1
|
Smith CE, O'Neil PM. Prevalence of Obesity Among Electronic Cigarette and Tobacco Users in the United States: Results from the 2018 Wave of the Behavioral Risk Factor Surveillance System. Subst Use Misuse 2024:1-7. [PMID: 38803011 DOI: 10.1080/10826084.2024.2354787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/29/2024]
Abstract
Objective: Tobacco use and obesity are leading causes of preventable death in the U.S. E-cigarette use is on the rise; however, obesity prevalence among e-cigarette users is unknown. The present study characterized obesity prevalence among e-cigarette and tobacco users in a national sample of U.S. adults. Method: Data were obtained from the 2018 Behavioral Risk Factor Surveillance System. Approximately 249,726 participants provided data on e-cigarette and tobacco use, height, weight, and demographics, and were categorized as follows: Ever vaped, ever smoked; Ever vaped, never smoked; Never vaped, ever smoked; Never vaped, never smoked. Results: Obesity prevalence (BMI ≥30 kg/m2) differed significantly across groups: 33.0% (ever vaped, ever smoked); 27.7% (ever vaped, never smoked); 33.1% (never vaped, ever smoked); 32.1% (never vaped, never smoked), p < .001. Groups also differed demographically. Logistic regressions adjusted for demographics revealed subjects in the never vaped, ever smoked group were significantly more likely to have obesity relative to those in the never vaped, never smoked group (p < 0.001) with vaping status having no main effect. Secondary analyses using never smokers as the reference found current smokers were less likely to have obesity and former smokers were more likely to have obesity, p < .001. Discussion: The present study is the first to characterize U.S. obesity prevalence among e-cigarette and tobacco users. Obesity prevalence was lower in the ever vaped, never smoked group; however, this finding appears to be attributable to demographic variables. As e-cigarette use becomes more common, future research should examine the development and maintenance of obesity among users.
Collapse
Affiliation(s)
- Caitlin E Smith
- Department of Psychiatry and Behavioral Sciences, Weight Management Center, Medical University of South Carolina, Charleston, South Carolina, USA
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
| | - Patrick M O'Neil
- Department of Psychiatry and Behavioral Sciences, Weight Management Center, Medical University of South Carolina, Charleston, South Carolina, USA
| |
Collapse
|
2
|
Toyon A, Bursac Z, Werner N, Krukowski RA. Impact of Weight Concern on Post-Cessation Weight Management, Smoking Cessation, and Program Engagement. Am J Health Promot 2024:8901171241234136. [PMID: 38356272 DOI: 10.1177/08901171241234136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2024]
Abstract
PURPOSE Weight concern is a barrier to smoking cessation. We examined the impact of weight concern on post-cessation weight gain, abstinence and program engagement. DESIGN Randomized-controlled trial. SETTING Telephone-based and group-based intervention sessions. SUBJECTS 305 participants were randomized and analyzed. INTERVENTION Participants were randomized to receive a self-guided intervention, a weight loss intervention, or a weight stability intervention prior to all receiving the same smoking cessation intervention. MEASURES Level of weight concern on three measures, point-prevalence abstinence, weight change, and session attendance at 12 months. ANALYSIS Continuous and discrete outcomes were compared between weight-concerned and non-weight-concerned participants using two-sample t-tests and chi-square tests respectively. RESULTS There were no significant differences in weight change (range: +1.77, -1.91 kg) when comparing weight-concerned and non-weight-concerned participants. Point-prevalence abstinence ranged from 36% to 64%, with no differences by condition based on level of weight concern. There were no significant differences in session attendance by weight concern (Weight sessions: 50-70%, Smoking cessation sessions: 41-56%, Booster sessions: 28-45%). Weight concern, on all measures, significantly decreased between screening and 2 months (after the weight management intervention), for most of the comparisons made overall and by condition. CONCLUSION It may not be necessary to screen for weight concerns in smoking cessation and/or post-cessation weight management programs, as the trial interventions were beneficial regardless of weight concern.
