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Addiction. 2009 Apr;104(4):661-8. doi: 10.1111/j.1360-0443.2009.02506.x. Epub 2009 Feb 10.

Overweight and perception of overweight as predictors of smokeless tobacco use and of cigarette smoking in a cohort of Swedish adolescents.

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Department of Statistics, University of Milano-Bicocca, Milan, Italy.



To study the association between measured or perceived overweight in adolescence and subsequent uptake of cigarette smoking and of the Swedish smokeless tobacco 'snus' (oral moist snuff).


Population-based prospective cohort study with 7 years' follow-up.


Self-administered questionnaires and school nurses' visits.


A total of 2922 children of both sexes and mean age 11.6 years at recruitment, resident in the Stockholm region, Sweden.


Tobacco use was self-reported at baseline and on six subsequent surveys. Subjects' height and weight were measured by school nurses during the first 4 years, self-reported thereafter. Overweight perception was self-reported at the age of 15 years.


Overweight and perception of overweight were not associated with subsequent uptake of either smoking or snus among males. Among females, overweight at baseline was associated with uptake of smoking [adjusted hazard ratio (HR) 1.34, 95% confidence interval (CI) 1.09-1.63], but not of snus. A similar pattern was found with overweight status during follow-up. Among girls with low-educated parents, overweight at baseline predicted the uptake of both snus and smoking. Among 15-year-old females who never used tobacco perceived overweight was associated with subsequent uptake of smoking (adjusted HR 1.71, 95% CI 1.20-2.46), but not of snus.


In Sweden, adolescent girls with actual or perceived overweight are at increased risk to start smoking, while indications that this increased risk applies to smokeless tobacco (snus) are limited to girls of low socio-economic status.

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