Skip to main content
Journal of the National Medical Association logoLink to Journal of the National Medical Association
. 2005 Dec;97(12):1630–1638.

Smoking cessation, obesity and weight concerns in black women: a call to action for culturally competent interventions.

Lisa A P Sánchez-Johnsen 1
PMCID: PMC2640716  PMID: 16396055

Abstract

Approximately 20.8% of black women and 23.1% of white women smoke, and significantly more blacks (37.4%) than whites (22.4%) are obese. Although the average amount of weight gain after quitting smoking is 6-8 lbs for women, blacks tend to gain substantially more weight. This large increase in postcessation weight gain in blacks may further augment the health risks that blacks face in conjunction with obesity. Interventions that promote smoking cessation, while simultaneously reducing weight concerns or weight gain has been proposed as a strategy to help weight-concerned women quit smoking. However, these studies have included primarily white samples and no studies have examined the feasibility or effectiveness of smoking-cessation and weight-control interventions for black women smokers. This review describes the literature on smoking, obesity/weight control and weight concerns in smokers, with a particular attention to black women smokers. A call to action to develop comprehensive and culturally competent smoking-cessation and obesity/weight-control interventions for black women is emphasized due to their high rates of smoking, obesity and postcessation weight gain.

Full text

PDF

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Ahluwalia J. S., McNagny S. E., Clark W. S. Smoking cessation among inner-city African Americans using the nicotine transdermal patch. J Gen Intern Med. 1998 Jan;13(1):1–8. doi: 10.1046/j.1525-1497.1998.00001.x. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Ahluwalia Jasjit S., Harris Kari Jo, Catley Delwyn, Okuyemi Kolawole S., Mayo Matthew S. Sustained-release bupropion for smoking cessation in African Americans: a randomized controlled trial. JAMA. 2002 Jul 24;288(4):468–474. doi: 10.1001/jama.288.4.468. [DOI] [PubMed] [Google Scholar]
  3. Airhihenbuwa C. O., Kumanyika S., Agurs T. D., Lowe A., Saunders D., Morssink C. B. Cultural aspects of African American eating patterns. Ethn Health. 1996 Sep;1(3):245–260. doi: 10.1080/13557858.1996.9961793. [DOI] [PubMed] [Google Scholar]
  4. Benowitz Neal L. Smoking cessation trials targeted to racial and economic minority groups. JAMA. 2002 Jul 24;288(4):497–499. doi: 10.1001/jama.288.4.497. [DOI] [PubMed] [Google Scholar]
  5. Borrelli B., Spring B., Niaura R., Kristeller J., Ockene J. K., Keuthen N. J. Weight suppression and weight rebound in ex-smokers treated with fluoxetine. J Consult Clin Psychol. 1999 Feb;67(1):124–131. doi: 10.1037//0022-006x.67.1.124. [DOI] [PubMed] [Google Scholar]
  6. Bowen D., Clifford C. K., Coates R., Evans M., Feng Z., Fouad M., George V., Gerace T., Grizzle J. E., Hall W. D. The Women's Health Trial Feasibility Study in Minority Populations: design and baseline descriptions. Ann Epidemiol. 1996 Nov;6(6):507–519. doi: 10.1016/s1047-2797(96)00072-5. [DOI] [PubMed] [Google Scholar]
  7. Cotugna N., Subar A. F., Heimendinger J., Kahle L. Nutrition and cancer prevention knowledge, beliefs, attitudes, and practices: the 1987 National Health Interview Survey. J Am Diet Assoc. 1992 Aug;92(8):963–968. [PubMed] [Google Scholar]
