Weight control smoking among sedentary women

Determinants of smoking related weight-concern in smokers participating in a community-based cessation program

BACKGROUND

Concern about weight gain is a barrier to smoking-cessation, but determinants of postcessation weight-concern have not been comprehensively assessed in the context of community-based cessation programs.

METHODS

This cross-sectional analysis used baseline data from a cessation trial of 392 adults randomized to physical activity (PA) or general wellness counseling as adjunctive treatment for smoking. Outcomes were 1) smoking behaviors to control weight and 2) anticipating relapse due to weight gain. Independent variables were PA and perceptions, sociodemographics, psychosocial measures, smoking behavior and perceptions, diet, and BMI. From bivariable models examining main and sex interaction effects, significant variables were entered into a linear (control) or logistic (relapse) regression model to identify key determinants.

RESULTS

For both measures, weight-concern was greater (p < .05) for female smokers (standardized b = 0.52, SE = 0.10; OR = 0.29, 95 % CI = 0.17-0.49), White (b = 0.12, SE = 0.05; OR = 0.39, 95 % CI = 0.23-0.66), and less motivated to quit (b = -0.14, SE = 0.05; OR = 0.77, 95 % CI = 0.59-1.0). Higher scores for smoking to control weight were associated with less PA (b = -0.10, SE = 0.05) and higher BMI (b = 0.21, SE = 0.05). For men, higher BMI was associated with greater anticipation of relapse (OR = 2.54, 95 % CI = 1.42-4.56).

CONCLUSIONS

Among adults attempting cessation, women, White smokers, and those less motivated to quit were more likely to smoke for weight control and to relapse due to weight gain. Higher BMI was associated with greater anticipation of relapse for men, but not women. Weight-concerns, for both measures, were not related to smoking history, psychosocial functioning, PA engagement or attitudes, or dietary variables. Results suggest potential cessation intervention targets for weight-concerned smokers.

Understanding daily life experiences of women who smoke: The role of smoking-related weight control expectancies

Smoking-related weight control expectancies are a motivational factor for maintaining cigarette use, particularly among women. Yet, less research has investigated the physiological and behavioral daily life weight-related experiences of women with smoking-related weight control expectancies. Increased research could contribute to understanding of maintenance factors for this group of smokers as well as unique intervention targets. Female smokers completed a baseline survey of smoking-related weight control expectancies and 35-days of ecological momentary assessment of physiological (i.e., smoking-related reduction in hunger, end-of-day perceived weight gain and bloating) and behavioral (i.e., daily exercise and sitting) weight-related experiences. Higher smoking-related weight control expectancies were associated with perceived smoking-related reductions in hunger and end-of-day perceived weight gain. Smoking-related weight control expectancies did not significantly associate with end-of-day bloating, daily exercise, or sitting. Given these findings, smoking-related weight control expectancies may maintain smoking in order to reduce hunger and to cope with perceived fluctuations in weight in daily life. It is critical for smoking cessation programs to assess smoking-related weight control expectancies and implement targeted treatments for these women.

Pilot feasibility trial of dual contingency management for cigarette smoking cessation and weight maintenance among weight-concerned female smokers

Many women who smoke cigarettes report that concern about weight gain is a barrier to quitting. Indeed, most quitters gain weight and some attribute relapses to weight gain concern. Contingency management (CM), which refers to reinforcing a target behavior with financial incentives, has been demonstrated effective for promoting smoking abstinence and weight management independently. We conducted a pilot trial to establish the feasibility of dual CM, in which both smoking cessation and weight maintenance were incentivized, as a smoking cessation intervention for female weight-concerned smokers. Participants (N = 10) received a 12-week intervention during which they earned financial incentives for smoking abstinence, verified by breath carbon monoxide (CO) testing, and for maintaining their weight (larger incentives for gaining less than five pounds, smaller incentives for 5-10 pound gain) while abstaining from smoking. They attended an end of intervention visit at week 13 and a follow-up visit at week 26. Total compensation was up to $550 ($255 for participation independent of smoking and weight, $145 for smoking abstinence incentives, and $150 for weight maintenance incentives). Results indicated that five of the 10 participants (50%) were continuously abstinent for at least 4 weeks and received at least 2 weight maintenance incentives. Three participants (33%) were abstinent at every visit they attended from quit date through week 26; 2 of these 3 had gained more than 10 pounds by week 26. Additional formative research to test alternative incentive schedules and modalities should be conducted before CM-W is evaluated in a larger trial. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Distress Intolerance in Relation to Reliance on Cigarettes for Weight, Shape, and Appetite Control

BACKGROUND

Distress intolerance, one's inability to withstand distressing emotional or physical states, is a transdiagnostic vulnerability implicated in affect-based health behaviors, including cigarette smoking and poor weight control. The current study evaluated associations between distress intolerance and the reliance on cigarettes for management of weight, appetite, or body dissatisfaction, which may pose a burden for cessation and increase risk of weight-related health problems.