Collapse
Affiliation(s)
- Anjola Toyon
- School of Medicine, University of Virginia, Charlottesville, VA, USA
| | - Zoran Bursac
- Department of Biostatistics, Florida International University, Miami, FL, USA
| | - Nicole Werner
- Department of Health & Wellness Design, Indiana University, Bloomington, IN, USA
| | | |
Collapse
|
3
|
Sahle BW, Chen W, Rawal LB, Renzaho AMN. Weight Gain After Smoking Cessation and Risk of Major Chronic Diseases and Mortality. JAMA Netw Open 2021; 4:e217044. [PMID: 33904915 PMCID: PMC8080225 DOI: 10.1001/jamanetworkopen.2021.7044] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
IMPORTANCE Smoking cessation is frequently followed by weight gain; however, whether weight gain after quitting reduces the health benefits of quitting is unclear. OBJECTIVE To examine the association between weight change after smoking cessation and the risk of cardiovascular diseases (CVD), type 2 diabetes, cancer, chronic obstructive pulmonary disease (COPD), and all-cause mortality. DESIGN, SETTING, AND PARTICIPANTS This cohort study analyzed data from a nationally representative sample of Australian adults aged 18 years or older who were studied between 2006 and 2014. Smoking status and anthropometric measurements were self-reported annually. Cox proportional hazards regressions were used to determine the hazard ratios (HRs) for the association between changes in weight and body mass index (BMI) and the risk of CVD, type 2 diabetes, cancer, COPD, and mortality. Data were analyzed in January 2019. EXPOSURES Annual self-reported smoking status; years since quitting. MAIN OUTCOMES AND MEASURES Weight gain after quitting, incident CVD, type 2 diabetes, cancer, COPD, and all-cause mortality. RESULTS Of a total 16 663 participants (8082 men and 8581 women; mean [SD] age, 43.7 [16.3] years), those who quit smoking had greater increases in weight (mean difference [MD], 3.14 kg; 95% CI, 1.39-4.87) and BMI (MD, 0.82; 95% CI, 0.21-1.44) than continuing smokers. Compared with continuing smokers, the HRs for death were 0.50 (95% CI, 0.36-0.68) among quitters who lost weight, 0.79 (95% CI, 0.51-0.98) among quitters without weight change, 0.33 (95% CI, 0.21-0.51) among quitters who gained 0.1 to 5.0 kg, 0.24 (95% CI, 0.11-0.53) among quitters who gained 5.1 to 10 kg, and 0.36 (95% CI, 0.16-0.82) among quitters who gained more than 10 kg. The HRs for death were 0.61 (95% CI, 0.45-0.83) among quitters who lost BMI, 0.86 (95% CI, 0.51-1.44) among quitters without change in BMI, 0.32 (95% CI, 0.21-0.50) among quitters who gained up to 2 in BMI, and 0.26 (95% CI, 0.16-0.45) among quitters who gained more than 2 in BMI. CONCLUSIONS AND RELEVANCE This cohort study found that smoking cessation was accompanied by a substantial weight gain; however, this was not associated with an increased risk of chronic diseases or an attenuation of the mortality benefit of cessation.
Collapse
Affiliation(s)
- Berhe W. Sahle
- School of Social Sciences and Psychology, Western Sydney University, Sydney, Australia
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Wen Chen
- Department of Medical Statistics, School of Public Health and Center for Migrant Health Policy, Sun Yat-sen University, Guangzhou, China
- Center for Migrant Health Policy, Sun Yat-sen University, Guangzhou, China
| | - Lal B. Rawal
- School of Social Sciences and Psychology, Western Sydney University, Sydney, Australia
- School of Health, Medical and Applied Sciences, Central Queensland University, Sydney, Australia
- Translational Health Research Institute, School of Medicine, Western Sydney University, Sydney, Australia
| | - Andre M. N. Renzaho
- School of Social Sciences and Psychology, Western Sydney University, Sydney, Australia
- Translational Health Research Institute, School of Medicine, Western Sydney University, Sydney, Australia
| |
Collapse
|
4
|
Javitz HS, Bush TM, Lovejoy JC, Torres AJ, Wetzel T, Wassum KP, Tan MM, Alshurafa N, Spring B. Six Month Abstinence Heterogeneity in the Best Quit Study. Ann Behav Med 2019; 53:1032-1044. [PMID: 31009528 DOI: 10.1093/abm/kaz014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Understanding the characteristics of smokers who are successful in quitting may help to increase smoking cessation rates. PURPOSE To examine heterogeneity in cessation outcome at 6 months following smoking cessation behavioral counseling with or without weight management counseling. METHODS 2,540 smokers were recruited from a large quitline provider and then randomized to receive proactive smoking cessation behavioral counseling without or with two versions of weight management counseling. A Classification and Regression Tree (CART) analysis was conducted to identify the individual pretreatment and treatment characteristics of groups of smokers with different quitting success (as measured by point prevalence of self-reported smoking of any amount at 6 months). RESULTS CART analysis identified 10 subgroups ranging from 25.5% to 70.2% abstinent. The splits in the CART tree involved: the total number of counseling and control calls received, whether a smoking cessation pharmacotherapy was used, and baseline measures of cigarettes per day, confidence in quitting, expectation that the study would help the participant quit smoking, the motivation to quit, exercise minutes per week, anxiety, and lack of interest or pleasure in doing things. Costs per quitter ranged from a low of $US270 to a high of $US630. Specific treatment recommendations are made for each group. CONCLUSIONS These results indicate the presence of a substantial variation in abstinence following treatment, and that the total extent of contact via counseling calls of any type and baseline characteristics, rather than assigned treatment, were most important to subgroup membership and abstinence. Tailored treatments to subgroups who are at high risk for smoking following a quit attempt could increase successful smoking cessation.
