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Journal of Addictive Diseases
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Gender, Weight Concerns, and
Adolescent Smoking
Sharon M. Boles PhD a & Patrick B. Johnson PhD a
a National Center on Addiction and Substance
Abuse , Columbia University , USA
Published online: 12 Oct 2008.
To cite this article: Sharon M. Boles PhD & Patrick B. Johnson PhD (2001) Gender,
Weight Concerns, and Adolescent Smoking, Journal of Addictive Diseases, 20:2, 5-14,
DOI: 10.1300/J069v20n02_02
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Gender, Weight Concerns,
and Adolescent Smoking
Sharon M. Boles, PhD
Patrick B. Johnson, PhD
ABSTRACT. This study examined the beliefs that adolescents’ hold
regarding smoking and weight. In particular, this study examined the
relationship between smoking status and self-perceptions of body
weight. In addition, it examined gender and age differences in adolescent
male and female smokers’ beliefs about smoking and weight control.
Analyses were conducted on the telephone interview responses of 1,200
adolescent smokers and nonsmokers between the ages of 12 and 17.
Chi-square analyses were utilized for univariate comparisons, and logis-
tic regression for multivariate comparisons. Results revealed gender and
age differences in perceptions of body weight. In addition, female smok-
ers were more likely than male smokers to adhere to the belief that
smoking controlled weight. While no relationship was observed between
males’ perceived weight and their smoking status, females who perceived
themselves to be either overweight or underweight were more likely to
smoke. Findings suggest a gender bias in processing social/environmen-
tal cues linking smoking and weight control. [Article copies available for a
fee from The Haworth Document Delivery Service: 1-800-342-9678. E-mail
address: <getinfo@haworthpressinc.com> Website: <http://www.HaworthPress.
com> E 2001 by The Haworth Press, Inc. All rights reserved.]
At the time this article was written, Sharon M. Boles was affiliated with the
National Center on Addiction and Substance Abuse at Columbia University. She is
currently with the UCLA Drug Abuse Research Center.
Patrick B. Johnson is affiliated with The National Center on Addiction and Sub-
stance Abuse at Columbia University.
Address correspondence to: Sharon M. Boles, PhD, UCLA Drug Abuse Research
Center, 1640 S. Sepulveda Boulevard, Suite 200, Los Angeles, CA 90025 (E-mail:
sboles@ucla.edu).
The research described in this paper was supported from a grant from the Robert
Wood Johnson Foundation. Preparation of this manuscript was supported in part by a
grant from the Counterdrug Technology Assessment Center of the Office of National
Drug Control Policy.
Journal of Addictive Diseases, Vol. 20(2) 2001
E 2001 by The Haworth Press, Inc. All rights reserved.
5

JOURNAL OF ADDICTIVE DISEASES
6
KEYWORDS. Gender, weight, adolescent smoking
INTRODUCTION
Research has consistently shown a connection between smoking and weight
among adults. For example, studies have found that smoking cessation
among adults often leads to weight gain.1-3 Conversely, studies have also
demonstrated that among adult smokers, particularly female smokers, height-
ened concern about weight gain is associated with weaker intentions to quit
smoking in the future and with fewer quit attempts.4-5
There is a widespread belief among both adult smokers and nonsmokers
that smoking controls body weight and evidence suggests that many people
(particularly women) begin to smoke to control their weight.4,6-8 In fact, the
perception that smoking helps to control weight is frequently mentioned by
people as the reason they began to smoke or continue to do so.9
Meyers and colleagues7 found that the smokers most likely to be con-
cerned about their weight tended to be female, tended to weigh less, and were
less likely to be overweight than smokers not expressing weight concerns.
Even though they tended to weigh less and were not likely to be overweight,
these smokers had higher levels of concern about weight.
Unlike the research on weight and weight concerns among adults, little
attention has been given to adolescent smoking and weight-related issues.10
This has changed somewhat in recent years, however, as researchers have
begun to explore the connections between adolescent smoking and weight
concerns.10-11 Like adults, adolescent smokers, especially young women, are
aware of nicotine’s weight suppressing effects.12 Studies indicate that adoles-
cent smokers are more likely to believe that smoking helps to control weight
than adolescent nonsmokers.10,13-14 In particular, weight concerns have been
found to be most prevalent among adolescent female smokers compared to
male smokers and male and female nonsmokers.6,10,13 Many adolescent girls
are also aware of the inverse relationship between smoking and weight gain
and often use the anticipation of weight gain as a reason for not initiating
smoking cessation.5,15 In addition, girls (but not boys) who constantly thought
about weight were more likely to initiate smoking than those who did not
report weight concerns.16 These findings indicate that weight-conscious
women may initiate smoking in an attempt to control their body weight or
continue smoking as a weight-control strategy, believing that smoking has
strong anorexic effects.10,17
In a study examining the relationship between smoking and how adoles-
cents perceived their own weight, Tucker18 found that boys who perceived
themselves to be overweight reported higher rates of intentions to smoke than
did their counterparts. Relatedly, Pederson and colleagues19 found that ado-