  8. Doherty K., Militello F. S., Kinnunen T., Garvey A. J. Nicotine gum dose and weight gain after smoking cessation. J Consult Clin Psychol. 1996 Aug;64(4):799–807. [PubMed] [Google Scholar]
  9. Domel S. B., Alford B. B., Cattlett H. N., Gench B. E. Weight control for black women. J Am Diet Assoc. 1992 Mar;92(3):346–348. [PubMed] [Google Scholar]
  10. Eyler A. A., Baker E., Cromer L., King A. C., Brownson R. C., Donatelle R. J. Physical activity and minority women: a qualitative study. Health Educ Behav. 1998 Oct;25(5):640–652. doi: 10.1177/109019819802500510. [DOI] [PubMed] [Google Scholar]
  11. Fiore M. C., Jorenby D. E., Baker T. B., Kenford S. L. Tobacco dependence and the nicotine patch. Clinical guidelines for effective use. JAMA. 1992 Nov 18;268(19):2687–2694. [PubMed] [Google Scholar]
  12. Flegal K. M., Carroll M. D., Kuczmarski R. J., Johnson C. L. Overweight and obesity in the United States: prevalence and trends, 1960-1994. Int J Obes Relat Metab Disord. 1998 Jan;22(1):39–47. doi: 10.1038/sj.ijo.0800541. [DOI] [PubMed] [Google Scholar]
  13. Flynn K. J., Fitzgibbon M. Body images and obesity risk among black females: a review of the literature. Ann Behav Med. 1998 Winter;20(1):13–24. doi: 10.1007/BF02893804. [DOI] [PubMed] [Google Scholar]
  14. Foy Capri Gabrielle, Bell Ronny A., Farmer Deborah F., Goff David C., Jr, Wagenknecht Lynne E. Smoking and incidence of diabetes among U.S. adults: findings from the Insulin Resistance Atherosclerosis Study. Diabetes Care. 2005 Oct;28(10):2501–2507. doi: 10.2337/diacare.28.10.2501. [DOI] [PubMed] [Google Scholar]
  15. 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]
  16. Froom P., Melamed S., Benbassat J. Smoking cessation and weight gain. J Fam Pract. 1998 Jun;46(6):460–464. [PubMed] [Google Scholar]
  17. Gans Kim M., Kumanyika Shiriki K., Lovell H. Joan, Risica Patricia M., Goldman Roberta, Odoms-Young Angela, Strolla Leslie O., Decaille Donna O., Caron Colleen, Lasater Thomas M. The development of SisterTalk: a cable TV-delivered weight control program for black women. Prev Med. 2003 Dec;37(6 Pt 1):654–667. doi: 10.1016/j.ypmed.2003.09.014. [DOI] [PubMed] [Google Scholar]
  18. Glasgow R. E., Strycker L. A., Eakin E. G., Boles S. M., Whitlock E. P. Concern about weight gain associated with quitting smoking: prevalence and association with outcome in a sample of young female smokers. J Consult Clin Psychol. 1999 Dec;67(6):1009–1011. doi: 10.1037//0022-006x.67.6.1009. [DOI] [PubMed] [Google Scholar]
  19. Hall S. M., Ginsberg D., Jones R. T. Smoking cessation and weight gain. J Consult Clin Psychol. 1986 Jun;54(3):342–346. doi: 10.1037//0022-006x.54.3.342. [DOI] [PubMed] [Google Scholar]
  20. Hall S. M., McGee R., Tunstall C., Duffy J., Benowitz N. Changes in food intake and activity after quitting smoking. J Consult Clin Psychol. 1989 Feb;57(1):81–86. doi: 10.1037//0022-006x.57.1.81. [DOI] [PubMed] [Google Scholar]
  21. Hall S. M., Tunstall C. D., Vila K. L., Duffy J. Weight gain prevention and smoking cessation: cautionary findings. Am J Public Health. 1992 Jun;82(6):799–803. doi: 10.2105/ajph.82.6.799. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Harris Kari Jo, Ahluwalia Jasjit S., Catley Delwyn, Okuyemi Kolawole S., Mayo Matthew S., Resnicow Ken. Successful recruitment of minorities into clinical trials: The Kick It at Swope project. Nicotine Tob Res. 2003 Aug;5(4):575–584. doi: 10.1080/1462220031000118540. [DOI] [PubMed] [Google Scholar]
