BMI and Smoking: Interrelated Factors among Cessation Website Users Jennifer Schindler-Ruwisch, MPH; Erik Augustson, PhD, MPH; Krystal Lynch, PhD, MPH; Heather Patrick, PhD Objective: To investigate the relationship between body mass index (BMI) and smoking. Methods: Participants (N = 2243) provided demographic, height, weight, smoking information through a survey conducted on smokefree.gov and women.smokefree.gov websites. Analysis assessed associations among BMI, smoking status, and cigarettes smoked per day (CPD). Results: The average (SD) BMI of never, former, intermittent, and daily smokers was 26.3 (6.2), 27.9 (6.5), 27.4 (6.7) and 28.1 (6.8) respectively. Daily

T

obacco smoking and obesity are 2 of the top contributors to death and morbidity. The second leading cause of preventable death worldwide in 2010 was tobacco smoking (including exposure to secondhand smoke), followed by high body mass index (BMI), which ranked sixth.1 In the United States (US), tobacco smoking is the leading cause of preventable death, responsible for 480,000 deaths annually.2 Likewise, high BMI is responsible for approximately 18% of US deaths per year.3 There is evidence that there is a relationship between tobacco use and BMI and that the nature of this relationship may be changing over time. Understanding the relationship between these 2 leading causes of preventable death is vital to promoting health and well-being. Data collected during the 1980s and 1990s largely supported the idea that smokers generally weighed less than nonsmokers.4,5 In 1976–1980, a national study of 12,103 men and women showed that non-smokers had an average BMI of 25.7 kg/

Jennifer Schindler-Ruwisch, BLH Technologies, Inc., Rockville, MD. Erik Augustson, Program Director, Tobacco Control Research Branch, Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Rockville, MD. Krystal Lynch, Public Health Data Analyst, BLH Technologies, Inc., Rockville, MD. Heather Patrick, Senior Director of Product Development, LiveHealthier, Inc., Bethesda, MD. Correspondence Dr Augustson; [email protected] or [email protected]

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(31.2%) and former (32.3%) were more likely to be to be obese compared to never (22.0%) and intermittent (26.1%) smokers. Odds of being obese increased with number of CPD adjusting for potential confounders. Conclusions: Smokers may currently have BMIs similar to the general population. BMI and CPD were positively correlated. Key words: body mass index; obesity; cigarette smoking Am J Health Behav. 2015;39(3):330-337 DOI: http://dx.doi.org/10.5993/AJHB.39.3.5

m2, whereas the average BMI of current smokers was lower at 24.6 kg/m2.5 In addition to weight differences between smokers and nonsmokers, as recent as the 2010 Surgeon General’s Report, nicotine in the body was associated with weight loss.6,7 Research also has shown smoking cessation was related to weight gain during the first year of cessation.8,9 In the 1990 Surgeon General’s Report, approximately 80% of smokers reported gaining an average of 5 pounds after quitting smoking8 and by the 2001 Surgeon General’s Report, the average weight gain reported for women who quit smoking in the last year ranged from 6 to12 pounds.9 To complicate the observed relationships between obesity and smoking further, overall obesity rates have been increasing in the general public. In 2009–2010, 33% of US adults had BMIs in the overweight range, 35.7% were in the obese range, and 6.4% were classified as extremely obese. The recent dramatic rise in obesity rates appeared to plateau for both men and women in 2009–2010.10,11 In the context of this increased overall obesity prevalence, the relationship between BMI and smoking may not be the same as previously observed. Studies have illustrated changes in the traditional cross-sectional relationship between BMI and smoking. In 2008, current smokers utilizing cessation quitlines had weight profiles similar to weight distributions seen in the general population—33.3% were obese, 30.2% overweight, 33.3% normal weight, and 3.2% underweight.12 Other studies have yielded additional evidence that con-

