Table 2.2Studies assessing belief that smoking controls body weight

508-Compliant Version

StudyDesign/populationMeasuresPercentage endorsingFindingsComments
Shor et al. 1981307 undergraduates
Age NR
Cross-sectional questionnaire on benefits of smoking
“Smoking helps smokers avoid weight gains”
“Smoking helps smokers control the quantity of food they eat”
5-point scale: “strongly agree” to “strongly disagree”
Smokers = 59%
Never smokers = 53%
Smokers = 49%*
Never smokers = 41%*
*Agreed or strongly agreed
  • 19.9% classified as current smokers
  • 45.9% classified as never smokers
  • Remaining 34.2% (former smokers) excluded from analysis
Strengths: bipolar response scale with 0 as neutral point; respondents included both current smokers and never smokers
Loken 1982178 female undergraduates
Age NR
Cross-sectional questionnaire about cigarette smoking
“My smoking cigarettes keeps (would keep) my weight down”
Agreement and outcome evaluation (based on good-bad affective scale) measured using 7-point bipolar scales from −3 to +3
NR
  • Strength of belief greater among heavy smokers than among light smokers or nonsmokers
  • Outcome evaluation regarding value of keeping one’s weight down did not differ by smoking status
Strengths: female population is of interest to antismoking organizations; focus on both positive and negative consequences of smoking; findings are in line with other research

Weaknesses: unable to compare findings by gender
Charlton 198415,175 students
Age NR (range 9–19 years)
Random sample stratified by age group and school type
Cross-sectional questionnaire
United Kingdom
“Smoking keeps your weight down” (yes, no, don’t know)Girls: Total = 24%
Never smokers = 17.4%
Experimenters = 23.4%
Current smokers = 40.0%
Former smokers = 26.8%
Boys: Total = 22%
Never smokers = 15.9%
Experimenters = 21.7%
Current smokers = 33.9%
Former smokers = 27.8%
  • Current smokers consuming ≥6 cigarettes/week most likely to endorse
  • Under age 12, current smokers least likely to agree smoking controls weight; after age 12, current smokers most likely to agree
NR
Brandon and Baker 1991547 undergraduates
Mean 18.7 years of age (SD = 2.8; range 16–47 years)
Cross-sectional questionnaire on smoking consequences
Smoking Consequences
Questionnaire (SCQ): a multidimensional measure of the subjective expected utility (SEU) of smoking
5-item factor assesses expected effects of smoking on appetite and weight control
Sample items: “Smoking helps me control my weight,” “Smoking controls my appetite”
Desirability of each consequence rated −5 to +5 and perceived probability rated 0 to 9
Cross-product of both ratings used to arrive at SEU
NR
  • Daily smokers rated expected utility of smoking for weight control higher than did occasional smokers and never smokers
  • Daily smokers rated likelihood that smoking would control weight/appetite higher than did occasional smokers
  • Among former smokers, females gave higher ratings than did males on likelihood of smoking affecting weight control
Strengths: high internal consistency reliability of scales; target sample is at transitional stage of smoking so scale may be useful in predicting eventual smoking status

Weaknesses: results cannot be generalized to adult population because of low smoking prevalence among sample
Camp et al. 1993659 high school students
Mean 16.3 years of age
Cross-sectional questionnaire
“Smoking cigarettes can help you control your weight/appetite”Total = 40.2%
Smokers = 67%
Never smokers = 36%
Black boys = 13.5%
Black girls = 10.0%
White boys = 29.9%
White girls = 45.7%
  • Smokers were more likely to endorse than were never smokers
  • Belief that smoking helps control weight/appetite differed as a function of race and gender
Strengths: addresses several gaps in literature; racially diverse sample; use of variables supported by research; uses conservative statistical tests