  23. Hill J. S. Effect of a program of aerobic exercise on the smoking behaviour of a group of adult volunteers. Can J Public Health. 1985 May-Jun;76(3):183–186. [PubMed] [Google Scholar]
  24. Jama J. W., Launer L. J., Witteman J. C., den Breeijen J. H., Breteler M. M., Grobbee D. E., Hofman A. Dietary antioxidants and cognitive function in a population-based sample of older persons. The Rotterdam Study. Am J Epidemiol. 1996 Aug 1;144(3):275–280. doi: 10.1093/oxfordjournals.aje.a008922. [DOI] [PubMed] [Google Scholar]
  25. Jeffery R. W., Boles S. M., Strycker L. A., Glasgow R. E. Smoking-specific weight gain concerns and smoking cessation in a working population. Health Psychol. 1997 Sep;16(5):487–489. doi: 10.1037//0278-6133.16.5.487. [DOI] [PubMed] [Google Scholar]
  26. Jeffery R. W., Hennrikus D. J., Lando H. A., Murray D. M., Liu J. W. Reconciling conflicting findings regarding postcessation weight concerns and success in smoking cessation. Health Psychol. 2000 May;19(3):242–246. doi: 10.1037//0278-6133.19.3.242. [DOI] [PubMed] [Google Scholar]
  27. Kanders B. S., Ullmann-Joy P., Foreyt J. P., Heymsfield S. B., Heber D., Elashoff R. M., Ashley J. M., Reeves R. S., Blackburn G. L. The black American lifestyle intervention (BALI): the design of a weight loss program for working-class African-American women. J Am Diet Assoc. 1994 Mar;94(3):310–312. doi: 10.1016/0002-8223(94)90374-3. [DOI] [PubMed] [Google Scholar]
  28. Kawachi I., Troisi R. J., Rotnitzky A. G., Coakley E. H., Colditz G. A. Can physical activity minimize weight gain in women after smoking cessation? Am J Public Health. 1996 Jul;86(7):999–1004. doi: 10.2105/ajph.86.7.999. [DOI] [PMC free article] [PubMed] [Google Scholar]
  29. Khot Umesh N., Khot Monica B., Bajzer Christopher T., Sapp Shelly K., Ohman E. Magnus, Brener Sorin J., Ellis Stephen G., Lincoff A. Michael, Topol Eric J. Prevalence of conventional risk factors in patients with coronary heart disease. JAMA. 2003 Aug 20;290(7):898–904. doi: 10.1001/jama.290.7.898. [DOI] [PubMed] [Google Scholar]
  30. King A. C., Blair S. N., Bild D. E., Dishman R. K., Dubbert P. M., Marcus B. H., Oldridge N. B., Paffenbarger R. S., Jr, Powell K. E., Yeager K. K. Determinants of physical activity and interventions in adults. Med Sci Sports Exerc. 1992 Jun;24(6 Suppl):S221–S236. [PubMed] [Google Scholar]
  31. Klesges R. C., Klesges L. M., Meyers A. W., Klem M. L., Isbell T. The effects of phenylpropanolamine on dietary intake, physical activity, and body weight after smoking cessation. Clin Pharmacol Ther. 1990 Jun;47(6):747–754. doi: 10.1038/clpt.1990.103. [DOI] [PubMed] [Google Scholar]
  32. Klesges R. C., Somes G., Pascale R. W., Klesges L. M., Murphy M., Brown K., Williams E. Knowledge and beliefs regarding the consequences of cigarette smoking and their relationships to smoking status in a biracial sample. Health Psychol. 1988;7(5):387–401. doi: 10.1037//0278-6133.7.5.387. [DOI] [PubMed] [Google Scholar]
  33. Kolonel L. N., Henderson B. E., Hankin J. H., Nomura A. M., Wilkens L. R., Pike M. C., Stram D. O., Monroe K. R., Earle M. E., Nagamine F. S. A multiethnic cohort in Hawaii and Los Angeles: baseline characteristics. Am J Epidemiol. 2000 Feb 15;151(4):346–357. doi: 10.1093/oxfordjournals.aje.a010213. [DOI] [PMC free article] [PubMed] [Google Scholar]