Schindler-Ruwisch et al tradicts the previously understood relationship between smoking cessation and weight gain. According to a meta-analysis of 62 studies by Aubin et al13 whereas most quitters gained an average of 9–11 pounds in the course of a year (mostly within the first 3 months after quitting), there was evidence that a sizeable proportion of quitters lost weight. In fact, they found that one year after quitting, up to one-fifth of individuals studied (16%–21%) experienced weight loss, rather than weight gain. A longitudinal study by Kim et al14 of 4542 men highlights the health implications and complexities between smoking and BMI. In this 3-year follow-up study, smoking status significantly influenced the odds of developing metabolic syndrome (defined as the presence of at least 3 risk factors, including high BMI, that contribute to heart disease, stroke, and other related health problems), especially among former smokers who were more likely than sustained smokers to develop metabolic syndrome.14 However, when weight change was accounted for in the analyses, smoking cessation was no longer a significant risk factor for metabolic syndrome, demonstrating that weight, rather than the absence of smoking was responsible for the relationship. Among current smokers, the frequency of smoking (both number of daily cigarettes and years of smoking) was positively related to risks of developing metabolic syndrome, compared to nonsmokers’ risk of developing metabolic syndrome without these risk factors.14 Research by Wada, Urashima, and Fukumoto15 further illustrated the complexity of the relationship among smoking status, smoking frequency, BMI, and resultant health risks. They found that the risk of metabolic syndrome increased with number of cigarettes smoked. Both current and former smokers had higher risks for metabolic syndrome than those who had never smoked (OR= 1.20 and 1.21, respectively).15 Wada et al15 suggested that the reason the risk for metabolic syndrome increased upon quitting may be because many smokers gain weight during periods of cessation. These results may be related to similar results from the recent Surgeon General’s Report documenting a causal link between smoking and diabetes.2 However, because metabolic syndrome is a confluence of a variety of health conditions, teasing out the influence of cigarette smoking on weight gain compared to metabolic syndrome and other related conditions (such as diabetes) is essential. Given the increases in changes in BMI that have occurred nationally, more research is needed to understand the relationship among BMI, smoking status, and smoking frequency. The purpose of this study was to improve understanding of the present day relationship between BMI and smoking in a treatment-seeking sample.

free.gov, and its sister site for women, women. smokefree.gov, are public websites and part of a larger mobile health initiative designed by the National Cancer Institute to provide online smoking cessation resources. All visitors to the smokefree. gov or women.smokefree.gov website homepages were prompted to respond to a brief survey during 2 phases of data collection, December 2012 through May 2013 and July 2013 through January 2014. The survey collected descriptive and smoking-related characteristics including age, sex, race, level of education, smoking status (daily, intermittent [some days], former, never), average daily cigarette consumption, quit history, height, weight, and reasons for accessing the site. Sample Data were collected from 2855 respondents; 1504 from smokefree.gov and 1351 from women. smokefree.gov. A total of 579 respondents were excluded (19.9% of the sample) for the following reasons: age (under 18), duplicate response (same response and time stamp), incomplete responses (473 cases), and BMI values more than 3 standard deviations from the mean (less than or equal to 15 or over 60). An additional 33 respondents were excluded due to missing smoking status information. A total of 2243 participants were included in this analysis.

METHODS This study utilizes data collected from users of 2 online smoking cessation interventions. Smoke-

Analysis Self-reported height and weight were used to calculate BMI [(mass[kg]/(height[m])2)]. BMI was grouped according to the National Heart, Lung and Blood Institute classifications for underweight (30).16 Data were analyzed with underweight (N = 52) and healthy weight combined and separated. Participants also were categorized according to their smoking status. “Ever smoker” was defined as those who had smoked at least 100 cigarettes in their lifetime. Those who did not smoke at least 100 cigarettes in their lifetime were considered “never smokers” and were excluded from subsequent analyses on smoking characteristics. Participants who identified as “ever smokers” were asked: “Do you now smoke cigarettes every day, some days, or not at all?” “Current smokers” consisted of daily and intermittent smokers. Intermittent smoker was defined as those that smoked some days, but not daily. Frequencies for all descriptive variables were calculated for the entire sample. Bivariate associations were calculated to assess the relationship among the descriptive variables, average BMI, current smoking status, and average CPD for current smokers. BMI distributions were viewed for the entire sample and for women and men separately to assess for potential differences in the distributions by sex. Chi-square analyses and Fisher’s exact tests were conducted to assess the relationship between smoking status (classified as daily, inter-

