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CORK Bibliography: Alcohol, Drug Use and Weight

66 citations. January 2010 to present

Prepared: June 2011

Bauer L; Dick D; Bierut L; Bucholz K; Edenberg H; Kuperman S et al. Obesity, smoking, and frontal brain dysfunction. American Journal on Addictions 19(5): 391-400, 2010. (55 refs.)

Obesity, smoking, and conduct problems have all been associated with decrements in brain function. However, their additive and interactive effects have rarely been examined. To address the deficiency, we studied P300a and P300b electroencephalographic potentials in 218 women grouped by the presence versus absence of: (1) a BMI >= 30 kg/m2; (2) recent smoking; and (3) >= 2 childhood conduct problems. Analyses revealed smaller P300a and P300b amplitudes over the posterior scalp among recent smokers versus nonsmokers. No corresponding group differences were found in P300 latencies or frontal scalp amplitudes. The most interesting analysis result was an interaction between conduct problems and obesity limited to the frontally generated P300a component: its latency was significantly greater in women with both attributes than in those with either or neither attribute. An exploratory ANOVA, substituting the genotype of a GABRA2 SNP for conduct problems, also demonstrated an interaction with obesity affecting P300a latency. It is hypothesized that conduct problems, and a conduct-problem-associated GABRA2 genotype, decrease the age-of-onset and/or increase the lifetime duration of obesity. As a result, they may potentiate the adverse effects of obesity on frontal white matter and thereby increase P300a latency. Smoking may affect brain function by a different mechanism to reduce posterior scalp P300a and P300b amplitudes while preserving frontal scalp P300a latency and amplitude.

Benton D. The plausibility of sugar addiction and its role in obesity and eating disorders. (review). Clinical Nutrition 29(3): 288-303, 2010. (156 refs.)

Background & aims: To consider the hypothesis that addiction to food, or more specifically sucrose, plays a role in obesity and eating disorders. Methods: By considering the relevant literature a series of predictions were examined, derived from the hypothesis that addiction to sucrose consumption can develop. Fasting should increase food cravings, predominantly for sweet items; cravings should occur after an overnight fast; the obese should find sweetness particularly attractive; a high-sugar consumption should predispose to obesity. More specifically predictions based on the hypothesis that addiction to sugar is central to bingeing disorders were developed. Dieting should predate the development of bingeing; dietary style rather than psychological, social and economic factors should be predispose to eating disorders; sweet items should be preferentially consumed while bingeing; opioid antagonists should cause withdrawal symptoms; bingeing should develop at a younger age when there is a greater preference for sweetness. Results: The above predications have in common that on no occasion was the behaviour predicted by an animal model of sucrose addiction supported by human studies. Conclusion: There is no support from the human literature for the hypothesis that sucrose may be physically addictive or that addiction to sugar plays a role in eating disorders.

Bigaard J; Christensen J; Tjonneland A; Thomsen BL; Overvad K; Sorensen TIA. Influence of lifestyle aspects on the association of body size and shape with all-cause mortality in middle-aged men and women. Obesity Facts 3(4): 252-260, 2010. (28 refs.)

Objective: Waist circumference, BMI and hip circumference are differentially associated with mortality. We investigated the potential influence of selected lifestyle aspects such as smoking, alcohol intake, sports activity and education. Method: The Danish prospective study 'Diet, Cancer and Health' recruited 27,179 men and 29,875 women from 1993 to 1997. Cox regression models were used to estimate mortality rate ratios. Results: Adjustment for smoking habits attenuated the associations between mortality and the three body size measurements in both sexes. Adjustment for sport activity and, to a lesser extent, alcohol intake weakened the associations further for the men, whereas alcohol intake slightly weakened associations for the women. In the fully adjusted models, mortality increased highly significantly with higher waist circumference and lower hip circumference, and decreased highly significantly with higher BMI for BMI below 25 kg/m(2). This pattern was seen for all levels of the selected lifestyle factor. Conclusion: A large waist circumference remained a strong risk indicator for mortality, and a large hip circumference appeared to be protective when smoking habits, alcohol intake and sport activity were accounted for. BMI below 25 kg/m(2) remained a risk factor, but not above 25 kg/m(2) once waist circumference was adjusted for.

Breitling LP; Arndt V; Drath C; Rothenbacher D; Brenner H. Smoking and gamma-glutamyltransferase: Opposite interactions with alcohol consumption and body mass index. PLoS ONE 5(9): e-article 13116, 2010. (32 refs.)

Background: Smoking has recently been suggested to synergistically interact with alcohol intake as a determinant of serum gamma-glutamyltransferase (gamma-GT), an emergent powerful predictor of disease and mortality. This study investigated whether this also applies to higher smoking and alcohol exposure ranges and to body mass index (BMI), which likewise is strongly associated with gamma-GT. Methodology/Principal Findings: Analyses were based on occupational health examinations of more than 15,000 German male workers aged 16-64 years, predominantly from the construction industry. Sociodemographics and other health-related information were collected during the exam. Joint associations of smoking and alcohol consumption or BMI with elevated or log-transformed gamma-GT were examined by tabulation and multiple adjusted regression models. Cigarette smoking exerted no effect on gamma-GT in teetotalers, but there was a statistically significant effect of smoking among participants with higher alcohol consumption intensity, odds of elevated gamma-GT being increased by 24% and 27% per additional 10 cigarettes smoked per day in subjects drinking 61-90 and > 90 gram alcohol per day, respectively (P for interaction = 0.039). The interaction was opposite for BMI, where no association was seen in obese subjects, whereas odds of elevated gamma-GT were increased by 24% per 10 cigarettes below 25 kg/m(2) (P for interaction = 0.040). This novel interaction was replicable in an independent cohort. Conclusion: The evidence for opposite interactions of smoking with alcohol and BMI as determinants of serum gamma-GT suggests that different physiological pathways are responsible for the associations between these factors.

Brook DW; Zhang CS; Brook JS; Finch SJ. Trajectories of cigarette smoking from adolescence to young adulthood as predictors of obesity in the mid-30s. Nicotine & Tobacco Research 12(3): 263-270, 2010. (37 refs.)

The purpose of this longitudinal study was to examine the relationship between two major health problems, smoking and obesity, and to determine to what extent trajectories of cigarette smoking from early adolescence to young adulthood are related to obesity in the mid-30s. Participants (N = 806) were interviewed using a structured questionnaire at 6 points in time over a period of 23 years. Semiparametric group-based modeling and logistic regression analyses were used to analyze the data. The main outcome measure was obesity, assessed by body mass index in the mid-30s. Five distinct trajectories of tobacco use were identified (N = 806): heavy/continuous smokers, late starters, quitters/decreasers, occasional smokers, and nonsmokers. Compared with nonsmokers, heavy/continuous smokers or late starters had a significantly lower likelihood of obesity. Also, compared with nonsmokers or occasional smokers, heavy/continuous smokers or late starters had a significantly lower likelihood of being overweight or obese. Smoking cessation programs should focus on weight control methods, such as physical exercise and learning healthy habits. In addition, weight control programs should incorporate smoking cessation efforts as integral components.

Buja A; Scafato E; Sergi G; Maggi S; Suhad MA; Rausa G et al. Alcohol consumption and metabolic syndrome in the elderly: Results from the Italian longitudinal study on aging. European Journal of Clinical Nutrition 64(3): 297-307, 2010. (44 refs.)

Background/Objectives: Although there is plenty of evidence of the association between metabolic syndrome ( MS) and cardiovascular disease, the relationship between alcohol consumption and MS is still questioned. The few publications with respect to the elderly seem to indicate that alcohol consumption is unassociated with MS. The aim of this study was to assess the association between alcohol consumption and the prevalence and incidence of MS, as well as its components in a large sample of Italian elderly people. Subjects/Methods: This is a multicenter study on a population-based sample of Italian people aged 65-84 years. The Italian Longitudinal Study on Aging (ILSA) included a prevalence phase in 1992 and an incidence phase from 1995 to 1996. The median length of follow-up was 3.5 years. In the present study, the analysis included 1321 men grouped into five alcohol consumption classes: abstainers, and those consuming <= 12, 13-24, 25-47 or >= 48 g of alcohol in a day. Among the 1122 women considered, the last two of the above five categories were pooled together ( 424 g/day). MS was defined according to ATP III criteria. All statistical analyses were stratified by gender. Results: Adjusted odds ratios showed that categorized alcohol consumption was not significantly associated with the prevalence and incidence of MS when compared with abstainers in either gender. For the MS incidence survey, three of five components (systolic pressure, glycemia and waist circumference) proved to be significantly and harmfully affected by alcohol consumption in males, whereas no such significant association emerged in females. Conclusions: These results suggest that alcohol can modify an individual's metabolic condition and that, even among the elderly, men might be more sensitive to the effects of alcohol than women.

Cavallo DA; Smith AE; Schepis TS; Desai R; Potenza MN; Krishnan-Sarin S. Smoking expectancies, weight concerns, and dietary behaviors in adolescence. Pediatrics 126(1): E66-E72, 2010. (23 refs.)

OBJECTIVE: The objective of this study was to examine the association of cigarette smoking and weight concerns in adolescents, given that adolescents may begin smoking or have difficulty quitting because of their expectancies of the effects of smoking on body weight. METHODS: This study used data from a cross-sectional survey of 4523 Connecticut high school adolescents to assess the influence of gender, smoking intensity, and dietary-restrictive behavior on smoking-related weight concerns. RESULTS: Heavy smokers were significantly less likely to engage in healthy dietary restrictions than nonsmokers; however, light smokers did not differ from nonsmokers. Both light and heavy smokers were significantly more likely to engage in unhealthy dietary restriction when compared with nonsmokers. In the model that was used to examine smokers only, heavy smokers were significantly less likely to engage in healthy dietary restriction than light smokers, but smoking level was not associated with unhealthy dietary restrictions. Dietary restrictions are significantly associated with smoking-related weight concerns; however, this seems to be related to type of dietary-restrictive behavior, with greater weight concerns observed only in those smokers who engaged in unhealthy dietary restrictions and not in those who engaged in healthy dietary restrictions or no restrictions. CONCLUSIONS: Although limited by its cross-sectional nature, the findings from this large, geographically diverse sample have clinical implications for smoking prevention and cessation interventions in adolescents.

Clair C; Chiolero A; Faeh D; Cornuz J; Marques-Vidal P; Paccaud F et al. Dose-dependent positive association between cigarette smoking, abdominal obesity and body fat: Cross-sectional data from a population-based survey. BMC Public Health 11: e-article 23, 2011. (41 refs.)