Sharon M. Boles and Patrick B. Johnson
7
lescent smokers who thought that they were too heavy were more likely to be
involved with smoking compared to nonsmokers, past smokers, or exper-
imenters.
There is some evidence that the relationship between smoking and weight
concerns may also be age related. For example, Camp and colleagues10 found
that older adolescent girls may be more likely to use smoking as a dieting
strategy than young adolescent boys. In addition, Charlton13 found that
smokers under the age of 13 were not likely to endorse the belief that smok-
ing would control their weight.
The present study was designed to examine the beliefs that adolescents’
hold regarding smoking and weight. In particular, this study examined
whether male and female perceptions of their own weight were linked to
current smoking status. This study also examined, from an age perspective,
differences in concern about weight gain among male and female smokers.
METHODS
Respondents. A random digit dial technique was employed by the Luntz
Research Companies to conduct this survey. Randomly generated telephone
numbers were pre-screened to determine if a adolescent in the 12-17 year-old
age group resided in a household. Twelve hundred adolescents were inter-
viewed as part of a survey designed to study the substance-related beliefs of
adolescents and their parents. The adolescent sample was 51% male and 49%
female. Sixty-six percent of the sample were Anglo, 12% were Hispanic, and
11% were African-American. The remaining 11% was comprised of Asian-
Americans, Native Americans, and adolescents who reported their ethnicity
as ‘‘other.’’ Table 1 presents sample characteristics.
The order of parent-adolescent interviews was based on opportunity and
subsequent examination of these interviews revealed no order effects. In
addition, because the adolescent samples’ characteristics with respect to gen-
der, ethnicity, socioeconomic status, and family composition were quite simi-
lar to those of the population of 12-17 year-olds in this country, no data
weighting was required.
Procedure. Adolescents were told that the interviewer was a college stu-
dent who was interviewing young people around the country ‘‘about current
events and about how it is to be a teenager in America today.’’ The adoles-
cents were also informed that the interview would take approximately 15
minutes and that there were no right or wrong answers to the questions.
Instrument. The adolescent survey contained 72 questions ranging from
demographic questions including age, gender, and household composition to
questions regarding the respondent’s substance use beliefs and behaviors.
To assess current smoking behavior, adolescents were asked, ‘‘Do you

JOURNAL OF ADDICTIVE DISEASES
8
TABLE 1. Sample Characteristics
N
%
Gender
Male
612
588
51.0
49.0
Female
Race/Ethnicity
Anglo
791
133
142
134
65.9
11.1
11.8
11.2
African American
Hispanic
Other
Age
12-13 Years Old
14-15 Years Old
16-17 Years Old
Smoking Status
Smoker
379
427
394
24.5
27.6
25.5
140
11.7
88.3
Nonsmoker
1060
currently smoke, meaning one or more cigarettes per day?’’ If the adolescent
indicated that they did not currently smoke, they were asked, ‘‘Have you ever
smoked?’’ Possible responses to the above questions were:
Less than one cigarette per day, 1-5 cigarettes per day, 1/2 pack per day,
1 pack per day, 1 1/2 packs per day, 2 or more packs per day, not current
smoker but smoked in the past, or never smoked.
Responses to the following questions were the focus of this paper.
1. ‘‘Do you think that smoking cigarettes help you to control your
weight?’’
2. ‘‘Do you consider yourself to be overweight, underweight, or is your
weight about where it should be?’’
RESULTS
To conduct age comparisons, the 12 to 17-year-old age range was divided
into three groups: 12-13, 14-15, and 16-17. Categorization of the current