  34. Kumanyika S. K. Obesity in minority populations: an epidemiologic assessment. Obes Res. 1994 Mar;2(2):166–182. doi: 10.1002/j.1550-8528.1994.tb00644.x. [DOI] [PubMed] [Google Scholar]
  35. Kumanyika S. Obesity in black women. Epidemiol Rev. 1987;9:31–50. doi: 10.1093/oxfordjournals.epirev.a036307. [DOI] [PubMed] [Google Scholar]
  36. Lee Rebecca E., Harris Kari Jo, Catley Delwyn, Shostrom Valerie, Choi Simon, Mayo Matthew S., Okuyemi Kola, Kaur Harsohena, Ahluwalia Jasjit S. Factors associated with BMI, weight perceptions and trying to lose weight in African-American smokers. J Natl Med Assoc. 2005 Jan;97(1):53–61. [PMC free article] [PubMed] [Google Scholar]
  37. Marcus B. H., Albrecht A. E., King T. K., Parisi A. F., Pinto B. M., Roberts M., Niaura R. S., Abrams D. B. The efficacy of exercise as an aid for smoking cessation in women: a randomized controlled trial. Arch Intern Med. 1999 Jun 14;159(11):1229–1234. doi: 10.1001/archinte.159.11.1229. [DOI] [PubMed] [Google Scholar]
  38. Marcus B. H., Albrecht A. E., Niaura R. S., Abrams D. B., Thompson P. D. Usefulness of physical exercise for maintaining smoking cessation in women. Am J Cardiol. 1991 Aug 1;68(4):406–407. doi: 10.1016/0002-9149(91)90843-a. [DOI] [PubMed] [Google Scholar]
  39. Marcus B. H., King T. K., Albrecht A. E., Parisi A. F., Abrams D. B. Rationale, design, and baseline data for Commit to Quit: an exercise efficacy trial for smoking cessation among women. Prev Med. 1997 Jul-Aug;26(4):586–597. doi: 10.1006/pmed.1997.0180. [DOI] [PubMed] [Google Scholar]
  40. McBride C. M., French S. A., Pirie P. L., Jeffery R. W. Changes over time in weight concerns among women smokers engaged in the cessation process. Ann Behav Med. 1996 Fall;18(4):273–279. doi: 10.1007/BF02895289. [DOI] [PubMed] [Google Scholar]
  41. McNabb W. L., Quinn M. T., Rosing L. Weight loss program for inner-city black women with non-insulin-dependent diabetes mellitus: PATHWAYS. J Am Diet Assoc. 1993 Jan;93(1):75–77. doi: 10.1016/0002-8223(93)92138-n. [DOI] [PubMed] [Google Scholar]
  42. Nies M. A., Vollman M., Cook T. African American women's experiences with physical activity in their daily lives. Public Health Nurs. 1999 Feb;16(1):23–31. doi: 10.1046/j.1525-1446.1999.00023.x. [DOI] [PubMed] [Google Scholar]
  43. Okuyemi K. S., Ahluwalia J. S., Harris K. J. Pharmacotherapy of smoking cessation. Arch Fam Med. 2000 Mar;9(3):270–281. doi: 10.1001/archfami.9.3.270. [DOI] [PubMed] [Google Scholar]
  44. Orleans C. T., Boyd N. R., Bingler R., Sutton C., Fairclough D., Heller D., McClatchey M., Ward J. A., Graves C., Fleisher L. A self-help intervention for African American smokers: tailoring cancer information service counseling for a special population. Prev Med. 1998 Sep-Oct;27(5 Pt 2):S61–S70. doi: 10.1006/pmed.1998.0400. [DOI] [PubMed] [Google Scholar]
  45. Perkins K. A., Levine M. D., Marcus M. D., Shiffman S. Addressing women's concerns about weight gain due to smoking cessation. J Subst Abuse Treat. 1997 Mar-Apr;14(2):173–182. doi: 10.1016/s0740-5472(96)00158-4. [DOI] [PubMed] [Google Scholar]
  46. Perkins K. A., Marcus M. D., Levine M. D., D'Amico D., Miller A., Broge M., Ashcom J., Shiffman S. Cognitive-behavioral therapy to reduce weight concerns improves smoking cessation outcome in weight-concerned women. J Consult Clin Psychol. 2001 Aug;69(4):604–613. [PubMed] [Google Scholar]