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Table 1 Demographic Characteristics of All Respondents by Average Body Mass Index (BMI), Current Smoking Status, and Average Cigarettes Smoked Per Day (CPD) Sample Sizea (N, %)

Average BMI (M, SD)b

Current Smokers (N, %)

Average CPD (M, SD)c

2243

27.9 (6.7)

1732 (77.2%)

16.0 (9.0)

Men

513 (22.9)

27.5 (6.0)

397 (77.4)

16.7 (9.6)

Women

1702 (75.9)

28.0 (6.9)

1315 (77.3)

15.8 (8.9)

28 (1.2)

27.4 (6.0)

20 (71.4)

15.8 (6.4)

  Total Sex

Unknown Hispanic Ethnicity Hispanic

140 (6.2)

28.6 (6.7)

109 (77.9)

13.3 (8.4)

2051 (91.4)

27.8 (6.7)

1586 (77.3)

16.3 (9.1)

52 (2.3)

27.1 (6.3)

37 (71.2)

13.3 (7.8)

White

1769 (78.9)

27.7 (6.6)

1352 (76.4)

17.2 (9.1)

Black

252 (11.2)

30.2 (7.3)

207 (82.1)

11.3 (7.2)

Non-Hispanic Unknown Race

Native American

82 (3.7)

27.7 (6.7)

65 (79.3)

13.7 (8.0)

Asian American

83 (3.7)

25.2 (4.9)

64 (77.1)

10.7 (7.4)

Unknown

57 (2.5)

28.0 (6.5)

44 (77.2)

12.6 (8.3)

< HS grad

160 (7.1)

28.6 (7.0)

140 (87.5)

18.1 (9.7)

HS grad, GED

462 (20.6)

27.6 (6.4)

395 (85.5)

17.3 (9.0)

HS +, < Bachelor degree

1016 (45.3)

28.6 (7.1)

815 (80.2)

15.9 (8.9)

Bachelor degree or greater

595 (26.5)

26.6 (5.8)

378 (63.5)

14.4 (8.8)

10 (0.4)

28.0 (9.7)

4 (40.0)

8.0 (5.7)

≤ 30

469 (20.9)

26.8 (6.9)

360 (76.8)

12.7 (7.7)

31-40

455 (20.3)

28.3 (7.1)

356 (78.2)

15.2 (8.5)

41-50

539 (24.0)

28.6 (6.9)

431 (80.0)

17.5 (8.7)

51+

718 (32.0)

27.8 (5.9)

539 (75.1)

17.6 (9.7)

62 (2.8)

27.6 (7.9)

46 (74.2)

16.4 (10.2)

Education

Unknown Age

Unknown

Note. a = Number of participants included those who responded yes or no to the question “Have you ever smoked more than 100 cigarettes…” (N = 2243). b = Average BMI is among all participants (N = 2243). c = Average CPD based on 1703 respondents.

mittent [some days], former, and never smokers) and BMI categories (underweight/healthy weight, overweight, obese) for the entire sample, and stratified by sex. Pearson’s Correlation and Analysis of Variance (ANOVA) tests were conducted to evaluate

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the differences in CPD (as a continuous and also as a categorical variable with the following categories: ≤10, 11-20, and >21 cigarettes) and BMI as a continuous variable. To control for potential confounding factors associated with BMI, a multi-

Schindler-Ruwisch et al

Table 2 Body Mass Index and Smoking Status for the Entire Samplea, and Stratified by Sex  

Number

Average BMI

Underweight/ Healthy

Overweight

Obese

 

Smoking Statusb

2158

27.9 (6.7)

843 (39.1)