Collapse
Affiliation(s)
| | - Terry M Bush
- Optum Center for Wellbeing Research, Optum, Seattle, WA USA
| | - Jennifer C Lovejoy
- Optum Center for Wellbeing Research, Arivale, Inc and Institute for Systems Biology, Seattle, WA, USA
| | - Alula J Torres
- Optum Center for Wellbeing Research, Optum, Seattle, WA USA
| | - Tallie Wetzel
- Education Division, SRI International, Menlo Park, CA, USA
| | - Ken P Wassum
- Optum Center for Wellbeing Research, Optum, Seattle, WA USA
| | - Marcia M Tan
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Nabil Alshurafa
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Bonnie Spring
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| |
Collapse
|
5
|
Farris SG, DiBello AM, Bloom EL, Abrantes AM. A Confirmatory Factor Analysis of the Smoking and Weight Eating Episodes Test (SWEET). Int J Behav Med 2019; 25:465-472. [PMID: 29560578 DOI: 10.1007/s12529-018-9717-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
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; Mage = 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.
Collapse
Affiliation(s)
- Samantha G Farris
- The Warren Alpert Medical School of Brown University, Providence, RI, 02906, USA.
- The Miriam Hospital, Providence, RI, USA.
- Butler Hospital, Providence, RI, USA.
- Rutgers, The State University of New Jersey, Piscataway, NJ, USA.
| | | | - Erika Litvin Bloom
- The Warren Alpert Medical School of Brown University, Providence, RI, 02906, USA
- Rhode Island Hospital, Providence, RI, USA
| | - Ana M Abrantes
- The Warren Alpert Medical School of Brown University, Providence, RI, 02906, USA
- Butler Hospital, Providence, RI, USA
| |
Collapse
|
6
|
Kauffman BY, Garey L, Jardin C, Otto MW, Raines AM, Schmidt NB, Zvolensky MJ. Body Mass Index and functional impairment: the explanatory role of anxiety sensitivity among treatment-seeking smokers. PSYCHOL HEALTH MED 2017. [PMID: 28651434 DOI: 10.1080/13548506.2017.1344357] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Obesity and smoking are highly prevalent public health concerns in the United States. Data indicate that elevated Body Mass Index (BMI) is related to functional impairment. However, there is limited understanding of mechanisms that may explain their comorbidity among smokers. The current study sought to test whether anxiety sensitivity explained the relation between BMI and functional impairment among 420 (46.9% females; Mage = 38 years, SD = 13.42) treatment-seeking, adult smokers. Results indicated that BMI yielded a significant indirect effect through anxiety sensitivity for functional impairment, b = 0.01, SE = .01, 95% CI = [.002, .021]. These findings remained significant after controlling for participant sex, negative affectivity, tobacco dependence, psychopathology, and medical conditions (i.e. hypertension, heart problems, respiratory disease, asthma). Such data provide novel empirical evidence that, among smokers, BMI may be a risk factor for functional impairment indirectly through anxiety sensitivity. Overall, such findings could potentially inform the development of personalized interventions among this particularly vulnerable segment of the smoking population.
Collapse
Affiliation(s)
- Brooke Y Kauffman
- a Department of Psychology , University of Houston , Houston , TX , USA
| | - Lorra Garey
- a Department of Psychology , University of Houston , Houston , TX , USA
| | - Charles Jardin
- a Department of Psychology , University of Houston , Houston , TX , USA
| | - Michael W Otto
- b Department of Psychological and Brain Sciences , Boston University , Boston , MA , USA
| | - Amanda M Raines
- c Department of Psychology , Florida State University , Tallahassee , FL , USA
| | - Norman B Schmidt
- c Department of Psychology , Florida State University , Tallahassee , FL , USA
| | - Michael J Zvolensky
- a Department of Psychology , University of Houston , Houston , TX , USA.,d Department of Behavioral Sciences , University of Texas MD Anderson Cancer Center , Houston , Texas , USA
| |
Collapse
|
7
|
Bush T, Lovejoy J, Javitz H, Mahuna S, Torres AJ, Wassum K, Magnusson B, Benedict C, Spring B. IMPLEMENTATION, RECRUITMENT AND BASELINE CHARACTERISTICS: A RANDOMIZED TRIAL OF COMBINED TREATMENTS FOR SMOKING CESSATION AND WEIGHT CONTROL. Contemp Clin Trials Commun 2017; 7:95-102. [PMID: 29124236 PMCID: PMC5673122 DOI: 10.1016/j.conctc.2017.06.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background Two-thirds of treatment-seeking smokers are obese or overweight. Most smokers are concerned about gaining weight after quitting. The average smoker experiences modest post-quit weight gain which discourages many smokers from quitting. Although evidence suggests that combined interventions to help smokers quit smoking and prevent weight gain can be helpful, studies have not been replicated in real world settings. Methods This paper describes recruitment and participant characteristics of the Best Quit Study, a 3-arm randomized controlled trial testing tobacco cessation treatment alone or combined with simultaneous or sequential weight management. Study participants were recruited via tobacco quitlines from August 5, 2013 to December 15, 2014. Results Statistical analysis on baseline data was conducted in 2015/2016. Among 5082 potentially eligible callers to a tobacco quitline, 2540 were randomized (50% of eligible). Compared with individuals eligible but not randomized, those randomized were significantly more likely to be female (65.7% vs 54.5%, p < 0.01), overweight or obese (76.3% vs 62.5%, p < 0.01), more confident in quitting (p < 0.01), more addicted (first cigarette within 5 min: 50.0% vs 44.4%, p < 0.01), and have a chronic disease (28.6% vs. 24.4%, p < 0.01). Randomized groups were not statistically significantly different on demographics, tobacco or weight variables. Two-thirds of participants were female and white with a mean age of 43. Conclusions Adding weight management interventions to tobacco cessation quitlines was feasible and acceptable to smokers. If successful for cessation and weight outcomes, a combined intervention may provide a treatment approach for addressing weight gain with smoking cessation through tobacco quitlines. Trial registration Clinicaltrials.gov NCT01867983.
