Associations of active and passive tobacco exposure with elevated blood pressure in Korean adolescents.

Objectives:To test the hypothesis that tobacco exposure is associated with elevated blood pressure in Korean adolescents, and that the association is dose dependent. Methods:This cross-sectional study used data from the 2011-2020 Korea National Health and Nutrition Survey (KNHANES). Subjects were eligible if they were 13-18 years at the time of participation in KNHANES. Tobacco exposure was defined by urine cotinine level. The main outcomes were elevated blood pressure (EBP) and hypertension. Statistical analyses were conducted using SAS 9.4 with appropriate sampling weights to account for the complex survey design, stratification, and cluster variable. Results:A total of 2518 adolescents was included in the analysis, representing 2.5 million Korean adolescents. The mean (SD) participant age was 15.3 (1.7) years, and 55.3% were male. The number of participants with active tobacco smoke exposure was 283 (11.2%), passive tobacco smoke exposure was 145 (5.8%), and no smoke exposure was 2090 (83.0%). Analysis of the 2518 urine-cotinine-verified participants showed that tobacco smoke exposure had a significant effect on EBP: with an elevated odds of BP of 3.00 (95% CI: 1.14-7.89). The odds of hypertension were 3.61 (95% CI: 1.13-11.49) in the active smoking group compared with the no tobacco exposure group after adjustment for potential confounders. Conclusion:It is necessary to present a range of public health plans to reduce tobacco exposure that affects adolescents' blood pressure, and further research with a larger number of participants using urine cotinine as a biomarker is needed.