Body weight control and tobacco smoking among adolescents: A prospective study

Background: Views are controversial about the relationship between smoking and adolescents' weight control beliefs. This study aimed to assess the impact of these beliefs on smoking decisions among adolescents. Methods: Baseline and follow-up data were collected by self-administered questionnaires in Hungary's six metropolitan cities in 2010 and 2011. Randomly selected 6th and 9th grade students (N=1,389, 54.6% girls) participated. Body Mass Index (BMI) values were based on objective measurements. Short forms of the Appetite-Weight Control Scale and Smoking Consequence Questionnaire were used to measure weight control perceptions. Contour Drawing Rating Scale and Body and Appearance Satisfaction Scale measured the participants' body image. Logistic regression was used to test associations. Results: At baseline, belief that tobacco decreases weight significantly predicted smoking in both genders, controlling for school grade, parental and peer smoking. Boys who desired more robust bodies (beyond their objectively measured body size) were also more likely to smoke. After a year, weight control beliefs remained significantly associated with smoking, but only among girls. At follow up, 11.2% of participants became new smokers. Girls' dissatisfaction with body image was significantly associated with starting smoking, but self-assessment of body image among boys was unrelated to smoking at follow-up. Conclusions: Beliefs that smoking curbs appetite plays a role in starting and maintaining adolescent tobacco use, particularly among girls. Dispelling this belief while stressing healthy methods of weight management in light increasing prevalence of obesity in Hungary must be a key element of tobacco prevention programs for adolescents.