Collapse
Affiliation(s)
- Terry Bush
- Alere Wellbeing, solely owned subsidiary of Optum, 999 Third Avenue Suite 1800, Seattle, Washington 98104-1139, USA
| | - Jennifer Lovejoy
- Arivale, Inc and University of Washington School of Public Health, Seattle, WA
| | | | | | - Alula Jimenez Torres
- Alere Wellbeing, solely owned subsidiary of Optum, 999 Third Avenue Suite 1800, Seattle, Washington 98104-1139, USA
| | | | | | - Cody Benedict
- Gates Foundation (previously at Alere Wellbeing), Seattle, WA
| | - Bonnie Spring
- Center for Behavior and Health, Feinberg School of Medicine, Northwestern University, Chicago, IL
| |
Collapse
|
8
|
Bush T, Lovejoy JC, Deprey M, Carpenter KM. The effect of tobacco cessation on weight gain, obesity, and diabetes risk. Obesity (Silver Spring) 2016; 24:1834-41. [PMID: 27569117 PMCID: PMC5004778 DOI: 10.1002/oby.21582] [Citation(s) in RCA: 106] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Revised: 04/21/2016] [Accepted: 05/17/2016] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Most smokers gain weight after quitting, and some develop new onset obesity and type 2 diabetes. The purpose of this paper is to synthesize the current science investigating the consequences of tobacco cessation on body weight and diabetes, as well as intervention strategies that minimize or prevent weight gain while still allowing for successful tobacco cessation. METHODS Systematic reviews and relevant studies that were published since prior reviews were selected. RESULTS Smoking cessation can cause excessive weight gain in some individuals and can be associated with clinically significant outcomes such as diabetes or obesity onset. Interventions that combine smoking cessation and weight control can be effective for improving cessation and minimizing weight gain but need to be tested in specific populations. CONCLUSIONS Despite the health benefits of quitting tobacco, post-cessation weight gain and new onset obesity and diabetes are a significant concern. Promising interventions may need to be more widely applied to reduce the consequences of both obesity and tobacco use.
Collapse
|
9
|
An individually-tailored smoking cessation intervention for rural Veterans: a pilot randomized trial. BMC Public Health 2016; 16:811. [PMID: 27535024 PMCID: PMC4989380 DOI: 10.1186/s12889-016-3493-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Accepted: 08/12/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Tobacco use remains prevalent among Veterans of military service and those residing in rural areas. Smokers frequently experience tobacco-related issues including risky alcohol use, post-cessation weight gain, and depressive symptoms that may adversely impact their likelihood of quitting and maintaining abstinence. Telephone-based interventions that simultaneously address these issues may help to increase treatment access and improve outcomes. METHODS This study was a two-group randomized controlled pilot trial. Participants were randomly assigned to an individually-tailored telephone tobacco intervention combining counseling for tobacco use and related issues including depressive symptoms, risky alcohol use, and weight concerns or to treatment provided through their state tobacco quitline. Selection of pharmacotherapy was based on medical history and a shared decision interview in both groups. Participants included 63 rural Veteran smokers (mean age = 56.8 years; 87 % male; mean number of cigarettes/day = 24.7). The primary outcome was self-reported 7-day point prevalence abstinence at 12 weeks and 6 months. RESULTS Twelve-week quit rates based on an intention-to-treat analysis did not differ significantly by group (Tailored = 39 %; Quitline Referral = 25 %; odds ratio [OR]; 95 % confidence interval [CI] = 1.90; 0.56, 5.57). Six-month quit rates for the Tailored and Quitline Referral conditions were 29 and 28 %, respectively (OR; 95 % CI = 1.05; 0.35, 3.12). Satisfaction with the Tailored tobacco intervention was high. CONCLUSIONS Telephone-based treatment that concomitantly addresses other health-related factors that may adversely affect quitting appears to be a promising strategy. Larger studies are needed to determine whether this approach improves cessation outcomes. TRIAL REGISTRATION ClinicalTrials.gov identifier number NCT01592695 registered 11 April 2012.