METHOD

Daily smokers (n = 577) completed an online survey assessing distress tolerance and reliance on cigarettes for weight and shape control with the four subscales of the Smoking and Weight Eating Episodes Test (SWEET). Four hierarchical regression models were constructed to test the association between distress intolerance and SWEET scores, accounting for the effect of relevant covarying factors.

RESULTS

After adjusting for model covariates, distress intolerance was significantly incrementally associated with greater tendency to rely on cigarettes to suppress appetite (adjR² = .040), prevent overeating (adjR² = .034), cope with body dissatisfaction (adjR² = .046), and cope with nicotine withdrawal-related appetite increases (adjR² = .030).

CONCLUSION

Distress intolerance may play an etiological role in maladaptive use of cigarettes to control appetite, weight, and body dissatisfaction among daily smokers, particularly those with weight- or shape-related concerns. Interventions aimed at increasing perceived ability to withstand distress could potentially reduce reliance on cigarettes for the aforementioned purposes.

A Confirmatory Factor Analysis of the Smoking and Weight Eating Episodes Test (SWEET)

INTRODUCTION

The Smoking and Weight Eating Episodes Test (SWEET; Adams et al. 2011) is a self-report measure designed to assess multiple reasons why and when smokers use cigarettes for appetite, weight, and shape management, that was initially developed and validated in young female smokers.

PURPOSE

The aim of the current study was to evaluate the factor structure and psychometric properties of the SWEET measure among both male and female daily cigarette smokers.

METHOD

Participants (n = 577; M_age = 44.42; SD = 13.80; 52.7% female) were daily smokers recruited through Qualtrics Online Sample for an anonymous study on smoking and health. On average, participants reported smoking for 25.7 years (SD = 14.35), smoked 17.0 cigarettes per day (SD = 8.38), and had moderate levels of tobacco dependence.

RESULTS

Confirmatory factor analyses supported the initial factor structure found in the original SWEET measure suggesting a four-factor structure fit the data well, but not a one-factor structure. Factors included using cigarettes for appetite suppression, using cigarettes to prevent overeating, smoking to cope with body dissatisfaction, and using cigarettes to cope with appetite-related withdrawal symptoms. Tests of measurement invariance revealed no significant differences when evaluating SWEET scores by participant sex. The SWEET factor scores evidenced internal consistency, known groups validity, convergent validity with related constructs (compensatory eating behaviors, tobacco dependence) and cessation-relevant variables (smoking abstinence expectancies, prior withdrawal symptoms), and discriminant validity with physical activity and sedentary behavior.

CONCLUSIONS

The present study provides evidence in support of the validity and reliability of scores on the SWEET as a multidimensional measure of smoking for appetite, weight, and body-related concerns in male and female daily cigarette smokers.

Smoking-related weight and appetite concerns and use of electronic cigarettes among daily cigarette smokers

Weight control is a common motive for cigarette smoking.  Some individuals also report using electronic cigarettes (e-cigarettes) for weight control.  This study tested the hypothesis that the tendency to use combustible cigarettes for weight/appetite control would be associated with higher odds of current e-cigarette use among adult daily combustible cigarette smokers. Participants (n = 577; M_age = 44.42; 52.7% female) were recruited to participate in an online survey. Smoking for weight/appetite control was assessed via the Smoking-Related Weight and Eating Episodes Test (SWEET). Results indicated that higher scores on two SWEET subscales were significantly associated with increased odds of current e-cigarette use: smoking to suppress appetite (OR = 1.356,CI_95% = 1.116-1.646, p = .002) and smoking to prevent overeating (OR = 1.314, CI_95% = 1.101-1.567, p = .002). Scores on the other SWEET subscales were not significantly associated with current e-cigarette use.  These findings indicate that daily smokers who smoke to manage their appetite and eating may be more likely to use e-cigarettes, potentially because e-cigarettes will also serve this function. Future research should evaluate beliefs about e-cigarettes in management of appetite and eating behavior, and the acute effects of e-cigarettes on weight and eating behavior relative to combustible cigarettes.

