All ETDs from UAB

Advisory Committee Chair

Anne Turner-Henson

Advisory Committee Members

Susan Davies

Connie Kohler

Marti Rice

Xiaogang Su

Document Type


Date of Award


Degree Name by School

Doctor of Philosophy (PhD) School of Nursing


High blood pressure is a prevalent precursor to cardiovascular disease. An estimated 3% of US adolescents have hypertension. In addition, prehypertension is predictive of hypertension in adolescents, with progression between these stages at approximately 7% per year. Tobacco use/exposure is strongly linked to cardiovascular risk and disease in adults. Further, rural communities have higher tobacco use prevalence and fewer community policies restricting tobacco use. Little is known about the effects of tobacco exposure on blood pressure and the mediating effects of inflammation (salivary C-reactive protein (CRP)) in rural adolescents. The purpose of this study is to determine the relationships between tobacco exposures, inflammation, and blood pressure among rural adolescents ages 15-18 after controlling for age, gender, ethnicity, parental history of hypertension, socioeconomic status, pubertal stage, and weight status. A convenience sample of 148 adolescents ages 15-18 was recruited from two rural high schools (88 female and 60 male, all Caucasian). Adolescents were measured for blood pressure, weight status (BMI, waist circumference), tobacco exposure (self-report, salivary cotinine), and inflammation (salivary CRP). Self-report measures of tobacco exposure included the Uptake Continuum and Peer and Family Smoking Index. The study found 25% of adolescent males and 11.4% of adolescent females had elevated systolic blood pressures. A fifth of the sample (22%) had elevated salivary cotinine levels indicative of secondhand smoke exposure. Nearly half of the rural adolescents participants stated that their family members smoke cigarettes. Salivary cotinine levels had a significant association with smoking exposure by family members (Xχ2 = 10.81, p = .001), though not with smoking exposure by peers (Xχ2 = 1.21, p = .271). Age, gender, waist circumference and salivary cotinine were found to contribute to 36.4% of the variance in systolic blood pressure and 19.1% of the variance in diastolic blood pressure. No evidence was found to support inflammation as a mediator between tobacco exposure and blood pressure. Tobacco exposure and elevated blood pressure are contributors to cardiovascular risk. Prehypertensive blood pressure measurements during adolescence are predictive of hypertension. In adolescents, elevated blood pressure measurements accompanied by other cardiovascular risk factors, such as tobacco use/exposure, are of concern. As part of the effort to improve rural public health, the health of rural adolescents must be made visible.

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