Collapse
|
10
|
Copeland AL, Spears CA, Baillie LE, McVay MA. Fear of fatness and drive for thinness in predicting smoking status in college women. Addict Behav 2016; 54:1-6. [PMID: 26656671 DOI: 10.1016/j.addbeh.2015.11.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Revised: 10/09/2015] [Accepted: 11/25/2015] [Indexed: 12/22/2022]
Abstract
Recent research has identified fear of fatness (FF) as a related yet distinct construct from drive for thinness (DT). Whereas DT may be associated with need for approval and an "approach" tendency, FF may be more strongly related to avoidance of disapproval and an avoidant problem-solving style. Although no research has directly compared the influence of FF vs. DT with regard to smoking behavior, FF and DT might represent distinct motivations for smoking. We predicted that both FF and DT would be significantly associated with cigarette smoking, but that FF would be a stronger predictor of smoking behavior, even after controlling for variables such as body mass index (BMI) and nicotine dependence. Participants (N=289) were female college undergraduate students. Daily smokers had the highest scores on measures of DT and FF, followed sequentially by infrequent smokers, "triers," and never smokers. More frequent smokers also reported greater levels of body dissatisfaction and eating pathology than less frequent and never-smokers. Hierarchical regression analyses showed that greater DT predicted higher likelihood of smoking on a daily basis; however, higher FF predicted fewer cigarettes smoked per day. FF and DT may each play a role in the relationship between eating pathology and smoking, but they might be differentially related to specific smoking patterns. Both FF and DT and their coinciding coping styles should be further researched in the role of smoking initiation and maintenance.
Collapse
Affiliation(s)
| | | | - Lauren E Baillie
- Jackson Montgomery Veterans Administration Medical Center, United States
| | | |
Collapse
|
11
|
Gender differences influence overweight smokers' experimentation with electronic nicotine delivery systems. Addict Behav 2015; 49:20-5. [PMID: 26036665 DOI: 10.1016/j.addbeh.2015.05.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Revised: 04/28/2015] [Accepted: 05/04/2015] [Indexed: 01/22/2023]
Abstract
INTRODUCTION Overweight and obese tobacco users possess increased risk of cancer, diabetes, heart disease and chronic tobacco-related disease. Efforts to prevent tobacco-related health risk in this comorbid population would be informed by better understanding and monitoring of trends in the concurrent use of electronic nicotine delivery systems (ENDS) among smokers in the US marketplace. METHOD The California Longitudinal Smokers Study (CLSS) established a cohort of current cigarette smokers in 2011 who were surveyed for tobacco use and health behavior at baseline and again in 2012 at follow-up. RESULTS We observed a large increase in reported experimentation with ENDS. As hypothesized, overweight or obese smokers were more likely to report experimentation with ENDS, an increase that was also observed among women. Experimentation with ENDS was not associated with a reduction in use of cigarettes or a decrease in cigarette dependence in this high risk population of smokers. CONCLUSIONS Continued surveillance of this vulnerable population is needed to better understand how experimentation with new ENDS products may impact health, facilitate switching to non-combustible tobacco or facilitate persistent cigarette dependence.
Collapse
|
12
|
Beebe LA, Bush T. Post-cessation weight concerns among women calling a state tobacco quitline. Am J Prev Med 2015; 48:S61-4. [PMID: 25528710 DOI: 10.1016/j.amepre.2014.09.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Revised: 09/05/2014] [Accepted: 09/05/2014] [Indexed: 11/25/2022]
Abstract
BACKGROUND Obese and overweight women who smoke are more likely to be concerned about weight gain following cessation, impacting ability to quit and relapse. PURPOSE To determine differences in weight concerns for underweight, normal weight, overweight, and obese female smokers by race/ethnicity. METHODS From March to November 2008, female adult tobacco users calling the Oklahoma Tobacco Helpline were asked questions to determine the prevalence of obesity and concern for cessation-related weight gain. A score of 50 or greater, where 0=not at all concerned and 100=very concerned, on one of two weight concerns questions defined the outcome. BMI was calculated from self-reported height and weight. For the current analyses in 2013, race, ethnicity, age, education, marital status, and tobacco use history were examined as covariates. Multiple logistic regression was used to calculate ORs and 95% CIs. RESULTS A significant interaction between race and BMI was observed; thus, separate models were created for white (n=3,579); black (n=330); American Indian (n=441); and Hispanic (n=125) women. BMI was independently associated with weight concerns among all racial/ethnic groups, but the strength of the association varied. For black and Hispanic women, there was a particularly strong association between BMI and weight concerns among obese women (OR=9.55, 95% CI=5.05, 18.07, and OR=8.46, 95% CI=2.57, 27.83, respectively), although sample sizes were small. CONCLUSIONS State quitlines should consider tailoring promotional efforts and treatment protocols to include concerns about weight gain, especially for obese African American and Hispanic smokers.
Collapse
Affiliation(s)
- Laura A Beebe
- Department of Biostatistics and Epidemiology, College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma.
