Determinants and Predictors of Smoking-related Weight Concern in Smokers Participating in a Community-based Cessation Program

Background: Concern about weight gain is a barrier to smoking cessation, but determinants of post-cessation weight concern have not been adequately evaluated in the context of community-based cessation programs. Methods: Baseline data were analyzed from a cessation trial of 392 adults randomized to physical activity (PA) or general wellness counseling as adjunctive treatment for cigarette smoking. Outcomes were 1) Use of smoking to control weight (“control”) and 2) Willingness to tolerate weight gain without returning to smoking (“intolerance”) using validated instruments. Independent variables were self-reported PA and perceptions, socio-demographics, psycho-social measures, smoking behavior and perceptions, diet, and body mass index (BMI). From bivariable models examining main and sex interaction effects, significant variables were entered into a linear or logistic regression model to identify determinants associated with control and intolerance outcomes, respectively. Results: For both measures, weight concern was significantly (p\u3c0.05) greater for smokers who are female (standardized b=0.52, SE=0.10; OR=.29, 95% CI=0.17-0.49), White (b=0.12, SE=0.05; OR=.39, 95% CI=0.23-0.66), and less motivated to quit (b=-0.14, SE= 0.05; OR=0.77, 95% CI=0.59-1.0). Higher control scores were associated with less PA (b=-0.10, SE=0.05) and higher BMI (b=0.21, SE=0.05). For men, higher BMI was associated with greater anticipation of relapse if weight gain occurred (OR=2.54, 95% CI=1.42-4.56) but for women, intolerance for post-cessation weight gain was not contingent upon BMI. Conclusions: Among adults participating in a community-based cessation program, women, whites, and those less motivated to quit are more likely to smoke for weight control and be less likely to tolerate post-cessation weight gain. In addition, higher BMI was associated with greater anticipation of relapse if weight gain occurred for men, but not for women. Weight concerns, measured by either use of smoking to control weight or intolerance of post-cessation weight gain were not related to smoking history, psychosocial functioning, PA engagement or attitudes, or dietary variables. These results suggest potential targets for efforts to address weight gain concerns among smokers undergoing a quit attempt