Background: Although smokers tend to have a lower body-mass index than non-smokers, smoking may favour abdominal body fat accumulation. To our knowledge, no population-based studies have assessed the relationship between smoking and body fat composition. We assessed the association between cigarette smoking and waist circumference, body fat, and body-mass index. Methods: Height, weight, and waist circumference were measured among 6,123 Caucasians (ages 35-75) from a cross-sectional population-based study in Switzerland. Abdominal obesity was defined as waist circumference >= 102 cm for men and >= 88 cm for women. Body fat (percent total body weight) was measured by electrical bioimpedance. Age-and sex-specific body fat cut-offs were used to define excess body fat. Cigarettes smoked per day were assessed by self-administered questionnaire. Age-adjusted means and odds ratios were calculated using linear and logistic regression. Results: Current smokers (29% of men and 24% of women) had lower mean waist circumference, body fat percentage, and body-mass index compared with non-smokers. Age-adjusted mean waist circumference and body fat increased with cigarettes smoked per day among smokers. The association between cigarettes smoked per day and body-mass index was non-significant. Compared with light smokers, the adjusted odds ratio (OR) for abdominal obesity in men was 1.28 (0.78-2.10) for moderate smokers and 1.94 (1.15-3.27) for heavy smokers (P = 0.03 for trend), and 1.07 (0.72-1.58) and 2.15 (1.26-3.64) in female moderate and heavy smokers, respectively (P < 0.01 for trend). Compared with light smokers, the OR for excess body fat in men was 1.05 (95% CI: 0.58-1.92) for moderate smokers and 1.15 (0.60-2.20) for heavy smokers (P = 0.75 for trend) and 1.34 (0.89-2.00) and 2.11 (1.253.57), respectively in women (P = 0.07 for trend). Conclusion: Among smokers, cigarettes smoked per day were positively associated with central fat accumulation, particularly in women.

Cropsey KL; McClure LA; Jackson DO; Villalobos GC; Weaver MF; Stitzer ML. The impact of quitting smoking on weight among women prisoners participating in a smoking cessation intervention. American Journal of Public Health 100(8): 1442-1448, 2010. (35 refs.)

Objectives. We examined the impact of smoking cessation on weight change in a population of women prisoners. Methods. Women prisoners (n=360) enrolled in a smoking cessation intervention; 250 received a 10-week group intervention plus transdermal nicotine replacement. Results. Women who quit smoking had significant weight gain at 3- and 6-month follow-ups, with a net difference of 10 pounds between smokers and abstainers at 6 months. By the 12-month follow-up, weight gain decreased among abstainers. Conclusions. We are the first, to our knowledge, to demonstrate weight gain associated with smoking cessation among women prisoners. Smoking cessation interventions that address postcessation weight gain as a preventative measure may be beneficial in improving health and reducing the high prevalence of smoking in prisoner populations.

Dhariwal M; Rasmussen M; Holstein BE. Body mass index and smoking: Cross-sectional study of a representative sample of adolescents in Denmark. International Journal of Public Health 55(4): 307-314, 2010. (42 refs.)

To quantify the association between body mass index (BMI) and smoking (at all and daily smoking) stratified by gender, family social class, and ethnicity among adolescents aged between 13 and 15. The analyses were based on the Danish contribution to the international Health Behaviour in School-aged Children survey in 2002 with self-reported data on height, weight, and smoking behaviour. The study population comprised 3,072 students aged between 13 and 15 (1,512 boys and 1,560 girls). Logistic regression analysis was used to quantify the association. Odds of at all smoking by BMI (per step) was 1.10 (95% CI 1.03-1.17) among boys but there was no association among girls (OR 0.98, 95% CI 0.93-1.04). No significant association was found for daily smoking and BMI. The association between at all smoking and BMI (per step) was significant among boys of middle social class (OR 1.13, 95% CI 1.03-1.24) and Danish ethnicity (OR 1.10, 95% CI 1.02-1.19). Significant association exists between smoking and BMI among boys of Danish ethnicity and middle family social class only.

Duncan AE; Lessov-Schlaggar CN; Nelson EC; Pergadia ML; Madden PAF; Heath AC. Body mass index and regular smoking in young adult women. Addictive Behaviors 35(11): 983-988, 2010. (56 refs.)

Little is known about the relationship between relative body weight and transition from experimentation to regular smoking in young adult women. In the current study, data from 2494 participants in wave 4 of the Missouri Adolescent Female Twin Study (aged 18-29 years) who reported ever smoking a cigarette were analyzed using logistic regression. Body mass index (BMI) at time of interview was categorized according to CDC adult guidelines, and regular smoking was defined as having ever smoked 100 or more cigarettes and having smoked at least once a week for two months in a row. Since the OR's for the overweight and obese groups did not differ significantly from one another in any model tested, these groups were combined. Forty-five percent of women who had ever smoked had become regular smokers. Testing of interactions between potential covariates and levels of the categorical BMI variable revealed a significant interaction between overweight/obesity and childhood sexual abuse (CSA; p<0.001) associated with regular smoking. Among women reporting CSA, the association between overweight/obesity and having become a regular smoker was negative (n = 374; OR = 0.48, 95% Cl: 0.28-0.81). Both underweight and overweight/obesity were positively associated with transition to regular smoking among women who did not report CSA (n = 2076; OR = 1.57,95% Cl: 1.05-2.35 and OR = 1.73, 95% Cl: 1.35-2.20, respectively). These results suggest that experiencing CSA alters the association between BMI and regular smoking in women who have experimented with cigarettes.

Farhat T; Iannotti RJ; Simons-Morton BG. Overweight, obesity, youth, and health-risk behaviors. American Journal of Preventive Medicine 38(3): 258-267, 2010. (50 refs.)

Background: The prevalence and severity of obesity have increased among children and adolescents. Although the medical and psychosocial consequences of youth obesity have been well documented, comparatively less information exists on the association of overweight/obesity with healthrisk behaviors, which are considered to be a primary threat to adolescent health. Purpose: This study aims to examine the association of overweight and obesity with health-risk behaviors among U.S. youth. Methods: Self-reported height and weight, substance use, violence, and bullying were assessed in a nationally representative sample of students aged 11-17 years (N=7825) who participated in the 2005-2006 Health Behaviors in School-Aged Children survey. Data were analyzed in 2009. Results: Significant gender and age differences in the relationship of overweight/ obesity with risk behaviors were observed. Overweight and obesity were significantly associated with substance use among girls only: Frequent smoking and drinking were associated with overweight and obesity among younger girls, whereas these behaviors were associated with obesity among older girls. Frequent smoking and cannabis use were associated with over-weight among younger girls only. Relationships between violent behavior and overweight/obesity were mainly observed among boys: Younger obese boys were more likely to be victims of bullying, whereas older obese boys were more likely to carry weapons compared to boys of normal weight. Conclusions: Overweight and obese young people are at risk of developing health-compromising behaviors that may compound medical and social problems associated with excess weight.

Ferguson SG; Shiffman S; Rohay JM; Gitchell JG; Garvey AJ. Effect of compliance with nicotine gum dosing on weight gained during a quit attempt. Addiction 106(3): 651-656, 2011. (24 refs.)

Aim: Using nicotine gum can reduce the amount of weight gained when quitting. Here we examine the relationship between weight gain and use of adequate amounts of gum. To mitigate the confounders associated with correlational analyses, we contrast the effects of active gum and placebo, and analyze outcomes prospectively. Design and setting Randomized double-blind placebo-controlled trial of nicotine gum. Participants were instructed to use nine to 15 pieces of gum/day for the first 2 months of treatment. Participants: Participants (n = 103) were randomized to either active (2 mg or 4 mg) or placebo gum. Measurements: We examined the effect on weight gain of the interaction between treatment (active versus placebo) and daily gum use [>= 9 pieces/day (compliant use) versus < 9 pieces/day]. Findings: After 30 days of abstinence, smokers treated with active gum had not gained significantly less weight than those on placebo (1.1 kg versus 1.6 kg, P = 0.175). However, a significant compliance-treatment interaction was observed (P = 0.005): active gum users who used >= 9 pieces/day during the first 14 days of treatment had gained less weight at follow-up (0.6 kg versus 1.6 kg for those who used < 9 pieces/day, P = 0.017), but participants randomized to the placebo group saw no such benefit from compliant use. A similar compliance-treatment interaction (P = 0.046) was also observed when the effect of compliance was examined within active treatment (2 mg versus 4 mg). Conclusions: When smokers are quitting, those who use more pieces of nicotine gum experience less weight gain in the first 30 days. This relationship is not seen for smokers on placebo gum.

Fountoulakis KN; Siamouli M; Panagiotidis P; Magiria S; Kantartzis S; Papastergiou N et al. Obesity and smoking in patients with schizophrenia and normal controls: A case-control study. Psychiatry Research 176(1): 13-16, 2010. (20 refs.)

Cardiovascular risk factors, especially obesity and smoking are highly prevalent in patients with schizophrenia. Central obesity and the metabolic syndrome are conditions mostly attributed to the use of antipsychotic medication and lifestyle habits, and they constitute a significant health concern. Our study sample included 105 patients suffering from schizophrenia aged 36.25 +/- 10.03 and 156 normal control subjects aged 36.03 +/- 11.33. All patients were in- or out-patients of a private hospital. Clinical diagnosis was made according to DSM-IV-TR criteria. Height, weight, waist circumference and number of cigarettes smoked daily were recorded. Duration of illness was calculated based on records concerning the age of first onset of psychotic symptoms. Body Surface Area (BSA) and Body Mass Index (BMI) were calculated as well as % body fat, with the use of LifeWise (TM) Body Fat Analyzers No 63-1525. The results of analysis of variance suggested a significant main effect regarding diagnosis and sex as well as for their interaction. There were significant differences between patients and controls regarding body weight, waist circumference, BMI, BSA and % body fat, with patients, espectially females, being more obese than controls. The results of the present study corroborate the increased prevalence of obesity in schizophrenia. The interpretation of this finding remains unclear.

French MT; Norton EC; Fang H; Maclean JC. Alcohol consumption and body weight. Health Economics 19(7): 814-832, 2010. (86 refs.)

The number of Americans who are overweight or obese has reached epidemic proportions. Elevated weight is associated with health problems and increased medical expenditures. This paper analyzes Waves 1 and 2 of the National Epidemiological Survey of Alcohol and Related Conditions to investigate the role of alcohol consumption in weight gain. Alcohol is not only an addictive substance but also a high-calorie beverage that can interfere with metabolic function and cognitive processes. Because men and women differ in the type and amount of alcohol they consume, in the biological effects they experience as a result of alcohol consumption, and in the consequences they face as a result of obesity, we expect our results to differ by gender. We use first-difference models of body mass index (BMI) and alcohol consumption (frequency and intensity) to control for time-invariant unobservable factors that may influence changes in both alcohol use and weight status. Increasing frequency and intensity of alcohol use is associated with statistically significant yet quantitatively small weight gain for men but not for women. Moreover, the first-difference results are much smaller in magnitude and sometimes different in sign compared with the benchmark pooled cross-sectional estimates.

Gastaldelli A; Folli F; Maffei S. Impact of tobacco smoking on lipid metabolism, body weight and cardiometabolic risk. (review). Current Pharmaceutical Design 16(23): 2526-2530, 2010. (70 refs.)