| | - Terry Bush
- Alere Wellbeing, Inc. Seattle, Washington
| |
Collapse
|
13
|
Strong DR, David SP, Johnstone EC, Aveyard P, Murphy MF, Munafò MR. Differential Efficacy of Nicotine Replacement Among Overweight and Obese Women Smokers. Nicotine Tob Res 2014; 17:855-61. [PMID: 25481918 DOI: 10.1093/ntr/ntu256] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Accepted: 11/17/2014] [Indexed: 01/16/2023]
Abstract
INTRODUCTION Rates of obesity are higher among more dependent smokers and 37%-65% of smokers seeking cessation treatment are overweight or obese. Overweight or obese smokers may possess metabolic and neurobiological features that contribute to difficulty achieving cessation using front-line nicotine replacement products. Attention to factors that facilitate effective cessation treatment in this vulnerable population is needed to significantly reduce mortality risk among overweight and obese smokers. METHOD This secondary analysis of 2 large trials of transdermal nicotine replacement in general medical practices evaluated the hypothesis that higher body mass index (BMI) would moderate the efficacy of the nicotine patch. We examined the potential for gender to further moderate the relationship between BMI and treatment efficacy. RESULTS In the placebo controlled trial (N = 1,621), 21-mg patch was no more effective than placebo for assisting biochemically verified point prevalence abstinence up to 1 year after quitting for women with higher BMI, but appeared to be effective for men at normal or high BMI (gender × BMI beta = -0.22, p = .004). We did not find differential long-term cessation outcomes among male or female smokers in the 15-mg patch trial (n = 705). However, we observed significantly higher rates of early lapse among women with higher BMI treated with nicotine patch across both trials. CONCLUSION These results suggest that increased BMI may affect the efficacy of nicotine patch on reducing risk of early lapse in women. Additional research is needed to explore mechanisms of risk for decreased efficacy of this commonly used cessation aid.
Collapse
Affiliation(s)
- David R Strong
- Department of Family and Preventive Medicine, University of California, San Diego, CA;
| | - Sean P David
- Center for Education and Research in Family and Community Medicine, Division of General Internal Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, CA
| | | | - Paul Aveyard
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Michael F Murphy
- Childhood Cancer Research Group, University of Oxford, Oxford, UK
| | - Marcus R Munafò
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK; UK Centre for Tobacco and Alcohol Studies and School of Experimental Psychology, University of Bristol, Bristol, UK
| |
Collapse
|
14
|
Bush T, Hsu C, Levine MD, Magnusson B, Miles L. Weight gain and smoking: perceptions and experiences of obese quitline participants. BMC Public Health 2014; 14:1229. [PMID: 25428130 PMCID: PMC4295229 DOI: 10.1186/1471-2458-14-1229] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Accepted: 11/17/2014] [Indexed: 05/01/2023] Open
Abstract
Background Weight gain that commonly accompanies smoking cessation can undermine a person’s attempt to quit and increase the risk for metabolic disorders. Research indicates that obese smokers have more weight concerns and gain more weight after quitting than non-obese smokers, yet little is known about possible reasons for these outcomes. We sought to gain an understanding of obese smokers’ experiences of quitting and their attitudes and beliefs about the association between smoking and weight gain. Methods In-depth semi-structured interviews were conducted with obese smokers who called a state tobacco quitline. Interviewers elicited discussion of obese smokers’ thoughts about smoking, the effects of quitting on change in weight, challenges they faced with quitting, and how quitlines might better serve their needs. Results Participants (n = 29) discussed their fear of gaining weight after quitting, their beliefs about smoking and their weight and significant experiences related to quitting. Participants’ awareness of weight gain associated with quitting was based on prior experience or observation of others who quit. Most viewed cessation as their primary goal and discussed other challenges as being more important than their weight, such as managing stress or coping with a chronic health condition. Although weight gain was viewed as less important than quitting, many talked about changes they had made to mitigate the anticipated weight gain. Conclusions Weight gain is a concern for obese smokers interested in quitting. Understanding the relative importance of body weight and other challenges related to smoking cessation can help tailor interventions for the specific group of smokers who are obese and interested in smoking cessation.
Collapse
Affiliation(s)
- Terry Bush
- Alere Wellbeing, 999 3rd Ave, Suite 2000, Seattle, WA 98104-1139, USA.
| | | | | | | | | |
Collapse
|
15
|
Bush TM, Levine MD, Magnusson B, Cheng Y, Chen X, Mahoney L, Miles L, Zbikowski SM. Impact of baseline weight on smoking cessation and weight gain in quitlines. Ann Behav Med 2014; 47:208-17. [PMID: 24048952 PMCID: PMC3960374 DOI: 10.1007/s12160-013-9537-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The use and effectiveness of tobacco quitlines by weight is still unknown. PURPOSE This study aims to determine if baseline weight is associated with treatment engagement, cessation, or weight gain following quitline treatment. METHODS Quitline participants (n = 595) were surveyed at baseline, 3 and 6 months. RESULTS Baseline weight was not associated with treatment engagement. In unadjusted analyses, overweight smokers reported higher quit rates and were more likely to gain weight after quitting than obese or normal weight smokers. At 3 months, 40 % of overweight vs. 25 % of normal weight or obese smokers quit smoking (p = 0.01); 42 % of overweight, 32 % of normal weight, and 33 % of obese quitters gained weight (p = 0.05). After adjusting for covariates, weight was not significantly related to cessation (approaching significance at 6 months, p = 0.06) or weight gain. CONCLUSIONS In the first quitline study of this kind, we found no consistent patterns of association between baseline weight and treatment engagement, cessation, or weight gain.