658 (30.5)

657 (30.4)

χ2 (6) = 25.2, p < .001

Never

141 (6.5)

26.3 (6.2)

81 (57.4)

29 (20.6)

31 (22.0)

Former

285 (13.2)

27.9 (6.5)

112 (39.3)

81 (28.4)

92 (32.3)

Intermittent

138 (6.2)

27.4 (6.7)

60 (43.5)

42 (30.4)

36 (26.1)

Daily

1594 (73.9)

28.1 (6.8)

590 (37.0)

506 (31.7)

498 (31.2)

513

27.5 (6.0)

175 (35.9)

188 (38.5)

85 (23.4)

Never

37 (7.2)

26.4 (5.8)

20 (54.1)

9 (24.3)

8 (21.6)

Former

54 (10.5)

29.1 (5.6)

12 (22.2)

17 (31.5)

25 (46.3)

Intermittent

33 (6.4)

27.3 (5.7)

12 (36.4)

14 (42.4)

7 (21.2)

Daily

364 (71.0)

27.4 (3.1)

131 (36.0)

148 (40.7)

85 (23.4)

1702

28.0 (6.9)

657 (40.0)

464 (28.2)

523 (31.8)

Never

102 (6.0)

26.2 (6.3)

60 (58.8)

19 (18.6)

23 (22.5)

Former

227 (13.3)

27.6 (6.6)

98 (43.2)

64 (28.2)

65 (28.6)

Intermittent

105 (6.2)

27.5 (7.0)

48 (45.7)

28 (26.7)

29 (27.6)

Daily

1210 (71.1)

28.3 (7.0)

451 (37.3)

353 (29.2)

406 (33.6)

Men (total)

Women (total)

χ2 (6) = 19.6, p = .003

χ2 (6) = 21.7, p = .001

Note. a = Total sample with available current smoking status = 2158 of 2243 respondents. b = Includes participants with unspecified sex (N = 28).

nomial logistic regression analysis was conducted among current smokers to evaluate the relationship between BMI and smoking intensity controlling for age, sex, education, race, and Hispanic ethnicity. All data were analyzed using the Statistical Package for Social Sciences (SPSS) version 22. RESULTS There were a total of 2243 participants included in this analysis. Table 1 provides an overview of the participant demographics. Ages of respondents ranged from 18 to 80 with a mean age of 43.3 (SD = 13.1, N = 2181). Approximately one-fourth of the sample consisted of men (22.9%) and the remainder of the sample were women (75.9%). More than three-fourths of respondents identified as white (78.9%, N = 1769). Additionally, 6.1% of the full sample identified as Hispanic or Latino, 11.9% as black or mixed race, 4.0% as Asian, and 3.7% as Native American or Pacific Islander. The majority of the sample (93.7%) had smoked at least 100 cigarettes in their lifetime. Of these respondents, 285 (13.2 %) were former smokers. There were 1732 (77.2) current smokers, and of the current smokers, 92% (N = 1594) were daily smokers, smoking from 1 to 60 cigarettes per day

(mean= 16.9, SD = 8.7, data not shown). Eight percent (N = 138) were intermittent smokers, smoking up to 50 cigarettes per day on the days when they smoked (mean = 6.3, SD = 6.4). Table 1 also illustrates current smoking status and average CPD by demographic characteristics. Similar current smoking rates were observed between Hispanic and non-Hispanics and between men and women. However, significant differences in prevalence were observed by education. Respondents with the highest educational attainment were less likely to be current smokers than all other education categories, 63.5% compared to 87.5% (those who had not completed high school), 85.5% (those with a high school or equivalent), and 80.2% (those with some college or associate’s degree). Most smoking respondents (88.3%) had tried to quit at some point in their lives. Most (83.4%) had visited smokefree.gov to get information to help them quit; 6.4% visited the site to get information for someone else; 5.6% visited out of general interest, and 4.5% for other reasons (data not shown). Table 2 illustrates BMI by smoking status (total sample, daily, intermittent, former, and never smokers). The results illustrated that BMI category was significantly associated with smoking status.

