Trends in the association of smoking with body weight among US high school students, 1999 - 2005

Background: Contradictory or inconclusive findings are noted in the literature as to the association between smoking and body weight among adolescents. Objectives: To investigate the association of current smoking with body mass index (BMI) and perceived body weight among high school students in the United States. Methods: We analyzed the data from the 1999-2005 National Youth Risk Behavior Survey (YRBS), a school-based survey that employed a 3-stage cluster sample design to produce a nationally representative sample of public and private high school students in the United States. Data were analyzed using STATA version 10.0. Weights generated by the CDC were used to correct for different probabilities of sample selection. Adjusted odds ratios (ORs), controlling for gender, grade, race, and vigorous and moderate physical activity, were calculated to test the association. Results: Perceived body weight and BMI were associated with adolescents' current smoking. Adjusted odds ratios of current smoking for overweight and at-risk-of-overweight BMI groups continued to increase over the entire survey years for both boys and girls. The more recent the cohort, the stronger the link of current smoking with BMI and perceived body weight. Conclusions: The relationship between body weight and current smoking strengthened over time. Smoking prevention and cessation efforts among adolescents should incorporate messages against the perceived benefit of smoking on weight maintenance.