Smoking Cessation and Changes in Body Mass Index: Findings From the First Randomized Cessation Trial in a Low-Income Country Setting

Background

In high-income countries, quitting cigarette smoking is associated with weight gain, which can reduce motivation to abstain. Whether smoking cessation is associated with weight gain in a low-income country context has never been investigated. We aimed to determine the post-cessation changes in body mass index (BMI) and its predictors among smokers who received a smoking cessation intervention in a low-income country setting.

Methods

We performed post hoc analyses of data from 269 smokers who participated in a two-group, parallel-arm, double-blind, placebo-controlled randomized trial of combined nicotine replacement therapy (NRT) and behavioral counseling in primary care clinics in Aleppo, Syria. We used generalized estimating equation modeling to identify predictors of changes in BMI at 6 weeks and 6- and 12-month follow-ups after quit date.

Results

The mean pre-cessation BMI of the sample was 27.9kg/m2 (SD = 5.2). Over 12 months of follow-up, BMI of smoking abstainers averaged 1.8 BMI units (approximately 4.8kg) greater than non-abstainers (p = .012). Throughout the study, greater BMI was associated with being female (p = .048), reporting smoking to control weight (p < .001) and having previously failed to quit due to weight gain (p = .036).

Conclusion

Similar to findings from high-income countries, smoking cessation in Syria is associated with weight gain, particularly among women and those who have weight concerns prior to quitting. This group of smokers may benefit from tailored cessation interventions with integrated body weight management elements that take into consideration the prevailing local and cultural influences on diet and levels of physical activity.

Implications

This study provides the first evidence regarding post-cessation changes in BMI among smokers who attempt to quit in a low-income country setting. Our findings advance knowledge regarding post-cessation weight gain and offers insight for researchers and clinicians to identify smokers at higher risk of post-cessation weight gain. This information will help in delivering interventions that take into account the prevailing cultural influence on diet and physical activity and will ultimately help in designing future tailored cessation programs in Syria and other low-income countries with similar cultural background and level of development.

Distress Tolerance Treatment for Weight Concern in Smoking Cessation Among Women: The WE QUIT Pilot Study

Fear of gaining weight after quitting cigarette smoking is a major barrier to smoking cessation among women. Distress tolerance, which refers to one's ability and willingness to tolerate physical and emotional discomfort, predicts successful behavior change. Novel interventions rooted in Acceptance and Commitment Therapy (ACT) have emerged that aim to increase distress tolerance and engagement in values-oriented behavior. In this study, we developed a 9-week, group-based distress tolerance intervention for weight concern in smoking cessation among women (DT-W). Using an iterative process, we piloted DT-W with two small groups ( n = 4 and n = 7) of female weight-concerned smokers. Results indicated that we successfully established the feasibility and acceptability of DT-W, which was well-attended and well-received. Biochemically verified 7-day point-prevalence abstinence rates at post-intervention, 1, 3, and 6 months were 64%, 36%, 27%, and 27%, respectively. We are now evaluating DT-W in a randomized controlled trial.

Job strain and changes in the body mass index among working women: a prospective study

OBJECTIVE

The relationship between job strain and weight gain has been unclear, especially for women. Using data from over 52,000 working women, we compare the association between change in job strain and change in body mass index (BMI) across different levels of baseline BMI.

SUBJECTS/METHODS

We used data from participants in the Nurses' Health Study II (n=52,656, mean age=38.4 years), an ongoing prospective cohort study. Using linear regression, we modeled the change in BMI over 4 years as a function of the change in job strain, baseline BMI and the interaction between the two. Change in job strain was characterized in four categories combining baseline and follow-up levels as follows: consistently low strain (low at both points), decreased strain (high strain at baseline only), increased strain (high strain at follow-up only) and consistently high strain (high at both points). Age, race/ethnicity, pregnancy history, job types and health behaviors at baseline were controlled for in the model.

RESULTS

In adjusted models, women who reported high job strain at least once during the 4-year period had a greater increase in BMI (ΔBMI=0.06-0.12, P<0.05) compared with those who never reported high job strain. The association between the change in job strain exposure and the change in BMI depended on the baseline BMI level (P=0.015 for the interaction): the greater the baseline BMI, the greater the BMI gain associated with consistently high job strain. The BMI gain associated with increased or decreased job strain was uniform across the range of baseline BMI.

CONCLUSIONS

Women with higher BMI may be more vulnerable to BMI gain when exposed to constant work stress. Future research focusing on mediating mechanisms between job strain and BMI change should explore the possibility of differential responses to job strain by initial BMI.

