Tobacco smoke exposure adversely affects respiratory health. However, the effects of exposure on adolescents without asthma are not well known.To what degree are biochemically measured and self-reported tobacco smoke exposure associated with pulmonary function and healthcare utilization among U.S. nonsmoking adolescents?and Methods: We analyzed 2007-2012 National Health and Nutrition Examination Survey data (N=2,482). Tobacco smoke exposure was assessed with serum cotinine and self-reported home exposure. We built multiple regression, logistic regression, and Poisson regression models, depending on the outcome.Approximately 3% of adolescents had high cotinine (3.00-15.00ng/mL), 35.7% had low cotinine (0.05-2.99ng/ml), and 10.9% had home exposure. Adolescents with high cotinine had significantly lower FEV1% (M=97.4,SE=2.09; β=-8.99, 95%CI=-15.64,-2.33) and FVC% (M=97.4,SE=2.06; β=-8.42, 95%CI=-14.74,-2.11) than adolescents with no/minimal cotinine (<0.05ng/ml; M=101.0,SE=0.45; M=99.9,SE=0.46, respectively). Adolescents with high cotinine were less likely to have a past year healthcare visit (aOR=0.57, 95%CI=0.38,0.88), but more likely to have an overnight hospital stay (aOR=4.82, 95%CI=2.58,9.00), and at increased risk of having a higher number of overnight hospital stays (aRR=4.04, 95%CI=2.27,7.21). Adolescents with low cotinine were less likely to have a healthcare visit (aOR=0.84, 95%CI=0.71,0.99), but more likely to have an overnight hospital stay (aOR=4.82, 95%CI=2.58,9.00) than adolescents with no/minimal cotinine. Adolescents with low cotinine were at increased risk of having a higher number of healthcare visits (aRR=1.06, 95%CI=1.02,1.11) and overnight hospital stays (aRR=2.02, 95%CI=1.46,2.81). Adolescents with home exposure had lower FEV1% (M=99.9,SE=1.17; β=-5.11, 95%CI=-9.26,-0.96) and FVC% (M=100.0,SE=1.16; β=-5.36, 95%CI=-9.30,-1.42) than adolescents with no home exposure (M=101.0,SE=0.38; M=100.2,SE=0.39, respectively). Adolescents with home exposure were more likely to have an overnight hospital stay (aOR=5.65, 95%CI=3.66,8.73) and at increased risk of having a higher number of overnight hospital stays (aRR=4.08, 95%CI=2.76,6.03).Detectable serum cotinine levels and self-reported home exposure were distinctively associated with decreased pulmonary function and increased healthcare utilization.