Dietary Intake, Environmental Tobacco Smoke, Nutrient Biomarkers, and Chronic Disease Risk in United States Adolescents

Environmental tobacco smoke (ETS) exposure and poor dietary intake and quality are known to increase chronic disease risk in adults. Chronic diseases like heart disease, diabetes, and metabolic syndrome (MetS) are major public health problems in the United States. Adolescence is a time period of development of identity and autonomy and increasing importance of peer influence, making teens susceptible to substance abuse and poor dietary intake. The relationships between ETS exposure, dietary intake and quality, nutrient biomarkers, and chronic disease have not been studied together in the adolescent population. This project utilized data collected as a part of the 2001-2006 National Health and Nutrition Examination Survey (NHANES) – a nationally representative surveillance survey conducted in the United States. Analyses were restricted to non-smokers. General linear models (GLM) were run in STATA to test for differences in diet quality/intake by ETS exposure and to determine whether ETS is related to measures of chronic disease risk in adolescents. Subsequent analyses utilized the Sobel test to determine whether the relationship between ETS exposure and chronic disease risk was mediated by nutrient biomarkers. GLMs with interaction terms were utilized to determine whether dietary intake/quality interacts with ETS exposure in the relationship with chronic disease risk. These studies found that ETS-exposed adolescents had lower diet quality scores, higher saturated fat intake, and lower nutrient intakes than their unexposed peers. ETS exposure was found to be positively correlated with continuous MetS score. Mediation analyses identified serum folate and trans-β-carotene as potential mediators in the relationship between ETS exposure and MetS risk. No interaction was identified between dietary intake and ETS exposure in the relationship with chronic disease risk. This research has demonstrated that adolescents who are exposed to ETS are more likely to have poor diet quality – both of which increase risk for chronic disease. Findings from this study also demonstrate the negative impact ETS exposure has on chronic disease risk and illustrate some of the potential mechanisms for this relationship. Longitudinal research is needed to confirm the relationships identified in this study