Smoking and pursuit of thinness in schoolgirls in London and Ottawa

Smoking Consequences Questionnaire: Factor Structure and Invariance among Smokers and Non-Smokers

BACKGROUND

The Smoking Consequences Questionnaire was developed to assess smoking expectancies, which have been found to be linked to the initiation and maintenance of smoking.

OBJECTIVES

The purpose of the current study was to examine the factor structure of a modified brief version of the instrument in Greek and to test its invariance between groups of smokers and nonsmokers.

METHODS

Participants were 813 Greek-Cypriot university students (524 females; Mean age =20.94, SD = 2.70) who completed this brief version of the instrument translated into Greek using the forward-backward method.

RESULTS

Confirmatory factor analysis supported a four-factor structure: Negative Consequences, Positive Reinforcement, Negative Reinforcement and Appetite/Weight Control. Multigroup confirmatory factor analysis indicated configural, metric and partial scalar invariance of the instrument in groups of smokers and nonsmokers. Comparison of the mean difference in the invariant factors showed significant difference in appetite/weight control mean scores, whereas mean difference in negative consequences was not significant. Conclusions/Importance. Findings support the four-factor structure of the brief Greek version of the SCQ in a sample of young adults, and factorial invariance between smokers and nonsmokers. More expectancies about appetite/weight control among smokers compared to nonsmokers suggest focusing on this category of smoking expectancies in smoking prevention and cessation programs.

Adolescent Weight and Electronic Vapor Product Use: Comparing BMI-Based With Perceived Weight Status

INTRODUCTION

This study examined the associations of BMI-based and perceived body weight status with electronic vapor product use, cigarette smoking, and dual use among U.S. adolescents.

METHODS

A cross-sectional analysis was conducted in 2017 on data from 15,129 adolescents in the National Youth Risk Behavior Survey, 2015. Multiple logistic regression analyses were used to examine the associations of BMI-based and perceived weight status with electronic vapor product use, cigarette smoking, and dual use, after adjusting for all other covariates. The regression models were stratified by gender.

RESULTS

Overall, 25.5% of males used electronic vapor products, 11.6% smoked cigarettes, and 8.1% used both; percentages among females were 22.6%, 9.8%, and 6.8%, respectively. Females who perceived themselves as overweight were more likely than those who perceived themselves as normal weight to be current electronic vapor product users (AOR=1.09, 95% CI=1.01, 1.19) and dual users (AOR=1.23, 95% CI=1.01, 1.49). When compared with normal BMI-based category, males with obese BMI status were more likely to be current cigarette smokers (AOR=1.61, 95% CI=1.06, 2.44), however, only females with overweight BMI status were more likely to be current smokers (AOR=1.89, 95% CI=1.25, 2.86).

CONCLUSIONS

Findings suggest that the influence of adolescents' body weight perceptions and BMI-based status should be accounted for when developing nicotine-containing product use prevention programs for adolescents. Specific strategies for influencing female adolescents who perceive themselves as overweight should be included to prevent emerging electronic vapor product and dual use.

The Demand for Cigarettes as Derived from the Demand for Weight Loss: A Theoretical and Empirical Investigation

This paper offers an economic model of smoking and body weight and provides new empirical evidence on the extent to which the demand for cigarettes is derived from the demand for weight loss. In the model, smoking causes weight loss in addition to having direct utility benefits and direct health consequences. It predicts that some individuals smoke for weight loss and that the practice is more common among those who consider themselves overweight and those who experience greater disutility from excess weight. We test these hypotheses using nationally representative data in which adolescents are directly asked whether they smoke to control their weight. We find that, among teenagers who smoke frequently, 46% of girls and 30% of boys are smoking in part to control their weight. As predicted by the model, this practice is significantly more common among those who describe themselves as too fat and among groups that tend to experience greater disutility from obesity. We conclude by discussing the implications of these findings for tax policy; specifically, the demand for cigarettes is less price elastic among those who smoke for weight loss, all else being equal. Public health efforts to reduce smoking initiation and encourage cessation may wish to design campaigns to alter the derived nature of cigarette demand, especially among adolescent girls.

