| Study | Design/population | Measures | Percentage endorsing | Findings | Comments |
|---|---|---|---|---|---|
| Klesges et al. 1987 | 204 undergraduates Mean 19.9 years of age (SD = 3.4; range 17–40 years) Cross-sectional Self-reported questionnaires | Participants selected from among 21 weight-loss strategies they had used in past 6 months including “smoke cigarettes/use caffeine” | Females = 21% Males = 4% |
| NR |
| Klesges and Klesges 1988 | 1,076 university students, faculty, and staff Mean 21.7 years of age (SD = 6.5; range 16–72 years) Cross-sectional Self-reported questionnaires | Participants selected which of 6 dieting strategies (including smoking) they had used in past 6 months to lose weight Smokers indicated whether they initially started smoking to lose or maintain weight Reasons for relapse (including weight gain and increased appetite) also assessed | Use of smoking: Total smokers = 32.5% Female smokers = 39% Male smokers = 25% Nonsmokers = 0.5% Female smokers = 5% Male smokers = 10% |
| Weaknesses: self-reported data |
| Worsley et al. 1990 | 809 adolescents Mean 15 years of age Cross-sectional study, part of the Dunedin Multidisciplinary Health and Development Study cohort New Zealand | Participants identified which weight-loss strategies they had used in past year, including cigarette smoking | Girls = 5% Boys = 2% |
| NR |
| Frank et al. 1991 | 364 female college freshmen Mean 18 years of age Cross-sectional Self-reported questionnaire | Participants selected from among healthy and unhealthy strategies they had used for losing or maintaining their weight | 37% of smokers reported 1 of the reasons they smoked was to control their weight |
| Strengths: sample was not biased toward people in physical activity class Weaknesses: self-report; questions did not specify if diet pills were prescribed by a doctor or were over-the-counter |
| Camp et al. 1993 | 659 high school students Mean 16.3 years of age Cross-sectional questionnaire | Item asked smokers whether they had used smoking to control their weight | All female smokers = 39% Black females = 0% White females = 61% All male smokers = 12% Black males = 0% White males = 12% |
| 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 |
| Klesges et al. 1997a | 6,961 7th-grade students enrolled in the Memphis Health Project Mean 13 years of age Cross-sectional questionnaire as part of Memphis Health Project Tennessee | Item asked smokers whether they had ever used smoking to control their weight | Total smokers = 12% All female smokers = 18% All male smokers = 8% All Black smokers = 9% Black girls = 11% Black boys = 7% All White smokers = 15% White girls = 27% White boys = 8% |
| Strengths: large sample size; high participation rate; ethnic and gender composition representative of Memphis schools; majority Black children in sample can add to literature re: 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 |
| Robinson et al. 1997 | 6,967 7th-grade students enrolled in the Memphis Health Project Mean 13 years of age Cross-sectional questionnaire as part of Memphis Health Project Tennessee | Item asked smokers whether they had ever used smoking to control their weight | NR |
| Strengths: examined predictors of experimental and regular smokers Weaknesses: only two ethnic groups examined; did not measure some variables thought to be associated with cigarette smoking; cross-sectional |
| Jarry et al. 1998 | 220 female undergraduate college students Mean 27.0 years of age Cross-sectional retrospective questionnaire Canada | Never smokers were asked if they ever considered starting to smoke to avoid gaining or to lose weight 7-point scale: “never considered” to “seriously considered” Current and former smokers indicated agreement with the statements “I started smoking to avoid gaining weight or to lose weight” and “I smoke(d) to avoid gaining weight or to lose weight” 7-point scale: “totally disagree” to “totally agree” | NR |
| Strengths: focus on female population; direct measurement of subjects’ self-perceived motivation to smoke as this relates to weight; assessment of self-reported postcessation weight gain among dieters and nondieters Weaknesses: retrospective nature of the design; subjects participated on a voluntary basis |
| Ryan et al. 1998 | 420 students Mean 15 years of age (range 14–17 years) Cross-sectional questionnaire Dublin, Ireland | Questionnaire assessing perceived body weight, weight concerns, and slimming practices including “beginning or continuing smoking” | Total sample: 13% |
| NR |
| Crisp et al. 1999 | 2,768 female students from London (n = 1,936) and Ottawa (n = 832) Age NR (range 10–19 years) Cross-sectional questionnaire United Kingdom and Canada | Smokers identified reasons for smoking, including “instead of eating” and “makes you less hungry” Smokers indicated expected consequences of quitting smoking, including “eat more” and “put on weight” | Reasons for smoking: Instead of eating: London = 21%* Ottawa = 33%* Makes less hungry: London = 19%* Ottawa = 36%* Expected consequences of quitting smoking: Eat more: London = 30%* Ottawa = 34%* Put on weight: London = 31%* Ottawa = 33%* *Responded “yes, definitely” |
| Weaknesses: low response rate in Ottawa schools |
| Crocker et al. 2001 | 702 female 9th-grade students Age NR (range 14–15 years) Cross-sectional questionnaire Canada | Smoking Situations Questionnaire (SSQ) 6 items to measure use of smoking for weight control (sample items: “I continue to smoke so that I don’t gain weight,” “I smoke at the end of a meal so I won’t eat so much”) | 19.4% of female smokers classified as smoking for weight control (defined based on scores of ≥2 on SSQ) |