  47. Perkins K. A. Weight gain following smoking cessation. J Consult Clin Psychol. 1993 Oct;61(5):768–777. doi: 10.1037//0022-006x.61.5.768. [DOI] [PubMed] [Google Scholar]
  48. Pinto B. M., Borrelli B., King T. K., Bock B. C., Clark M. M., Roberts M., Marcus B. H. Weight control smoking among sedentary women. Addict Behav. 1999 Jan-Feb;24(1):75–86. doi: 10.1016/s0306-4603(98)00034-3. [DOI] [PubMed] [Google Scholar]
  49. Pirie P. L., McBride C. M., Hellerstedt W., Jeffery R. W., Hatsukami D., Allen S., Lando H. Smoking cessation in women concerned about weight. Am J Public Health. 1992 Sep;82(9):1238–1243. doi: 10.2105/ajph.82.9.1238. [DOI] [PMC free article] [PubMed] [Google Scholar]
  50. Pomerleau C. S., Zucker A. N., Namenek Brouwer R. J., Pomerleau O. F., Stewart A. J. Race differences in weight concerns among women smokers: results from two independent samples. Addict Behav. 2001 Sep-Oct;26(5):651–663. doi: 10.1016/s0306-4603(00)00148-9. [DOI] [PubMed] [Google Scholar]
  51. Pulvers Kim M., Lee Rebecca E., Kaur Harsohena, Mayo Matthew S., Fitzgibbon Marian L., Jeffries Shawn K., Butler James, Hou Qingjiang, Ahluwalia Jasjit S. Development of a culturally relevant body image instrument among urban African Americans. Obes Res. 2004 Oct;12(10):1641–1651. doi: 10.1038/oby.2004.204. [DOI] [PubMed] [Google Scholar]
  52. Resnicow K., Baranowski T., Ahluwalia J. S., Braithwaite R. L. Cultural sensitivity in public health: defined and demystified. Ethn Dis. 1999 Winter;9(1):10–21. [PubMed] [Google Scholar]
  53. Resnicow K., Jackson A., Wang T., De A. K., McCarty F., Dudley W. N., Baranowski T. A motivational interviewing intervention to increase fruit and vegetable intake through Black churches: results of the Eat for Life trial. Am J Public Health. 2001 Oct;91(10):1686–1693. doi: 10.2105/ajph.91.10.1686. [DOI] [PMC free article] [PubMed] [Google Scholar]
  54. Rigotti N. A. Treatment options for the weight-conscious smoker. Arch Intern Med. 1999 Jun 14;159(11):1169–1171. doi: 10.1001/archinte.159.11.1169. [DOI] [PubMed] [Google Scholar]
  55. Russell P. O., Epstein L. H., Johnston J. J., Block D. R., Blair E. The effects of physical activity as maintenance for smoking cessation. Addict Behav. 1988;13(2):215–218. doi: 10.1016/0306-4603(88)90016-0. [DOI] [PubMed] [Google Scholar]
  56. Sanders-Phillips K. Correlates of health promotion behaviors in low-income Black women and Latinas. Am J Prev Med. 1996 Nov-Dec;12(6):450–458. [PubMed] [Google Scholar]
  57. Silagy C., Lancaster T., Stead L., Mant D., Fowler G. Nicotine replacement therapy for smoking cessation. Cochrane Database Syst Rev. 2001;(3):CD000146–CD000146. doi: 10.1002/14651858.CD000146. [DOI] [PubMed] [Google Scholar]
  58. Spring B., Wurtman J., Gleason R., Wurtman R., Kessler K. Weight gain and withdrawal symptoms after smoking cessation: a preventive intervention using d-fenfluramine. Health Psychol. 1991;10(3):216–223. doi: 10.1037//0278-6133.10.3.216. [DOI] [PubMed] [Google Scholar]
  59. Spring Bonnie, Pagoto Sherry, Pingitore Regina, Doran Neal, Schneider Kristin, Hedeker Don. Randomized controlled trial for behavioral smoking and weight control treatment: effect of concurrent versus sequential intervention. J Consult Clin Psychol. 2004 Oct;72(5):785–796. doi: 10.1037/0022-006X.72.5.785. [DOI] [PMC free article] [PubMed] [Google Scholar]
