1. APHA 140th Annual Meeting & Expo, October 27-31, 2012, San Francisco, CA
Body weight control and tobacco smoking among adolescents: a prospective study
Melinda Pénzes M.D.1, Edit Czeglédi M.A.2,
Péter Balázs M.D., Ph.D1, Kristie L. Foley Ph.D3
1 Semmelweis University Budapest, Institute of Public Health
2 Eötvös Loránd University Budapest,
Doctoral School of Psychology, Institute of Psychology
3 Davidson College, Medical Humanities Program, NC

2. Presenter Disclosures “No relationships to disclose”
Dr. Melinda Penzes
(1) The following personal financial relationships with commercial interests relevant to this presentation existed during the past 12 months:
“No relationships to disclose”

3. Funding
This study was made possible by Grant Number R01 TW from the Fogarty International Center, the National Cancer Institute, and the National Institutes on Drug Abuse, within the National Institutes of Health (NIH).
„Increasing Capacity for Tobacco Research in Hungary”

4. Introduction I.
Body weight and current smoking is inversely associated among adults.
Widespread belief among adults as well as adolescents that tobacco smoking controls body weight.
Does smoking have weight-loss effect in adolescence?
Views are controversial about the relationship between smoking and adolescents’
body shape
weight concerns
belief that smoking controls weight.

5. Introduction II.
Findings about adolescent smoking and body weight-related factors
Association with Smoking
By gender
Overweight
Positive or no
Inconsistent
Perceived overweight
May play a role in initiation and maintenance of smoking
Mainly girls
Weight concerns
Positive association
Dieting behavior
Clear positive association
Girls
Belief that smoking controls weight
More prevalent among smokers

6. X Purpose Body Mass Index Satisfaction with body and appearance
Desire for change body shape
Weight control belief of tobacco smoking
Associated with tobacco smoking in adolescence?
Differs by gender?
Change in the strength of possible association?
Play role in the initiation of smoking? X

7. Methods – Survey
„Longitudinal Study of Tobacco Smoking and Body Weight Management among Adolescents”
Prospective cohort study
The capital and 5 Hungarian metropolitan cities
Baseline (2010.) and follow-up survey (2011.)
Randomly selected elementary and high schools
6th and 9th graders at baseline
Self-administered questionnaire annually
Body weight, body height measurement by school nurses
n=1,389
Hungary
Miskolc
Győr
Budapest
Debrecen
Szeged
Pécs

8. Methods – Measurements
Smoking status
Current smokers: were smoking in the past 30 days
Non-smokers: were not smoking in the past 30 days or did not try smoking
Objective Body Mass Index
Calculated from measured body weight and body height (kg/m2)
Short form of the Smoking Consequences Questionnaire (MG. Myers, 2003)
Appetite-Weight Control Subscale
Cronbach α: Wave 1: .91; Wave 2: .89
Subscale was dichotomized using median split
Low agreement with the belief that smoking controls weight
High agreement with the belief that smoking controls weight

9. Methods – Measurements
Contour Drawing Rating Scale (MA. Thompson & JJ. Gray, 1995)
9 male and female front-view contour drawings
Current and ideal figure
Current – ideal discrepancy
No discrepancy
Desire thinner body
Desire more robust body
Body and Appearance Satisfaction Scale (N. Kiss, 2008)
6 items (satisfaction with body weight, height, muscularity, face, body shape, overall appearance)
Cronbach α: Wave 1: .85; Wave 2: .86
Subscale was dichotomized using median split
Less satisfied / more satisfied with body and appearance

10. Methods – Analyses Chi-squared tests Independent samples T-tests
Multivariate binary logistic regression analyses
(controlled for grade, parental and peer smoking)
SPSS 17.0; CI 95%; p<.05
Predictors
Wave 1
Smoking status by gender
Wave 1
Model 1
Predictors
Wave 2
Smoking status by gender
Wave 2
Model 2
Predictors
Wave 1
Smoking initiation at Wave 2
by gender
Model 3

11. Results – Demographics
SURVEY
1. (2010.)
2. (2011.)
GRADE 6. 9.
Total 7.
10.
Sample (n)
807
1401
2208
740
1341
2081
In follow-up (n)
525
864
1389
Mean age (years)
[SD]
12.0 [0.61]
15.0 [0.62]
13.9 [1.57]
13.0 [0.65]
16.0 [0.61]
14.9 [1.59]
Range
11-15
14-17
11-17
12-17
14-19
12-19
Gender: boys: 45.4%; girls: 54.6%
Type of settlement: capital (Budapest): 58.7%; metropolitan cities: 41.3%
Type of school: Elementary school: 37.8%
High school: 24.6%
Vocational school: 37.7%

