V C U Differences in Food Intake and Exercise by Smoking Status in Middle and High School Students Diane B. Wilson*, EdD, RD, Brian N. Smith, PhD, Ilene S. Speizer, PhD, Melanie K. Bean, BA, Karen S. Mitchell, BS, L. Samy Uguy, PhD, Elizabeth Fries, PhD *Department of Internal Medicine, Department of Psychology, Virginia Commonwealth University, Richmond, VA Objective To examine the relationship between smoking and the intake of fruit, vegetables, and milk/dairy products and the frequency of exercise among males and females in middle school and high school. Introduction Tobacco use, poor diet, and lack of exercise, are the leading preventable causes of death in the US. Currently, 23% of high school students and many teens do not meet the recommended Healthy People 2010 standards for eating healthy, nutrient dense foods. It is not fully understood how poor diet and smoking together may impact chronic disease risk. This study was designed to examine how smoking is related to diet and exercise among middle school and high school adolescents towards improving lifestyle habits in this population. Methods This study was designed to examine the relationship of smoking and the intake of fruit, vegetables, and milk/dairy products, as well as the frequency of exercise, in Middle School (n=8,022) and High School (n=2,613) adolescents. Baseline data, collected as a part of a comprehensive state-wide outcome evaluation of youth tobacco prevention programs, were analyzed using multivariate regression models. Table 1. Demographic and variable frequencies (%) by school level. Table 2. Outcome variable frequencies (%) by school level Variable MIDDLE SCHOOL N=8,022 HIGH SCHOOL N=2,613 Gender Female 51.4 53.0 Male 48.6 47.0 Ethnicity Black 19.6 20.3 White 74.6 71.7 Other 5.8 8.0 Grade in school 6th 42.4 7th 34.4 8th 23.2 9th 40.4 10th 25.1 11th 19.0 12th 15.5 Smoking Status Smoker 5.0 20.9 Non-smoker 95.0 79.1 BMI Underweight (≤18.54) 38.3 13.4 Normal (18.55-24.94) 47.2 63.5 Overweight (24.95-29.94) 10.0 15.2 Obese (≥29.95) 4.5 7.9 Weight Goals Trying to lose weight 47.7 42.6 Not trying to lose weight 52.3 57.4 Variable MIDDLE SCHOOL N=8,022 HIGH N=2,613 Fruit Consumption ≥1 serving/day 46.8 43.7 <7 servings/week 53.2 56.3 Vegetable Consumption 50.8 52.6 49.2 47.4 Milk/Dairy Consumption 61.5 63.0 38.5 37.0 Exercise Frequency ≥3 times/week 77.6 71.7 <3 times/week 22.4 28.3 Figure 1. Gender comparisons of food consumption and exercise frequency in Middle School smokers and non-smokers. Notes: Adjusted analysis; non-smokers are referent category. Covariates include BMI, grade, weight loss goals, and ethnicity. Odds ratios <1.0 indicate that smokers are less likely to have consumed food or exercised; odds ratios ≥1.0 indicate that smokers are more likely to have consumed food or exercised. Results Demographic characteristics, smoking frequencies, and covariates of the study sample are shown in Table 1. In HS male, female, and total HS sample, smokers were significantly less likely to eat ≥1 serving/day of milk/dairy products and to exercise ≥3x/week tan non-smokers. Smoking and vegetable consumption in HS females and HS total sample were also significant. In middle school, female smokers were significantly less likely to eat ≥1 serving/day of vegetables. Both MS female and total MS sample smokers were significantly less likely than non-smokers to exercise ≥3x/week. Conclusions Adolescents who smoke were less likely to consume vegetables and milk/dairy products, and to exercise less frequently than non-smokers. We found evidence of these patterns in high school students than in middle school students, and more often in girls than in boys. Ethnicity, particularly being African American, was significantly associated with decreased odds of eating vegetables, milk products, and exercising. Figure 2. Gender comparisons of food consumption and exercise frequency in high school smokers and non-smokers. Notes: Adjusted analysis; non-smokers are referent category. Covariates include BMI, grade, weight loss goals, and ethnicity. Odds ratios <1.0 indicate that smokers are less likely to have consumed food or exercised; odds ratios ≥1.0 indicate that smokers are more likely to have consumed food or exercised. Acknowledgement: The authors wish to thank Jerlym S. Porter, MS for her assistance in the preparation of the poster. Implications This study indicated that smoking prevention/cessation interventions for youth need to combine a strong emphasis on eating healthy foods and exercising. These results underscore smoking and diet/exercise concerns starting in middle school and particularly in females that warrant greater attention.