Predictors of marked weight gain in a population of health care and industrial workers following smoking cessation

Background

Concerns about postcessational weight gain might hamper rather than encourage smokers to quit smoking.

Methods

We conducted a comprehensive multi-institutional smoking cessation program for health care and industrial workers (n = 654) employed at University Hospital Basel (Switzerland) and two local health industry companies (Novartis International AG, F. Hoffmann-La Roche AG). The program contained counselling with an option of pharmacological support. Changes in body weight were observed during 24 months of follow-up. Factors associated with longitudinal weight gain (>5 % of baseline weight) were identified by cox-regression analysis.

Results

In 51 % of permanent quitters no significant changes of mean body weight were observed after 12 (0.52 kg, SD ±2.87 kg) and 24 months (0.40 kg, SD ± 2.99 kg). Marked weight gain following smoking cessation was characterized by a wide margin of changes. In more than a half of former smokers (58 %) weight increases were moderate (<5 kg), whereas excessive increases (>10 kg) were seen in only 10 % of quitters. Lower baseline BMI (HR 0.60, 95 % CI 0.40- 0.80, p = 0.03), daily consumption of less than ten cigarettes (HR 0.53, 95 % CI 0.27- 0.63, p = 0.04) and ischemic cardiopathy (HR 0.21, 95 % CI 0.07-0.62; p < 0.01) were associated with a lower risk for weight gain. Employees with lower educational levels (HR 2.60, 95 % CI 1.60-5.50, p < 0.01), diabetes mellitus (HR 3.05, 95 % CI 2.20-8.06, p = 0.02) and those smoking to reduce boredom in life (HR 1.68, 95 % CI 1.21-2.33, p < 0.01) were at highest risk.

Conclusion

Marked postcessational weight gain occurs less often than expected, but remains difficult to be predicted. Our findings might be helpful to alleviate weight concerns in the average smoker willing to quit.

Yoga as a complementary treatment for smoking cessation in women

BACKGROUND

Tobacco smoking remains the leading preventable cause of death among American women. Aerobic exercise has shown promise as an aid to smoking cessation because it improves affect and reduces nicotine withdrawal symptoms. Studies outside the realm of smoking cessation have shown that yoga practice also reduces perceived stress and negative affect.

METHODS

This pilot study examines the feasibility and initial efficacy of yoga as a complementary therapy for smoking cessation. Fifty-five women were given 8-week group-based cognitive behavioral therapy for smoking cessation and were randomized to a twice-weekly program of Vinyasa yoga or a general health and wellness program (contact control). The primary outcome measure was 7-day point prevalence abstinence at the end of treatment validated by saliva cotinine testing. Longitudinal analyses were also conducted to examine the effect of intervention on smoking cessation at 3- and 6-month follow-up. We examined the effects of the intervention on potential mediating variables (e.g., confidence in quitting smoking, self-efficacy), as well as measures of depressive symptoms, anxiety, and perceived health (SF-36).

RESULTS

At end of treatment, women in the yoga group had a greater 7-day point-prevalence abstinence rate than controls (odds ratio [OR], 4.56; 95% CI, 1.1-18.6). Abstinence remained higher among yoga participants through the six month assessment (OR, 1.54; 95% CI, 0.34-6.92), although differences were no longer statistically significant. Women participating in the yoga program also showed reduced anxiety and improvements in perceived health and well-being when compared with controls.

CONCLUSIONS

Yoga may be an efficacious complementary therapy for smoking cessation among women.

Offer of a weight management program to overweight and obese weight-concerned smokers improves tobacco dependence treatment outcomes

Weight concern is a common and significant barrier to abstinence for many smokers. This quasi-experimental pilot study used multivariate logistic regression to examine the effects of offering a weight management treatment program on tobacco dependence treatment outcomes. Age, gender, ethnicity, educational level, nicotine dependence level, body mass index, and concern about weight gain were entered as factors/covariates to account for differences between groups. Offering a weight management program increased attendance at the first scheduled contact (88.1% vs. 71.6%; OR = 2.93; p = .029) and increased 6-month abstinence (21.4% vs. 10.1%; OR = 2.42; p = .052). With factors and covariates included in the multivariate models to account for group differences, those offered weight management were five times more likely to attend their first session (OR = 5.10; 95% CI 1.53-16.98; p = .008) and three times more likely to be abstinent 6 months after tobacco treatment (OR = 2.98; 95% CI = 1.09-8.17; p = .033). Proactively informing weight-concerned, overweight/obese smokers about the availability of a weight management program as an incentive for completing treatment for tobacco dependence may improve tobacco treatment outcomes. 

