Adolescent smoking: The relationship between cigarette consumption and BMI

Background Studies relating cigarette smoking and body weight yield conflicting results. Weight-lowering effects in women and men have been associated with smoking, however, no effects on weight have been proven. This study examined the association between cigarette smoking and relative weight in adolescent males and females as they age into young adults. Methods Data from the National Longitudinal Survey of Youth—a nationally representative survey conducted annually—was used for this analysis. The sample consists of 4225 males and females observed annually from 1997 at age 12 to 17 through 2011 at age 27 to 31. Hierarchical generalized models (HGM) assess the impact of smoking on the likelihood of having higher BMI controlling for demographic, household and environmental impacts. The second estimation considers the possibility that smoking is endogenous and utilizes a multinomial instrument (IV) for smoking level. Results HGM models reveal a negative association between cigarette smoking and BMI for both males and females. Individuals who smoke more have lower BMI compared to infrequent or non-smokers. General health rating, region of residence and income were used instrument for smoking in a linear two-stage IV specification. The instrument is highly correlated with BMI and results mirror the HGM. Finally, models run on early, middle and advanced adolescents show that the relationship diminishes over time. The relationship between BMI and smoking decreases as females age but increases for males. Conclusions Empirical models confirm an association cigarette consumption and BMI in both males and females. This negative relationship varies with age. It is important to identify health risks—obesity—and modifiable risk factors—smoking—that contribute to health disparities among adolescents. However, the increase in one risky behavior leading to the decrease in the prevalence of the other, complicates the issue. The higher prevalence of frequent cigarette uses among both adolescents and young adults of lower BMI suggest that smoking could be used curb or suppress appetite.
Highlights • The weight impact of tobacco use by adolescents, unlike adults, has not been conclusively determined. • This study examines the relationship between cigarette use and the body weight (BMI) of high school aged youth. • Since smoking can be considered endogeneous in weight studies, smoking is instrumented in a two-stage process. • Cigarette use is associated with higher BMI, but magnitudes vary by age. • Models run on early, middle and older adolescents show that the relationship diminishes over time. • The relationship between BMI and smoking decreases as females age but increases for males. • Overweight and obese adolescents were more frequent tobacco users. • Results suggest that electronic and conventional tobacco has similar BMI associations when used independently.