Tobacco Exposure Linked to Elevated Blood Pressure in Pediatric Patients


Children and adolescents with direct or indirect exposure to tobacco had higher odds of having elevated blood pressure.

Rebecca Levy, MSc

Rebecca Levy, MSc

A new study noted the presence of elevated blood pressure in children and adolescents who have been exposed to tobacco.

The investigative team, led by Rebecca Levy, MSc, Department of Pediatrics, Montefiore Medical Center, used data from the 2007-2016 National Health and Nutrition Examination Survey (NHANES) to determine associations between active and passive tobacco exposure and odds of increased blood pressure in pediatric patients.

Patient ages ranged from 8-19 years old. All participants completed an in-depth interview and underwent an examination consisting of medical and physiological measurements, in addition to laboratory tests.

Tobacco and Blood Pressure

Individuals were considered exposed to tobacco if they reported the presence of at least 1 smoker at home or had a serum cotinine level >0.05 µg/L.

Furthermore, Levy and colleagues defined active smoking as “answering yes to the question ‘During the past 5 days, including today, did you smoke cigarettes, pipes, cigars, little cigars or cigarillos, water pipes, hookahs, or e-cigarettes?’ or having a serum cotinine level greater than 10 µg/L.”

In these studies, serum cotinine levels were measured by isotope dilution high-performance liquid chromatography and atmospheric pressure chemical ionization tandem mass spectrometry.

As such, the cross-sectional study looked at 8520 participants, which represented 41 million US children.

The mean age was 13.1 years, a majority (51%) of the population were male, and 58% were non-Hispanic White individuals.

The investigators noted that those with any tobacco smoke exposure were more likely to be older (mean age, 13.3 years) than those without exposure (12.8 years).

Further, participants were more likely to be male (53% [95% CI, 51-55) vs 49% [95% CI 47-50]) and non-Hispanic Black individuals (19% [95% CI, 16-22] vs 10% [95% CI, 8-12).

Additionally, those who were overweight or obese, had no or public insurance, and had a poverty index less than 130% of the federal poverty threshold were more likelty to have any tobacco exposure.

Following adjustment of covariates, the investigators also found that the odds of having elevated blood pressure was 1.31 (95% CI, 1.06-1.61) for any tobacco exposure. These odds were similar across subgroups (age, sex, race/ethnicity) and sensitivity analyses.


“Our findings are supported by the existence of data showing a biological plausibility for the association between tobacco exposure and blood pressure,” wrote the investigators. 

“Nicotine causes acute elevations in blood pressure through stimulation of the adrenergic pathway via epinephrine and norepinephrine,” they continued.

Levy and team also touched on the importance of these findings on public health and the need to address this modifiable risk factor in children.

“With a national adult prevalence of smoking of 15.5%, 5.6 million children can be expected to die prematurely during adulthood from smoking-associated causes,” they wrote.

Nevertheless, they acknowledged greater potential in collecting stronger observational data through prospective, longitudinal studies. These studies can also help elucidate associations with duration and timing of passive tobacco exposure as well as tobacco ingestion method.

The study, “Analysis of Active and Passive Tobacco Exposures and Blood Pressure in US Children and Adolescents,” was published online in JAMA Network Open.

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