Yoga as a complementary treatment for smoking cessation: rationale, study design and participant characteristics of the Quitting-in-Balance study

Background

Tobacco smoking remains the leading preventable cause of death among American women. Exercise has shown promise as an aid to smoking cessation because it reduces weight gain and weight concerns, improves affect, and reduces nicotine withdrawal symptoms and cigarette craving. Studies have shown that the practice of yoga improves weight control, and reduces perceived stress and negative affect. Yoga practice also includes regulation of breathing and focused attention, both of which may enhance stress reduction and improve mood and well-being and may improve cessation outcomes.

Methods/Design

This pilot efficacy study is designed to examine the rates of cessation among women randomized to either a novel, 8-week Yoga plus Cognitive Behavioral Therapy (CBT) smoking cessation intervention versus a Wellness program plus the same CBT smoking cessation intervention. Outcome measures include 7-day point prevalence abstinence at end of treatment, 3 and 6 months follow up and potential mediating variables (e.g., confidence in quitting smoking, self-efficacy). Other assessments include measures of mindfulness, spirituality, depressive symptoms, anxiety and perceived health (SF-36).

Discussion

Innovative treatments are needed that address barriers to successful smoking cessation among men and women. The design chosen for this study will allow us to explore potential mediators of intervention efficacy so that we may better understand the mechanism(s) by which yoga may act as an effective complementary treatment for smoking cessation. If shown to be effective, yoga can offer an alternative to traditional exercise for reducing negative symptoms that often accompany smoking cessation and predict relapse to smoking among recent quitters.

Trial Registration

ClinicalTrials NCT00492310

Smoking-related weight concerns among underserved, black maternal smokers

OBJECTIVE

To expand understanding of a smoking cessation barrier for women, weight concerns, in a medically underserved population.

METHODS

Baseline weight concerns were examined among 235 low-income, black maternal smokers enrolled in a smoking trial. Logistic regression evaluated factors related to weight concerns.

RESULTS

Higher BMI (OR 3.35, P < .001), intention to quit (OR 2.12, P = .02), more previous quit attempts (OR 1.14, P = .03), and less support for quitting (OR 0.81, P = .05) predicted weight concerns.

CONCLUSIONS

This is the first study to delineate factors predicting weight concerns in this population, thus expanding our understanding of a key cessation barrier and informing future cessation strategies in a population known to bear increased risk of tobacco-related disease.

Psychosocial factors associated with weight control expectancies in treatment-seeking African American smokers

African Americans are disproportionately affected by tobacco smoking and obesity. As weight control expectancies can reinforce smoking maintenance, the purpose of this study was to explore psychosocial factors related to expectancies for weight control among African Americans seeking cessation treatment. African American smokers (N = 117) provided information on demographics, family medical history, personal risk factors, smoking, weight control expectancies and concerns, perceived stress, and acculturation. Multivariate analyses examined hypotheses regarding determinants of weight control expectancies. Fifty-one percent of participants were concerned about gaining weight upon cessation. Positive expectations for weight control through smoking were associated with older age, a family history of heart disease, greater perceived stress, and a lower level of acculturation. In conclusion, many African American smokers are concerned about postcessation weight gain: expectations for weight control through smoking are most evident those with elevated perceived stress, traditional African American cultural values, and a family history of chronic illness. Needed are culturally specific smoking cessation interventions that include weight management strategies as an adjunct to smoking cessation treatments.

A cognitive-behavioral weight control program improves eating and smoking behaviors in weight-concerned female smokers