A systematic review of longitudinal studies on the association between depression and smoking in adolescents

Background

It is well-established that smoking and depression are associated in adolescents, but the temporal ordering of the association is subject to debate.

Methods

Longitudinal studies in English language which reported the onset of smoking on depression in non clinical populations (age 13-19) published between January 1990 and July 2008 were selected from PubMed, OVID, and PsychInfo databases. Study characteristics were extracted. Meta-analytic pooling procedures with random effects were used.

Results

Fifteen studies were retained for analysis. The pooled estimate for smoking predicting depression in 6 studies was 1.73 (95% CI: 1.32, 2.40; p < 0.001). The pooled estimate for depression predicting smoking in 12 studies was 1.41 (95% CI: 1.21, 1.63; p < 0.001). Studies that used clinical measures of depression were more likely to report a bidirectional effect, with a stronger effect of depression predicting smoking.

Conclusion

Evidence from longitudinal studies suggests that the association between smoking and depression is bidirectional. To better estimate these effects, future research should consider the potential utility of: (a) shorter intervals between surveys with longer follow-up time, (b) more accurate measurement of depression, and (c) adequate control of confounding.

Smoking in eating disorders

OBJECTIVE

Smoking has been reported as an appetite and weight control method in eating disorders; however, few studies have explored patterns of smoking across subtypes of eating disorders. The aim of this paper was to explore the patterns and prevalence of smoking behavior in 1,524 women from two of the multisite Price Foundation Genetic studies.

METHOD

Smoking behavior was assessed in 306 individuals with anorexia nervosa-restricting type (RAN), 186 with anorexia nervosa-purging type (PAN), 180 with anorexia nervosa and bulimia nervosa (ANBN), 107 with anorexia nervosa-binging type (BAN), 71 individuals with purging type-bulimia nervosa (PBN), and 674 female community controls. We compared smoking prevalence and smoking behaviors across eating disorder (ED) subtypes and in comparison to controls using the Fagerstrom Test of Nicotine Dependence (FTND).

RESULTS

Overall, women with eating disorders reported higher rates of smoking and greater nicotine dependence than controls. Women with binge/purge subtypes of eating disorders reported the highest rates of smoking of all of the subtypes. Smoking in eating disorders was related to impulsive personality traits.

CONCLUSIONS

Women with eating disorders appear to be at increased risk for smoking, particularly those who binge eat and/or purge and display impulsive personality characteristics. Given the high prevalence, the impact of ongoing smoking on maintenance of eating disorders symptoms is worthy of both clinical and research attention.

Smoking, Weight Loss Intention and Obesity-Promoting Behaviors in College Students

OBJECTIVE

To examine whether college smoking was associated with trying to lose weight and other weight-related behaviors.

METHODS

We surveyed 300 students at the University of Kansas about smoking (ever, current, and amount), weight loss intention (y/n), weight-related attitudes, and eating and exercise behavior. Weight, height, and body fat were measured.

RESULTS

About half the students (49%) self-identified as having ever smoked while 53 (17.6%) self-identified as current smokers. After controlling for sex, age, and ethnicity, ever smoking was not related to weight loss intention but was associated with greater pressure to maintain a healthy weight (p = 0.05), and having engaged in mild exercise on more days in the previous year (p = 0.05). Compared to nonsmokers, current smokers ate more at restaurants serving high calorie foods (p < 0.05) and ate more frequently in front of the TV (p < 0.01). Amount smoked was related to diminished use of exercise facilities (p = 0.03) and more frequent eating at restaurants serving high calorie foods (p < 0.05) and in front of the TV (p = 0.01).

CONCLUSIONS

Current smoking among college students was related to weight loss intention. Despite wanting to lose weight, current smoking was concomitant with obesity-promoting behaviors such as eating higher calorie foods and eating in front of the TV. College-based interventions to prevent smoking initiation or promote smoking cessation should include a focus on healthy eating, exercise and healthful ways to lose or maintain weight.

Smoking and weight control behaviors

OBJECTIVE

To examine the association between weight control and tobacco use in young women.

METHODS

Smoking status and weight and eating related issues, endorsement of the belief "smoking helps to control weight" dieting status (DEBQ-R), current and ideal weight and current height were assessed in 144 students.