Collapse
Affiliation(s)
- Terry M Bush
- Alere Wellbeing, 999 Third Avenue, Ste 2100, Seattle, WA, 98104, USA,
| | | | | | | | | | | | | | | |
Collapse
|
16
|
Bush T, Levine MD, Beebe LA, Cerutti B, Deprey M, McAfee T, Boeckman L, Zbikowski S. Addressing weight gain in smoking cessation treatment: a randomized controlled trial. Am J Health Promot 2013; 27:94-102. [PMID: 23113779 DOI: 10.4278/ajhp.110603-quan-238] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To evaluate the effectiveness of a cognitive behavioral treatment (CBT) addressing cessation-related weight concerns delivered via a tobacco quitline that does not address weight concerns. DESIGN Randomized controlled trial, blinded 6-month follow-up. SETTING The Oklahoma Tobacco Helpline (OKHL). SUBJECTS All 7998 smokers who called the OKHL were screened; 4240 were eligible; 2000 were randomized to the standard quitline (STD) or the brief version of the CBT weight concerns program (WCP). INTERVENTION Telephone counseling to help people quit smoking and address concerns about cessation-related weight gain. MEASURES Demographics, weight, tobacco status, weight concerns, self-efficacy in quitting, and quitting without weight gain. ANALYSIS Descriptive statistics and logistic regression. RESULTS Of those randomized, 1002 participants completed the 6-month survey (response rates = 53.2% for STD, 47% for WCP). Compared with STD, WCP led to reduced weight concerns (p < .01) and less weight gain among quitters (1.8 vs. -3.4 pounds; p = .01). Although not significant, participants in the WCP were more likely to report 30-day abstinence (33.3% vs. 36.8%, p = .24; intent to treat = 17.7 vs. 17.3). CONCLUSION The WCP was successfully delivered via a quitline and resulted in improved attitudes about weight and decreased cessation-related weight gain without harming quit rates. Promotion of a quitline focused on addressing weight in conjunction with quitline treatment for smoking cessation may improve cessation and weight outcomes. Study limitations include use of self-report and survey response.
Collapse
Affiliation(s)
- Terry Bush
- Alere Wellbeing, Seattle, Washington, USA.
| | | | | | | | | | | | | | | |
Collapse
|
17
|
Schauer GL, Bush T, Cerutti B, Mahoney L, Thompson JR, Zbikowski SM. Use and effectiveness of quitlines for smokers with diabetes: cessation and weight outcomes, Washington State Tobacco Quit Line, 2008. Prev Chronic Dis 2013; 10:E105. [PMID: 23806800 PMCID: PMC3696044 DOI: 10.5888/pcd10.120324] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
INTRODUCTION Having diabetes and smoking increases the risk of morbidity and mortality. However, cessation-related weight gain, a common side effect during quitting, can further complicate diabetes. Evidence-based telephone quitlines can support quitting but have not been studied adequately in populations with chronic diseases such as diabetes. The purpose of this study was to evaluate the use and effectiveness of a tobacco quitline among tobacco users with diabetes. Cessation-related weight concerns and weight gain were also assessed. METHODS We administered a telephone-based follow-up survey to tobacco users with and without diabetes 7 months after their enrollment in a quitline. We collected and analyzed data on demographics, tobacco use, dieting, weight concern, quitting success (7- and 30-day point prevalence), and weight gain. We computed summary statistics for descriptive data, χ(2) and t tests for bivariate comparisons, and multivariable analyses to determine correlates of cessation. RESULTS Tobacco users with diabetes used the quitline in a greater proportion than they were represented in the general population. Quit rates for those with and without diabetes did not differ significantly (24.3% vs 22.5%). No significant differences existed between groups for weight gain at follow-up, regardless of quit status. However, participants with diabetes reported more weight gain in previous quit attempts (34.2% vs 22.4% gained >20 lbs, P = .03). Weight concern was a significant correlate of continued smoking, regardless of diabetes status. CONCLUSIONS Results suggest that quitlines are effective for participants with diabetes, but tailored interventions that address weight concerns during cessation are needed.
Collapse
Affiliation(s)
- Gillian L Schauer
- Department of Behavioral Sciences and Health Education, Emory University, Atlanta, GA 30322, USA.
| | | | | | | | | | | |
Collapse
|
18
|
Levine MD, Bush T, Magnusson B, Cheng Y, Chen X. Smoking-related weight concerns and obesity: differences among normal weight, overweight, and obese smokers using a telephone tobacco quitline. Nicotine Tob Res 2012; 15:1136-40. [PMID: 23100456 DOI: 10.1093/ntr/nts226] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
INTRODUCTION Substantial evidence suggests that concerns about postcessation weight gain interfere with cessation efforts. However, it is unclear to what extent weight pretreatment affects smoking-related weight concerns. Given that the prevalence of overweight and obesity among callers to tobacco quitlines mirrors that of the population at large, and that women and obese smokers may be more concerned about weight gain, we sought to compare weight gain concerns among normal weight, overweight, and obese callers to a quitline. METHODS A sample of 34.6% (n = 206) normal weight, 30.6% (n = 182) overweight, and 34.8% (n = 207) obese quitline callers completed assessments of tobacco use history and smoking-specific weight concerns. Weight categories were compared and gender differences evaluated. RESULTS Obese smokers endorsed significantly more concerns about postcessation weight gain [F(2, 592) = 20.35, p < .0001], had less confidence in their ability to maintain their weight without smoking [F(2, 592) = 7.67, p = .0005], and were willing to tolerate less weight gain after quitting than normal weight or overweight smokers [F(2,574) = 30.59, p < .0001). There also were gender differences in weight concerns by weight status. Significantly more women callers were obese (38.2% vs. 28.4%, p = .011), and women consistently endorsed more concern about postcessation weight gain than did men [F(1,588) = 24.04, p < .0001). CONCLUSIONS Overweight and obese smokers, particularly women, express substantial concern about gaining weight after quitting. It is possible that smokers who begin quitline treatment with a BMI in the obese range may benefit from adjunctive interventions designed to address smoking-related weight concerns.