12. Results – Prevalence of smoking
Tried smoking at Survey 1 and 2 by gender and grade
Grade 6th to 7th
Boys: χ2(1)=16.24, p<.001
Girls: χ2(1)=28.24, p<.001
Grade 9th to 10th
Boys: χ2(1)=30.05, p<.001
Girls: χ2(1)=21.62, p<.001

13. Results – Prevalence of smoking
Current smokers at Survey 1 and 2 by gender and grade
Grade 6th to 7th
Boys: χ2(1)=2.09, ns
Girls: χ2(1)=10.42, p=.001
Grade 9th to 10th
Boys: χ2(1)=24.07, p<.001
Girls: χ2(1)= 27.18, p<.001

14. Results – Prevalence of smoking
Survey 1
Survey 2
Change
χ2 test
Experimenters (%)
44.0
55.8
11.8
77.95***
Current smokers (%)
18.7
26.6
7.9
56.53***
***p< .001
GRADE
6th7th
9th10th
Total
Became new smoker (%)
4.8
15.2
11.2
Quit smoking (%)
1.9
4.3
3.4

15. Results – Smoking status and BMI
kg/m2
p=.006
Cohen d=0.34
p=.001
Cohen d=0.37
p=.014
Cohen d=0.29 ns
Cohen d=0.16
Means and 95% confidence intervals

16. Results – Smoking status and weight control belief of smoking
p=.008
Cohen d=0.29
p<.001
Cohen d=0.47
p=.006
Cohen d=0.27
p<.001
Cohen d=0.42
Means and 95% confidence intervals

17. Results – Smoking status and satisfaction with body and appearance
Cohen d=0.19
p=.004
Cohen d=0.27
p=.092
Cohen d=0.16
p=.001
Cohen d=0.26
Means and 95% confidence intervals

18. Results – Smoking status and desire for change body shape
χ2(2)=8.11 ns
p=.013
χ2(2)=8.72 ns

19. Results – Logistic regression analysis
Results – Logistic regression analysis predicting current smoking at Wave 1
Predictor
Boys
Girls OR
95% CI
Higher Objective BMI
1.11*
1.05
Less satisfied with body and appearance
1.54
0.97
Discrepancy of current-ideal body shape
Desire thinner body
0.63
1.21
Desire more robust body
2.20+
1.51
Agreement with the belief that smoking controls weight
1.84+
1.73*
Nagelkerke R2
31.5%
34.2%
* p < .05; + p < .10

20. Results – Logistic regression analysis
Results – Logistic regression analysis predicting current smoking at Wave 2
Predictor
Boys
Girls OR
95% CI
Higher Objective BMI
1.04
1.03
Less satisfied with body and appearance
1.00
0.57+
Discrepancy of current-ideal body shape
Desire thinner body
1.18
0.95
Desire more robust body
1.55
0.82
Agreement with the belief that smoking controls weight
1.29
2.26**
Nagelkerke R2
41.3%
43.7%
** p < .01; + p < .10

21. Results – Logistic regression analysis predicting
Results – Logistic regression analysis predicting smoking initiation for Wave 2
Predictor
Boys
Girls OR
95% CI
Higher Objective BMI
1.07
0.96
Less satisfied with body and appearance
1.03
4.10**
Discrepancy of current-ideal body shape
Desire thinner body
1.34
0.67
Desire more robust body
1.21
0.54
Agreement with the belief that smoking controls weight
0.72
Nagelkerke R2
14.7%
13.3%
** p < .01

22. Summary
At baseline, the belief that smoking controls body weight predicted smoking especially among girls.
Boys who desired more robust bodies were also more likely to smoke.
After a year, weight control beliefs remained significantly associated with smoking, but only among girls.
At follow up, the prevalence of smoking increased remarkably especially among higher graders and 11.2% of participants became smoker.
Girls’ dissatisfaction with body image represented risk for starting smoking, but self-assessment of body image among boys was unrelated to smoking at follow-up.

23. Conclusions
The weight control belief of smoking did not play a role in smoking initiation.
The weight control belief began to recover consciousness among those adolescents who were already smokers.
Danger lies in the fact that later in life this belief may play a role in not quitting smoking.
Tobacco prevention programs for adolescents
should be differentiate by gender,
should emphasize the adverse effects of smoking as a weight control method as well as stressing healthy methods of healthy weight management.

24. References
Kiss N. The relationship between self-esteem and body image dissatisfaction in adolescence. Unpublished master’s thesis, Eötvös Loránd University, Budapest, Hungary.
Myers MG. et al. Constructing a short form of the Smoking Consequences Questionnaire with adolescents and young adults. Psychol Assess Jun;15(2):
Thompson MA, Gray JJ. Development and validation of a new body-image assessment scale. J Pers Assess Apr;64(2):

25. Thank you for your attention!
Questions?