How Weight Control Belief Impacts Smoking and Quitting Among … · 2020-05-12 · How Weight Control Belief Impacts Smoking and Quitting Among Students: Evidence from South Carolina

How Weight Control Belief Impacts Smoking and

Quitting Among Students:

Evidence from South Carolina

Vahé Heboyan1 & Andy Pope2

presentation at the

Center for Nursing

Research (CNR) Seminar

October 10, 2014

{1} Assistant Professor, Health & Behavioral Economics, Dept. of Health Management and Informatics

{2} Clinical Assistant Professor, Health Promotion, Education, and Behavior, University of South Carolina.

Introduction | smoking facts

Tobacco is the leading cause of preventable and premature deathin US [1].

443,000 people die annually due to tobacco use.

Annually costs over $210 billion in direct medical costs and lostproductivity.

Over 3,800 young people under 18 years of age smoke their firstcigarette every day and over 1,000 become daily smokers.

Vast majority of these young Americans will become addicted tonicotine by young adulthood.

2Georgia Regents University | Dr. Vahé Heboyan | a presentation at the CNR Seminar | Oct 10, 2014

Introduction | smoking facts

Smoking causes more deaths each year than all of these combined[2]:

AIDS/HIV

Heroine, Cocaine use

Alcohol use

Motor vehicle injuries

Firearm-related incidents

40% of young adults 18-24 years of age attended college in 2013 [3].

exposed to peer-smoking, secondhand smoke, and tobacco industry promotions

19% of young adults initiate smoking at 18-24; almost none initiates after age 25 [1].

90% smokers started smoking by age 18

99% started by age 26

progression from occasional to daily smoking almost always occurs by age 26.


Introduction | weight gain concern

Belief that smoking helps to control weight is usual among youth and young adults

For some, this is an important factor in deciding to use tobacco

This belief increases with smoking experience

Is higher among women

Mixed findings regarding the association between weight gain concern and smoking decisions Initiation

Smoking frequency and quantity

Quitting

Relapse


Introduction | body image and smoking

Health beliefs, including weight gain concern andbody image, are among important factors drivingsmoking and quitting decisions

Can significantly impact effectiveness of smokingcessation programs and policies, especially onuniversity campuses.

Weight gain concerns may prevent or delay quittingdecisions by young adults resulting in lifetimepatterns and potentially affect long-term health.


Objective

estimate …

prevalence of weight control belief, and

its association with cigarette consumption and

quitting behavior by socio-economic, demographic,

and behavioral characteristics among university

students.


Data

Cross-sectional data are collected during 2013 from four public universities

in SC.

All students (5,622) were invited and 1,339 students (24%) completed an

online extensive questionnaire measuring

tobacco use

quitting behavior

beliefs about smoking and quitting

social norming

socio-economic and demographic factors.

Question of Interest has asked of how much they agree or disagree with

the “Someone who quits smoking will probably gain weight” statement.


Methods

(1) Descriptive Analysis

(2) Regression Modeling

A Tobit model is used to estimate the effects of regressors including weight gain belief on cigarette consumption.

This approach allows to model the corner solution outcome observed in cigarette consumption, which takes on the value of zero with positive probability but is continuous over strictly positive values.

𝐶𝑖 = 𝐱𝑖𝜷 + 𝑢𝑖 for all positive cigarette consumption

0 otherwise

where

Ci is the number of cigarettes smoked over the past 30 days

xi is a set of regressors (including belief about weight gain due to quitting) that are hypothesized to affect the amount of cigarette consumption. control for socio-economic, demographic, and behavioral factors as well as tobacco use status as

described.


Current use of tobacco among students … (n=1,336)

prevalence of cigarette use in SC among adults and youth: 23%

15%

5% 5%

1%

8%

1%

21%

19%

11%

14%

12%

1%

17%

9%

7%

5%

9%

1%

Cigarette Cigar e-cigarette Smokelesstobacco

Hookah Other

Female Male Total


Smoking Initiation (n=470)

1%

4%

26%

45%

19%

5%

1% 0%

8 years old oryounger

9 - 11 12 - 14 15 - 17 18 - 20 21 – 23 24 - 26 27 or older


Results | Belief about Weight Gain

Georgia Regents University | Dr. Vahé Heboyan | a presentation at the CNR Seminar | Oct 10, 201411

Smokers: majority believes that quitting may lead to weight gain

Slightly more among women

Non-Smokers: majority does not believe that quitting leads to weight gain

All students Students who smokeStudents who do not

smoke

Female Male Female Male Female Male

Strongly agree 7.4 % 8.5 % 15.2 % 16.7 % 6.0 % 5.9 %

Somewhat agree 33.1 % 31.8 % 39.2 % 35.6 % 32.0 % 30.7 %

Somewhat disagree 28.3 % 35.1 % 22.8 % 34.4 % 29.3 % 35.7 %

Strongly disagree 31.2 % 24.6 % 22.8 % 13.3 % 32.7 % 27.7 %

“Someone who quits smoking will probably gain weight”

Results


Results | Regression

Statistically significant associations …

Those who believed quitting will probably lead to weight gain, in average, smoke 54 more cigarettes per month.

Those who believe that nonsmokers are more attractive, in average, smoke 68 cigarettes less per month.

Older students tends to smoke more.

Smoking spouse/partner increases smoking by 44 per month.

