Adolescent Attitudes Towards Smoking and Weight Loss: Relationship to Gender and Smoking Status Melanie K. Bean*, MS1, Karen S. Mitchell, BS1, Ilene S. Speizer, PhD2, Diane Baer Wilson, EdD3, Brian N. Smith, PhD1, & Elizabeth A. Fries, PhD1 1Department of Psychology, 2Department of Preventive Medicine and Community Health, 3Department of Internal Medicine, Virginia Commonwealth University, Richmond, VA, USA Discussion Findings & Conclusions 15% of sample are smokers; 44% experimental smokers Consistent with prior research, peer smoking is the strongest predictor of youth smoking. Students with more peers who smoke, with 1 or more parents who smoke, and overweight students are more likely to have tried smoking. Both boys and girls endorse the attitude that smoking helps with weight loss: More girls think that people smoke for weight control More boys think that if they stopped smoking they would gain weight When controlling for other factors, however, attitudes towards the link between weight loss and smoking similarly predicts smoking status in boys and girls. Attitudes towards smoking and weight loss can reliably separate current smokers from experimental smokers, but are not helpful in distinguishing never smokers from experimental smokers: Interestingly, although current smokers are more likely to believe they will gain weight if they quit, they are less likely than never and experimental smokers to report that people smoke for weight control. Experimental smokers believe people smoke for weight control more than current smokers do. Nonsmokers believe others smoke for weight control but do not believe that they would gain weight if they do not smoke. Because they endorse the attitude, smoking could potentially become a weight loss strategy and lead to initiation. Limitations Self-report data No Control group Single-item measures Correlational design – causality cannot be inferred Implications The widespread attitude that smoking helps with weight loss, plus the fact that many youth, particularly girls say they want to lose weight, highlights the fact that addressing attitudes towards smoking and weight loss is essential as part of prevention efforts. Girls as well as boys seem to be smoking for weight control, suggesting that healthy weight loss/maintenance, as well as improving body image, must be targeted in prevention programs. Self vs Others’ reasons for smoking seems to be an important distinction to make when assessing attitudes towards smoking and weight loss. More research should include both girls’ and boys’ weight loss/smoking attitudes and beliefs. Objective As part of the Youth Tobacco Evaluation Project’s (YTEP) assessment of state-wide tobacco-prevention programming in Virginia, participants from three high schools in rural Virginia were surveyed using a comprehensive instrument to assess smoking-related characteristics and behaviors at baseline. The present research examined the roles of two attitudinal measures of the link between smoking and weight loss to determine whether supportive attitudes were associated with smoking status in high school boys and girls. Participants Results Table 1. Participant Characteristics Variable Total (N=748) Boys (n=346) Girls (n=402) % Grade In School 9th 10th 11th 12th 22.1 20.7 31.1 26.1 22.3 20.5 30.9 26.36 21.9 20.9 31.3 25.9 Ethnicity Black White Hispanic/other 12.5 82.0 5.5 12.0 81.5 6.5 12.9 82.5 4.6 Smoking Status Current Experimental Never 14.5 44.1 41.4 14.7 42.5 42.8 14.2 40.5 45.3 Weight Loss Goals Lose Weight Stay the Same Gain Weight 40.9 42.4 16.7 24.3 48.0 27.7 55.2*** 37.6*** 7.2*** Weight Range (BMI) Underweight (< 18.5) Normal (18.5-24.9) Overweight (25.0-29.9) Obese (> 30.0) 11.8 64.3 16.4 7.5 11.3 61.3 17.9 9.5 12.2 66.9 15.2 5.7 Either Parent Smokes 55.9 42.6 45.4 Friends smoking None A few Half Most All 16.5 50.4 13.6 3.0 13.5 51.0 18.8 12.6 4.1 19.0 49.9 2.0 *p<.05, ***p<.001, all comparing males to females Table 3. Multinomial Logistic Regression Coefficients (Standard Error) in Models Comparing Current, Experimental, and Never Smokers (N = 748) Variable Experimenter vs. Never Current vs. Never Current vs. Experimenter Gender Male Female (ref) -.05 (.19) --- -.20 (.30) -- -.15 (.28) Ethnicity African American/Other Caucasian (ref) .09 (.23) -.67 (.39) -.76 (.36)* Weight Goals Lose Weight Gain Weight Stay the Same (ref) .36 (.21) .73 (.26)** .33 (.32) .27 (.42) -.03 (.30) -.46 (.38) Perception of number of friends who smoke .80 (.11)*** 1.69 (.12)*** .88 (.13)*** Either parent smokes .40 (.18)* .67 (.27)* .28 (.26) Weight Range based on BMI Underweight Normal Overweight Obese (ref) .06 (.42) .23 (.35) .80 (.39)* .28 (.71) .66 (.56) 1.14 (.61) .22 (.67) .43 (.52) .35 (.55) If I stay tobacco-free I will gain weight (attitudes towards self) .08 (.10) .42 (.15)** .34 (.14)* People smoke for weight control (attitudes towards others) -.06 (.04) -.22 (.06)*** -.16 (.05)** *p<.05, **p<.01, ***p<.001 Figure 1. Gender differences in attitudes that people smoke for weight control by smoking status. Mean Scores Background Tobacco use is the most preventable cause of death in the U.S. Most adult smokers began smoking during adolescence In the U.S., 22% of high school students currently smoke cigarettes, defined as having smoked on at least 1 of the 30 days preceding the survey (MMWR, 2004) It is important to identify factors that may be related to, and predictive of, adolescents’ tobacco use to inform prevention efforts. Perceptions that smoking will curb appetite and thus help weight loss are widespread among youth, particularly among girls. Methods Design: cross sectional; survey Procedures: Tobacco-related behaviors and characteristics of students from three high schools were assessed with a comprehensive survey. 16-page baseline survey before beginning of tobacco-related interventions 20-35 minutes Placed completed survey in a blank envelope and sealed it Instructors returned sealed envelopes to the YTEP Participants High school students from 3 rural high schools 99% of the eligible participants (1002 out of 1117) returned surveys Due to missing data, final sample for analyses: N = 748 Variables Demographics (gender & ethnicity) Attitudes toward remaining tobacco-free “If I stay tobacco-free, I will gain weight” Range 1-5; 5-pt scale- Strongly Disagree (1) to Strongly Agree (5) Attitudes towards smoking and weight loss “People smoke because …” It helps them lose weight It helps them stay thin It makes them less hungry Total score: range 3- 15; 5-pt Likert scale- Definitely Not (1) – Definitely Yes (5) alpha = .87 Smoking status Current smoker: smoked at least one cigarette in past 30 days Experimental smoker: smoked at least one cigarette, but not in past 30 days Never smoker: never smoked a cigarette Weight Loss Goals Response Options: Lose weight, Gain weight, Stay the same/No goals. Weight Range based on Body Mass Index (BMI) Calculated from self-reported height and weight Parent Smoking Status Mom/Female Guardian Smokes (Y/N) Dad/Male Guardian Smokes (Y/N) Perception of the number of friends that smoke Response Options: None, Few, Half, Most, All Note: Response options are 1 (Definitely Not) to 5 (Definitely Yes); Possible Range: 3-15 for total score, with high scores meaning more endorsement of the attitude that people smoke for weight control. Figure 2. Gender differences in item, “If I stay tobacco-free, I will gain weight” by smoking status. Mean Scores Table 2. Description, Means, and Standard Deviations of Attitudinal Measures Construct Variable M SD Personal Attitudes about Smoking for Weight Loss If I stay tobacco free I will gain weight 2.41 (of 5) .95 Attitudes towards Others’ Smoking for Weight Loss People smoke because it helps them stay thin 8.82 (of 15) 2.5 Compared to nonsmokers, current smokers report significantly more endorsement of the attitude that they will gain weight if they are tobacco-free: F(2, 744) = 4.12, p < .05. Compared to experimental smokers and nonsmokers, current smokers report significantly less endorsement of the attitude that people smoke for weight control: F(2, 745) = 12.82, p < .001. Girls (M = 9.26, SD = 2.5) report significantly more agreement than boys (M = 8.3, SD = 2.4) with the attitude that people smoke for weight control, t(746) = -5.22, p < .001. Boys (M = 2.5, SD = .92) report significantly higher agreement than girls (M = 2.34, SD = .97) with the attitude that remaining or becoming tobacco-free will make them gain weight, t(745) = 2.3, p < .05. Note: Response options are 1 (Strongly Disagree) to 5 (Strongly Agree); Possible Range: 1-5 for the item, “If I stay tobacco-free, I will gain weight,” with high scores meaning more endorsement of the attitude. Acknowledgements: Funding for this project was provided by the Virginia Tobacco Settlement Foundation (VTSF)