Tobacco smoking is the most important preventable cause of cardiovascular disease. In this paper we review current epidemiological and pathophysiological evidence linking smoking with cardiovascular and metabolic diseases. Among the effects of smoking there is the alteration of lipid metabolism through the increase in lipolysis, insulin resistance and tissue lipotoxicity. Smoking is both prothrombotic and atherogenic. As an effect, the risk of acute myocardial infarction, sudden cardiac death, stroke, aortic aneurysm and peripheral vascular disease is increased. Even very low doses of exposure increase the risk of cardiovascular disease (CVD) and metabolic alterations. On the other hand, smoking cessation restores, at least in part, lipid metabolism and the benefits can be observed already after a short period of abstinence from smoking, although it occurs several years before the risks approach those of the never-smoker.

Gazdzinski S; Durazzo TC; Mon A; Meyerhoff DJ. Body mass index is associated with brain metabolite levels in alcohol dependence: A multimodal magnetic resonance study. Alcoholism: Clinical and Experimental Research 34(12): 2089-2096, 2010. (67 refs.)

Background: Recent studies demonstrated that alcohol dependence and excessive alcohol consumption are associated with increased rates of obesity. In healthy light-drinkers, we and others have observed associations between elevated body mass index (BMI) and reductions in brain volumes, lower concentrations of N-acetyl-aspartate (NAA, marker of neuronal viability) and choline-containing compounds (Cho, involved in membrane turnover), and lower glucose utilization, particularly in frontal lobe-a brain region that is particularly vulnerable to the effects of alcohol dependence. Here, we evaluated whether BMI in alcohol-dependent individuals was independently associated with regional measures of brain structure, metabolite concentrations, and neocortical blood flow. Methods: As part of a study on the effects of alcohol dependence on neurobiology, we analyzed retrospectively data from 54 alcohol-dependent males, abstinent from alcohol for about 1 month and with BMI between 20 and 37 kg/m(2) by structural MRI, perfusion MRI (blood flow), and proton magnetic resonance spectroscopic imaging. Results: After correction for age, smoking status, and various measures of alcohol consumption, higher BMI was associated with lower concentrations of NAA, Cho, creatine and phosphocreatine (Cr, involved in high energy metabolism), and myo-inositol (m-Ino, a putative marker of astrocytes) primarily in the frontal lobe, in subcortical nuclei, and cerebellar vermis (p < 0.004). Regional brain volumes and perfusion were not significantly related to BMI. Furthermore, comorbid conditions, clinical laboratory measures, and nutritional assessments were not significant predictors of these MR-based measures. Conclusions: The results suggest that BMI, independent of age, alcohol consumption, and common comorbidities, is related to regional NAA, Cho, Cr, and m-Ino concentrations in this cohort of alcohol-dependent individuals. Additionally, as some common comorbid conditions in alcohol dependence such as cigarette smoking are associated with BMI, their associations with regional brain metabolite levels in alcohol-dependent individuals may also be influenced by BMI.

Grucza RA; Krueger RF; Racette SB; Norberg KE; Hipp PR; Bierut LJ. The emerging link between alcoholism risk and obesity in the United States. Archives of General Psychiatry 67(12): 1301-1308, 2010. (62 refs.)

Context: The prevalence of obesity has risen sharply in the United States in the past few decades. Etiologic links between obesity and substance use disorders have been hypothesized. Objective: To determine whether familial risk of alcohol dependence predicts obesity and whether any such association became stronger between the early 1990s and early 2000s. Design: We conducted analyses of the repeated cross-sectional National Longitudinal Alcohol Epidemiologic Survey (1991-1992) and National Epidemiologic Survey on Alcohol and Related Conditions (2001-2002). Setting: The noninstitutionalized US adult population in 1991-1992 and 2001-2002. Participants: Individuals drawn from population-based, multistage, random samples (N=39 312 and 39 625). Main Outcome Measure: Obesity, defined as a body mass index (calculated from self-reported data as weight in kilograms divided by height in meters squared) of 30 or higher and predicted from family history of alcoholism and/or problem drinking. Results: In 2001-2002, women with a family history of alcoholism (defined as having a biological parent or sibling with a history of alcoholism or alcohol problems) had 49% higher odds of obesity than those without a family history (odds ratio, 1.48; 95% confidence interval, 1.360-1.61; P<.001), a highly significant increase (P<.001) from the odds ratio of 1.06 (95% confidence interval, 0.97-1.16) estimated for 1991-1992. For men in 2001-2002, the association was significant (odds ratio, 1.26; 95% confidence interval, 1.14-1.38; P<.001) but not as strong as for women. The association and the secular trend for women were robust after adjustment for covariates, including sociodemographic variables, smoking status, alcohol use, alcohol or drug dependence, and major depression. Similar trends were observed for men but did not meet statistical significance criteria after adjustment for covariates. Conclusions: These results provide epidemiologic support for a link between familial alcoholism risk and obesity in women and possibly in men. This link has emerged in recent years and may result from an interaction between a changing food environment and predisposition to alcoholism and related disorders.

Harakeh Z; Engels RCME; Monshouwer K; Hanssen PF. Adolescent's weight concerns and the onset of smoking. Substance Use & Misuse 45(12): 1847-1860, 2010. (29 refs.)

The hypothesis that adolescents start smoking because they perceive it as a strategy to control their weight was examined. At the same time, we controlled for sociodemographic, individual, and parental factors. Longitudinal data were collected among 428 Dutch families (mother, father, and two siblings between 13 and 16 years of age) in two measurements: the first in 2002-2003 and the second a year later. Logistic regression analyses supported the hypothesis: weight control motives to smoke were positively related with smoking initiation. The study's limitations and implications are discussed.

Harris KM; Lee H; DeLeone FY. Marriage and health in the transition to adulthood: Evidence for African Americans in the Add Health Study. Journal of Family Issues 31(8): 1106-1143, 2010. (75 refs.)

This article explores the relationships among early marriage (before age 26 years), cohabitation, and health for African Americans and Whites during the transition to adulthood using the National Longitudinal Study of Adolescent Health (Add Health). The study examines three categories of health outcomes relevant to young adulthood: physical health, mental health, and health risk behaviors. Lagged dependent variable models are used to examine the health effects of early marriage and cohabitation accounting for potential health selection into unions. The results indicate that early marriage by young adults does not have protective effects for African Americans; the authors also find more negative effects for African American men than for women. There are mixed results for Whites with some protective effects of marriage for binge drinking. Early marriage for African Americans and Whites is associated with increased body mass index. Cohabitation is uniformly associated with negative health outcomes for all racial and gender groups.

Hatzis CM; Papandreou C; Kafatos AG. School health education programs in Crete: Evaluation of behavioural and health indices a decade after initiation. Preventive Medicine 51(3-4): 262-267, 2010, 2010. (32 refs.)

Objective. To assess the long-term effectiveness of a school-based health education intervention program 10 years after its initiation. Method. In 1992 the total population of first grade students from three counties of Crete participated in the study. Over 1000 students were randomly selected for initial and periodic evaluation. Biochemical and behavioural parameters (anthropometric, lipoproteins, blood pressure, physical activity, dietary record and health habits) were measured. Re-evaluation of the program was performed at 3, 6 and 10 years after its initiation. Results. Ten years after the initiation of the program, the results showed that BMI had increased significantly less (p < 0.001) and performance in the shuttle run test was significantly better (p < 0.001) in the intervention group as compared to the control group. The reduction in total cholesterol noted in both groups was significantly greater in the intervention group than in the control group (p < 0.001). The incidence of smoking was also significantly lower in the intervention group (intervention group 7%, control group 13%, p < 0.005). Conclusion. This program appears to improve children's health and decrease risk factors for chronic diseases. If these positive effects are maintained in the forthcoming decades, the risk of chronic diseases may well be reduced.

Hayatbakhsh MR; O'Callaghan MJ; Mamun AA; Williams GM; Clavarino A; Najman JM. Cannabis use and obesity and young adults. American Journal of Drug and Alcohol Abuse 36(6): 350-356, 2010. (28 refs.)

Background: There is shortage of evidence about the relationship between use of cannabis and obesity. Objectives: This study aimed to examine the association between cannabis use and overweight/obesity in young adults. Methods: Data were from a 21-year follow-up of mothers and their children recruited into the Mater-University of Queensland Study of Pregnancy (MUSP), a longitudinal pre-birth cohort. The study is based on 2566 young adults (1264 males and 1302 females) who had data available on cannabis use and age of initiation to use of cannabis and BMI at the 21-year follow-up (MUSP children). Those who did not provide data on cannabis use and BMI were excluded from the analysis. Results: Frequency of cannabis use and body mass index (BMI) was assessed at the 21-year follow-up. Potential confounders were prospectively measured between the child's birth and the 21-year follow-up. Some 50.9% of young adults reported use of cannabis in the last month or year and 34.1% had BMI <= 25. Multivariate analysis showed that those who had used cannabis were less likely to be categorised in the BMI >= 25 group with the least prevalence of overweight/obesity being observed in every day cannabis users (odds ratio = .2; 95% confidence interval [CI]:. 1-.4). Conclusions and Scientific Significance: The existing data suggest lower prevalence of overweight and obesity among young adult cannabis users. Further research is needed to examine the mechanism of this association.

Ikeda M; Maki T; Yin G; Kawate H; Adachi M; Ohnaka K et al. Relation of coffee consumption and serum liver enzymes in Japanese men and women with reference to effect modification of alcohol use and body mass index. Scandinavian Journal of Clinical & Laboratory Investigation 70(3): 171-179, 2010. (36 refs.)

Objective. Previous studies have shown that coffee consumption is inversely related to serum levels of liver enzymes such as alanine aminotransferase (ALT), aspartate aminotransferase (AST), and gamma-glutamyl transferase (GGT), but few have addressed the relation in women and effect modifications of alcohol use and obesity. We examined the association of coffee and green tea consumption with serum activities of liver enzymes in free-living Japanese men and women, focusing on sex difference and effect modifications of alcohol and obesity. Material and methods. The data were derived from the baseline survey of the Kyushu University Fukuoka Cohort Study, and included 12,020 Japanese men and women aged 49-76 years who were free of chronic liver diseases. Results. There was an inverse association between coffee consumption and elevated ALT in men, and the association between the two was weaker in women. In the analyses stratified by aminotransferases category, inverse associations of coffee consumption with serum activities of liver enzymes were observed in both men and women within the whole range and among those with aminotransferases within the reference range (ALT/AST < 40 IU/L for men and ALT/AST < 30 IU/L for women). Inverse associations of coffee with liver enzymes were more evident in those with high alcohol consumption and in those with low body mass index. Conclusions. Coffee drinking probably confers protection against alcohol-related increase in liver enzymes.

Iliadou AN; Koupil I; Villamor E; Altman D; Hultman C; Langstrom N et al. Familial factors confound the association between maternal smoking during pregnancy and young adult offspring overweight. International Journal of Epidemiology 39(5): 1193-1202, 2010. (36 refs.)