RESULTS

Smoker (S) restrained eaters (RE) scored higher on dietary restraint than nonsmoker (NS) RE. In the smoking questionnaire, S-RE selected a significantly higher number of items concerning hunger, eating and weight than S unrestrained eaters (URE). S-RE had a greater level of endorsement of the belief: "smoking helps to control weight" than NS-URE. The subjects who marked those items had significantly higher scores in the DEBQ-R and were more likely to be RE than those who marked none of them.

CONCLUSION

Our findings suggest that among young women who smoke and diet there might be a risk group that smokes as a weight control strategy.

Perceived importance of being thin and smoking initiation among young girls

BACKGROUND

Smoking among adolescents remains unacceptably high and the difference in potential risk factors for smoking initiation between male and female adolescents has been explored. Although the association between smoking initiation and dieting behaviour has been observed among girls, the mechanism of the association is unknown.

OBJECTIVE

To examine prospectively the association between perceived importance of being thin at baseline and smoking initiation among girls.

DESIGN

A four year prospective cohort survey including perceived importance of being thin at baseline and smoking behaviour, conducted in 1993 and 1996.

SETTING AND PARTICIPANTS

273 Massachusetts female adolescents aged 12-15 years at baseline who reported having smoked no more than one cigarette by the time of the baseline survey, drawn from households sampled by random digit dialing.

MAIN OUTCOME MEASURE

Progression to established smoking, defined as having smoked 100 or more cigarettes in their lifetime.

RESULTS

After adjusting for age, smoking status at baseline, and race/ethnicity, girls who valued thinness most strongly and somewhat strongly were both more likely to have become established smokers, compared to the girls who valued thinness least strongly. The odds ratios are 4.5 (95% confidence interval (CI), 1.4 to 16.7) and 3.4 (95% CI 1.04 to 10.9), respectively.

CONCLUSIONS

The level of perceived importance of being thin among young female adolescents predicts future smoking initiation. Smoking prevention programmes designed for female adolescents may therefore benefit from the inclusion of content related to importance of being thin.

Associates of obesity and weight dissatisfaction among Finnish adolescents

OBJECTIVE

We investigated behavioural and socio-economic factors associated with obesity and weight dissatisfaction among Finnish adolescents.

DESIGN

A total of 60,252 Finnish adolescents aged 14 to 16 years filled in a questionnaire about their health, health behaviour and socio-economic background. Food choices were obtained by using a short food-frequency questionnaire. Obesity was defined as a weight at least 120% of the sex- and height-specific mean weight for subjects.

RESULTS

Of girls and boys, 54% and 66%, respectively, were satisfied with their weight. Among dissatisfied normal-weight adolescents, 81% of girls but only 48% of boys thought they were overweight. Of obese boys, 25% were satisfied with their weight. For both genders, obesity and weight dissatisfaction were associated with economic problems in the family. In girls, an association was also found with poor school performance, low educational level of parents and not having evening meals at home; and in boys, with physical inactivity and not eating school lunch. Smoking was more common among girls who were dissatisfied with their weight. Differences in food choices were small between different weight and weight satisfaction categories.

CONCLUSIONS

Having normal weight and being satisfied with that weight are favourable for an adolescent. Obesity and weight dissatisfaction are associated mostly with disadvantageous health behaviours and low socio-economic status. Health behaviour seems to be associated more with weight satisfaction than with actual weight.

The relationship between body weight perceptions, weight control behaviours and smoking status among adolescents

OBJECTIVES

This paper examines the relation between body weight perceptions, weight control behaviours and smoking status among a representative sample of Ontario students.

METHODS

Bivariate and multivariate logistic regression analysis was used to evaluate the association between smoking status and perception of being overweight, and between smoking status and specific weight control behaviours.

RESULTS

Among females, the odds of being a smoker were significantly higher among those who perceived themselves to be overweight and who had employed weight control behaviours in the last 12 months. Among males, the adjusted odds of being a smoker was higher only among those who skipped meals in the past 12 months.