African Americans smoke 102 less cigarettes per month than whites.


Results |

Weight Gain Belief and Intention to Quit among Current Smokers


Someone who quits smoking will probably gain weight

Disagree Agree Disagree Agree Disagree Agree

What best describes your intention to quit? All students Female Male

In the future, not in the next 6 months 21.1 % 28.6 % 21.2 % 31.7 % 20.9 % 23.4 %

In the next 6 months 8.3 % 7.9 % 9.1 % 6.3 % 7.0 % 10.6 %

In the next month 13.8 % 11.9 % 18.2 % 10.1 % 7.0 % 14.9 %

Not sure 44.9 % 39.7 % 42.4 % 39.2 % 48.8 % 40.5 %

Do not expect to quit 11.9 % 11.9 % 9.1 % 12.7 % 16.3 % 10.6 %

Females who disagree with belief, show higher intention to quit.

49% female vs 35% male

A significant portion (≈40-48%) uncertain about quitting.

Effective target for health promotion ?

of those who currently smoke … (216 of 1,244a)

Why would you like to quit smoking? Check up to 4.

2

5

7

10

14

17

18

18

21

27

39

45

56

68

Smoking ban

Non-smoking friends or peers

Motivated or pressured by others

Advice from medical staff

Effect of smoking on others’ health

Please someone whose opinion matters to me

Look or feel more attractive

Negative image of smoking

Be a role model

Prove I can do it

Feel better about myself

Fear of illness or death

Cost of smoking

Health concerns

number of choices (out of 347)


a out of 3 schools

of those who reported having quit for 1 day or longer … (201 of 1,244a)

During your most recent attempt to stop smoking for 1 day or longer because

you were trying to quit smoking, what were your top 4 reasons for doing so?

4

11

12

16

21

24

26

30

39

41

52

58

71

80

Smoking ban

Advice from medical staff

Non-smoking friends or peers

Motivated or pressured by others

Effect of smoking on others’ health

Be a role model

Negative image of smoking

Look or feel more attractive

Prove I can do it

Please someone whose opinion matters to me

Fear of illness or death

Feel better about myself

Cost of smoking

Health concerns

number of choices (out of 485)


a out of 3 schools

of those who reported having quit for 30 days or longer … (156 of 1,339)

since your last successful quit for 30 days or longer, what were the 2

(two) most significant reasons you began smoking AGAIN:

2

3

4

5

6

14

15

17

18

30

52

Side effects of medications that help you quit

Cost (expenses) of quitting

Other

Weight gain

Being in a relationship with someone who smokes

Withdrawal (cravings, mood swings)

Activities associated with smoking

Life-changing events

Social pressures

Enjoyed smoking

General life stress

Number of responses (out of 156)


Results

Compared to SC adult smokers (23%, 2012 BRFSS), only 15% of female and 21% of male students were smoking cigarettes.

Majority initiated in late teens and young adulthood

Almost none initiated after 24 years of age

Young adults who smoke agree that quitting will lead to weight gain compared to non-smokers.

Women slightly more

Those who believe quitting will lead to weight gain, smoke significantly more.

Females who disagree with weight gain belief, show higher intention to quit.


Conclusions

Even though, weight gain concern affects amount of cigarette smoking, it is not among the primary factors affecting decisions to relapse or quit smoking.

Effective health promotion campaigns and messaging to educate young adults is needed.

Impact of smoking on weight gain

Stress management

Financial implications of smoking

Suggesting alternative weight control mechanisms (e.g. physical activity, nutrition) may lead to decrease in the concern over weight gain due to quitting.


Select References

1. U.S. Department of Health and Human Services (DHHS). Preventing Tobacco Use Among Youth and

Young Adults: A Report of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human

Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention

and Health Promotion, Office on Smoking and Health, 2012.

2. Mokdad AH, Marks JS, Stroup DF, Gerberding JL. Actual Causes of Death in the United States. JAMA:

Journal of the American Medical Association 2004;291(10):1238–45.

3. US Census Bureau. Enrollment Status of the Population 3 Years Old and Over, by Sex, Age, Race,

Hispanic Origin, Foreign Born, and Foreign-Born Parentage: October 2013. Available at:

http://www.census.gov/hhes/school/data/cps/2013/Tab01-01.xls

4. Shang C, FJ Chaloupka; GT Fong; M Thompson; M Siahpush; W Ridgeway. “The impact of weight

control belief on cigarette consumption among Adults: Findings from the ITC Project.” The American

Society of Health Economists (ASHEcon), June 22-25, University of Southern California, Los Angeles,

CA.

5. Whooley MA, Avins AL, Miranda J, Browner WS. “Case-finding instruments for depression. Two

questions are as good as many”. Journal of General Internal Medicine, 1997 Jul;12(7):439-45.


http://www.census.gov/hhes/school/data/cps/2013/Tab01-01.xls

Georgia Regents University | Dr. Vahé Heboyan | a presentation at the CNR Seminar | Oct 10, 201421

Thank you!

How Weight Control Belief Impacts Smoking and Quitting

Among Students:

Evidence from South Carolina

Vahé Heboyan1 & Andy Pope2

Documents

How Weight Control Belief Impacts Smoking and Quitting Among … · 2020-05-12 · How Weight Control Belief Impacts Smoking and Quitting Among Students: Evidence from South Carolina