| Strengths: incorporated a validated physical self-perception model and instrument; used a large regionalized sample of 9th- grade girls from various socioeconomic levels; included a measure of using smoking as a means to control weight Weaknesses: cross-sectional design; low prevalence of smoking and dietary restraint behavior; not assessing other weight control strategies; used self-reported data |
| George and Johnson 2001 | 1,852 college students Age NR (>90%, range 17–24 years) Cross-sectional self-administered questionnaire | Participants identified their primary reason for smoking | 4% of female and 1% of male smokers cited weight control as primary reason for smoking |
| 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 |
| Granner et al. 2001 | 206 Black and White college students Mean 20.6 years of age (SD = 2.17) Cross-sectional ex post facto design | Weight Control Smoking Scale (WCSS) Eating Disorders Inventory-2 Sample item: “I smoke to keep from gaining weight” | 58% endorsed at least one item regarding smoking for weight control 11.1% of Black smokers and 20.0% of White smokers scored above the cutoff (≥6) for being classified as a weight-control smoker |
| Weaknesses: cross-sectional design and convenience sampling; some relatively small cell sizes may have limited the ability to fully test associations |
| Plummer et al. 2001 | 2,808 9th-grade students enrolled in a study of smoking, sun protection habits, and reduction in dietary fat Mean 15.2 years of age (SD = 0.6) Cross-sectional data from first intervention session Part of a larger study (n = 4,983) | 2 items from the Temptation to Smoke measure for adolescents (Ding et al. 1994) that addressed temptations associated with weight control: “when I am afraid I might gain weight” and “when I want to get thinner” | NR |
| Strengths: largest sample in which these theoretical constructs have been evaluated; provides basis for interventions based on the Transtheoretical Model (TTM), improved measurement model previously developed by Pallonen et al. (1998) (by including a Habit Strength factor and by using both smokers and nonsmokers in the development of the Weight Control subscale) Weaknesses: cross-sectional; sample not nationally representative |
| Zucker et al. 2001 | 188 female undergraduates Mean 19.0 years of age (SD = 0.9; range 14–17 years) Cross-sectional-correlational Self-reported questionnaire | WCSS | NR |
| Weaknesses: generalizability limited because of highly selective sample; could not include ethnicity as a variable predicting smoking status |
| Croll et al. 2002; Fulkerson and French 2003 | Population-based sample of 81,247 9th- and 12th-grade public school students Age NR Cross-sectional from Minnesota Student Survey | “During the last 12 months, have you done any of the following to lose or control your weight? (mark all that apply)” Response choices included “smoking cigarettes” | Female smokers (in past 30 days): Total = 48.8% White = 48.6% Black = 32.6% Hispanic = 43.2% Asian American = 50.0% Native American = 49.4% Other/mixed = 55.0% Male smokers (in past 30 days): Total = 27.6% White = 26.5% Black = 27.8% Hispanic = 32.0% Asian American = 35.0% Native American = 38.2% Other/mixed = 31.3% |
| Strengths: examined ethnic-specific risk and protective factors for disordered eating across a large, statewide, population-based sample utilizing a range of socioenvironmental, personal, and behavioral measures (Croll et al. 2002) Weaknesses: caution needed when making inferences outside of Minnesota youth; socioeconomic status (SES) not directly assessed; nonspecific nature of the survey questions regarding disordered eating behaviors; not able to distinguish between youth with more severe, frequent disordered eating behaviors and those engaging in disordered eating behaviors less frequently (Croll et al. 2002) Weaknesses: staff-measured height and weight not feasible—unable to examine relationships among body mass index and perceptions of overweight, worrying about weight, and smoking to lose or control weight; SES data not collected; data do not include adolescents who are not enrolled in public school; cross-sectional (Fulkerson and French 2003) |
| Neumark-Sztainer et al. 2002 | Population-based sample of 4,746 adolescents from urban public schools participating in Project EAT Mean 14.9 years of age (SD = 1.7) Cross-sectional questionnaire including height and weight measurements by staff; Project EAT surveys | Participants identified healthy, unhealthy, and extreme weight-control behaviors they had engaged in over the past year including “smoked more cigarettes” | Girls: Total = 9.2% White = 10.5% African American = 6.1% Hispanic = 9.3% Asian American = 7.1% Native American = 23.3% Other/mixed = 7.4% Boys: Total = 4.7% White = 4.1% African American = 2.8% Hispanic = 6.7% Asian American = 6.5% Native American = 8.7% Other/mixed = 6.7% |
| Strengths: large size and diverse nature of the study population; collection of actual height and weight measurements; assessment of a variety of weight-related concerns and behaviors Weaknesses: self-reported behaviors; generalizations to other populations need to be made cautiously |
| Forman and Morello 2003 | 2,524 8th- and 11th- grade students Age NR (range ≤13 to ≥18 years) Cross-sectional self-administered anonymous survey Argentina | Item and response indicative of weight control smoking: |