Sharon M. Boles and Patrick B. Johnson
9
smoking behavior question yielded three groups: current smokers, current
nonsmokers who smoked in the past (‘‘past smokers’’), and current non-
smokers who had never smoked (‘‘nonsmokers’’). For our smoker-nonsmok-
er comparisons, ‘‘past smokers’’ were merged into the nonsmoker category.
The current smokers were almost evenly divided between males (53.6%) and
females (46.4%). See Table 1 for age and smoking characteristics.
Comparisons of Smokers’ Belief That Smoking Controls Weight
More than 15% of the current smokers (n = 140) adhered to the belief that
cigarettes helped control weight. Since this question was only asked of smok-
ers, we cannot say whether this percentage is more/less/the same as among
adolescents who do not currently smoke.
Significantly more female smokers believed that smoking controls weight
than male smokers (22.2% vs. 9.9%) (X2 = 3.86, df = 1, p < .05). In addition,
examination of this belief by both age and gender revealed distinct male and
female patterns. For males, adherence to this belief was strongest in the
youngest cohort and weakest in the oldest cohort. For females, the opposite
pattern obtained (see Figure 1). In addition, a significant gender difference
was observed in the oldest group of smokers where 4.7% of the males and
29.4% of the females indicated that they believed that smoking helped con-
trol weight (X2 = 8.85, df = 1, p < .005).
FIGURE 1. Percent of female and male smokers who believe that smoking
controls weight
100
90
80
70
60
Female
Male
50
40
30
20
10
0
25.0
28.6
16.7
16.7
4.3
0.0
12-13 Year Olds
14-15 Year Olds
16-17 Year Olds

JOURNAL OF ADDICTIVE DISEASES
10
Perceptions of Body Weight Comparisons
More than three-quarters of the total sample (n = 2100) perceived their
weight to be ‘‘where it should be,’’ 9.5% perceived themselves to be under-
weight, and 14.0% perceived themselves to be overweight (see Table 2).
Significantly more adolescent girls (17.4%) perceived themselves to be over-
weight than adolescent boys (10.8%) (X2 = 10.66, df = 2, p < .01). Converse-
ly, somewhat more adolescent boys considered their weight to be ‘‘about
where it should be’’ than adolescent girls (79.3% vs. 73.4%). Perceptions of
weight appear to significantly change with age. Significantly more of the
youngest cohort perceived themselves to be underweight while the oldest
cohort perceived themselves to be overweight. The middle cohort was most
likely to perceive themselves to be weight appropriate (X2 = 14.93, df = 2, p <
.01) (see Table 2).
To determine the relative importance of gender, age, and smoking status in
relationship to perceived weight appropriateness, these measures were en-
tered simultaneously as determinants in separate logistic regression analyses,
where the perceived body weight was the dichotomous outcome (e.g., ap-
propriate vs. non-appropriate). As presented in Table 3, smokers were more
likely than nonsmokers to perceive they were not at their appropriate weight.
Not surprisingly, adolescent girls were more likely than adolescent boys to
perceive they were not at their appropriate weight. Finally, a logistic regres-
sion indicated that older adolescents were less likely than younger adoles-
cents to perceive their weight as appropriate.
DISCUSSION
Female smokers were more likely than male smokers to believe that smok-
ing controls weight. This findings supports previous research conducted with
adults4,6-8 and more recent adolescent research.6,10,13 Though not surprising,
this finding is unfortunate since the belief that smoking controls weight may
lead some adolescents (particularly girls) to initiate smoking as a weight
control measure. It may also serve as a reason for not initiating smoking
cessation attempts. Unfortunately, this question was only asked of smokers.
Thus, it was impossible to compare the responses of smokers to nonsmokers
on this question. It would have been interesting to see if nonsmokers also
believed that smoking controls weight.
It also appears that as females move through adolescence, a greater pro-
portion of female smokers come to believe that smoking can help control
their weight. Whether this change represents an attempt to rationalize why
they do not want to stop smoking or to reduce the frustration they feel at

