Tobacco Use and Utilization of Medical Services in Adolescence: An Analysis of the KiGGS Data

Objective: In Germany, there is a lack of information on the correlation between tobacco use by adolescents and their utilization of medical care. The aim of this article is to identify possible early consequences of adolescent smoking. Methods: We conducted a re-analysis of cross-sectional data of the baseline wave (2003-2006) of the German Health Survey for Children and Adolescents (KiGGS). To examine the association between current smoking status and utilization of medical care during the 12 months before the interview, prevalence of selected diseases was calculated, and stratified by smoking status. Besides, the proportion of adolescents who consulted a physician at least once and the total number of medical consultations were estimated. For the inpatient setting, information about the number of nights spent in a hospital was analyzed. In a multiple logistic regression, the association of smoking behavior with utilization of outpatient medical care was assessed, further adjusting for sociodemographic variables and comorbidities. Results: The study population included 3679 adolescents aged between 14 and 17 years. 49.1% were female and 31.7% were current smokers. Among smokers, there was an increased prevalence of cystitis (+87.0%) and bronchitis (+50.0%). Tobacco users consulted a general practitioner more frequently than non-smokers (+30.8%). As far as medical specialists are concerned, there were more consultations with psychiatrists (+171.4%) and psychologists (+94.4%), but there was no increase in the total number of visits. Additionally, smoking adolescents were more frequently hospitalized (+26.5%) and the stays were of longer duration (+19.7%). There was a statistically significant association between current tobacco use and a greater utilization of medical care (OR=1.20; 95%-CI: 1.02-1.40). Conclusions: Tobacco use among adolescents was associated with increased prevalence of certain diseases and a greater utilization of medical care. Nevertheless, whether there is a causal connection is still debatable. The KiGGS cohort study will provide opportunities to further clarify the observed association.