| Strengths: use of profile analysis using generalized estimating equations to compare clustered groups of adolescents; large sample size; inclusion of specific survey questions regarding different types of weight concerns and perceived difficulty in quitting Weaknesses: inability to make causal inferences due to cross-sectional nature of the data; use of a single self- report questionnaire to assess the relationships among smoking, perceived difficulty in quitting, and weight concerns | |
| “Why did you first try cigarettes?” (“to avoid getting fat”) | Female smokers = 11.3% Male smokers = 4.0% | ||||
| “In what situations do you smoke?” (“to avoid eating when I am hungry”) | Female smokers = 22.3% Male smokers = 12.9% | ||||
| “Why do you smoke?” (“to maintain my weight”) | Female smokers = 16.0% Male smokers = 7.0% | ||||
| Park et al. 2003 | 297 high school students who were current or former smokers Age NR Cross-sectional study; used TTM and structured self-report questionnaire Korea | Temptation to Smoke measure for adolescents (Ding et al. 1994) | NR |
| NR |
| Dowdell and Santucci 2004 | 54 urban 7th-grade students Mean 11.9 years of age (range 11–13 years) Descriptive correlational study using a convenience sample; used Youth Risk Behavior Surveillance System (YRBSS) questionnaire | NR | 62% of students who smoked indicated that controlling their weight was the reason they smoked |
| Strengths: YRBSS has a kappa statistic reliability of 61–80% or higher; alpha reliability of 0.79 determined for this sample of 54 students Weaknesses: small sample size; absence of information about parental health-related lifestyle behaviors and attitudes; absence of information about the subjects’ access to health care providers and nurses; sample predominantly White children |
| Nichter et al. 2004 | 205 female 10th- and 11th-grade students interviewed during year 3 of a longitudinal study 10th grade (Mean 16.02 years of age; SD = 0.44) 11th grade (Mean 16.99 years of age; SD = 0.49) 178 surveyed again 5 years later Longitudinal study known as the Teen Lifestyle Project Qualitative and quantitative data collection | Various study-specific items assessing smoking for reasons related to weight control | Year 3 (current smokers): “Did you start smoking as a way to control your weight”? = 11% “I sometimes smoke so I’ll be less hungry” = 25% of occasional and regular smokers 5-year follow-up (current and former smokers): “Thinking back to when you first started smoking, would you say that you started smoking as a way to control your weight?” = 8% “Did you ever smoke as a way to control your weight?” = 15% “Do/did you ever smoke at the end of a meal so you wouldn’t continue eating?” = 3% “Do you smoke at times so you’ll be less hungry?” = 20% |
| Strengths: longitudinal span; use of ethnography to explore complex relationship between dieting and smoking; the rapport that was developed with informants over a period of years Weaknesses: sample of smokers is small and the response rate to the survey questionnaire mailed follow-up is low; findings may not be generalizable to other regions or girls of different ages |
| Facchini et al. 2005 | 144 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 | Participants selected from among various reasons for starting to smoke, currently smoking, anticipated consequences of quitting, and reasons for not quitting, several of which were related to eating and body weight | Reasons for starting to smoke: To avoid eating = 9% Because it makes them less hungry = 7% To control weight = 4% Reasons for currently smoking: Because it makes them less hungry = 27% Instead of snacking when bored = 24% At the end of a meal so they will not eat so much = 19% To avoid eating = 16% Reasons for not quitting: Eating more = 37% Putting on weight = 34% |
| Strengths: first study of its kind in Argentina and with females older than 18; high level of participation Weaknesses: cross-sectional design; greater psychometric data on psychosocial items; convenience sample; self-reported weight and height |
| Malinauskas et al. 2006 | 185 female undergraduate college students Mean 19.7 years of age (SD = 1.4; range 18–24 years) Quasi-experimental design; convenience sample; surveys and body composition assessment | Participants completed a dieting practices questionnaire (Calderon et al. 2004) that assessed the use of 15 different weight-loss behaviors | Total = 9% Normal weight = 8% Overweight = 14% Obese = 5% | NR | Weaknesses: cross-sectional study design—cannot determine if a causal relationship exists between dieting and weight control; only involved female students from 1 university |
| Jenks and Higgs 2007 | 30 female undergraduates Current dieters (n = 15) Nondieters (n = 15) Mean 20.5 years of age (SD = 1.6; range 18–24 years) Randomized intervention with participants randomized to session ordering by food cues Dieting status was used as an effect modifier | WCSS Participants also rated agreement with: “I started smoking to control my weight” and “I am concerned about weight gain upon smoking cessation” 100-mm visual analog scale: “totally disagree” to “totally agree” | NR |
| Strengths: examined for the first time the relationship between weight-control smoking and smoking-related variables in young women and examined the effect of presentation of food cues on these responses Weaknesses: measurement of expired air carbon monoxide may not be sensitive enough to pick up small differences in the number of cigarettes smoked at low levels of daily smoking; self-report bias |
Note: CI = confidence interval; mm = millimeter; NR = not reported; SD = standard deviation.
From: 2, The Health Consequences of Tobacco Use Among Young People
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