Sharon M. Boles and Patrick B. Johnson
11
TABLE 2. Number and Proportion of Adolescent Responses for Perceived
Body Weight by Gender, Age Group, and Smoking Status
Gender
Age Group
Smoking
Total
N, (%)
Male
n, (%)
Female
n, (%)
12-13
n, (%)
14-15
n, (%)
16-17
n, (%)
Yes
n, (%)
No
n, (%)
Perceived
Body Weight
Underweight
Overweight
Appropriate
114
(9.5%)
60
54
52
31
(7.3%)
31
17
97
(9.2%)
(9.8%) (9.2%) (13.8%)
(7.9%) (12.3%)
168
66 102 54
51
63 25
142
(14.0%) (10.8%) (17.4%) (14.3%) (12.0%) (16.0%) (18.1%) (13.5%)
915 484 431 272 344 299 96 816
(76.4%) (79.3%) (73.4%) (72.0%) (80.8%) (76.1%) (69.9%) (77.3%)
Note: Total, Gender, Age, or Smoking specific numbers may not be equal due to missing data.
TABLE 3. Multivariate Odds Ratios (and 95% Confidence Intervals) for Per-
ceived Body Weight Given Gender, Age, and Smoking Status
Perceived Appropriate
Body Weight
GENDER (Girls vs. Boys)
1.4 (1.1, 1.8)
AGE
(14-15 vs. 12-13)
(16-17 vs. 12-13)
.56 (.40, .78)
.71 (.41, 1.0)
SMOKING (Yes vs. No)
1.7 (1.2, 2.6)
being unable to quit even when they have tried or something else is impossi-
ble to know. What it does reflect, however, is increasing adherence to a belief
that will ultimately make it more difficult for them to initiate a serious quit
attempt. In the absence of such attempts, these young women cannot quit and
increase the likelihood that they will be less likely to do so should they try to
stop smoking.
A further possibility for the increase in proportion of females (as they age)
who believe that smoking can control weight is the change in shape which
will be occurring between the youngest and oldest cohort. The youngest
group is moving from a child’s to a woman’s shape. When body fat begins to
be deposited in areas such as hips and model images are of narrow hips the
issue of weight may become more pressing and raise further anxieties.
More adolescents girls than boys perceived themselves to be overweight.
This perception of being less weight appropriate appears to increase with age.

JOURNAL OF ADDICTIVE DISEASES
12
Adolescent smokers were also less likely to perceive themselves to be at their
appropriate weight. The present findings support previous work that has
shown weight concerns connected to female, but not to male smoking sta-
tus.18-19 In addition, analyses revealed that while males’ beliefs about the
impact of smoking on weight decreased with age, females’ beliefs increased.
This suggests that a gender-specific bias may exist in the processing of social
cues regarding the smoking-weight control connection. It may be that fe-
males are more attuned to weight-relevant environmental cues because weight
issues are more salient for them. Previous research20 revealed that young
females also appeared to be more attuned than young males to information
about the self-medicating properties of alcohol.
More research needs to be conducted on the relationship of weight con-
cerns and smoking relapse among adolescents. Several authors have hypothe-
sized that the prospect of weight gain may inhibit smoking cessation efforts
and increase relapse in adults smokers.1,5,21 For example, Streater and col-
leagues22 speculated that women, because they fear a resultant weight gain
from smoking cessation, do not stop smoking as readily as do men or, if they
do attempt to stop, relapse as the fear of weight gain increases. Likewise,
weight gain following cessation may be a factor in resumption of smoking
among some ex-smokers.1 Little is known about the relationship between
concerns about weight gain and smoking relapse among adolescents.
At the same time, an effort should be made to determine whether a connec-
tion exists between smoking status, perceived weight appropriateness, and
gender. This is necessary to separate the effects of weight concerns generally
and the effects of concern about being overweight on cigarette use. Unfortu-
nately the interview did not include information about the adolescents’ actual
weight and height. This information would have provided additional insight
into the issue of ‘‘ideal body shape,’’ particularly in the lives of adolescent
females.
Caution should be exercised in interpreting the present findings for at least
three reasons. First, the small number of young adolescent smokers militated
against finding proportional differences among younger and older adolescent
smokers. Second, since the question regarding whether smoking controls
weight was only asked of smokers, it was impossible to make smoker-nonsmok-
er comparisons. Third, the fact that parents were also interviewed during the
same phone call may have led to the low rate of reported adolescent smoking.
REFERENCES
1. Emont SL, Cummings KM. Weight gain following smoking cessation: A possible
role for nicotine replacement in weight management. Addict Behav. 1987; 12: 151-5.
2. Hall SM, Tunstall CD, Vila KL, Duffy, J. Weight gain prevention and smoking
cessation: Cautionary findings. Am J Public Health. 1992; 82: 799-803.