Methods: In a population-based Swedish cohort comprising 124 203 singleton males born to Nordic mothers between 1983 and 1988, we examined the association between maternal smoking during pregnancy and the risk of overweight in the offspring at age similar to 18 years. We also investigated the association within siblings, controlling for common genes and shared environment. Results: In the cohort analyses, the risk of overweight was increased in sons of smoking mothers compared with sons of non-smokers: adjusted odds ratios 1.41, 95% confidence interval (CI) 1.34-1.49, and 1.56, 95% CI 1.46-1.66, for one to nine cigarettes per day, and > 10 cigarettes per day, respectively. Stratifying for maternal smoking habits across two subsequent male pregnancies, there was an increased risk of overweight for the second son only if the mother was smoking in both male pregnancies. The effect of smoking during pregnancy on the offspring's body mass index was not present when the association was evaluated within full and half sibling pairs. Conclusion: The association between maternal smoking during pregnancy and offspring's risk of overweight appears to be confounded by familial factors.

Johansson S; Wilhelmsen L; Welin C; Eriksson H; Welin L; Rosengren A. Obesity, smoking and secular trends in cardiovascular risk factors in middle-aged women: data from population studies in Goteborg from 1980 to 2003. Journal of Internal Medicine 268(6): 594-603, 2010. (49 refs.)

Background. To study the trends in cardiovascular risk factors in middle-aged city-dwelling Swedish women from 1980 to 2003. Methods. Using cross-sectional population-based surveys, five random population samples of a total of 1915 women aged between 45 and 54 years, participating in the BEDA study in 1980, WHO MONICA studies in 1985, 1990 and 1995, and a study of 50-year-old women in 2003 were measured for the following parameters: anthropometry, serum cholesterol and triglyceride levels, smoking habits, blood pressure, physical activity and stress. Results. Over almost 25 years, middle-aged women gained on average 4.4 kg in weight, with a net increase in body mass index (BMI) from 24.7 to 25.6 kg m-2. The proportion of participants classified as obese (>= 30 kg m-2) increased by 50% from 10.4% to 15.1%. Women who were smokers in 2003 did not have lower BMI values than nonsmokers. Mean serum cholesterol concentrations decreased markedly, whereas smoking habits did not significantly change. The prevalence of hypertension decreased by 8%, whereas that of diabetes remained stable at around 2%. Optimal risk factor status - no smoking, normotension and serum cholesterol < 5 mmol l-1- was present in less than one in six women in 2003, and similar across BMI categories. Conclusion. The favourable decline in cholesterol levels and hypertension and the increase in leisure time physical activity were offset by an increase in obesity, triglyceride levels and experience of stress, with only a minority of participants (less than one in six) having an optimal level of risk factors with respect to smoking, serum cholesterol and hypertension in 2003. This applied also to overweight and obese women. In earlier cohorts, subjects with low BMI values were more often smokers, whereas the opposite is observed in recent cohorts. Thus, women who smoke no longer have the advantage of lower weight.

Kadota K; Takeshima F; Inoue K; Takamori KI; Yoshioka S; Nakayama S et al. Effects of smoking cessation on gastric emptying in smokers. Journal of Clinical Gastroenterology 44(4): E71-E75, 2010. (35 refs.)

Background: Smoking cessation can lead to changes in appetite and weight gain in some patients; thus, smoking cessation may alter gastrointestinal motility. Effects of smoking cessation on gastric emptying in smokers have not been established. Aim: This study sought to determine how smoking cessation affects gastric emptying in smokers. Methods: Participant group comprised 53 habitual smokers and 12 healthy nonsmokers. Habitual smokers were treated for 2 months with transdermal nicotine patches. Gastric emptying was studied using C-13 acetate breath tests at the beginning of the study, and at 1 week and 9 weeks after cessation of patch use. Maximal (CO2)-C-13 excretion time (T-max), (CO2)-C-13 excretion half-life (T-1/2), and parameters beta and kappa, representing initial and subsequent gastric-emptying phases, respectively, were determined using conventional formulae. Results: Before smoking cessation, T-max was reached significantly later in smokers (0.94 +/- 0.3 h, P = 0.014) than in controls (0.89 +/- 0.1 h). At 1 week after the end of treatment, Tmax was significantly decreased (from 1.05 +/- 0.32 h to 0.72 +/- 0.64 h, P= 0.003). T-1/2 also tended to decrease, but not significantly. Although beta was decreased significantly (from 2.46 +/- 0.40 to 2.17 +/- 0.58, P = 0.022), kappa was unchanged. However, by 9 weeks after the end of treatment, T-max (1.28 +/- 0.69 h) had increased to levels seen before treatment. Conclusions: Smoking cessation temporarily accelerates gastric emptying, and decreases in beta suggest that initial-phase gastric emptying accelerates after smoking cessation. The temporary acceleration of gastric emptying after smoking cessation may be involved in the temporary increase in appetite and weight gain seen after smoking cessation.

Kamerow D. Yankee doodling smoking versus obesity: Must we target only one? (editorial). British Medical Journal 341(c4631), 2010. (6 refs.)

Kleppinger A; Litt MD; Kenny AM; Oncken CA. Effects of smoking cessation on body composition in postmenopausal women. Journal of Women's Health 19(9): 1651-1657, 2010. (36 refs.)

Background: Smoking cessation is associated with weight gain, but the effects of smoking cessation on measures of body composition (BC) have not been adequately evaluated. The purpose of this study is to examine the effects of 16 months of cigarette abstinence on areas of BC measured by dual-energy x-ray absorptiometry (DXA). Methods: One hundred fifty-two postmenopausal women participated in a smoking cessation study using the nicotine patch. Secondary analyses were conducted on data from 119 subjects (age 56 +/- 7 years, range 41-78 years) who had had DXA scans at baseline and 16 months later. Participants were classified either as quitters (self-reported cigarette abstinence confirmed with exhaled carbon monoxide [co] <= 8 ppm at 3 and 16 months after quit date) or as continued smokers. BC was assessed using a General Electric Lunar DXA IQ machine. Four areas of BC (kg) were measured: whole body weight, fat mass, muscle mass, and functional skeletal muscle mass in arms and legs (ASM/ht(2)). Multivariate analysis of covariance (MANCOVA) assessed changes in BC in quitters vs. continued smokers between baseline and 16 months of follow-up. Increases in BC measures were evaluated as a function of increased calorie intake or change in physical activity, using linear regression. Results: Quitters significantly increased body weight (p < 0.001), fat mass (p < 0.001), muscle mass (p = 0.04), and functional muscle mass (p = 0.004) over time, when baseline BC measures and other confounding factors were controlled. Regression analysis indicated change in BC could not be accounted for by calorie intake or physical activity. Conclusions: Smoking cessation may be associated with increased fat and muscle mass in postmenopausal women. The novel finding of an increase in functional muscle mass suggests that smoking cessation could increase functional capacity. Further studies need to replicate these findings and examine mechanisms of these effects.

Kwok MK; Schooling CM; Lam TH; Leung GM. Paternal smoking and childhood overweight: Evidence from the Hong Kong "Children of 1997". Pediatrics 126(1): E46-E56, 2010. (50 refs.)

OBJECTIVE: This study examined, in a non-Western sociohistorical context, whether prenatal or postnatal secondhand smoke (SHS) exposure for children of nonsmoking mothers was associated with higher childhood BMI, and it clarified whether the observed associations were biologically mediated or socioeconomically confounded. METHODS: A total of 6710 and 6519 children of nonsmoking mothers (N = 7924) with BMI data at similar to 7 and similar to 11 years, respectively, from a population-representative (N = 8327), Hong Kong Chinese birth cohort ("Children of 1997"), born in April or May 1997, were included in the analysis. RESULTS: Compared with no SHS exposure, daily paternal smoking increased mean BMI z scores, but not height, at 7 years (difference: 0.10 [95% confidence interval: 0.02-0.19]) and at 11 years (difference: 0.16 [95% confidence interval: 0.07-0.26]), with adjustment for gender, birth order, socioeconomic position, mother's place of birth, breast-feeding, serious morbidity, and pubertal status. CONCLUSIONS: Our findings, although preliminary, suggest that the association of paternal smoking with child overweight might be biologically mediated. Given the known harms of smoking, reducing SHS exposure from conception as a precautionary action for childhood overweight might be warranted.

Leeman RF; O'Malley SS; White MA; Mckee SA. Nicotine and food deprivation decrease the ability to resist smoking. Psychopharmacology 212(1): 25-32, 2010. (39 refs.)

Attempts to simultaneously control food intake and smoking may lead to smoking cessation failure. We sought to model this relationship using a human laboratory paradigm of smoking lapse behavior. We examined the combined effect of food and nicotine deprivation, compared to nicotine deprivation alone, on the ability to resist smoking and on subsequent ad libitum smoking. In a between-subjects design, daily smokers (N = 30) were all deprived of nicotine for 18 h and were either food-deprived (12 h) or not during a laboratory session. Following exposure to individualized food cues, participants had the option of initiating tobacco self-administration or delaying up to 50 min in exchange for monetary reinforcement. Subsequently, the tobacco self-administration period consisted of 1 h in which participants could choose to smoke or receive monetary reinforcement for cigarettes not smoked. Smokers who had been deprived of food and nicotine smoked their first cigarette sooner and were more likely to smoke at some point during the laboratory session, compared to those who were only nicotine-deprived. Those who were food- and nicotine-deprived smoked slightly more cigarettes than those who were nicotine-deprived only, although this difference was not statistically significant. There were no sex differences in outcomes. Hunger and food craving ratings while trying to resist smoking were greater in the food + nicotine-deprived group. Tobacco craving was predictive of outcome in both conditions. These findings support the hypothesis that food deprivation can undermine a smoker's ability to resist smoking.

Leventhal AM; Mickens L; Dunton GF; Sussman S; Riggs NR; Pentz MA. Tobacco use moderates the association between major depression and obesity. Health Psychology 29(5): 521-528, 2010. (53 refs.)

Objective: Based on a maladaptive coping explanation, the relationship between major depression (MD) and obesity could be strong among nonsmokers, who may engage in unhealthy eating and sedentary behavior to cope with depression. By contrast, the MD-obesity association could be weak among smokers, who can use tobacco (instead of food or sedentary behavior) to cope with mood symptoms. This study examined smoking status and tobacco dependence as moderators of the MD-obesity link. Design: Correlational, cross-sectional population-based survey of 41,654 U.S. adults. Main Outcome Measures: Obesity (body mass index [BMI] >= 30 kg/m(2)) and quantitative BMI value. Results: Current smoking status moderated the association between past-year MD and current obesity, as well as the link between MD and BMI value (ps <= .0001). MD predicted obesity and BMI among nonsmokers (ps < .0001) but did not do so in smokers (ps >= .10). Similar findings emerged with tobacco dependence as the moderator. Each finding persisted after accounting for demographics, psychiatric variables, and potential confounds. Conclusion: Tobacco use characteristics appear to moderate the MD-obesity association in the U.S. population. These findings may shed light on the mechanisms linking MD and obesity and have implications for identifying which individuals may benefit most from obesity interventions that target depressive symptoms.