Weaknesses: cannot infer causality; results may not generalize to other areas or to nonparochial subjects; did not use bogus pipeline or biochemical methods
Li et al. 1994585 Asian female airline cabin crew members
Age NR (range 20–41 years; 87% <30)
Cross-sectional questionnaire
Participants questioned regarding beliefs about various health risks of smoking, including that it will “help control body weight”Total = 37%
Never smokers = 34%
Former smokers = 29%
Current smokers = 48%
  • Endorsement among current smokers greater than among never smokers and former smokers
Weaknesses: underreporting of smoking due to uncertainty of employer’s views; inconsistent interpretation of various terms by subjects (i.e., “fit”)
West and Hargreaves 1995146 student nurses (80% female)
Mean of age 24 years (SD = 5.42)
Cross-sectional questionnaire
United Kingdom
Participants completed questions regarding the perceived positive and negative effects of smoking including that “Smoking helps with weight control”
5-point scale: “strongly disagree” to “strongly agree”
Smokers = 38%
Former smokers = 26%
Never smokers = 11%
  • Current smokers more likely to endorse belief that smoking helps control weight
  • Belief in weight-controlling effects of smoking not related to desire to quit
Weaknesses: limited generalizability; small sample size; possible underreporting of smoking
Klesges et al. 1997a6,961 7th-grade students in Memphis public schools
13 years of age
Cross-sectional questionnaire as part of Memphis Health Project
Tennessee
Item asked whether participants endorsed belief that smoking cigarettes helps people control their weightTotal = 39.4%
  • Endorsement increased with smoking exposure (daily smokers > regular [nondaily] smokers > experimental smokers > never smokers)
  • Race × gender interaction: White girls most likely and White boys least likely to endorse this belief
  • Among Black youth, boys more likely than girls to endorse this belief
Strengths: large sample size; high participation rate; ethnic and gender composition representative of Memphis schools; majority Black children in sample can add to literature about the behaviors and concerns of this population

Weaknesses: limited generalizability outside of Memphis public schools; did not use bogus pipeline or biochemical procedures; possible response bias due to substance users missing school; lack of temporality
Wang et al. 1998National sample of high school dropouts (weighted N = 492,352)
Age NR (range 15–18 years)
Cross-sectional computer-assisted telephone interview as part of the Teenage Attitudes and Practices Survey
“Smoking helps people keep their weight down”NR
  • Smoking rate among those who agreed smoking helps control body weight (69.1%) higher than for those who did not endorse this belief (54.6%)
Strengths: focuses on a rarely studied population of school dropouts
Cepeda-Benito and Ferrer 2000212 Spanish smokers comprised of college students and university employees
Mean 22.5 years of age (SD = 5.0)
Cross-sectional questionnaire to test the validity of the SCQ when used on a Spanish population
SCQ-S, Spanish version of the SCQ
Includes a 5-item subscale designed to assess expected effects of smoking on weight control
NR
  • Female smokers endorsed higher expectancies than did male smokers for effect of smoking on body weight
  • SEU of smoking for weight control not related to nicotine dependence after Bonferroni adjustment for multiple comparisons
Strengths: good construct validity and internal consistency for instrument and scales

Weaknesses: questionnaire may not generalize to other Spanish-speaking populations outside of Spain
Boles and Johnson 20011,200 adolescents
Age NR (range 12–17 years)
Cross-sectional telephone interview
“Do you think that smoking cigarettes helps you to control your weight”Current smokers = 15%
Girls: Total = 22.2%
Aged 12–13 years = 0.0%
Aged 14–15 years = 16.7%
Aged 16–17 years = 28.6%
Boys: Total = 9.9%
Aged 12–13 years = 25.0%
Aged 14–15 years = 16.7%
Aged 16–17 years = 4.3%
  • Question asked only of current smokers (n = 140)
  • Endorsement levels differed by gender and age
  • Agreement increased with age among female smokers and decreased with age among male smokers
Weaknesses: unable to make smoker-nonsmoker comparisons; did not collect height and weight data; small number of smokers in sample prohibited age comparisons; parents were interviewed during the same call as the adolescents
Budd and Preston 2001172 undergraduates
Mean 21.5 years of age (SD = 4.96; range 19–51 years)
Cross-sectional questionnaire
Pilot test of a newly developed instrument used to measure perceived consequences of smoking among young adults
Attitudes and Beliefs about Perceived
Consequences of Smoking Scale: includes 3-item Body Image scale
Sample items: “Smoking prevents weight gain,” “Smoking keeps a person thin”
5-point scale: “strongly agree” to “strongly disagree”
NR
  • Smokers endorsed stronger beliefs than did nonsmokers on the body-image-enhancing effects of smoking
Strengths: findings are in line with previous research; more precise measure of cigarette use compared to other studies

Weaknesses: small number of male participants; convenience sample may not be representative of population
George and Johnson 20011,852 college students
Age NR; >90%, 17–24 years of age
Cross-sectional self-administered questionnaire
“How do you think smoking affects your weight?” (keeps it down, no effect, keeps it up, don’t know)22% of female smokers and 16% of male smokers believed smoking kept their weight down
  • Male smokers more likely than nonsmokers to have dieted for weight loss during the past month
  • Female smokers more likely than nonsmokers to have used diet pills in the past month
Strengths: unique population of ethnically diverse university students