Many people use smoking as a weight control mechanism and are averse to quitting for fear of weight gain. These weight-concerned smokers tend to be women, are significantly less likely to stop smoking or to join smoking cessation programs, and will relapse more often than smokers who are not weight-concerned. Research suggests that a woman's motivation to quit smoking correlates positively with her confidence in her ability to control her weight after quitting. Likewise, success in smoking cessation has been associated with increased self-efficacy for weight control. This randomized controlled trial investigated the effects of a weight control program on eating and smoking behaviors in a group of female, weight-concerned smokers from July 2005 to June 2006. Two hundred sixteen subjects who wanted to lose weight but were not yet ready to quit smoking were recruited to participate in a 12-week, cognitive-behavioral weight control program consisting of 12 1-hour sessions. Subjects were randomly assigned to either the weight-control program (intervention group) or the control group. Differences between the intervention and control groups were evaluated using t tests for continuous variables, Wilcoxon rank-sum tests for ordinal variables and chi(2) tests for categorical variables. The intervention group had a 14% increase (P<0.001) in self-efficacy for weight control (Weight Efficacy Life-Style Questionnaire), which was associated with improved diet quality (Healthy Eating Index) (r=0.292, P<0.01), weight loss (r=0.582, P<0.001), increased self-efficacy for quitting smoking (Smoking Self-Efficacy Questionnaire) (r=0.291, P<0.014), a decrease in number of cigarettes smoked (r=0.331, P<0.005), and positive movement in stage of change toward smoking cessation (r=0.435, P<0.001). These findings suggest that for this group of weight-concerned smokers' success in changing eating behavior may trigger a positive change in smoking behavior.

Factors associated with higher body mass index, weight concern, and weight gain in a multinational cohort study of smokers intending to quit

The ATTEMPT cohort study is multi-national, longitudinal study of smokers intending to quit recruited in the U.S.A., Canada, U.K. and France. Data on demographics, medical history, body mass index (BMI), weight concerns and smoking status were collected at baseline and after six months. A total of 2,009 subjects provided data at baseline and 1,303 at six months. High baseline BMI was associated with recent quit attempts, high weight concerns and high cigarette consumption. Weight gain was associated with low income, being single and number of cigarette-free days, but not with baseline weight concerns and confidence in preventing weight gain. Quit attempts were more frequent in subjects with a high baseline BMI and low weight concerns.

Smoking-related weight control expectancies among African American light smokers enrolled in a smoking cessation trial

Concern about weight gain following smoking cessation has been frequently described in the literature. However, little is known about smoking-related weight expectancies among African American, light smokers (defined as < or = 10 cigarettes per day [CPD] for > 25 of last 30 days). Given the high rate of obesity among African Americans, concern about weight gain may be a significant barrier to cessation. The association of demographic, psychosocial and tobacco-related variables and smoking-related weight control expectancies were examined in 755 African American regular, light smokers enrolled in a smoking cessation trial (number of years smoked=23.9+11.9; CPD=7.6+/-3.2; age=45.1+/-10.7; BMI=31+/-8.1; 67% female). Overall, participants had minimal smoking-related weight control expectancies (M=3.7/10, SD+/-3.4); however, higher weight control expectancies were related to female gender, lower dietary fat intake and lower internal self-efficacy to refrain from smoking. Further, smoking-related weight control expectancies were not associated with cessation outcome at week-26. Findings suggest that weight control expectancies exist among some African American light smokers and are related to decreased self-efficacy to refrain from smoking. However, the relationship between smoking-related weight expectancies and health behaviors are complex and modest in magnitude.

Smoking status relationships with the food and fluid intakes of free-living humans

OBJECTIVE

The relation of cigarette smoking to food and fluid intakes was studied.

METHODS

Ninety-nine smoking and 551 non-smoking free-living adult humans provided a detailed record of their eating and drinking in 7-d diaries.

RESULTS

Cigarette smoking was associated with significant changes in overall intakes and meal pattern. Smokers had higher intakes of fluids in the form of drinks due to higher levels of alcohol and coffee/tea consumption. Smokers were less hungry but more responsive to social facilitation and time of day. There were also substantial gender differences in smoking relations to intake, with male smokers tending to have higher overall and meal intakes particularly of fats than non-smokers, whereas female smokers tended to have lower overall intakes, fewer meals, and lower amounts of carbohydrates than non-smokers. Male smokers tended to be less responsive to their before-meal stomach content, their level of hunger, and the palatability of the meal than non-smokers, whereas females tend to be more responsive to all of these influences on meal size.

CONCLUSION

These results suggest that smoking has very few direct simple effects on intake but rather influences intake indirectly through its covariation with alcohol and caffeine intakes and with dietary restraint and that smoking has different, sometimes opposite, influences in males and females.

The prevalence of weight concerns in a smoking abstinence clinical trial

Recent research has demonstrated there is a high prevalence of weight concerns in smokers and that smokers with weight concerns may respond poorly to treatment for tobacco dependence. Most studies have focused only on females or have consisted of small samples. In this study of a 12-week randomized trial of nicotine inhaler, bupropion or both for smoking cessation, 50% of the 1012 female smokers and 26% of the 680 male smokers, at study entry, were weight concerned. In examining the impact of weight concerns on the 12-week point-prevalence smoking abstinence, 26% of non-weight-concerned smokers quit smoking compared to 22% of weight-concerned smokers (p=0.06). This study, which includes a large sample of both genders, provides further evidence that approximately half of females who are seeking smoking cessation treatment are weight concerned and that one quarter of male smokers are weight concerned. Additionally, being weight concerned may impact the short-term success rates of stopping smoking using pharmacotherapy.