Levine MD; Marcus MD; Kalarchian MA; Houck PR; Cheng Y. Weight concerns, mood, and postpartum smoking relapse. American Journal of Preventive Medicine 39(4): 345-351, 2010. (54 refs.)

Background: The majority of women who quit smoking as a result of pregnancy will resume smoking during the first 6 months postpartum. Evidence suggests that changes in depressive symptoms, perceived stress, and concerns about weight may relate to postpartum smoking relapse. Purpose: This study was designed to prospectively evaluate the relationship of mood and weight concerns to postpartum smoking among women who quit smoking during pregnancy. Methods: Pregnant women who had quit smoking (N = 183) were recruited between February 2003 and November 2006. Women completed assessments of mood (depressive symptoms, perceived stress, positive and negative affect) and weight concerns during the third trimester of pregnancy and at 6, 12, and 24 weeks postpartum. Self-reported smoking status was verified by expired-air carbon monoxide and salivary cotinine at each assessment. Cox regression analyses in which mood and weight concerns were treated as time-dependent covariates were conducted in 2007 and 2009. Results: By 24 weeks postpartum, 65% of women had resumed smoking. Smoking-related weight concerns increased risk of relapse, and positive affect and self-efficacy for weight management without smoking decreased risk of relapse postpartum. Moreover, after controlling for variables previously related to postpartum relapse, weight concerns remained significantly related to smoking relapse. Conclusions: Smoking-related weight concerns and positive affect increase the likelihood that a woman will resume smoking postpartum. Moreover, weight concerns appear to be salient even in the context of other factors shown to affect postpartum smoking. This study suggests that interventions may need to address women's weight concerns and mood to help sustain smoking abstinence after childbirth.

Levine MD; Perkins KA; Kalarchian MA; Cheng Y; Houck PR; Slane JD et al. Bupropion and cognitive behavioral therapy for weight-concerned women smokers. Archives of Internal Medicine 170(6): 543-550, 2010. (25 refs.)

Background: We previously documented that cognitive behavioral therapy for smoking-related weight concerns (CONCERNS) improves cessation rates. However, the efficacy of combining CONCERNS with cessation medication is unknown. We sought to determine if the combination of CONCERNS and bu-propion therapy would enhance abstinence for weight-concerned women smokers. Methods: In a randomized, double-blind, placebo-controlled trial, weight-concerned women (n =349; 86% white) received smoking cessation counseling and were randomized to 1 of 2 adjunctive counseling components: CONCERNS or STand ARD (standard cessation treatment with added discussion of smoking topics but no specific weight focus), and 1 of 2 medication conditions: bupropion hydrochloride sustained release (B) or placebo (P) for 6 months. Rates and duration of biochemically verified prolonged abstinence were the primary outcomes. point-prevalent abstinence, postcessation weight gain, and changes in nicotine withdrawal, depressive symptoms, and weight concerns were evaluated. Results: Women in the CONCERNS + B group had higher rates of abstinence (34.0%) and longer time to relapse than did those in the STand ARD + B (21%; P = .05) or CONCERNS + p (11.5%; P = .005) groups at 6 months, although rates of prolonged abstinence in the CONCERNS + B and STand ARD + B groups did not differ significantly at 12 months. Abstinence rates and duration did not differ in the STand ARD + B group (21% and 19%) compared with the STand ARD + P group (10% and 7%) at 6 and 12 months, respectively. There were no difference among abstinent women in postcessation weight gain or weight concerns, although STand ARD + B produced greater decreases in nicotine withdrawal and depressive symptoms than did STand ARD + P. Conclusions: Weight-concerned women smokers receiving the combination of CONCERNS + B were most likely to sustain abstinence. This effect was not related to differences in postcessation weight gain or changes in weight concerns.

Levitan RD; Davis C. Emotions and eating behaviour: Implications for the current obesity epidemic. University of Toronto Quarterly 79(2, special issue): 783-799, 2010. (80 refs.)

Developed countries around the world are experiencing an epidemic of overeating and obesity with significant costs at a personal, familial, and societal level. While most research on obesity has focused on metabolic factors, this paper considers how emotional factors might contribute to this problem. Two examples we address are the use of food to modify negative mood states, also called emotional eating, and food intake as an addiction. Our central question is what makes some individuals prone to emotional eating and/or food addiction, while others are clearly less vulnerable in this regard. Ultimately, we suggest how obesity research, prevention, and treatment might address the emotional underpinnings of the current overeating epidemic.

Liu F; Zhang N; Cheng KW; Wang H. Reduced smoking and rising obesity: Does smoking ban in the workplace matter? Economics Letters 108(3): 249-252, 2010. (11 refs.)

Using worksite smoking ban as an instrumental variable for smoking, we examine the relationship between smoking and body weight in a two-stage least square estimation. We find evidence that reduced smoking may lead to the rising of obesity.

Liu YJ; von Deneen KM; Kobeissy FH; Gold MS. Food addiction and obesity: Evidence from bench to bedside. Journal of Psychoactive Drugs 42(2): 133-145, 2010. (146 refs.)

Obesity has become a major health problem and epidemic. However, much of the current debate has been fractious and etiologies of obesity have been attributed to eating behavior or fast food, personality issues, depression, addiction, or genetics. One of the interesting new hypotheses for epidemic obesity is food addiction, which is associated with both substance-related disorder and eating disorder. Accumulating evidences have shown that there are many shared neural and hormonal pathways as well as distinct differences that may help researchers find why certain individuals overeat and become obese. Functional neuroimaging studies have further revealed that good or great smelling, looking, tasting, and reinforcing food has characteristics similar to that of drugs of abuse. Many of the brain changes reported for hedonic eating and obesity are also seen in various forms of addictions. Most importantly, overeating and obesity may have an acquired drive like drug addiction with respect to motivation and incentive; craving, wanting, and liking occur after early and repeated exposures to stimuli. The acquired drive for great food and relative weakness of the satiety signal would cause an imbalance between the drive and hunger/reward centers in the brain and their regulation.

Love SJ; Sheffer CE; Bursac Z; Prewitt TE; Krukowski RA; West DS. Offer of a weight management program to overweight and obese weight-concerned smokers improves tobacco dependence treatment outcomes. American Journal on Addictions 20(1): 1-8, 2011. (57 refs.)

Weight concern is a common and significant barrier to abstinence for many smokers. This quasi-experimental pilot study used multivariate logistic regression to examine the effects of offering a weight management treatment program on tobacco dependence treatment outcomes. Age, gender, ethnicity, educational level, nicotine dependence level, body mass index, and concern about weight gain were entered as factors/covariates to account for differences between groups. Offering a weight management program increased attendance at the first scheduled contact (88.1% vs. 71.6%; OR = 2.93; p = .029) and increased 6-month abstinence (21.4% vs. 10.1%; OR = 2.42; p = .052). With factors and covariates included in the multivariate models to account for group differences, those offered weight management were five times more likely to attend their first session (OR = 5.10; 95% CI 1.53-16.98; p = .008) and three times more likely to be abstinent 6 months after tobacco treatment (OR = 2.98; 95% CI = 1.09-8.17; p = .033). Proactively informing weight-concerned, overweight/obese smokers about the availability of a weight management program as an incentive for completing treatment for tobacco dependence may improve tobacco treatment outcomes.

Lubin JH; Gaudet MM; Olshan AF; Kelsey K; Boffetta P; Brennan P et al. Body mass index, cigarette smoking, and alcohol consumption and cancers of the oral cavity, pharynx, and larynx: Modeling odds ratios in pooled case-control data. American Journal of Epidemiology 171(12): 1250-1261, 2010. (34 refs.)

Odds ratios for head and neck cancer increase with greater cigarette and alcohol use and lower body mass index (BMI; weight (kg)/height(2) (m(2))). Using data from the International Head and Neck Cancer Epidemiology Consortium, the authors conducted a formal analysis of BMI as a modifier of smoking- and alcohol-related effects. Analysis of never and current smokers included 6,333 cases, while analysis of never drinkers and consumers of < 10 drinks/day included 8,452 cases. There were 8,000 or more controls, depending on the analysis. Odds ratios for all sites increased with lower BMI, greater smoking, and greater drinking. In polytomous regression, odds ratios for BMI (P = 0.65), smoking (P = 0.52), and drinking (P = 0.73) were homogeneous for oral cavity and pharyngeal cancers. Odds ratios for BMI and drinking were greater for oral cavity/pharyngeal cancer (P < 0.01), while smoking odds ratios were greater for laryngeal cancer (P < 0.01). Lower BMI enhanced smoking- and drinking-related odds ratios for oral cavity/pharyngeal cancer (P < 0.01), while BMI did not modify smoking and drinking odds ratios for laryngeal cancer. The increased odds ratios for all sites with low BMI may suggest related carcinogenic mechanisms; however, BMI modification of smoking and drinking odds ratios for cancer of the oral cavity/pharynx but not larynx cancer suggests additional factors specific to oral cavity/pharynx cancer.

Lycett D; Hajek P; Aveyard P. Trial Protocol: Randomised controlled trial of the effects of very low calorie diet, modest dietary restriction, and sequential behavioural programme on hunger, urges to smoke, abstinence and weight gain in overweight smokers stopping smoking. Trials 11( e-94), 2010. (41 refs.)

Background: Weight gain accompanies smoking cessation, but dieting during quitting is controversial as hunger may increase urges to smoke. This is a feasibility trial for the investigation of a very low calorie diet (VLCD), individual modest energy restriction, and usual advice on hunger, ketosis, urges to smoke, abstinence and weight gain in overweight smokers trying to quit. Methods: This is a 3 armed, unblinded, randomized controlled trial in overweight (BMI > 25 kg/m(2)), daily smokers (CO > 10 ppm); with at least 30 participants in each group. Each group receives identical behavioural support and NRT patches (25 mg(8 weeks), 15 mg(2 weeks), 10 mg(2 weeks)). The VLCD group receive a 429-559 kcal/day liquid formula beginning 1 week before quitting and continuing for 4 weeks afterwards. The modest energy restricted group (termed individual dietary and activity planning(IDAP)) engage in goal-setting and receive an energy prescription based on individual basal metabolic rate(BMR) aiming for daily reduction of 600 kcal. The control group receive usual dietary advice that accompanies smoking cessation i.e. avoiding feeling hungry but eating healthy snacks. After this, the VLCD participants receive IDAP to provide support for changing eating habits in the longer term; the IDAP group continues receiving this support. The control group receive IDAP 8 weeks after quitting. This allows us to compare IDAP following a successful quit attempt with dieting concurrently during quitting. It also aims to prevent attrition in the unblinded, control group by meeting their need for weight management. Follow-up occurs at 6 and 12 months. Outcome measures include participant acceptability, measured qualitatively by semi-structured interviewing and quantitatively by recruitment and attrition rates. Feasibility of running the trial within primary care is measured by interview and questionnaire of the treatment providers. Adherence to the VLCD is verified by the presence of urinary ketones measured weekly. Daily urges to smoke, hunger and withdrawal are measured using the Mood and Physical Symptoms Scale-Combined (MPSS-C) and a Hunger Craving Score (HCS). 24 hour, 7 day point prevalence and 4-week prolonged abstinence (Russell Standard) is confirmed by CO < 10 ppm. Weight, waist and hip circumference and percentage body fat are measured at each visit.