CONCLUSIONS

Body weight perceptions and the use of weight control behaviours were significantly associated with predictors of smoking among adolescent females. This suggests a need to incorporate discussion on body weight perception and body image in smoking prevention and cessation programs targeted toward adolescent females.

The relationship between body weight perceptions, weight control behaviours and smoking status among adolescents

OBJECTIVES

This paper examines the relation between body weight perceptions, weight control behaviours and smoking status among a representative sample of Ontario students.

METHODS

Bivariate and multivariate logistic regression analysis was used to evaluate the association between smoking status and perception of being overweight, and between smoking status and specific weight control behaviours.

RESULTS

Among females, the odds of being a smoker were significantly higher among those who perceived themselves to be overweight and who had employed weight control behaviours in the last 12 months. Among males, the adjusted odds of being a smoker was higher only among those who skipped meals in the past 12 months.

CONCLUSIONS

Body weight perceptions and the use of weight control behaviours were significantly associated with predictors of smoking among adolescent females. This suggests a need to incorporate discussion on body weight perception and body image in smoking prevention and cessation programs targeted toward adolescent females.

A tale of corruption

The multi-disciplinary team of Becker and colleagues elegantly present their findings addressing aspects of the impact on Fijian schoolgirls of exposure to Western television (Beckeret al, 2002, this issue). These findings support the notion that such exposure has generated disordered eating, underlying body dissatisfaction and intergenerational conflicts within the family that may, in part, be fuelling the process. Focusing on the expected escalation of such disordered eating in this population under these circumstances, their study was naturalistic in capitalising on the recent introduction of television to Fiji, with the first survey of these schoolgirls taking place within 1 month of its advent. The second survey was 3 years later in 1998. The authors point out that the traditional Fijian culture has ‘supported robust appetites and body shapes'.

Smoking behaviour and dietary restraint in young adolescent women: the role of physical self-perceptions

OBJECTIVE

To investigate the relationship among BMI, smoking consumption, dietary restraint, smoking to control weight, physical self-perception and self-esteem in young female adolescents.

METHODS

702 grade 9 students (14-15 yrs old) completed self-reported validated measures in classroom settings.

RESULTS

26.7% of students had smoked in the last 30 days. Cigarette consumption was low with only 13% smoking one or more cigarettes a day. MANOVA revealed smokers had higher dietary restraint and lower perceptions of physical appearance, conditioning, and self-esteem. A similar pattern emerged for those girls classified as using smoking to control weight. Multiple regression found dietary restraint was predicted by higher BMI, and lower body appearance and self-esteem.

CONCLUSIONS

The data provided converging evidence that girls with low self-perceptions are more likely to engage in health-compromising behaviours. Smoking behaviours and dietary restraint were also linked. However, the small effect sizes for smoking behaviours warrants caution.

Through the haze of cigarettes: teenage girls' stories about cigarette addiction

Narrative inquiry was used to explore the meaning of nicotine addiction among teenage girls, age 14 to 17 years, who had recent experience with smoking. The following three narratives emerged: invincibility, giving in, and unanticipated addiction. Those who told a story of invincibility depicted how they were in control of their smoking and not addicted. Participants who gave accounts of giving in to smoking described yielding to external forces. In the narrative of unanticipated addiction, participants recounted their surprise at realizing that they were addicted. Two subnarratives, needing to quit and repeating history, were also uncovered. The study findings reveal the importance of semantics and identity issues as teenage girls talked about nicotine addiction. Listening to their stories is paramount in continued efforts in the reduction of tobacco consumption.

Smoking and weight loss attempts in overweight and normal-weight adolescents

AIM

To explore the relationship between smoking and dieting in a cross-sectional nationally representative sample of young adolescents.

METHODS

Smoking was assessed by serum cotinine concentrations in 1132 adolescents aged 12-18 y enrolled in the NHANES III study. Information on adolescents' weight loss attempts were obtained by questionnaire. Normal weight was defined as a body mass index (BMI) less than the 85th percentile for age and gender. Overweight was defined as a BMI equal to or greater than the 85th percentile for age and gender. Nutritional intake was assessed with a 24 h recall and food frequency questionnaire.