Smoking status and weight loss in three weight loss programs

The purpose of the study was to examine differences in current, former, and never smokers' weight loss in three comprehensive weight loss programs. Archival data from 389 overweight participants enrolled in three comprehensive weight loss programs were analyzed. The programs differed in length and by type of diet (food-based low calorie diet, partial meal replacement low calorie diet, and supplement-based very low calorie diet). Significant differences in weight loss were found among former, current, and never smokers in one weight loss program (partial meal replacement low calorie diet). Post hoc analyses showed that former smokers lost significantly more weight than current smokers. Results suggest that current smokers are not more successful at behavioral weight loss than former smokers, and if anything, are less successful. Former smokers do not appear to have difficulty losing weight compared to current and never smokers.

The therapeutic potential of nicotine and nicotinic agonists for weight control

Transdermal nicotine patches have been successfully introduced as a safe and powerful aid to smoking cessation; this has contributed to the rising interest in additional therapeutic applications for nicotine and synthetic nicotinic agonists. Nicotine and nicotinic agonists may have a therapeutic potential for a variety of disorders, including Alzheimer's and Parkinson's diseases, depression, attention deficit disorder, Tourette's syndrome and ulcerative colitis. These interests are partially fuelled by the urgent need of the tobacco industry to find new niches for nicotine in a world bound eventually to retire from cigarette smoking. At the same time, there is an increased interest in developing drugs for fighting obesity, a growing affliction of industrialised nations. This review presents data on the potential of nicotine, and in particular synthetic nicotinic agonists, for controlling body weight. Nicotinic agonists may become relatively safe, effective and inexpensive alternatives for several optional drugs currently being developed for treating human obesity, including beta-3-adrenergic agonists, leptin and its agonists, and neuropeptide Y antagonists.

Weight concerns among male smokers

Many smokers perceive that smoking controls their body weight and that stopping smoking leads to weight gain. This study examined characteristics associated with weight concerns in 72 male smokers enrolled in a controlled trial for smoking cessation. Motivation to quit smoking was found to be significantly lower in those with weight concerns (P < .001). Further investigation is needed to enable the tailoring of interventions for weight-concerned male smokers.

Changes in eating self-efficacy and body image following cognitive-behavioral group therapy for binge eating disorder: a clinical study

Binge eating disorder (BED) is a frequent and significant psychiatric comorbidity among individuals seeking treatment for obesity. Cognitive-behavioral therapy (CBT) is frequently recommended for the treatment of obese individuals with BED. However, there is limited investigation into the effectiveness of the specific components of CBT. In this study, we examine the impact of CBT for BED in obese women on self-efficacy for eating behavior and body image issues. Participants were 12 obese women who participated in a 15-week CBT group program. As predicted, results indicated a reduction in binge episode frequency and significant improvements in self-efficacy and body image pre- and posttreatment. These findings support the premise that a structured cognitive-behavioral group treatment program for obese individuals with BED will promote changes in self-efficacy and body image.

Experimenter-defined quit dates for smoking cessation: adherence improves outcomes for women but not for men

AIMS

Smoking cessation treatment trials often require that smokers quit on or before a protocol-defined date. The goals of this paper were to: (1) identify factors associated with adherence to a protocol-defined quit date and (2) determine whether such adherence predicts cessation outcome (relapse).

DESIGN

A quasi-experimental secondary analysis of data collected from a randomized placebo-controlled trial of fluoxetine (60 mg or 30 mg) versus placebo for smoking cessation.

SETTING AND PARTICIPANTS

Clinic-based smoking cessation treatment program comprising 989 non-depressed smokers.

INTERVENTION

Participants received cognitive behavioral therapy for smoking cessation and either study medication or placebo for 10 weeks. They were required to set a quit date within 2 weeks of their second study visit (by visit 4).

FINDINGS

Significant predictors of quit date adherence were low nicotine dependence and active drug treatment. High-dose fluoxetine (60 mg) and male gender were protective against relapse. Adherence to quit date was not an independent predictor of relapse; instead there was a significant interaction between quit date adherence and gender. Among non-adherers to the quit date, women were more than 2.5 times as likely as men to relapse; among adherers to the quit date, women were only 1.3 times as likely as men to relapse.

