They're Still Kids

Two articles in this issue of The Journal are important reminders that health risk affecting all children may have an even greater impact on children and youth with chronic illnesses. Hofer and the DPV-Weiss Study Group¹ present cross-sectional data on the prevalence of smoking in a large cohort of German and Austrian youth with type 1 diabetes. The authors report that the prevalence of smoking in youth with diabetes was not different from that of the general population, despite their increased risk of cardiovascular and microvascular disease. Although detailed recent data on smoking in youth with diabetes from the US are not available, older data suggest that the prevalence is similar in this country.² In the U.S. general population, 8% of middle school children and 23% of high school youth self-report current cigarette use. In addition, U.S. middle school and high school students report smoking cigars and using smokeless tobacco products.⁴ Although high school children may perceive these alternative tobacco products as safer than cigarettes, they are known to promote vascular constriction, endothelial dysfunction, and increased cardiovascular inflammation. Therefore they likely pose a risk similar to that of cigarettes for the promotion of cardiovascular and microvascular disease in young people with type 1 diabetes mellitus.