practice rejecting an offered cigarette. With this intervention, new onset of smoking could be reduced by 50% over 2 years with a limited (8h) educational intervention. Reasons for the onset of cigarette smoking are different for boys and girls. The percentage of pupils smoking decreases with the increasing social status of the parents. The tobacco industry has recognized that children are an important target group as future consumers, and it uses that fact in its public relations and advertising strategy. However, the government undertakes virtually no efforts to control illegal sales of cigarettes to minors. Tax incomes from illegal sales of cigarettes to minors by far exceed the expenses for preventive efforts of state agencies. A change of this permissive attitude appears warranted.