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. 2003 Sep;12(3):289–295. doi: 10.1136/tc.12.3.289

Perceived importance of being thin and smoking initiation among young girls

K Honjo 1, M Siegel 1
PMCID: PMC1747738  PMID: 12958390

Abstract

Background: Smoking among adolescents remains unacceptably high and the difference in potential risk factors for smoking initiation between male and female adolescents has been explored. Although the association between smoking initiation and dieting behaviour has been observed among girls, the mechanism of the association is unknown.

Objective: To examine prospectively the association between perceived importance of being thin at baseline and smoking initiation among girls.

Design: A four year prospective cohort survey including perceived importance of being thin at baseline and smoking behaviour, conducted in 1993 and 1996.

Setting and participants: 273 Massachusetts female adolescents aged 12–15 years at baseline who reported having smoked no more than one cigarette by the time of the baseline survey, drawn from households sampled by random digit dialling.

Main outcome measure: Progression to established smoking, defined as having smoked 100 or more cigarettes in their lifetime.

Results: After adjusting for age, smoking status at baseline, and race/ethnicity, girls who valued thinness most strongly and somewhat strongly were both more likely to have become established smokers, compared to the girls who valued thinness least strongly. The odds ratios are 4.5 (95% confidence interval (CI), 1.4 to 16.7) and 3.4 (95% CI 1.04 to 10.9), respectively.

Conclusions: The level of perceived importance of being thin among young female adolescents predicts future smoking initiation. Smoking prevention programmes designed for female adolescents may therefore benefit from the inclusion of content related to importance of being thin.

