Body mass index and tobacco-product use among U.S. youth: Findings from wave 1 (2013-2014) of the Population Assessment of Tobacco and Health (PATH) Study.

introductionTobacco and obesity are leading contributors to mortality in the United States. Due to emerging changes in youth tobacco use, further examination of co-occurrence of these issues is warranted.

methodsThis study examined associations between body mass index (BMI) and tobacco-product use and whether these varied by gender in a nationally representative sample of 12,416 Wave 1 (2013-2014) U.S. youth (12-17 years) from the Population Assessment of Tobacco and Health Study. Multivariable logistic regression analyses examined the odds of past 30-day tobacco-product use according to BMI. BMI was analyzed categorically using the Centers for Disease Control and Prevention (CDC) BMI-for-age weight status categories (underweight/healthy weight, overweight, and obese) and as a continuous variable.

resultsYouth classified as overweight or obese were not more likely to use any tobacco, cigarettes, e-cigarettes, any cigar, or hookah. However, youth who were obese were more likely to use smokeless tobacco (Adjusted Odds Ratio (AOR) = 1.68, 95% Confidence Interval (CI): 1.01, 2.81). There were no significant gender interactions for these associations. When BMI was analyzed continuously, a 5-unit and 10-unit increase was significantly associated with using any tobacco, cigarettes, any cigar, and smokeless tobacco. This linear association was supported by similar results for a log-transformed BMI variable.

conclusionsFindings suggest a continuum between weight increase and tobacco-product use among American youth. Clinicians should consider screening for tobacco use among youth who gain weight within any weight class, not just those considered overweight or obese.