CONCLUSIONS

Although women were more likely than men to relapse regardless of quit date adherence, adherence was strongly protective against relapse for women.

Smoking cessation in women. Special considerations

Women may be at relatively greater risk of smoking-related diseases than men but tend to have less success than men in quitting smoking. The failure of most outcome studies to report results by gender and the lack of statistical power for detecting significant gender differences currently do not allow for many firm conclusions to be drawn about smoking cessation rates in women, but several trends warrant attention and further study. First, the difference in cessation rates for women versus men may be even greater in trials of nicotine replacement therapies (NRT). This suggests that women benefit less from NRT relative to men, although this difference may depend on the particular form of NRT (e.g. inhaler versus gum). On the other hand, some non-NRT medications may reverse the poorer outcome of women, producing quit rates in women comparable with those in men. Gender differences in outcome, as well as overall success rates, with NRT and some of the non-NRT medications appear to be enhanced when treatment includes substantial behavioural counselling. However, while several of the non-NRT medications may be particularly appropriate to consider for treating women trying to quit smoking, adverse effects may limit widespread use of some of these drugs, such as clonidine and naltrexone. Thus, even if the gender differences in outcome with NRT versus non-NRT drugs are confirmed in further research, such findings do not necessarily justify limiting NRT use in women, because such treatment is clearly effective and is likely to be safer and more readily available than non-NRT medications. Nevertheless, study of the mechanisms by which some non-NRT drugs are effective in women may aid our understanding of factors that are more influential in smoking behaviour in women than in men. Secondly, smoking cessation treatment for women must address several other issues that often emerge, and these are most likely to require behavioural counselling that is tailored to these problems. These issues include concern about bodyweight gain, restrictions on medication use in pregnant smokers, variability in mood and withdrawal as a function of menstrual cycle phase, harnessing social support to foster abstinence, and the possibility that smoking-associated environmental cues may be more influential in smoking behaviour in women than men. Greater attention to gender differences in clinical trial outcomes and to addressing concerns of women smokers may aid in the development of substantially improved smoking cessation interventions for women.

Cigarette smoking in veteran women: the impact of job strain

To evaluate the health effects of role overload, the relationship between multiple role (i.e., worker, spouse, caretaker) strain and current cigarette smoking was examined. A cross-sectional survey of women veterans, aged 36-85 years, was performed measuring home and job strain and health behaviors. Of the 275 women who rated both their work and home strains, 25% (n = 69) currently smoke cigarettes. Higher work strain, but not higher home strain, was associated with smoking adjusting for age, education, income, weight, and marital status. A stressful work environment may trigger persistent smoking and should be addressed during smoking cessation counseling.

Smoking and weight control in adolescent females

This paper examines the association between smoking and various weight control techniques among adolescent girls in two school-based samples. Previous studies have relied heavily on clinical trials of adults and have focused mainly on dietary restraint rather than purging behavior. This study seeks to determine whether purging is associated with smoking and if purging and dietary restraint effects upon smoking are additive or synergistic. Data from adolescent girls were gathered from two school-based surveys conducted in the upper Midwest. Assessments were conducted for smoking, dietary restraint, diet pill use, and purging. Logistic regression was used to test for main and interaction effects. Analysis revealed significant associations between smoking and weight control. Purging was more highly associated with smoking than dietary restraint or diet pill use. The form of these associations was interactive rather than additive in both data sets. Nonpurging girls were significantly more likely to smoke if they were dieting or using diet pills than if they were not practicing dieting behavior. Thus, the effect of dieting and diet pill use on smoking is dependent on purging behavior. Weight control is associated with smoking behavior in adolescent girls but the form of these associations may be more complex than originally thought. Future research is needed to determine if there are two subtypes of smoking-weight control girls.

Eating self-efficacy and weight cycling: a prospective clinical study

Previous retrospective studies have not identified global psychosocial consequences of weight cycling. These lack of findings may be due to limitations associated with retrospective research or with using general psychological measures rather than weight-specific measures. This prospective study examined changes in a weight-specific measure, eating self-efficacy, using an obese clinical population who returned to a multidisciplinary weight management program subsequent to weight regain. Subjects did not demonstrate any change in eating self-efficacy despite experiencing weight loss and then weight regain. Individuals returning for treatment may be a select population, thus suggesting that there may not be negative psychological effects of weight cycling for all individuals. Implications for further research are discussed.