Walden University ScholarWorks Walden Dissertations and Doctoral Studies Walden Dissertations and Doctoral Studies Collection 2018 Relationships among Vitamin D Deficiency, Metabolic Syndrome, Smoking Behavior, and Physical Activity Ethan Pham Walden University Follow this and additional works at:https://scholarworks.waldenu.edu/dissertations Part of theAnalytical Chemistry Commons,Epidemiology Commons, and thePublic Health Education and Promotion Commons This Dissertation is brought to you for free and open access by the Walden Dissertations and Doctoral Studies Collection at ScholarWorks. It has been accepted for inclusion in Walden Dissertations and Doctoral Studies by an authorized administrator of ScholarWorks. For more information, please [email protected]. Walden University College of Health Sciences This is to certify that the doctoral dissertation by Ethan Pham has been found to be complete and satisfactory in all respects, and that any and all revisions required by the review committee have been made. Review Committee Dr. Donald Goodwin, Committee Chairperson, Public Health Faculty Dr. Patricia Risica, Committee Member, Public Health Faculty Dr. Diana Naser, University Reviewer, Public Health Faculty Chief Academic Officer Eric Riedel, Ph.D. Walden University 2018 Abstract Relationships among Vitamin D Deficiency, Metabolic Syndrome, Smoking Behavior, and Physical Activity by Ethan Pham, Ph.D. MBA, Bay Path University, 2011 BS, American International College, 2004 Dissertation Submitted in Partial Fulfilment of the Requirements for the Degree of Doctor of Philosophy School of Public Health Sciences-Epidemiology Walden University February 2018 Abstract Aging increases the risk of both vitamin D deficiency and metabolic syndrome. Vitamin D deficiency and metabolic syndrome may be related, although there are mixed findings. Furthermore, literature suggests other factors such as physical fitness activity and smoking behavior are associated with Vitamin D deficiency and the development of metabolic syndrome. A number of studies have documented associations between Vitamin D levels and physical fitness activities, while other studies found correlations between Vitamin D levels, metabolic syndrome, and smoking behavior. However, no previous study has examined the links between physical fitness activity, smoking behavior, Vitamin D levels, and the risks for metabolic syndrome. The purpose of this study was to examine if smoking behavior and physical fitness activity moderated the relationship between Vitamin D deficiency and metabolic syndrome among older individuals. The research problem was addressed through the use of retrospective data collected from the National Health and Nutrition Examination Survey (NHANES) 2005- 2006. This study utilized a quantitative, retrospective, cross-sectional design employing regression and correlational analysis to determine that Vitamin D deficiency (p = 0.02) predicts metabolic syndrome (n = 1570). However, neither physical activity (p = 0.99) nor smoking behavior (p = 0.23) moderated the relationship between Vitamin D deficiency and metabolic syndrome (n = 1570). The results of the study could give practitioners a better understanding and insights into the different risk factors to metabolic syndrome among older individuals, which can eventually enable primary and secondary prevention interventions. Relationships among Vitamin D Deficiency, Metabolic Syndrome, Smoking Behavior, and Physical Activity by Ethan Pham, Ph.D. MBA, Bay Path University, 2011 BS, American International College, 2004 Dissertation Submitted in Partial Fulfilment of the Requirements for the Degree of Doctor of Philosophy School of Public Health Sciences-Epidemiology Walden University February 2018 Dedication I would like to dedicate this dissertation to my grandfather Nguyen Van Chut. Our time together was brief, yet your contribution and inspiration are engraved forever in my heart. To my children Sophia Nhi Pham, Fiona Vi Pham and Bella An Pham, never give up on your dreams. So long as you have the desire, the dedication, and the commitment, your dreams can become real. Acknowledgments My dissertation would never finish without the guidance of my committee member, support from my family and friends. I am grateful to have as my mentor Dr. Goodwin, who has remained a steadfast adviser throughout my dissertation. His feedback, patience, and guidance of my work will always be appreciated. I also wish to thank Dr. Risica for guiding me on methodology, and assisting me in overcoming issues of sample size, allowing me to move forward on my dissertation. I also wish to thank Dr. Naser for continuing to provide me with sound guidance. I need to thank W. Sumner Davis, PhD, MPH, MSHS, ACHE and Dr. Tan Bui, PhD good friends who are always willing to help and offer suggestions. Finally, I need to thank my parents Van Ngoc Pham, Nguyen Thi Nga, my parents in law Nguyen Van Hieu, Huynh Kim Dong, and my sister Thi Pham; your love and encouragement was invaluable in pursuing my education. Most important, I want to thank my wife Nguyen Huynh Xuan Thao; she has been, and remains, the definitive role model in my life. Throughout the PhD process, her encouragement has been unwavering. I would not be the person I am today without all of your love and support. Table of Contents List of Tables ......................................................................................................... iv Chapter 1: Introduction to the Study ........................................................................1 Background ........................................................................................................3 Problem Statement .............................................................................................5 Purpose of the Study ..........................................................................................6 Research Questions and Hypotheses .................................................................6 Theoretical Framework for the Study ................................................................8 Nature of the Study ............................................................................................9 Definitions........................................................................................................10 Assumptions .....................................................................................................11 Scope and Delimitations ..................................................................................12 Limitations .......................................................................................................13 Significance......................................................................................................13 Summary ..........................................................................................................14 Chapter 2: Literature Review .................................................................................16 Literature Search Strategy................................................................................20 Theoretical Framework ....................................................................................21 Historical and Conceptual Background of the Social Ecology Model ......22 Applications of the Social Ecological Model in Health Research .............23 Logistical Challenges of Research and Interventions ................................24 Review of the Literature ..................................................................................25 Vitamin D Deficiency ................................................................................25 i Metabolic Syndrome ..................................................................................32 Vitamin D Deficiency, Metabolic Syndrome, Smoking and Second-Hand Smoke ............................................................................................40 Vitamin D Deficiency, Metabolic Syndrome and Physical Activity .........43 Effects of Multiple Levels of Variables that Promote High-Risk Behaviors .......................................................................................44 Conclusion .......................................................................................................52 Chapter 3: Research Method ..................................................................................54 Introduction ......................................................................................................54 Research Design and Rationale .......................................................................54 Methodology ....................................................................................................55 Population .......................................................................................................55 Sampling and Sampling Procedures ..........................................................56 Procedures for Recruitment, Participation, and Data Collection ...............56 Instrumentation and Operationalization of Variables ................................58 Threats to Validity .....................................................................................63 Ethical Procedures .....................................................................................65 Summary ..........................................................................................................67 Chapter 4: Results ..................................................................................................68 Introduction ......................................................................................................68 Data Collection ................................................................................................68 Results ..............................................................................................................77 Summary ..........................................................................................................84 ii Chapter 5: Results, Conclusions, and Recommendations ......................................85 Introduction ......................................................................................................85 Discussion of the Conclusions in Relation to the Literature and the FieldError! 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Research Question 1 ..................................................................................86 Research Question 2 ..................................................................................89 Research Question 3 ..................................................................................90 Limitations .......................................................................................................91 Recommendations for Further Study ...............................................................92 Conclusion .......................................................................................................93 References ..............................................................................................................94 Appendix A: G*Power Computation for Sample Size ........................................123 Appendix B: NHANES Data Release and Access Policy ...................................124 Appendix C: Smoking Behavior Survey Questionnaire ......................................128 Appendix D: Examination Consent Form............................................................135 Appendix E: Specimen Storage Consent .............................................................138 iii