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BMI and Smoking: Interrelated Factors among Cessation Website Users

Table 3 Odds of Overweight or Obese BMI among Current Smokersa  

Overweight

 

Obese

OR

CI

p

OR

CI

p

Men

1.53

1.16, 2.02

.003

0.74

0.54, 1.01

.06

Women

1.00

1.00

< 12 grade

1.00

1.00

HS Grad/GED

0.75

0.46, 1.21

.24

0.61

0.37, 0.99

.05

Some college/Assoc.

0.76

0.48, 1.20

.24

0.92

0.58, 1.44

.71

Bachelor’s degree or higher

0.77

0.47, 1.25

.28

0.60

0.37, 0.99

.05

Sex

Education

Race White

1.00

Black

2.17

1.45, 3.24

< .001

1.00 2.84

1.90, 4.23

< .001

Native American

0.82

0.45, 1.50

.51

0.80

0.43, 1.50

.49

Asian American

0.92

0.50, 1.70

.78

0.72

0.33, 1.56

.40

Yes

1.54

0.90, 2.65

.12

0.74

0.54, 1.01

.12

No

1.00

1.00

≤ 10

1.00

1.00

11-20

1.21

0.92, 1.58

.17

1.35

1.03, 1.79

.03

21-40

1.17

0.81, 1.69

.42

1.65

1.14, 2.37

.008

41-60

3.38

0.34, 33.20

.30

15.35

1.85, 127.7

.01

Hispanic Ethnicity

Cigarettes per day

Age and ≤ 25; > 25 and ≤ 30; > 30 Kg/m2

Participants who were daily smokers and former smokers had the highest frequencies of overweight and obesity (combined 62.9% for daily smokers, and 60.7% for former smokers respectively) compared to other smoking categories. The highest prevalence of underweight/healthy BMI was seen for never smokers (57.4%) and intermittent smok-

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ers (43.5%), with the highest obesity rates occurring in daily (31.2%) and former smokers (32.3%, χ2 (6) = 25.2, p < .001). Stratifying by sex illustrated notable differences in BMI by smoking status between men and women. Whereas the number of men who are former smokers is low (N = 54, 10.5%), they were significantly more likely to be

Schindler-Ruwisch et al obese than never, intermittent, or daily smokers (χ2 (6) = 19.6, p = .003). Like the overall sample, greater prevalence of underweight/normal weight was observed for never smokers, compared to intermittent and daily smokers. However, BMI results were similar between men who identified as intermittent and daily smokers. Among women, who made up the majority of the sample, greater prevalence of obesity was observed among daily smokers compared to all other smoking status categories (χ2 (6) = 21.7, p = .001). The higher obesity rates for former smokers compared to other smoking status categories were not observed among women. Among current smokers (N = 1732), BMI as a continuous variable was positively correlated to CPD (Pearson r = 0.084, p < .001) for the entire sample; when stratifying by sex (women, Pearson r = .082, p = .003; men, Pearson r = 0.103, p = .033). Bivariate comparisons of CPD by BMI categories also yielded significant, yet slightly different results, and further illustrated the association between CPD and BMI. Women who were obese smoked significantly more CPD on average (mean = 17.0 cigarettes) than normal weight smokers (mean = 15.0 cigarettes; 1-way ANOVA F2,1289 = 6.17, p = .002). CPD was not significantly related to BMI as a categorical variable among men. The relationship between the average number of cigarettes smoked daily and overweight and obesity was assessed using a multinomial logistic regression including sex, Hispanic ethnicity, education, race, and CPD in the final model. This model indicated the odds of being overweight or obese compared to underweight and healthy weight among current smokers in the sample (Table 3). Men were 1.53 times more likely to be overweight (95% CI, 1.16–2.01) but 26% less likely to be obese compared to women (OR = 0.74, 95% CI 0.54–1.01), holding all other covariates and cigarette smoking intensity constant. Furthermore, current smokers who completed high school or its equivalent, and those who completed a bachelor’s degree or higher were approximately 30% less likely to be obese compared to those with less than a 12th grade education, and those who completed high school (OR = 0.61, 95% CI 0.37–0.99) and a bachelor’s degree or more (OR = 0.60, 95% CI 0.37–0.99). Respondents who identified as black were 2.17 times more likely to be overweight (95% CI 1.45– 3.24) and 2.84 times more likely to be obese (95% CI 1.90–4.23) than those who identified as white. Increased odds of overweight and obesity with age were also observed. In terms of cigarette consumption frequency, the odds of obesity increased significantly as the number of cigarettes consumed increased. Those who smoked 21–40 CPD were 1.65 more likely to be obese compared to those who smoked ≤10 CPD (95% CI 1.14–2.37). Odds of obesity increased even further with greater cigarette consumption, although the estimates were less precise due to the small sample size within that category. However,