Lycett D; Munafo M; Johnstone E; Murphy M; Aveyard P. Associations between weight change over 8 years and baseline body mass index in a cohort of continuing and quitting smokers. Addiction 106(1): 188-196, 2011. (39 refs.)

Aim: To examine the association between weight change and baseline body mass index (BMI) over 8 years in a cohort of continuing and quitting smokers. Design: Prospective cohort. Setting: Oxfordshire general practices nicotine patch/placebo trial with 8-year follow-up. Participants: Eighty-five participants were biochemically proven abstinent at 3, 6, 12 months and 8 years (abstainers). A total of 613 smoked throughout the 8 years (smokers), 26 quit for a whole year but were smoking again by 8 years (relapsed); 116 smoked for the first year but were abstinent at 8 years (late abstainers). Measurements: Weight and BMI was measured at baseline and at 8 years. Regression models were used to examine weight gain by smoking status and the association of BMI at the time of quitting. Findings: Abstainers gained 8.79 kg [standard deviation (SD) 6.36; 95% confidence interval (CI) 7.42, 10.17]. Smokers gained 2.24 kg (SD 6.65; 95% CI 1.7, 2.77). Relapsed smokers gained 3.28 kg (SD 7.16; 95% CI 0.328, 6.24). Late abstainers gained 8.33 kg (SD 8.04; 95% CI 6.85, 9.81). The association between baseline BMI and weight change was modified by smoking status. In smokers there was a negative linear association of BMI, while in abstainers a J-shaped curve fitted best. These models estimated weight change over 8 years in abstainers of +9.8 kg, +7.8 kg, +10.2 kg, +19.4 kg and in smokers of +3.9 kg, +2.6 kg, 1.0 kg and -0.8 kg, where BMI was 18, 23, 29 and 36, respectively. Conclusion: Obese smokers gain most weight on quitting smoking, while obese continuing smokers are likely to remain stable or lose weight. Obese quitters have the greatest need for interventions to ameliorate weight gain.

Maisonet M; Christensen KY; Rubin C; Holmes A; Flanders WD; Heron J et al. Role of prenatal characteristics and early growth on pubertal attainment of British girls. Pediatrics 126(3): E591-E600, 2010. (43 refs.)

OBJECTIVES: The objective of this study was to explore the influence of maternal prenatal characteristics and behaviors and of weight and BMI gain during early childhood on the timing of various puberty outcomes in girls who were enrolled in the Avon Longitudinal Study of Parents and Children. METHODS: Repeated self-assessments of pubertal development were obtained from similar to 4000 girls between the ages of 8 and 14. Data on prenatal characteristics and weight at birth and 2, 9, and 20 months of age were obtained from questionnaires, birth records, and clinic visits. Infants' weights were converted to weight-for-age and BMI SD scores (SDSs; z scores), and change values were obtained for the 0- to 20-month and other intervals within that age range. We used parametric survival models to estimate associations with age of entry into Tanner stages of breast and pubic hair and menarche. RESULTS: Maternal initiation of menarche at age <12, smoking during pregnancy, and primiparity were associated with earlier puberty. A 1-unit increase in the weight SDS change values for the 0- to 20-month age interval was associated with earlier ages of entry into pubertal outcomes (0.19-0.31 years). Increases in the BMI SDS change values were also associated with earlier entry into pubertal outcomes (0.07-0.11 years). CONCLUSIONS: Many of the maternal prenatal characteristics and weight and BMI gain during infancy seemed to have similar influences across different puberty outcomes. Either such early factors have comparable influences on each of the hormonal processes involved in puberty, or processes are linked and awakening of 1 aspect triggers the others.

Mangrio E; Lindstrom M; Rosvall M. Early life factors and being overweight at 4 years of age among children in Malmo, Sweden. BMC Public Health 10: e-article 764, 2010. (43 refs.)

Background: Rising rates of obesity and overweight is an increasing public health problem all over the world. Recent research has shown the importance of early life factors in the development of child overweight. However, to the best of our knowledge there are no studies investigating the potential synergistic effect of early life factors and presence of parental overweight on the development of child overweight. Methods: The study was population-based and cross-sectional. The study population consisted of children who visited the Child Health Care (CHC) centers in Malmo for their 4-year health check during 2003-2008 and whose parents answered a self-administered questionnaire (n = 9009 children). Results: The results showed that having overweight/obese parents was strongly associated with the child being overweight or obese. Furthermore, there was an association between unfavorable early life factors (i.e., mother smoking during pregnancy, presence of secondhand tobacco smoke early in life, high birth weight) and the development of child overweight/obesity at four years of age, while breastfeeding seemed to have a protective role. For example, maternal smoking during pregnancy was associated with an odds ratio (OR) of 1.47 (95% CI: 1.22, 1.76) for overweight and 2.31 (95% CI: 1.68, 3.17) for obesity. The results further showed synergistic effects between parental overweight and exposure to unfavourable early life factors in the development of child overweight. Conclusions: The present study shows the importance of early life factors in the development of child overweight and obesity, and thus puts focus on the importance of early targeted interventions.

Moore JB. Navigating the minefield between smoking and obesity. (editorial). Journal of Public Health Management and Practice 16(4): 275-276, 2010. (13 refs.)

Neovius K; Rasmussen F; Sundstrom J; Neovius M. Forecast of future premature mortality as a result of trends in obesity and smoking: Nationwide cohort simulation study. European Journal of Epidemiology 25(10): 703-709, 2010. (29 refs.)

In many countries obesity has increased dramatically during the last decades, while there has been a parallel decrease in smoking. The objective of the present study was to estimate the net effect on premature mortality of these trends. A simulation model was developed to estimate the expected number of deaths between ages 19-56 years for cohorts of young men (n = 50,000), depending on inputs of obesity and smoking prevalence. The model was populated with nationwide data of Swedish men performing mandatory military conscription tests between 1969 and 2005. Risk equations for all cause mortality with smoking and obesity status as predictors were developed based on the 1969-1970 conscription cohort (n = 45,920; 2,897 deaths, median follow-up 38 years). It was found that between 1969 and 2005, the prevalence of smoking decreased from 58.6 to 23.2%, while overweight increased from 5.7 to 15.6% and obesity from 0.8 to 5.5%. As a result of these trends, a 14% (CI95% 6, 21%) reduction of premature deaths between ages 19 and 56 years was forecasted for men aged 19 year in 2004-2005 compared to men aged 19 years in 1969-1970 (2,679 vs. 3,116 deaths). However, one-third of the survival benefit from reduced smoking during the period was offset due to the parallel increase in obesity. This study shows that despite large increases in overweight and obesity, a continued decline in premature deaths among Swedish males is expected due to reduced smoking during the last four decades.

Plourde H; Nolin B; Receveur O; Ledoux M. Psychosocial correlates of body mass index in four groups of Quebec adults. Journal of Biosocial Science 42(5): 601-618, 2010. (47 refs.)

The objective of the present analysis was to study the associations between body weight psychosocial correlates and body mass index (BMI) among four groups of adults in the Quebec population. Data were taken from the Social Lifestyles and Health 1998 Survey performed by the Institut de la Statistique du Quebec (ISQ). The suggested guidelines of the ISQ were used to estimate the population's proportions and for statistical analysis. The groups studied were 25- to 44- and the 45- to 64-year-old men and women. In all groups, currently trying to lose weight increased the odds of reporting an excess weight. Better perceived eating habits was associated with lower BMI in most groups except in the 25- to 44-year-old women, where the trend was not significant. Higher number of physical activities related to transport and cigarette smoking were associated with lower BMI in both men groups. In both women groups, more frequent consumption of alcoholic beverages decreased significantly the odds of reporting excess body weight. A university degree was associated with a lower BMI only in the 25- to 44-year-old men. Regular practise of leisure time physical activity was associated with a lower BMI only in 45- to 64-year-old women. Opposite associations were observed between perceived health and BMI. In the 45- to 64-year-old men, better perceived health increased the odds of reporting an excess weight. Conversely, the odds of reporting excess weight decreased with better health in 25- to 44-year-old women. Many correlates differ between age group and sex. The identification of these factors illustrates the need to adapt obesity-related programmes toward specific sub-groups within the general population.

Power C; Atherton K; Thomas C. Maternal smoking in pregnancy, adult adiposity and other risk factors for cardiovascular disease. Atherosclerosis 211(2): 643-648, 2010. (30 refs.)

Objective: To establish whether maternal smoking in pregnancy is associated with risk factors for cardiovascular disease (CVD) in mid-adulthood and whether associations are explained by postnatal influences. Methods: Participants were 8815 men and women in the 1958 British birth cohort, with data on CVD risk factors measured at 45 y. Maternal smoking was recorded at birth. Results: Offspring of smokers had a higher adult BMI, waist circumference, blood pressure, HbA1c and triglycerides on average than offspring of non-smokers; females had lower HDL cholesterol levels. Total cholesterol was unrelated to maternal smoking. Associations were abolished after adjustment for postnatal influences across life, except for BMI and waist circumference: offspring of smokers had a BMI greater by 0.83 kg/m(2) on average than offspring of non-smokers and a 1.8cm larger waist circumference. Mean BMI and waist circumference increased with number of cigarettes that the mother smoked, but were not elevated in offspring whose mother had quit smoking before or early in pregnancy. Conclusions: Adults exposed to tobacco in utero had a more adverse CVD risk profile in mid-adulthood which appeared to reflect a lifetime accumulation of postnatal influences; whereas their higher BMI and central adiposity may be due in part to intrauterine mechanisms.

Rees DI; Sabia JJ. Body weight and smoking initiation: Evidence from Adolescent Health. Journal of Health Economics 29(5): 774-777, 2010. (8 refs.)

In volume 23, issue 2 of this journal, Cawley, Markowitz and Tauras used data from the National Longitudinal Survey of Youth 1997 Cohort to estimate the relationship between body weight and smoking initiation. Using maternal obesity status as an instrument, they found strong evidence that overweight females between the ages of 12 and 21 were more likely to initiate smoking. Drawing on data from the National Longitudinal Study of Adolescent Health, we reexamine the relationship between body weight and smoking initiation. Our results are generally consistent with those of Cawley, Markowitz and Tauras.

Ruckinger S; Beyerlein A; Jacobsen G; von Kries R; Vik T. Growth in utero and body mass index at age 5 years in children of smoking and non-smoking mothers. Early Human Development 86(12): 773-777, 2010. (35 refs.)

