Gender and weight concerns in adolescent smokers

Abstract

The aim of this study was to examine smoking-specific weight concerns in a well-characterized sample of adolescent daily smokers and the influence of gender, age, and body mass index (BMI). Adolescent smokers (n = 103) were asked two smoking-specific weight concern questions: “How much do cigarettes help you control your weight?” and “How concerned are you about gaining weight as a result of quitting?” A significant positive relationship was found between average daily cigarette use and belief in smoking as a means to control weight and a significant negative relationship between the years of smoking and belief that smoking controls weight. There was no significant relationship between BMI and smoking to control weight for females, whereas for males, there was a positive relationship, indicating that heavier males were more likely to report smoking to control weight. Additionally, females who smoked more cigarettes reported more concern about gaining weight upon quitting, a pattern not seen in males. Results highlight potentially important gender differences in the relationship between weight concerns and smoking and the influence these concerns may have on quitting smoking.

Introduction

Adolescence is a critical time when cigarette smoking develops, with approximately 2000 adolescents beginning to smoke each day (Johnston, O'Malley, & Bachman, 2003). Data suggests that 72.9% of adolescent daily smokers tried to quit smoking, but only 13.5% succeeded (CDC, 2001). One reason adolescents may start smoking, return to smoking after quitting, or never attempt to quit may be related to the perceived benefits of smoking on body weight.

The belief that smoking helps control weight appears to be gender-specific, with female adolescents worrying more about their weight and being more likely to report smoking to control their weight than males (Camp et al., 1993, Charlton, 1984, Coogan et al., 1998). Other variables that influence this relationship include smoking amount and age. Regular smokers (smoking ≥ once per week) are more likely than experimental smokers (smoking less than one cigarette weekly) to believe that smoking is a weight control strategy (Robinson, Klesges, Zbikowski, & Glaser, 1997). Camp and colleagues (see Camp et al., 1993), have shown that the belief that smoking could control weight did not differ between regular smokers (smoking ≥ once per week) and never smokers, but was significantly greater in the regular smokers when compared with experimental smokers (smoked 1–2 cigarettes in lifetime). This suggests that weight control properties of cigarettes may be learned over time and may reinforce continued smoking behavior. Interestingly, among regular smokers, being older and female predicted those who smoked for weight-control reasons. Boles and Johnson (2001) examined the association between age and weight concerns in three cohorts of adolescents (i.e. 12–13, 14–15, and 16–17 year-old smokers) smoking ≥ one cigarette daily and found the youngest male and oldest female groups were most likely to believe smoking controls weight.

Concern about gaining weight upon quitting is related to cigarette specific weight control, but there is also some evidence to suggest that these two variables maintain some independent role in smoking-specific weight concern as indicated by the adult literature. Smoking for weight control may explain smoking initiation, while concerns about gaining weight upon quitting may explain smoking maintenance and the difficulty in quitting. In adult smokers, weight gain is often cited as an important reason for relapse to smoking (Borrelli and Mermelstein, 1998, Swan, et al., 1993, USDHHS, 2001) and concerns about post-cessation weight gain predict lower intentions to quit smoking (Klesges et al., 1989, Weekley et al., 1992). Although the prevalence of weight-concerned adults who participate in formal smoking cessation programs is low, those who are weight concerned are less likely to quit smoking than those who intend to accept a significant postcessation weight gain (Meyers et al., 1997). There is currently no data to support or refute this relationship in adolescent smokers.

There is conflicting evidence on the influence of the adolescent smoker's actual weight on smoking-related weight concerns, with some studies showing a correlation between BMI and smoking status (Klesges et al., 1998, Robinson et al., 1997, Townsend et al., 1991) in both genders, and other studies showing no association (Crocker et al., 2001, Killen et al., 1997, Voorhees et al., 2002). Similarly, some studies report a positive relationship between being moderately overweight and increased smoking (Crisp et al., 1999, Halek et al., 1993) while others find a negative association between weight and smoking, especially among females (Austin & Gortmaker, 2001). Furthermore, the association between BMI and smoking may be altered by smoking intensity (Robinson et al., 1997) and age (Townsend et al., 1991).

In summary, the above literature suggests a strong association between weight concerns and smoking in adolescents (see Potter, Pederson, Chan, Aubut, & Koval, 2004 for review). However, most of these studies used a broad range of smoking rates to define a regular smoker and did not differentiate regular daily smokers from other smokers. To date, no studies have examined adolescents with established daily smoking patterns in relation to their belief about how smoking controls their weight and more importantly, how concerned they are about gaining weight upon quitting. These daily smokers may have a difficult time quitting smoking due to their beliefs about the relationship between smoking and weight. Furthermore, potential gender and age-related differences related to these concerns and beliefs need to be examined. The purpose of the current study was to conduct a preliminary examination of smoking-specific weight concerns in a well-characterized sample of adolescent daily smokers (with biochemical verification of smoking status) and the influence of gender, age, BMI, and smoking intensity on these concerns.