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Selected References

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  1. Austin S. B., Gortmaker S. L. Dieting and smoking initiation in early adolescent girls and boys: a prospective study. Am J Public Health. 2001 Mar;91(3):446–450. doi: 10.2105/ajph.91.3.446. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Biener L., Siegel M. Tobacco marketing and adolescent smoking: more support for a causal inference. Am J Public Health. 2000 Mar;90(3):407–411. doi: 10.2105/ajph.90.3.407. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Camp D. E., Klesges R. C., Relyea G. The relationship between body weight concerns and adolescent smoking. Health Psychol. 1993 Jan;12(1):24–32. doi: 10.1037//0278-6133.12.1.24. [DOI] [PubMed] [Google Scholar]
  4. Charlton A. Smoking and weight control in teenagers. Public Health. 1984 Sep;98(5):277–281. doi: 10.1016/s0033-3506(84)80003-7. [DOI] [PubMed] [Google Scholar]
  5. Choi W. S., Pierce J. P., Gilpin E. A., Farkas A. J., Berry C. C. Which adolescent experimenters progress to established smoking in the United States. Am J Prev Med. 1997 Sep-Oct;13(5):385–391. [PubMed] [Google Scholar]
  6. Choi W. S., Pierce J. P., Gilpin E. A., Farkas A. J., Berry C. C. Which adolescent experimenters progress to established smoking in the United States. Am J Prev Med. 1997 Sep-Oct;13(5):385–391. [PubMed] [Google Scholar]
  7. Crisp A. H., Halek C., Sedgewick P., Stravraki C., Williams E., Kiossis I., Sedgwick P., Stavrakaki C. Smoking and pursuit of thinness in schoolgirls in London and Ottawa. Postgrad Med J. 1998 Aug;74(874):473–479. doi: 10.1136/pgmj.74.874.473. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Crisp A., Sedgwick P., Halek C., Joughin N., Humphrey H. Why may teenage girls persist in smoking? J Adolesc. 1999 Oct;22(5):657–672. doi: 10.1006/jado.1999.0261. [DOI] [PubMed] [Google Scholar]
  9. Dawson D. A. Ethnic differences in female overweight: data from the 1985 National Health Interview Survey. Am J Public Health. 1988 Oct;78(10):1326–1329. doi: 10.2105/ajph.78.10.1326. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Feldman W., Hodgson C., Corber S. Relationship between higher prevalence of smoking and weight concern amongst adolescent girls. Can J Public Health. 1985 May-Jun;76(3):205–206. [PubMed] [Google Scholar]
  11. Field A. E., Camargo C. A., Jr, Taylor C. B., Berkey C. S., Colditz G. A. Relation of peer and media influences to the development of purging behaviors among preadolescent and adolescent girls. Arch Pediatr Adolesc Med. 1999 Nov;153(11):1184–1189. doi: 10.1001/archpedi.153.11.1184. [DOI] [PubMed] [Google Scholar]
  12. Field A. E., Wolf A. M., Herzog D. B., Cheung L., Colditz G. A. The relationship of caloric intake to frequency of dieting among preadolescent and adolescent girls. J Am Acad Child Adolesc Psychiatry. 1993 Nov;32(6):1246–1252. doi: 10.1097/00004583-199311000-00019. [DOI] [PubMed] [Google Scholar]
  13. Fisher M., Schneider M., Pegler C., Napolitano B. Eating attitudes, health-risk behaviors, self-esteem, and anxiety among adolescent females in a suburban high school. J Adolesc Health. 1991 Jul;12(5):377–384. doi: 10.1016/0197-0070(91)90051-m. [DOI] [PubMed] [Google Scholar]
  14. Frank R. E., Serdula M. K., Adame D. Weight loss and bulimic eating behavior: changing patterns within a population of young adult women. South Med J. 1991 Apr;84(4):457–460. doi: 10.1097/00007611-199104000-00011. [DOI] [PubMed] [Google Scholar]
  15. French S. A., Jeffery R. W. Consequences of dieting to lose weight: effects on physical and mental health. Health Psychol. 1994 May;13(3):195–212. doi: 10.1037//0278-6133.13.3.195. [DOI] [PubMed] [Google Scholar]
  16. French S. A., Perry C. L., Leon G. R., Fulkerson J. A. Changes in psychological variables and health behaviors by dieting status over a three-year period in a cohort of adolescent females. J Adolesc Health. 1995 Jun;16(6):438–447. doi: 10.1016/1054-139X(94)00002-V. [DOI] [PubMed] [Google Scholar]
  17. French S. A., Perry C. L., Leon G. R., Fulkerson J. A. Weight concerns, dieting behavior, and smoking initiation among adolescents: a prospective study. Am J Public Health. 1994 Nov;84(11):1818–1820. doi: 10.2105/ajph.84.11.1818. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. French S. A., Perry C. L. Smoking among adolescent girls: prevalence and etiology. J Am Med Womens Assoc. 1996 Jan-Apr;51(1-2):25–28. [PubMed] [Google Scholar]
  19. French S. A., Story M., Downes B., Resnick M. D., Blum R. W. Frequent dieting among adolescents: psychosocial and health behavior correlates. Am J Public Health. 1995 May;85(5):695–701. doi: 10.2105/ajph.85.5.695. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Garner D. M., Garfinkel P. E., Schwartz D., Thompson M. Cultural expectations of thinness in women. Psychol Rep. 1980 Oct;47(2):483–491. doi: 10.2466/pr0.1980.47.2.483. [DOI] [PubMed] [Google Scholar]