Background: High birth weight is associated with overweight later in life, while tobacco exposure in utero is associated with low birth weight, but with later risk of overweight. Aims: To examine whether body mass index (BMI) z-scores of children at age 5 are associated with measurements of mid-abdominal diameter (MAD) in utero comparing smoking and non-smoking mothers. Study Design: Growth in utero was recorded as MAD in mm per days of gestational age (MAD for gestational age) at 17, 25, 33 and 37 weeks of gestation in 561 infants whose mothers participated in a population-based study in Scandinavia (1986-1988). Outcome Measures: The offspring's BMI z-score at 5 years was used as a dependent variable, and MAD for gestational age as well as birth weight divided by gestational age in days were included as explanatory variables in separate linear regression models. Maternal BMI was considered as a potential confounder. Results: At 17 and 25 weeks gestation there were no relevant differences in MAD for gestational age between smokers and non-smokers. At 33 and 37 weeks gestation, children of smoking mothers had less increase in MAD than children of non-smoking mothers. In adjusted models, MAD for gestational age in week 33 and 37 was positively associated with BMI z-score at 5 years of age among children of both smoking and nonsmoking mothers. Conclusions: In this study overweight in children exposed to tobacco smoking in utero was apparently not mediated through foetal growth retardation, followed by enhanced fat accretion after birth.

Sanchez-Johnsen LAP; Carpentier MR; King AC. Race and sex associations to weight concerns among urban African American and Caucasian smokers. Addictive Behaviors 36(1-2): 14-17, 2011. (27 refs.)

This study compared general weight concerns (Drive for Thinness Body Dissatisfaction and Cognitive Restraint) and smoking specific weight concerns among adult African American and Caucasian women and men smokers enrolled in a smoking cessation clinical Mal Participants were 119 African Americans (73 female) and 182 Caucasians (90 female). Results revealed that general weight concerns were higher in Caucasians versus African Americans and in women compared with men, but there were no race by sex interactions. Drive for Thinness and Body Dissatisfaction was higher in women compared with men and Cognitive Restraint was highest in Caucasian women. Finally smoking-specific weight concerns were higher in Caucasian women than both Caucasian and African American men, with African American women intermediate. Results indicate that while Caucasian women preparing to quit smoking exhibited the highest levels of concern about weight, smoking-specific weight concerns and certain sub components of general weight concerns were also prevalent among African Americans and Caucasians. Future research is needed to elucidate how race and sex differences in weight concerns may Impact smoking cessation.

Saules KK; Wiedemann A; Ivezaj V; Hopper JA; Foster-Hartsfield J; Schwarz D. Bariatric surgery history among substance abuse treatment patients: Prevalence and associated features. Surgery for Obesity and Related Disease 6(6): 615-621, 2010. (22 refs.)

Background: In 2006, Brighton Hospital (Brighton, Michigan), a comprehensive substance abuse treatment facility, began observing increasing admissions who reported a history of bariatric surgery. Data on the magnitude of this postoperative outcome is lacking. The hospital instituted procedures to better track this variable in the electronic medical records at admission to estimate the prevalence of bariatric surgery history among substance abuse treatment admissions. Methods: The data analyzed for the present report included the electronic medical record data obtained from 7199 patients admitted from 2006 to 2009 and the chart review data from 54 bariatric patients and 54 controls. Results: The findings suggested that 2-6% of recent admissions were positive for a bariatric surgery history. The substance abuse treatment patients with a bariatric surgery history were significantly more likely to be women and nonsmokers. The bariatric and nonbariatric patients were equally likely to have been diagnosed with alcohol dependence; however, bariatric patients were significantly more likely to also have a diagnosis of alcohol withdrawal. Relative to the matched control cases, the alcohol-dependent bariatric patients reported consuming a significantly greater maximum quantity of drinks per drinking day. Conclusion: A bariatric surgery history might be overrepresented in substance use programs and such patients' recovery efforts might pose unique challenges.

Sen A; Entezarkheir M; Wilson A. Obesity, smoking, and cigarette taxes: Evidence from the Canadian Community Health Surveys. Health Policy 97(2-3): 180-186, 2010. (23 refs.)

Objectives: Recent studies suggest an ambiguous relationship between obesity and cigarette taxes. We employ Canadian data to evaluate the effects of cigarette taxes on smoking and obesity. Methods: We use a simple reduced form approach and exploit the significant cross-province differences that exist between Eastern and Western Canada to estimate the effects of higher cigarette taxes using aggregate health region and individual level data from the 2003 and 2005 waves of the Canadian Community Health Surveys (CCHS). Results: OLS estimates based on health regions data suggest that a 10% increase in cigarette taxes is significantly correlated with a 4-5% increase in the percentage of obese population. We also find cigarette tax elasticities of between -0.2 and -0.4 with respect to the percentage of smokers. Estimates from individual level data are similar. Conclusions: In tandem, these results offer support to the possibility that health benefits from higher cigarette taxes and lower smoking, might be partially offset by a corresponding increase in obesity levels.

Shen Z; Li YM; Yu CH; Shen Y; Xu L; Xu CF et al. A cohort study of the effect of alcohol consumption and obesity on serum liver enzyme levels. European Journal of Gastroenterology and Hepatology 22(7): 820-825, 2010. (40 refs.)

Objective: To conduct a cohort study of the effect of alcohol and obesity on liver enzymes in China. Methods: To study 500 individuals of liver enzymes normality randomly in the 1999-year epidemiological survey, and liver enzyme levels (461 complete data) in 2006. Results: Logistic-regression analysis showed a daily alcohol intake of at least 40 g, duration of drinking at least 10 years, and obesity, which were closely related to abnormality in liver enzyme levels; the relative risk (95% confidence interval) was 2.014 (1.108-3.662), 2.085 (1.106-3.928), and 1.772 (1.140-2.754), respectively (all P < 0.05). According to the value of daily alcohol intake/duration of drinking and body mass index (BMI) to categorize, seven-year cumulative incidence of liver enzymes levels abnormality for the daily alcohol intake at least 40 g and obesity group or the duration of drinking at least 10 years and obesity group was the highest, 51.47 and 47.12%, respectively. No significant dose-response relationship was found between daily alcohol intake/duration of drinking and liver enzyme level abnormalities. Conclusion: The risk of alcohol consumption and obesity-inducing liver injury together is far greater than the risk of a single factor inducing liver injury. An alcoholic threshold effect may be more important than a dose-response effect on liver enzyme levels.

Stommel M; Schoenborn CA. Variations in BMI and prevalence of health risks in diverse racial and ethnic populations. Obesity 18(9): 1821-1826, 2010. (48 refs.)

When examining health risks associated with the BMI, investigators often rely on the customary BMI thresholds of the 1995 World Health Organization report. However, within-interval variations in morbidity and mortality can be substantial, and the thresholds do not necessarily correspond to identifiable risk increases. Comparing the prevalence of hypertension, diabetes, coronary heart disease (CHD), asthma, and arthritis among non-Hispanic whites, blacks, East Asians and Hispanics, we examine differences in the BMI-health-risk relationships for small BMI increments. The analysis is based on 11 years of data of the National Health Interview Survey (NHIS), with a sample size of 337,375 for the combined 1997-2007 Sample Adult. The analysis uses multivariate logistic regression models, employing a nonparametric approach to modeling the BMI-health-risk relationship, while relying on narrowly defined BMI categories. Rising BMI levels are associated with higher levels of chronic disease burdens in four major racial and ethnic groups, even after adjusting for many socio-demographic characteristics and three important health-related behaviors (smoking, physical activity, alcohol consumption). For all population groups, except East Asians, a modestly higher disease risk was noted for persons with a BMI <20 compared with persons with BMI in the range of 20-21. Using five chronic conditions as risk criteria, a categorization of the BMI into normal weight, overweight, or obesity appears arbitrary. Although the prevalence of disease risks differs among racial and ethnic groups regardless of BMI levels, the evidence presented here does not support the notion that the BMI-health-risk profile of East Asians and others warrants race-specific BMI cutoff points.

Tang AM; Forrester JE; Spiegelman D; Flanigan T; Dobs A; Skinner S et al. Heavy injection drug use is associated with lower percent body fat in a multi-ethnic cohort of HIV-positive and HIV-negative drug users from three US cities. American Journal of Drug and Alcohol Abuse 36(1): 78-86, 2010. (26 refs.)

Background: The clinical implications of lower body weight in drug using populations are uncertain given that lower mean weights may still fall within the healthy range. Objectives: To determine the effect of type, mode and frequency of drug use on underlying body composition after accounting for differences in body shape and size. Methods: We conducted a cross-sectional analysis of 511 participants from the Tufts Nutrition Collaborative (TNC) Study. Data included measures of body composition, a 24-hour dietary recall, and a detailed health history and lifestyle questionnaire. Multivariate regression analysis was used to determine the independent effect of drug use on percent body fat (BF) after adjusting for BMI and waist circumference. Results: Heavy injection drug users (IDUs) had a 2.6% lower percent BF than non-users after adjusting for BMI, waist circumference, and other confounders. (p=0.0006). Differences in percent BF were predominantly due to higher lean mass, rather than lower fat mass. Cocaine and heroin had similar effects on body composition. Conclusions: In the U. S., where the general population is prone to over-nutrition, the average percent BF for heavy injectors does not fall into a range low enough to suggest harmful effects. However, in populations with substantial levels of under-nutrition, small differences in percent BF among drug users will have a greater impact on health status. Scientific Significance: Differences in BMI, weight and body composition are not always straightforward. Accounting for underlying nutritional status and relative differences in fat and FFM is critical when interpreting results. diagnosed patients and prevent them from returning to prison.

Tanner-Smith EE. Negotiating the early developing body: Pubertal timing, body weight, and adolescent girls' substance use. Journal of Youth and Adolescence 39(12): 1402-1416, 2010. (49 refs.)

Despite knowledge that early pubertal timing predicts adolescent girls' substance use, it is still unclear whether this relationship persists beyond early adolescence and whether it is conditional on girls' body weight. This study examined the moderating role of body weight in the association between early pubertal timing and adolescent girls' substance use using three waves of data from the National Longitudinal Study of Adolescent Health. The analytic sample included 5,591 adolescent girls attending middle-schools and high-schools in the United States (ages 10-15, 71% White, 14% Black). Results indicated that early pubertal timing was associated with substance use risk but effects were attenuated after controlling for prior use. Body weight moderated the association between early pubertal timing and girls' reported number of substances tried in middle adolescence. Body weight magnified the risk of having tried one substance, but buffered the risk of having tried three substances. Among those girls who did use substances, body weight did not moderate the relationship between early pubertal timing and heavy substance use. It is concluded that the substance use risk associated with early pubertal timing is most salient during the developmental period in adolescence when sensitivity to bodily changes may be heightened.

Taylor VH; Curtis CM; Davis C. The obesity epidemic: The role of addiction. (editorial). Canadian Medical Association Journal 182(4): 327-328, 2010. (16 refs.)

Toll BA; White M; Wu R; Meandzija B; Jatlow P; Makuch R et al. Low-dose naltrexone augmentation of nicotine replacement for smoking cessation with reduced weight gain: A randomized trial. Drug and Alcohol Dependence 111(3): 200-206, 2010. (54 refs.)