results show that increased cigarette consumption was related to increased odds of obesity, controlling for other demographic covariates. Odds of overweight were not significantly related to CPD when adjusting for sex, education, race, Hispanic ethnicity, and age. The relationship between the average number of cigarettes smoked daily and obesity was assessed among daily smokers as well, with statistically significant results similar to those seen among current smokers (data not shown).

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DISCUSSION The current study, along with a growing body of literature, suggests the relationship between smoking frequency and BMI may be changing in the context of the escalated obesity prevalence in the general population. This study revealed that the average BMI among ever smokers seeking online smoking cessation resources through smokefree.gov and women.smokefree.gov was 27.96 kg/ m2, resembling the mean BMI in the US, which was 28.7 kg/m2 in 2009-2010.11 Among current smokers, bivariate analyses revealed that a variety of factors were significantly related to BMI category, including sex, education, and race. However, even when holding all these demographic variables constant, cigarette smoking frequency was still significantly related to BMI, such that obese smokers in this sample smoked significantly more cigarettes daily than smokers with BMI scores ≤ 25.0. Although further study is required to understand these findings better, this co-occurrence of high cigarette consumption and high BMI may increase the multi-morbid risk factors of smoking and obesity further.14,15,17 Regardless of biological and social mechanisms, weight gain post-cessation is still a concern for smokers. In this study, former smokers were more likely to be obese compared to never smokers and intermittent smokers. This differential was more pronounced among men, but was also present among women. However, our sample of former smokers was small, so the results should be interpreted cautiously. A study of obese callers to quitlines found they were more likely than normal weight or overweight smokers to fear weight gain during cessation.18 Despite the fact that weight profiles of smokers may be more similar to the general population than previously understood, this fear of weight gain represents a potential obstacle to sustaining quit attempts. Further elucidating the relationship between BMI and cigarette consumption could help those interested in cessation understand how best to manage their weight. One possible explanation for the relationship between smoking and obesity seen in this study is that addictive patterns associated with smoking also may affect eating behaviors. In a study of cessation therapy, Komiyama et al19 found that weight gain 3 months after quitting was greatest among those who had the most intense nicotine addiction (indicated by their scores on the Fagerstrom