Weaknesses: sample demographics and size; possible bias in self-reported weight and smoking status, question design, study design
Zucker et al. 2001188 female undergraduates
Mean 19.0 years of age (SD = 0.9; range 17–25 years)
Cross-sectional-correlational
Self-report questionnaire
“Smoking helps people control weight”
7-point scale: “do not agree at all” to “definitely agree”
NR
  • Belief that smoking controls weight associated with greater odds of being a smoker
Weaknesses: generalizability limited because of highly selective sample; could not include ethnicity as a variable predicting smoking status
Cachelin et al. 2003211 junior high and high school students
Mean 16.3 years of age (SD = 1.3)
Cross-sectional self-administered school-based questionnaire
Two items from Smoking
Beliefs and Attitudes Scale:
“Smoking keeps you from eating”
“Smoking helps you control your weight”
NR
  • Female dieters more likely than nondieters to believe smoking keeps one from eating
  • Among females, dieting status not related to belief that smoking helps control weight
  • Among males, dieting status not related to beliefs about smoking and eating or weight control
Strengths: ethnically diverse sample

Weaknesses: small sample size of some groups (i.e., White and Hispanic dieters); self-report data; self-selection of sample; active consent may have resulted in a biased sample and underreported smoking levels
Copeland and Carney 2003441 female undergraduates attending Louisiana State University
Mean 19.9 years of age (SD = 1.6)
Cross-sectional questionnaire; smoking status verified using carbon monoxide (CO) analysis
Appetite/Weight Control scale from SCQNR
  • Expectancies for appetite and weight control a significant predictor of current smoking (vs. nonsmoking)
  • Among smokers, expectancies regarding appetite/weight control positively related to weekly smoking rate
Strengths: use of validated scales; use of CO analysis to verify smoking status

Weaknesses: conclusions regarding mediation may not be warranted; naive sample of smokers; cannot compare results with older female smokers
Honjo and Siegel 2003273 female adolescents who reported lifetime history of smoking ≤1 cigarettes
Age NR (range 12–15 years at baseline)
4-year prospective cohort telephone-based survey
Households chosen by random-digit dialing
“Do you believe that smoking helps people keep their weight down?”Total = 20.0%Strengths: first longitudinal study examining this relationship; included analysis of subjects lost to follow-up

Weaknesses: small number of experimenters at baseline prohibited further analyses; 1-item measure of independent variable may be weak psychometrically; homogeneous sample prohibited comparison by gender or ethnicity
Facchini et al. 2005144 female students
Mean 20.0 years of age (SD = 1.74; range 18–27 years)
Cross-sectional design, convenience sample, using a self-reported questionnaire
Argentina
“Smoking helps to control weight”
5-point scale (anchors not reported)
NR
  • Smokers endorsed higher levels of belief than did nonsmokers that smoking helps to control body weight
Strengths: first study of its kind in Argentina and with females older than 18; high level of participation

Weaknesses: cross-sectional design; need for greater psychometric data on psychosocial items; convenience sample; self-reported weight and height
Cavallo et al. 2006103 high school smokers who were interested in quitting
Mean 16.5 years of age (range 14–18 years)
Pilot study to determine which format of cognitive behavioral therapy is most effective when paired with a contingency management program 4-week school-based smoking cessation program
“How much do cigarettes help you control your weight?” and “How concerned are you about gaining weight as a result of quitting?”
5-point scale from “not at all” to “very much”
NR
  • Female smokers reported stronger beliefs that smoking helps control weight than did males; females also expressed greater concerns about postcessation weight gain
  • Belief that smoking helps control weight positively associated with daily smoking rate and negatively related to years smoking
  • Among females, positive correlation between concerns about postcessation weight gain and daily smoking rate
Strengths: monetary incentives for contingency management

Weaknesses: small sample size and high dropout rate; biochemical test cannot confirm smoking during entire follow-up period; infrequent assessment of abstinence posttreatment
McKee et al. 200640 female undergraduate smokers
Mean 20.0 years of age (SD = 4.3)
Participants viewed 30 slides of either nature scenes (neutral prime) or fashion models (body image prime) and rated their preference for each image
Participants also completed a questionnaire on smoking outcomes and eating restraint
Appetite/Weight Control scale from SCQNR
  • Restrained eaters exposed to a body image prime visual reported greater expectancies than did nonrestrained eaters that smoking helps to manage weight
  • Among participants exposed to a neutral (control) prime visual, expectancies regarding the effect of smoking on weight control did not differ according to dietary restraint
Strengths: confirmed smoking status by having subjects show their cigarettes

Weaknesses: small sample size; limited generalizability; low level of nicotine dependence; no biochemical confirmation of smoking status; dietary restraint was measured after viewing images, which may have affected scores
Vidrine et al. 2006350 female and 315 male high school students
Age NR
Secondary analysis of cross-sectional data gathered in a school-based survey
Students listed 10 positive and 10 negative expected outcomes of smoking
A questionnaire gathered information about self and peer smoking behavior
Participants asked to self-generate positive and negative expected outcomes from smokingProportion reporting weight-related outcome expectancies related to smoking:
Girls = 23%
Boys = 6%
  • Girls more likely than boys to generate weight-control outcome expectancies for smoking
  • Weight-control outcome expectancies did not differ by smoking status
Strengths: good interrater agreement