Background: Fear of weight gain is a significant obstacle to smoking cessation preventing some smokers from attempting to quit Several previous studies of naltrexone yielded promising results for minimization of post-quit weight gain Given these encouraging findings we endeavored to test whether minimization of weight gain might translate to better quit outcomes for a population that is particularly concerned about gaining weight upon quitting. Methods: Smokers (N=172) in this investigation were prospectively randomized to receive either 25 mg naltrexone or placebo for 27 weeks (1 week pre- 26 weeks post-quit) for minimization of post-quit weight gain and smoking cessation. All participants received open label therapy with the nicotine patch for the first 8 weeks post-quit and behavioral counseling over the 27-week treatment. The 2 pre-specified primary outcomes were change in weight for continuously abstinent participants and biologically verified end-of-treatment 7-day point-prevalence abstinence at 26 weeks after the quit date. Results: The difference in weight at 26 weeks post-quit between the naltrexone and placebo groups (naltrexone 6 8 lbs +/- 8 94 vs placebo 9 7 lbs +/- 9 19 p=0 45) was not statistically different Seven-day point-prevalence smoking abstinence rates at 26 weeks post-quit was not significantly different between the 2 groups (naltrexone 22% vs placebo 27% p =0 43). Conclusions: For smokers high in weight concern the relatively small reduction in weight gain with low-dose naltrexone is not worth the potential for somewhat lower rates of smoking abstinence.

Troy JD; Hartge P; Weissfeld JL; Oken MM; Colditz GA; Mechanic LE et al. Associations between anthropometry, cigarette smoking, alcohol consumption, and non-hodgkin lymphoma in the prostate, lung, colorectal, and ovarian cancer screening trial. American Journal of Epidemiology 171(12): 1270-1281, 2010. (42 refs.)

Prospective studies of lifestyle and non-Hodgkin lymphoma (NHL) are conflicting, and some are inconsistent with case-control studies. The Prostate, Lung, Colorectal, and Ovarian (PLCO) Cancer Screening Trial was used to evaluate risk of NHL and its subtypes in association with anthropometric factors, smoking, and alcohol consumption in a prospective cohort study. Lifestyle was assessed via questionnaire among 142,982 male and female participants aged 55-74 years enrolled in the PLCO Trial during 1993-2001. Hazard ratios and 95% confidence intervals were calculated using Cox proportional hazards regression. During 1,201,074 person-years of follow-up through 2006, 1,264 histologically confirmed NHL cases were identified. Higher body mass index (BMI; weight (kg)/height (m)(2)) at ages 20 and 50 years and at baseline was associated with increased NHL risk (P-trend < 0.01 for all; e.g., for baseline BMI >= 30 vs. 18.5-24.9, hazard ratio = 1.32, 95% confidence interval: 1.13, 1.54). Smoking was not associated with NHL overall but was inversely associated with follicular lymphoma (ever smoking vs. never: hazard ratio = 0.62, 95% confidence interval: 0.45, 0.85). Alcohol consumption was unrelated to NHL (drinks/week: P-trend = 0.187). These data support previous studies suggesting that BMI is positively associated with NHL, show an inverse association between smoking and follicular lymphoma (perhaps due to residual confounding), and do not support a causal association between alcohol and NHL.

Urban R; Demetrovics Z. Smoking outcome expectancies: A multiple indicator and multiple cause (MIMIC) model. Addictive Behaviors 35(6): 632-635, 2010. (22 refs.)

The present study was carried out to assess the construct validity of the short form of the Smoking Consequences Questionnaire, a brief measure of smoking outcome expectancies on a large sample of adolescents (N = 953). The results of this study support a four-factor structure of smoking outcome expectancies, including expectancies of negative consequences, positive reinforcement, negative reinforcement and appetite-weight control, as well as the assertion that gender, smoking status and sensation-seeking have a distinct pattern of associations with the four outcome expectancy factors.

Vallejo-Torres L; Morris S. The contribution of smoking and obesity to income-related inequalities in health in England. Social Science & Medicine 71(6): 1189-1198, 2010. (36 refs.)

Reducing avoidable inequalities in health is a priority in many health care systems, including the NHS in Great Britain. Evidence suggests that lifestyle factors may play a role in explaining socioeconomic inequalities in health. In this paper we measure the contribution of smoking and obesity to income-related inequality in health. We use the corrected concentration index to measure inequality across time and areas of England, and decomposition methods to quantify directly the contribution of smoking and obesity to income-related inequality. Instrumental variables regression is used to test the endogeneity of smoking and obesity. We use data from nine rounds of the Health Survey for England (1998-2006). The results show that there are significant income-related health inequalities in England, that the extent of the inequality varies by area, and that in some areas it has increased over time. Nationally, smoking and obesity make a significant but modest contribution to income-related inequality in health (2.3% and 1.2%, respectively). Despite the reduction in smoking prevalence, the contribution of smoking has slightly increased over time, due to its increasing concentration among the poor and its negative effect on health. While the prevalence of obesity is increasing, it is more equally distributed across society. The prevalence of these problems varies between areas, and so does the contribution they make to income-related inequalities in health.

VanBuskirk KA; Potenza MN. The treatment of obesity and its co-occurrence with substance use disorders. (review). Journal of Addiction Medicine 4(1): 1-10, 2010. (135 refs.)

Obesity and binge eating disorder are detrimental health conditions that are associated with lower qualities of life. Individuals with obesity often face societal discrimination and frequently experience related medical disorders such as diabetes, hypertension, and hyperlipidemia. Current research suggests neurobiological similarities among obesity, binge eating disorder, and substance dependence. In addition, behavioral similarities link the two conditions; obese and substance-dependent individuals often report similar features such as cravings and diminished control over consumption of food and substances, respectively. Treatment options for obesity have begun to use this information to formulate pharmacological and therapeutic interventions that may provide improved results for weight loss and decreased binge frequency. Similarly, treatment approaches to substance addictions should consider aspects of weight management. Findings from research and treatment studies are presented with the aim of reviewing the current literature of obesity within the context of an addiction framework and providing information on empirically supported approaches to the treatment of co-occurring obesity and substance addiction.

Wang L; Lee IM; Manson JE; Buring JE; Sesso HD. Alcohol consumption, weight gain, and risk of becoming overweight in middle-aged and older women. (editorial). Archives of Internal Medicine 170(5): 453-461, 2010. (42 refs.)

Background: The obesity epidemic is a major health problem in the United States. Alcohol consumption is a source of energy intake that may contribute to body weight gain and development of obesity. However, previous studies of this relationship have been limited, with inconsistent results. Methods: We conducted a prospective cohort study among 19,220 US women aged 38.9 years or older who were free of cardiovascular disease, cancer, and diabetes mellitus and had a baseline body mass index (BMI; calculated as weight in kilograms divided by height in meters squared) within the normal range of 18.5 to less than 25. Alcoholic beverage consumption was reported on a baseline questionnaire. Body weight was self-reported on baseline and 8 annual follow-up questionnaires. Results: There was an inverse association between amount of alcohol consumed at baseline and weight gained during 12.9 years of follow-up. A total of 7942 (41.3%) initially normal-weight women became over-weight or obese (BMI >= 25) and 732 (3.8%) became obese (BMI >= 30). After adjusting for age, baseline BMI, smoking status, nonalcohol energy intake, physical activity level, and other lifestyle and dietary factors, the relative risks of becoming overweight or obese across total alcohol intake of 0, more than 0 to less than 5, 5 to less than 15, 15 to less than 30, and 30 g/d or morewere 1.00, 0.96, 0.86, 0.70, and 0.73, respectively (P for trend <.001). The corresponding relative risks of becoming obese were 1.00, 0.75, 0.43, 0.39, and 0.29 (P for trend <.001). The associations were similar by subgroups of age, smoking status, physical activity level, and baseline BMI. Conclusion: Compared with nondrinkers, initially normal-weight women who consumed a light to moderate amount of alcohol gained less weight and had a lower risk of becoming overweight and/or obese during 12.9 years of follow-up.

White MA; Grilo CM; O'Malley SS; Potenza MN. Binge eating disorder, obesity, and tobacco smoking. (editorial). Journal of Addiction Medicine 4(1): 11-19, 2010. (73 refs.)

White MA; Masheb RM; Grilo CM. Self-reported weight gain following smoking cessation: A function of binge eating behavior. International Journal of Eating Disorders 43(6): 572-575, 2010. (13 refs.)

Objective: This study investigated patterns of self-reported weight gain following smoking cessation among overweight individuals with and without binge eating. Method: Participants were 103 overweight (BMI >= 25) community volunteers who completed a battery of questionnaires online. Key items queried smoking cessation history and weight gain in the year following cessation. Participants were classified as nonbinge eating overweight (NBO, n = 56) or binge eating disorder (BED, n = 47). Results: BED participants were significantly more likely to report weight gain in the year following smoking cessation than NBO participants. After controlling for current BMI, the amount of self-reported weight gain following smoking cessation differed significantly between groups, with the NBO group reporting an average gain of 5.0 kg and the BED group reporting 11.2-kg gain. Discussion: Since many individuals resume smoking due to cessation-associated weight gain, these findings highlight the need for targeted interventions for overweight individuals particularly those who also binge eat.

White MA; Peters EN; Toll BA. Effect of binge eating on treatment outcomes for smoking cessation. Nicotine & Tobacco Research 12(11): 1172-1175, 2010. (18 refs.)

Introduction: This study investigated the effect of binge eating on smoking cessation outcomes. Methods: Participants (n = 186) reported binge eating status at baseline and at a 6-week postquit evaluation during a larger clinical trial for smoking cessation. Binge eating was defined with a single self-report questionnaire item from the Dieting and Bingeing Severity Scale. Participant groups defined by binge eating status were compared on abstinence rates. Results: Among participants, 22% reported binge eating at baseline, 17% denied binge eating at baseline but endorsed binge eating by 6 weeks, and 61% denied binge eating at both timepoints. Participants who reported binge eating prior to or during treatment had lower quit rates at 6-week postquit and at the 24-week follow-up point than those without binge eating; the groups did not differ at the 12-week follow-up point. The group that experienced an emergence of binge eating reported significantly more weight gain than the other groups. Conclusions: These results suggest that treatments addressing problematic eating behaviors during smoking cessation are warranted.

Wilson GT. Eating disorders, obesity and addiction. European Eating Disorders Review 18(5): 341-351, 2010. (84 refs.)

An addiction model of both eating disorders and obesity has received increasing attention in the popular and scientific literature. The addiction is viewed as a brain disease that must be directly targeted if treatment is to succeed. Evidence from laboratory feeding studies, epidemiology, genetic and familial research, psychopathological mechanisms, and treatment outcome research on cognitive behaviour therapy (CBT) is inconsistent with the clinical validity or utility of the addiction model of eating disorders. Neurobiological research has shown commonalities in brain reward processes between obesity and substance abuse disorders. Yet emphasis on apparent similarities overlooks important differences between obesity and drug addiction. Interest in obesity as a brain disease should not detract froma public health focus on the 'toxic food environment' that is arguably responsible for the obesity epidemic and related nutrition-based chronic disease.