Smoking Addiction Risk Doubled in Obese vs Nonobese Girls

Laurie Barclay, MD

June 21, 2011

June 21, 2011 — Compared with nonobese adolescent girls, obese adolescent girls have more than twice the risk for high-level nicotine addiction in young adulthood, according to the results of a survey study reported online June 21 in the Journal of Adolescent Health.

"As we address the issue of obesity, it is important to prevent poor medical outcomes, but we must also recognize the risk for these psychosocial outcomes and support and counsel teens appropriately," said lead author Aliya Esmail Hussaini, MD, MSc, from the Michael & Susan Dell Foundation in Austin, Texas, in a story by Laura Kennedy, from the Health Behavior News Service, part of the Center for Advancing Health.

The hypotheses tested by this study were that obese adolescent girls would be at increased risk for nicotine addiction in young adulthood, and that this association would be modulated by specific individual and social variables.

The National Longitudinal Study of Adolescent Health (Add Health) is a nationally representative school-based and in-home survey performed in 3 waves. The study sample consisted of more than 4000 Add Health student survey respondents. The relationship between obesity and the level of nicotine addiction was assessed with use of multivariate linear and logistic regression analyses, which also allowed identification of variables influencing the association.

After controlling for demographic variables, smoking by parents and friends, and baseline smoking, obesity was associated with double the risk for the highest level of nicotine addiction (odds ratio [OR], 2.12; 95% confidence interval [CI], 1.22 - 3.68). The strongest predictor of nicotine addiction was family smoking (OR, 4.72; 95% CI, 2.89 - 7.72), with grade point average (GPA) a partial mediator of this association (OR, 0.48; 95% CI, 0.32 - 0.74).

According to Richard Jessor, PhD, director of the Health and Society Research Program at the University of Colorado-Boulder Institute of Behavioral Science, who had no affiliation with the study, the term heavy smoker would be more appropriate than high-level nicotine addiction. He told the Health Behavior News Service that the latter description might suggest someone similar to "a heroin addict in the last stage of desperation."

"Obese, adolescent females are at increased risk for high-level nicotine addiction in young adulthood as compared with their nonobese peers," the study authors write. "Grade point average partially mediates the association, and may represent a confluence of factors including increased absenteeism, social marginalization, biases, and lack of confidence in academic ability. Obese, adolescent females may require targeted interventions to address their risk of subsequent high-level nicotine addiction, especially if risk factors such as parental smoking and poor school performance are present."

Dr. Jessor noted that obesity might not be a stand-alone risk factor for heavy smoking, but that similar psychosocial risk factors might result in a syndrome of problem behaviors including obesity as well as heavy smoking.

According to the Health Behavior News Service, Drs. Hussaini and Jessor agree that it is vitally important for parents to model positive behaviors by not smoking, eating healthy, participating in physical activity, and encouraging commitment to school.

Limitations of this study include sample limited to those adolescents who completed all 3 waves of Add Health, lack of generalizability to other populations, exploration of mediating covariates limited by the available data in Add Health, failure to control for family history of obesity, and uneven time frame among waves of the survey.

"Explanatory factors that link obesity with smoking behavior reaffirm the critical influence of smoking in the family as a persistent predictor," the study authors conclude. "Future work to better describe the process by which obese females become highly addicted to nicotine will further direct specific interventions for this population with substantial dual health risks."

Add Health was funded by a grant from the National Institute of Child Health and Human Development, with cooperative funding from 17 other agencies. Dr. Hussaini was supported from the Robert Wood Johnson Foundation through the Robert Wood Johnson Clinical Scholars Program at the University of Pennsylvania. One of the study authors is employed by Merck.

J Adolesc Health. Published online June 21, 2011. Abstract

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