Weaknesses: cannot establish direction of relationship because of cross-sectional design; smoking rates have changed since data were collected in 1997, which limits generalizability of results
Copeland et al. 2007742 students in grades
2–6 from 2 Catholic schools
Mean 9.2 years of age (SD = 1.5; range 7–13 years)
Aim of study was to develop a smoking expectancy measure for children
Cross-sectional data
Questionnaires were administered in group setting and were read to younger students
SCQ-Child, a revised version of the SCQ“Smokers are thinner than nonsmokers”
Total = 37.9%
Aged 7–8 years = 38.9%
Aged 9–10 years = 33.8%
Aged 11–13 years = 43.1%

“Smokers eat less than nonsmokers”
Total = 52.2%
Aged 7–8 years = 56.8%
Aged 9–10 years = 48.2%
Aged 11–13 years = 52.1%
  • Scores on the Appetite/Weight Control scale lower among students who had a family member who smoked
  • Scores on the Appetite/Weight Control scale did not differ according to age, gender, peer smoking, perceived availability of cigarettes, ability to get cigarettes from friends, or whether students had ever tried cigarettes
Strengths: first smoking expectancy measure to be developed for use with children

Weaknesses: low reliability of two scales; self-selected sample may have resulted in bias; homogeneous mainly White sample; low rate of smoking possibly due to religiosity; possible that young children did not understand questions
Kendzor et al. 2007727 private school students in grades 2–6 were assigned to an environmental obesity prevention program or alcohol and tobacco prevention program
Mean 9.2 years of age (SD = 1.5; range 7–13 years)
Cross-sectional self-report questionnaire conducted in the classroom, measured height and weight
“Smokers are thinner than non-smokers”All Black students = 50.0%
Black males = 46.5%
Black females = 53.1%
All White students = 36.6%
White males = 37.7%
White females 35.6%
  • Black students more likely than Whites to believe smokers are thinner than nonsmokers
  • Black girls more likely than White girls to agree smokers are thinner than nonsmokers; differences among males not significant
  • No racial differences in belief that smokers eat less than nonsmokers
Strengths: elementary age sample; use of Eating Attitudes scale with internal reliability; included other factors related to weight concern and smoking in analyses

Weaknesses: low smoking prevalence; racially homogeneous sample; convenience sample from Catholic schools may have introduced bias
“Smokers eat less than non-smokers”All Black students = 54.3%
Black males = 53.5%
Black females = 55.1%
All White students = 52.4%
White males = 52.3%
White females 52.6%
Bean et al. 2008730 rural high school students
Mean 15.7 years of age (SD = 1.2; range 12–20 years)
Part of Youth Tobacco Evaluation Project, which evaluates all Tobacco-Settlement-funded prevention programs
Cross-sectional self-report questionnaire conducted in the classroom
Virginia
Personal attitudes about link between smoking and body weight: “If I stay tobacco free, I will gain weight”
5-point scale: “strongly disagree” to “strongly agree”
Perceptions of other people’s weight-related reasons for smoking: composite score from 3 items: “People smoke because…” “…it helps them lose weight,” “…it helps them stay thin,” and “it makes them less hungry”
5-point scale: “definitely not” to “definitely yes”
NR
  • Girls expressed greater agreement than did boys that people smoke for weight control
  • Boys endorsed stronger beliefs that remaining or becoming tobacco free would lead to weight gain
  • In multivariate models, smokers more likely than experimenters and nonsmokers to agree they will gain weight if they are tobacco free; in gender-stratified analyses, results were significant only for girls
  • Current smokers less likely than experimenters or nonsmokers to agree that people smoke for weight control
Strengths: first study to examine relationship between weight and smoking in a rural adolescent population; instrument composed of valid and reliable items; high participation rate

Weaknesses: nested analyses not possible since school IDs were not recorded; possible bias due to self-reported data (i.e., height and weight); cross-sectional; limitations in how “smoker” is defined; use of single-item measures for some constructs; limited generalizability; considerable amount of missing data

Note: NR = not reported; SD = standard deviation.

From: 2, The Health Consequences of Tobacco Use Among Young People

Cover of Preventing Tobacco Use Among Youth and Young Adults
Preventing Tobacco Use Among Youth and Young Adults: A Report of the Surgeon General.
National Center for Chronic Disease Prevention and Health Promotion (US) Office on Smoking and Health.

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