Sharon M. Boles and Patrick B. Johnson
13
3. Klesges RC, Meyers AW, Klesges LM, LaVasque ME. Smoking, body weight,
and their effects on smoking behavior: A comprehensive review of the literature.
Psychol Bull. 1989; 106: 204-30.
4. Klesges RC, Somes GW, Pascale R, Klesges LM, Murphy M, Brown K, Wil-
liams E. Knowledge and beliefs regarding the consequences of cigarette smoking and
their relationships to smoking status in a biracial sample. Health Psychol. 1988; 7:
387-401.
5. Weekley CK, Klesges RC, Relyea, G. Smoking as a weight control strategy
and its relationship to smoking status. Addict Behav. 1992; 17: 259-71.
6. Klesges RC, Klesges LM. Cigarette smoking as a dieting strategy in a univer-
sity population. Int J Eat Disord. 1988; 7: 413-9.
7. Meyers AW, Klesges RC, Winders SE, Ward KD, Peterson BA, Eck LH. Are
weight concern predictive of smoking cessation? A prospective analysis. J Consult
Clin Psychol. 1997; 65: 448-52.
8. Pirie PL, Murray DM, Luepker RB. Gender differences in a cigarette smoking
and quitting in a cohort of young adults. Am J Public Health. 1991; 81: 324-7.
9. Klesges RC, Ward KD, Ray J, Cutter G, Jacobs DR, Wagenknecht LE. The
prospective relationships between smoking and weight in a young, biracial cohort:
the Coronary Artery Risk Development in Young Adults Study. J Consult Clin Psy-
chol. 1998; 66: 987-93.
10. Camp DE, Klesges RC, Relyea G. The relationship between body weight con-
cerns and adolescent smoking. Health Psychol. 1993; 12: 24-32.
11. Perkins KA, Levine MD, Marcus MD, Shiffman S. Addressing women’s con-
cerns about weight gain due to smoking cessation. J Subst Abuse Treat. 1997; 14:
173-82.
12. U. S. Department of Health and Human Services. The health consequences of
smoking: Nicotine addiction: A report of the Surgeon General. (DHHS Publication
No. CDC 88-8406). Rockville, MD: Centers for Disease Control, Center for Health
Promotion and Education, Office of Smoking and Health, 1988.
13. Charlton A. Smoking and weight control in teenagers. Public Health. 1984;
98: 277-81.
14. Feldman W, Hodgson C, Corber S. Relationship between higher prevalence of
smoking and weight concern amongst adolescent girls. Can J Public Health. 1985;
76: 205-6.
15. U.S. Department of Health, Education, and Welfare. Adult use of tobacco
1975 (DHHS Publication No. CDC 21-74-520). Rockville, MD; Centers for Disease
Control, National Clearinghouse for Smoking and Health, 1976.
16. French SA, Perry CL, Leon GR, Fulkerson JA. Weight concerns, dieting be-
havior, and smoking initiation among adolescents: A prospective study. Am J Public
Health. 1994; 84: 1818-20.
17. Wiseman CV, Turco RM, Sunday SR, Halmi KA. Smoking and body image
concerns in adolescent girls. Int J Eat Disord. 1998; 24: 429-33.
18. Tucker LA. Cigarette smoking intentions and obesity among high school mal-
es. Psychol Rep. 1983; 52: 530.

JOURNAL OF ADDICTIVE DISEASES
14
19. Pederson LL, Koval JJ, McGrady GA, Tyas SL. The degree and type of rela-
tionship between psychosocial variables and smoking status for students in grade 8:
Is there a dose-response relationship? Prev Med. 1998; 27: 337-47.
20. Johnson, PB, Johnson HL. Children’s beliefs about adult and adolescent
drinking. Paper included in symposium ‘‘The development of children’s alcohol-re-
lated beliefs.’’ Presented at Society for Research on Child Development Convention,
Seattle, 1991.
21. French SA, Jeffery RW, Klesges LM, Forster JL. Weight concerns and change
in smoking behavior over two years in a working population. Am J Public Health.
1995; 85: 720-722.
22. Streater JL, Sargent RG, Ward DS. A study of factors associated with weight
change in women who attempt smoking cessation. Addict Behav. 1989; 14:523-30.
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