Is overweight perception a risk factor for youth smoking?

Objectives: This study aims to (1) determine the causal effect of overweight perception on youth smoking; and (2) test whether sex and weight loss effort may play a mediating role.

Methods: We analyze data from 2005-2009 Youth Risk Behavior Survey of nationally-representative 9–12 graders in the U.S. Outcomes include dichotomous indicators for current smoking and frequent current smoking. Body weight perception variables include dichotomous very overweight, slightly overweight, and normal weight perception. To obtain the causal effect of perceived weight on smoking, we estimate a survey-weighted bivariate probit model in which actual body weight influences smoking through weight perception. We also estimate the model on subgroups stratified by sex and weight loss effort.

Results: As compared to those with normal-weight perception, adolescents with very-overweight perception are more likely to be a current smoker and frequent smoker by 4 percentage points and 3 percentage points, respectively (p > 0.01). Adolescents with a slightly overweight perception are more likely than those with normal weight perception to be current smokers and frequent smokers by 8.4 percentage points and 2.7 percentage points, respectively (p > 0.01). Overweight perception is significantly associated with increased current and frequent smoking among female students (p > 0.01), especially those who try to lose weight (p > 0.01).

Conclusions: The perception of being overweight has a significant impact on smoking behavior among adolescents. Strategies to combat youth smoking may become more effective when the positive relationship between overweight perception and smoking is considered in identifying at-risk adolescents.