Body mass index, body dissatisfaction and adolescent smoking initiation

- Smoking has been shown to affect body weight but evidence for the converse is limited.
- Higher body mass index (BMI) was associated with smoking initiation in adolescent females but not males.
- Body dissatisfaction was associated with smoking initiation in both sexes.
- BMI genetic risk score did not predict smoking, but estimates were imprecise.
- BMI and body dissatisfaction may be important considerations for smoking prevention.

BackgroundSmoking influences body weight, but there is little evidence as to whether body mass index (BMI) and body dissatisfaction increase smoking initiation in adolescents.MethodsWe evaluated the association between measured BMI, body dissatisfaction and latent classes of smoking initiation (never smokers, experimenters, late onset regular smokers, early onset regular smokers) in the Avon Longitudinal Study of Parents and Children. In observational analyses we used BMI (N = 3754) and body dissatisfaction at age 10.5 years (N = 3349). In Mendelian randomisation (MR) analysis, we used a BMI genetic risk score of 76 single nucleotide polymorphisms (N = 4017).ResultsIn females, higher BMI was associated with increased odds of early onset regular smoking (OR: 1.11, 95% CI: 1.04, 1.18) compared to being a never smoker, but not clearly associated with experimenting with smoking (OR: 1.04, 95% CI: 0.99, 1.10) or late onset regular smoking (OR: 1.01, 95% CI: 0.94, 1.09). No clear evidence was found for associations between BMI and smoking initiation classes in males (p-value for sex interaction ≤ 0.001). Body dissatisfaction was associated with increased odds of late-onset regular smoking (OR: 1.71, 95% CI: 1.32, 1.99) in males and females combined (P-value for sex interaction = 0.32). There was no clear evidence for an association between the BMI genetic risk score and smoking latent classes in males or females but estimates were imprecise.ConclusionsBMI in females and body dissatisfaction in males and females are associated with increased odds of smoking initiation, highlighting these as potentially important factors for consideration in smoking prevention strategies.