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BMI and Smoking: Interrelated Factors among Cessation Website Users Test for Nicotine Dependence). The implication of this finding, consistent with ones from the current study, is that there is a complex interrelationship between smoking status and BMI, and that nicotine may play a role in this relationship. Whereas we did control for a variety of demographic variables (sex, education, race) in our analysis, there are other potentially pertinent demographic variables not included in this study— such as socioeconomic status—that may affect the relationship between BMI and smoking. It is also possible that another variable, such as physical activity, may be responsible for the association between smoking and BMI, but such indicators were not collected in the current study. Kaufman et al’ findings suggest that levels of physical activity and sedentary behavior among current and former smokers may play a key role in BMI.20 Because continuing to engage in sedentary behavior while quitting may increase the likelihood that smokers will gain weight after they stop smoking, physical activity may be another potential intervention avenue to minimize risks of weight gain post-cessation. Further study of the relationship of physical activity, BMI, and smoking status may help treatment-seeking smokers better understand how to control weight while smoking and during quit attempts. There are several limitations to this study. The findings are based on BMIs calculated from selfreported height and weight data. People are likely to underestimate their weight,21 in which case these results would be conservative estimates of a possibly more significant trend. Additionally, these data are based on visitors to smokefree.gov, who are likely interested and motivated to quit as well as Internet savvy and able to seek out health information online, which may not be representative of the general population. However, although those who chose to respond to the survey may differ from those who did not respond, it is unlikely that any systematic bias was present regarding obesity or weight status of respondents. This study illustrated significant relationships between CPD and obesity for women and for men. However the relationship was different in that women who were daily smokers were more likely to be obese and men who were daily smokers were more likely to be overweight but not obese, although the sample size of men in this study was much smaller. Results from a similar study conducted in Germany among men who were former smokers also illustrated a positive relationship between CPD and overweight and obesity.22 The same study illustrated a negative relationship between CPD and odds of overweight and odds of obesity among men who were current smokers who smoked 10–19 or 20 CPD. Additionally, women who smoked 20 CPD were less likely to be overweight than healthy weight but results were not significant for odds of being obese.22 Data in this study were cross-sectional and do not

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illustrate causality. Future studies should incorporate longitudinal data to identify BMI and smoking patterns over time to improve understanding of this relationship. To inform interventions better, additional studies analyzing the effects of various cessation methods on BMI over time and other health risk factors are needed. These preliminary analyses suggest that smokers seeking online cessation information have BMIs similar to the general population and that BMI and CPD are positively correlated. Understanding weight patterns in the smoking population is critical to the development of synergistic smoking cessation and weight-related interventions, especially within the context of the obesity epidemic in the US. Human Subjects Statement This study was exempt from Institutional Review Board approval. This study has been approved by the US Federal Office of Management and Budget, Office of Information and Regulatory Affairs, approval #0925-0642-12. Conflict of Interest Statement None of the authors have conflicts of interest relevant to this study. Acknowledgments This project has been funded in part with Federal funds from the National Cancer Institute, National Institutes of Health, US Department of Health and Human Services; this analysis was funded partially under Contract No. HHSN261201000043C. Disclaimer The views and opinions expressed in this paper are those of the authors only and do not necessarily represent the views, official policy, or position of the US Department of Health and Human Services or any of its affiliated institutions or agencies. References

 1. Lim SS, Vos T, Flaxman AD, et al. A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012;380(9859):2224– 2260.  2. US Department of Health and Human Services. The Health Consequences of Smoking—50 Years of Progress. A Report of the Surgeon General. Atlanta, GA: US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health; 2014. Available at: http:// www.surgeongeneral.gov/library/reports/50-years-ofprogress/full-report.pdf. Accessed March 13, 2014.  3. Masters RK, Reither EN, Powers DA, et al. The impact of obesity on US mortality levels: the importance of age and cohort factors in population estimates. Am J Public Health. 2013;103(10):1895–1901. doi: 10.2105/ AJPH.2013.301379.  4. Klesges RC, Meyers AW, Klesges LM, La Vasque ME. Smoking, body weight, and their effects on smoking behavior: a comprehensive review of the literature. Psychol