Collapse
Affiliation(s)
- Michele D Levine
- Department of Psychiatry, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA.
| | | | | | | | | |
Collapse
|
19
|
Adams CE, McVay MA, Stewart DW, Vinci C, Kinsaul J, Benitez L, Copeland AL. Mindfulness Ameliorates the Relationship between Weight Concerns and Smoking Behavior in Female Smokers: A Cross-Sectional Investigation. Mindfulness (N Y) 2012; 5:179-185. [PMID: 24778746 DOI: 10.1007/s12671-012-0163-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Weight concerns are common among female smokers and may interfere with smoking cessation. It is imperative to identify protective factors to lessen the likelihood that smoking-related weight concerns prompt smoking and hinder cessation efforts. Mindfulness is one potential protective factor that might prevent weight concerns from triggering smoking. In the current study, relationships among facets of trait mindfulness, smoking-related weight concerns, and smoking behavior were examined among 112 young adult female smokers (70.5% daily smokers; 83% Caucasian; mean age 20 [SD = 1.69]). After controlling for demographic variables, the Describing facet of trait mindfulness predicted lower smoking-related weight concerns. The mindfulness characteristics of Acting with Awareness, Nonreactivity, and Describing moderated the relationship between smoking-related weight concerns and smoking frequency, such that smoking-related weight concerns predicted greater smoking frequency in female smokers with low and medium levels of these mindfulness characteristics but did not in those with higher levels of mindfulness. These results suggest that mindfulness-based interventions may be effective for weight-concerned smokers.
Collapse
Affiliation(s)
- Claire E Adams
- Department of Health Disparities Research, The University of Texas MD Anderson Cancer Center - Unit 1440, PO Box 301402, Houston, TX 77230-1402
| | - Megan Apperson McVay
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center
| | - Diana W Stewart
- Department of Health Disparities Research, The University of Texas MD Anderson Cancer Center - Unit 1440, PO Box 301402, Houston, TX 77230-1402
| | - Christine Vinci
- Department of Psychology, Louisiana State University, Baton Rouge, LA
| | - Jessica Kinsaul
- Department of Psychology, Louisiana State University, Baton Rouge, LA
| | - Lindsay Benitez
- Department of Psychology, The University of Tennessee at Chattanooga, Chattanooga, TN
| | - Amy L Copeland
- Department of Psychology, Louisiana State University, Baton Rouge, LA
| |
Collapse
|
20
|
Adams CE, Baillie LE, Copeland AL. The Smoking-Related Weight and Eating Episodes Test (SWEET): development and preliminary validation. Nicotine Tob Res 2011; 13:1123-31. [PMID: 21849410 DOI: 10.1093/ntr/ntr162] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
INTRODUCTION Many smokers believe that smoking helps them to control their weight, and concerns about weight gain can interfere with smoking cessation. As researchers typically assess general weight concerns, a measure specific to smoking-related weight concerns is needed. METHODS The Smoking-related Weight and Eating Episodes Test (SWEET) was created by generating items from 4 content domains: Hunger, Craving, Overeating, and Body Image. Female undergraduate smokers (N = 280) rated their postcessation weight gain concern and completed the SWEET, Fagerström Test for Nicotine Dependence, Brief Smoking Consequences Questionnaire-Adult, Eating Attitudes Test (EAT)-26, Bulimia Test-Revised (BULIT-R), and Body Shape Questionnaire. RESULTS Factor analysis of the initial items suggested a 4-factor solution, suggesting 4 subscales: Smoking to suppress appetite, smoking to prevent overeating, smoking to cope with body dissatisfaction, and withdrawal-related appetite increases. Based on these results, the SWEET subscales were revised and shortened. The resulting 10-item SWEET showed excellent internal consistency (total α = .94; mean α = .86) and evidence of validity by predicting smoking frequency, eating pathology, and body image concerns (ps < .05). Smoking frequency, eating pathology, and body image concerns were significantly predicted by the SWEET while controlling for existing measures of postcessation weight gain concern. CONCLUSIONS The SWEET appears to be a reliable and valid measure of tendencies to smoke in response to body image concern and nicotine withdrawal and as a way to control appetite and overeating.
Collapse
Affiliation(s)
- Claire E Adams
- Department of Psychology, Louisiana State University, 236 Audubon Hall, Baton Rouge, LA 70803, USA.
| | | | | |
Collapse
|