  60. Stamford B. A., Matter S., Fell R. D., Papanek P. Effects of smoking cessation on weight gain, metabolic rate, caloric consumption, and blood lipids. Am J Clin Nutr. 1986 Apr;43(4):486–494. doi: 10.1093/ajcn/43.4.486. [DOI] [PubMed] [Google Scholar]
  61. Starling R. D., Toth M. J., Carpenter W. H., Matthews D. E., Poehlman E. T. Energy requirements and physical activity in free-living older women and men: a doubly labeled water study. J Appl Physiol (1985) 1998 Sep;85(3):1063–1069. doi: 10.1152/jappl.1998.85.3.1063. [DOI] [PubMed] [Google Scholar]
  62. Svetkey L. P., Simons-Morton D., Vollmer W. M., Appel L. J., Conlin P. R., Ryan D. H., Ard J., Kennedy B. M. Effects of dietary patterns on blood pressure: subgroup analysis of the Dietary Approaches to Stop Hypertension (DASH) randomized clinical trial. Arch Intern Med. 1999 Feb 8;159(3):285–293. doi: 10.1001/archinte.159.3.285. [DOI] [PubMed] [Google Scholar]
  63. Sánchez-Johnsen Lisa A. P., Fitzgibbon Marian L., Ahluwalia Jasjit S., Spring Bonnie J. Eating pathology among Black and White smokers. Eat Behav. 2005 Feb;6(2):127–136. doi: 10.1016/j.eatbeh.2004.08.011. [DOI] [PubMed] [Google Scholar]
  64. Sánchez-Johnsen Lisa A. P., Fitzgibbon Marian L., Martinovich Zoran, Stolley Melinda R., Dyer Alan R., Van Horn Linda. Ethnic Differences in correlates of obesity between Latin-American and black Women. Obes Res. 2004 Apr;12(4):652–660. doi: 10.1038/oby.2004.75. [DOI] [PubMed] [Google Scholar]
  65. Sánchez-Johnsen Lisa A. P., Spring Bonnie J., Sommerfeld Beth Kaplan, Fitzgibbon Marian L. Weight concerns and smoking in Black and White female smokers. Addict Behav. 2005 Mar;30(3):601–605. doi: 10.1016/j.addbeh.2004.07.007. [DOI] [PubMed] [Google Scholar]
  66. Talcott G. W., Fiedler E. R., Pascale R. W., Klesges R. C., Peterson A. L., Johnson R. S. Is weight gain after smoking cessation inevitable? J Consult Clin Psychol. 1995 Apr;63(2):313–316. doi: 10.1037//0022-006x.63.2.313. [DOI] [PubMed] [Google Scholar]
  67. Taylor C. B., Houston-Miller N., Haskell W. L., Debusk R. F. Smoking cessation after acute myocardial infarction: the effects of exercise training. Addict Behav. 1988;13(4):331–335. doi: 10.1016/0306-4603(88)90039-1. [DOI] [PubMed] [Google Scholar]
  68. Vander Weg M. W., Klesges R. C., Ward K. D. Differences in resting energy expenditure between black and white smokers: implications for postcessation weight gain. Eur J Clin Nutr. 2000 Dec;54(12):895–899. doi: 10.1038/sj.ejcn.1601110. [DOI] [PubMed] [Google Scholar]
  69. Vollmer W. M., Svetkey L. P., Appel L. J., Obarzanek E., Reams P., Kennedy B., Aicher K., Charleston J., Conlin P. R., Evans M. Recruitment and retention of minority participants in the DASH controlled feeding trial. DASH Collaborative Research Group. Dietary Approaches to Stop Hypertension. Ethn Dis. 1998;8(2):198–208. [PubMed] [Google Scholar]
  70. Voorhees C. C., Stillman F. A., Swank R. T., Heagerty P. J., Levine D. M., Becker D. M. Heart, body, and soul: impact of church-based smoking cessation interventions on readiness to quit. Prev Med. 1996 May-Jun;25(3):277–285. doi: 10.1006/pmed.1996.0057. [DOI] [PubMed] [Google Scholar]

Articles from Journal of the National Medical Association are provided here courtesy of National Medical Association

RESOURCES