Schindler-Ruwisch et al Bull. 1989;106(2):204–230.  5. Albanes D, Jones DY, Micozzi MS, Mattson ME. Associations between smoking and body weight in the US population: analysis of NHANES II. Am J Public Health. 1987;77(4):439–444. doi: 10.2105/AJPH.77.4.439.  6. US Department of Health and Human Services. How Tobacco Smoke Causes Disease: The Biology and Behavioral Basis for Smoking-Attributable Disease. A Report of the Surgeon General. Atlanta, GA: US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health; 2010. Available at: http://www.ncbi.nlm.nih. gov/books/NBK53017/. Accessed June 24, 2014.  7. Chen H, Vlahos R, Bozinovski S, et al. Effect of shortterm cigarette smoke exposure on body weight, appetite and brain neuropeptide Y in mice. Neuropsychopharmacology. 2005;30:713–719.  8. US Department of Health and Human Services. The Health Benefits of Smoking Cessation. A Report of the Surgeon General. Atlanta, GA: US Department of Health and Human Services, Public Health Service, Centers for Disease Control, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health; 1990. DHHS Publication No. (CDC) 908416. Available at: http://profiles.nlm.nih.gov/ps/access/NNBBCT.pdf. Accessed June 24, 2014.  9. US Department of Health and Human Services. Women and Smoking. A Report of the Surgeon General. Atlanta, GA: US Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health; 2001. Available at: http://www.ncbi.nlm.nih. gov/books/NBK44303/. Accessed June 24, 2014. 10. Fryar CD, Carroll MD, Ogden CL. Prevalence of overweight, obesity, and extreme obesity among adults: United States: trends 1960–1962 through 2009–2010. NCHS Health E-Stat. 2012. Available at: http://www. cdc.gov/nchs/data/hestat/obesity_adult_09_10/obesity_adult_09_10.htm. Accessed October 3, 2013. 11. Flegal KM, Carroll MD, Kit BK, Ogden CL. Prevalence of obesity and trends in the distribution of body mass index among US adults, 1999–2010. JAMA. 2012;307(5):491– 497.

12. Bush T, Levine MD, Deprey M, et al. Prevalence of weight concerns and obesity among smokers calling a quitline. J Smok Cessat. 2008;4(5):74–78. 13. Aubin H, Farley A, Lycett D, et al. Weight gain in smokers after quitting cigarettes: meta-analysis. BMJ. 2012;345:e4439. Available at: http://www.bmj.com/ content/345/bmj.e4439.long. Accessed October 7, 2013. 14. Kim BJ, Kim BS, Sung KC, et al. Association of smoking status, weight change, and incident metabolic syndrome in men: a 3-year follow-up study. Diabetes Care. 2009;32:1314–1316. 15. Wada T, Urashima M, Fukumoto T. Risk of metabolic syndrome persists twenty years after the cessation of smoking. Intern Med. 2007;46:1079–1082. 16. National Institutes of Health, National Heart, Lung, and Blood Institute. Classification of Overweight and Obesity by BMI, Waist Circumference, and Associated Disease Risks, 2014. Available at: http://www.nhlbi.nih.gov/ health/public/heart/obesity/lose_wt/bmi_dis.htm. December 4, 2014. 17. Ford ES, Bergmann MM, Boeing H, et al. Healthy lifestyle behaviors and all-cause mortality among adults in the United States. Prev Med. 2012;55:23–27. 18. Levine MD, Bush T, Magnusson B, et al. Smoking-related weight concerns and obesity: differences among normal weight, overweight, and obese smokers using a telephone tobacco quitline. Nicotine Tob Res. 2012;15(6):1136– 1140. 19. Komiyama M, Hiromichi W, Ura S, et al. Analysis of factors that determine weight gain during smoking cessation therapy. PLOS ONE. 2013;8(8):e72010:1–6. 20. Kaufman A, Augustson EM, Patrick H. Unraveling the relationship between smoking and weight: the role of sedentary behavior. J Obes. 2012;1–11. Available at: http:// www.hindawi.com/journals/jobe/2012/735465/. Accessed December 1, 2013. 21. Gorber SC, Tremblay MS. The bias in self-reported obesity from 1976 to 2005: a Canada-US comparison. Obesity (Silver Spring). 2010;18(2):354–361. doi: 10.1038/ oby.2009.206. 22. John U, Hanke M, Rumpf H-J, Thyrian JR. Smoking status, cigarettes per day, and their relationship to overweight and obesity among former and current smokers in a national adult general population sample. Intl J Obesity. 2005;29:1289–1294.

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BMI and smoking: interrelated factors among cessation website users.

To investigate the relationship between body mass index (BMI) and smoking...
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