RESULTS

There was a two-fold increase in smoking among normal-weight adolescent girls who reported trying to lose weight (23.7% vs 12.6%, P<0.01). In contrast, prevalence of smoking was similar among overweight adolescent girls who tried to lose weight compared to those who did not (15.8% vs 14.1%, P=0.76). Similar trends were observed in boys. However, overweight boys who were trying to lose weight were less likely to smoke than overweight boys who were not trying to lose weight (9.8% vs 24.5%, P<0.05). There were no differences in body weight, BMI, caloric intake or fat intake among smokers and non-smokers. However, smokers reported eating less fruit and vegetables compared to non-smokers, and were over five times more likely to drink alcohol compared to non-smokers (odds ratio: > or =1x/month, 5.28 (3.82-7.28), > or =4x/month, 5.29 (3.58-7.82).

CONCLUSION

Tobacco use is common among normal weight adolescents trying to lose weight. Tobacco use is also associated with a cluster of other unhealthy dietary practices in adolescents.

Women and lung cancer: does oestrogen play a role?

Smoking-related disease remains a major public-health problem. Large numbers of women continue to smoke, and new smokers are almost as likely to be female as male. Lung cancer is still a largely incurable disease; annual lung-cancer mortality in women exceeds that of breast cancer, and lung cancer now accounts for 12% of all new female cancer cases. The results of several studies suggest that women are more susceptible than men to lung cancer and to conditions that predispose to this cancer, such as chronic obstructive pulmonary disease. There is still much controversy about whether there is an increased lung-cancer risk in women across all populations. Many epidemiological studies have been negative or equivocal when comparing male and female lung-cancer risk. This article is not intended to be a comprehensive review of all epidemiological studies, or of all possible lung-cancer risk factors. Lung-cancer incidence and risk in women are discussed, and evidence for possible mechanisms of increased female risk are presented, including the role of oestrogen in the development of lung cancer.

International trends in adolescent nutrition

This paper addresses international trends in adolescent nutrition by reviewing the literature from English-language indexed journals and online sources from around the world. Information is presented by geographic region and by nation within region. The literature shows that malnutrition remains a significant problem for adolescents, worldwide, but that the types of nutritional problems impacting this group have changed significantly over the past two decades. While undernutrition and wasting are reported, these conditions, as well as growth stunting, seem to be on the decline. In developed countries, social pressures to achieve a distorted body image are creating a malnutrition of affluence among some groups of adolescents. There appears to be an increasing prevalence of obesity among adolescents worldwide, explained by widespread nutrition transitions to lipid-rich diets and a decrease in physical activity, especially among urban adolescents. These trends are of international importance as they imply the world will see a shift towards longer life spans for this adolescent cohort, with a concomitant increase in the prevalence of chronic diseases as it ages. The epidemiologic transition that will result may be a mixed blessing. It is likely to produce a larger and healthier international workforce, but it also has the potential of becoming a serious burden as demands for health care and support services for those with chronic diseases increase. To prevent inordinate health care demands on the international economy in the future, dietary recommendations with nutritional education programs that are culturally appropriate need to become national priorities.

Why may teenage girls persist in smoking?

Teenage girls often smoke cigarettes, recognizing that it protects them from the impulse to binge eat with its feared weight-gain consequences. Evidence is marshalled from our studies of a female eating-disordered population, teenage females (London, U.K. and Ottawa, Canada) and middle-aged women (London and rural England) in the general population. Teenage female data analysis reveals links between smoking and body-weight/shape concerns. Those who smoked were likely to be moderately overweight. Smoking was also related at all ages to being postmenarchal. Sensitivity to shape is largely and qualitatively prompted by the development of body fat in puberty. Smoking by the London schoolgirls in particular also independently revealed an association with greater weight loss since puberty. Smoking was powerfully linked with vomiting undertaken as another defence against weight gain and may also be further reinforced as a behaviour by it. The eating-disordered population showed these latter associations most strikingly. Since smoking amongst older women is associated with below average body-weight it may indeed be effective in curbing weight gain and therefore promoting desired weight loss. Our studies provide little evidence of association between smoking and generalized or social anxiety. We propose that preventative psychological approaches to teenage female smoking should include attention to these matters.