UMMS Affiliation

Division of Endocrinology, Department of Pediatrics

Publication Date


Document Type



Endocrinology, Diabetes, and Metabolism | Environmental Public Health | Pediatrics


IMPORTANCE: The role of tobacco-smoke exposure on serum vitamin D concentration in US pediatric population is not known. We hypothesized that tobacco smoke exposure would increase the prevalence of vitamin D deficiency in US children.

METHODS: Representative national data were accessed from the National Health and Nutrition Examination Survey (NHANES) 2009-2010 databank on 2,263 subjects of ages 3 to 17 years. Subjects were categorized into two groups based on their age: children, if <10 >years; and youth if 10 to 17 years. Descriptive and multiple logistic regression analyses were conducted to determine the effect of serum cotinine-verified tobacco smoke exposure on vitamin D status after controlling for key sociodemographic confounders. Vitamin D deficiency was defined as 25(OH)D/mL, insufficiency as 25(OH)D of 20-29.9 ng/mL, and sufficiency as 25(OH)D of ≥30 ng/mL. Tobacco smoke exposure status was defined by serum cotinine concentration as follows: unexposed and non-smoking (

RESULTS: The prevalence of second-hand smoke exposure was 42.0% (95%CI, 36.7%-47.5%); while the prevalence of active smoking among teenagers was 9.0% (95%CI, 6.2%-12.5%). Vitamin D deficiency occurred at a frequency of 15.1% in children unexposed to tobacco smoke, 20.9% in children exposed to passive tobacco smoke, and 18.0% among actively smoking youth (p

CONCLUSIONS: This analysis of a nationwide database reports that tobacco smoke exposure is an independent predictor of vitamin D deficiency in US children.


Smoking habits, Vitamin D deficiency, Vitamin D, Smoking related disorders, Adolescents, Children, Regression analysis, Micronutrient deficiencies

Rights and Permissions

Copyright: © 2018 Nwosu, Kum-Nji. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

DOI of Published Version



PLoS One. 2018 Oct 8;13(10):e0205342. doi: 10.1371/journal.pone.0205342. eCollection 2018. Link to article on publisher's site

Journal/Book/Conference Title

PLoS One

Related Resources

Link to article in PubMed. Data Availability: Data are available from the University of Massachusetts Medical School’s institutional repository, eScholarship@UMMS, at or

PubMed ID


Creative Commons License

Creative Commons Attribution 4.0 License
This work is licensed under a Creative Commons Attribution 4.0 License.