  21. Gritz E. R. Cigarette smoking by adolescent females: implications for health and behavior. Women Health. 1984 Summer-Fall;9(2-3):103–115. doi: 10.1300/J013v09n02_07. [DOI] [PubMed] [Google Scholar]
  22. Gritz E. R., Crane L. A. Use of diet pills and amphetamines to lose weight among smoking and nonsmoking high school seniors. Health Psychol. 1991;10(5):330–335. doi: 10.1037//0278-6133.10.5.330. [DOI] [PubMed] [Google Scholar]
  23. Gritz E. R., Nielsen I. R., Brooks L. A. Smoking cessation and gender: the influence of physiological, psychological, and behavioral factors. J Am Med Womens Assoc. 1996 Jan-Apr;51(1-2):35–42. [PubMed] [Google Scholar]
  24. Halek C., Kerry S., Humphrey H., Crisp A. H., Hughes J. M. Relationship between smoking, weight and attitudes to weight in adolescent schoolgirls. Postgrad Med J. 1993 Feb;69(808):100–106. doi: 10.1136/pgmj.69.808.100. [DOI] [PMC free article] [PubMed] [Google Scholar]
  25. Himes J. H., Dietz W. H. Guidelines for overweight in adolescent preventive services: recommendations from an expert committee. The Expert Committee on Clinical Guidelines for Overweight in Adolescent Preventive Services. Am J Clin Nutr. 1994 Feb;59(2):307–316. doi: 10.1093/ajcn/59.2.307. [DOI] [PubMed] [Google Scholar]
  26. Killen J. D., Taylor C. B., Telch M. J., Robinson T. N., Maron D. J., Saylor K. E. Depressive symptoms and substance use among adolescent binge eaters and purgers: a defined population study. Am J Public Health. 1987 Dec;77(12):1539–1541. doi: 10.2105/ajph.77.12.1539. [DOI] [PMC free article] [PubMed] [Google Scholar]
  27. Killen J. D., Taylor C. B., Telch M. J., Robinson T. N., Maron D. J., Saylor K. E. Depressive symptoms and substance use among adolescent binge eaters and purgers: a defined population study. Am J Public Health. 1987 Dec;77(12):1539–1541. doi: 10.2105/ajph.77.12.1539. [DOI] [PMC free article] [PubMed] [Google Scholar]
  28. Klem M. L., Klesges R. C., Bene C. R., Mellon M. W. A psychometric study of restraint: the impact of race, gender, weight and marital status. Addict Behav. 1990;15(2):147–152. doi: 10.1016/0306-4603(90)90018-s. [DOI] [PubMed] [Google Scholar]
  29. Klesges R. C., Meyers A. W., Klesges L. M., La Vasque M. E. Smoking, body weight, and their effects on smoking behavior: a comprehensive review of the literature. Psychol Bull. 1989 Sep;106(2):204–230. doi: 10.1037/0033-2909.106.2.204. [DOI] [PubMed] [Google Scholar]
  30. Ogden J., Fox P. Examination of the use of smoking for weight control in restrained and unrestrained eaters. Int J Eat Disord. 1994 Sep;16(2):177–185. doi: 10.1002/1098-108x(199409)16:2<177::aid-eat2260160209>3.0.co;2-7. [DOI] [PubMed] [Google Scholar]
  31. Patton G. C., Hibbert M., Rosier M. J., Carlin J. B., Caust J., Bowes G. Is smoking associated with depression and anxiety in teenagers? Am J Public Health. 1996 Feb;86(2):225–230. doi: 10.2105/ajph.86.2.225. [DOI] [PMC free article] [PubMed] [Google Scholar]
  32. Pierce J. P., Choi W. S., Gilpin E. A., Farkas A. J., Berry C. C. Tobacco industry promotion of cigarettes and adolescent smoking. JAMA. 1998 Feb 18;279(7):511–515. doi: 10.1001/jama.279.7.511. [DOI] [PubMed] [Google Scholar]
  33. Pierce J. P., Choi W. S., Gilpin E. A., Farkas A. J., Merritt R. K. Validation of susceptibility as a predictor of which adolescents take up smoking in the United States. Health Psychol. 1996 Sep;15(5):355–361. doi: 10.1037//0278-6133.15.5.355. [DOI] [PubMed] [Google Scholar]
  34. Pierce J. P., Choi W. S., Gilpin E. A., Farkas A. J., Merritt R. K. Validation of susceptibility as a predictor of which adolescents take up smoking in the United States. Health Psychol. 1996 Sep;15(5):355–361. doi: 10.1037//0278-6133.15.5.355. [DOI] [PubMed] [Google Scholar]
  35. Robinson T. N., Killen J. D., Taylor C. B., Telch M. J., Bryson S. W., Saylor K. E., Maron D. J., Maccoby N., Farquhar J. W. Perspectives on adolescent substance use. A defined population study. JAMA. 1987 Oct 16;258(15):2072–2076. [PubMed] [Google Scholar]
  36. Tiggemann M., Pickering A. S. Role of television in adolescent women's body dissatisfaction and drive for thinness. Int J Eat Disord. 1996 Sep;20(2):199–203. doi: 10.1002/(SICI)1098-108X(199609)20:2<199::AID-EAT11>3.0.CO;2-Z. [DOI] [PubMed] [Google Scholar]
  37. Tomeo C. A., Field A. E., Berkey C. S., Colditz G. A., Frazier A. L. Weight concerns, weight control behaviors, and smoking initiation. Pediatrics. 1999 Oct;104(4 Pt 1):918–924. doi: 10.1542/peds.104.4.918. [DOI] [PubMed] [Google Scholar]
  38. Tucker L. A. Cigarette smoking intentions and obesity among high school males. Psychol Rep. 1983 Apr;52(2):530–530. doi: 10.2466/pr0.1983.52.2.530. [DOI] [PubMed] [Google Scholar]

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