PRIMARY PREVENTION IN A HIGH-RISK GROUP - SMOKING-HABITS IN ADOLESCENTS WITH HOMOZYGOUS ALPHA-1-ANTITRYPSIN DEFICIENCY (ATD)

The serious form of alpha-1-antitrypsin deficiency (ATD) Pi ZZ strongl y predisposes the individual for pulmonary emphysema and premature dea th in adulthood, especially if exposed to tobacco smoking. General scr eening of all new-born children was conducted in Sweden during 1972-19 74, the major purpose being to reduce exposure of the child to parenta l smoking while growing up and to prevent the child from starting to s moke. Sixty-one children with ATD neonatally identified through mass-s creening, and their families, have been compared with a demographicall y matched control group regarding smoking habits, as studied through i nterviews and questionnaires on two occasions. When the children were 5-7 years old, the smoking rates among parents of the ATD children and especially among the ATD fathers exceeded smoking rates for controls. Thirteen years later no differences in parental smoking were found be tween the groups. At 18-20 years of age the ATD children reported smok ing significantly less than the control children (p < 0.05). From the perspective of prevention. the goal of the neonatal screening to reduc e the smoking rates among the parents of the ATD children was not atta ined, while it was achieved among the ATD children. The results indica te that a screening program with early detection of ATD effectively pr events adolescent children from starting to smoke. From ethical, medic al and psychological points of view, a voluntary screening program for ATD in pre-adolescence is recommended.