Double the happiness – double the worry for research

Smoking and obesity both have serious, potentially fatal consequences for health and well-being. But recent research in Southern California has confirmed a well-known suspicion by indicating that smoking actually protects adolescents against obesity in adulthood.

The finding comes from a follow-up study of adults in their thirties who participated as teenagers in a successful substance abuse prevention trial. The Mid Western Prevention Project (MPP) targeted young people in sixth or seventh grade, trained them how to identify social pressures to smoke and taught them how to avoid drug use.

MPP draws heavily on social learning techniques such as modeling, role play and discussion with peers and students. Primarily delivered in a school setting, it also involves community-based components, including a mass media strategy, parent education programs and local policy changes in relation to tobacco, alcohol and other drugs. All together there are five component programs – school, parent, community organization, health policy and mass media.

In 1984, eight schools involved in the MPP trial in Kansas City, Missouri, were randomly allocated either to the program or to a control group. Over 1,600 students were followed up six months after they completed the program, and thereafter as many as possible have been assessed on a year to 18-monthly basis.

There have been 16 waves of follow up data collection. Among other positive outcomes, young people who received the prevention program experienced a 40% reduction in daily smoking and similar reductions in alcohol and marijuana use, all of which were maintained into early adulthood.

These successes were duly noted by Blueprints for Violence Prevention and other organizations such as the US Substance Abuse Health and Services Administration (SAMHSA). All agree that MPP meets their respective criteria for effective proven models or programs.

The unexpected poor outcome came to light in the latest analysis of program data. Writing in Nicotine and Tobacco Research, the program developers at the Institute for Health Promotion and Disease Prevention Research at the University of Southern California, Alhambra, report that cigarette use beginning in early adolescence and continuing into early adulthood is associated with lower Body Mass Index (BMI) scores.

This suggests that when the program is successful it reduces the likelihood of smoking, but in doing so increases the likelihood of obesity. The team explain that adolescents' concern about weight gain can be a barrier to them making the decision to quit smoking. This is one of only a few studies to have examined the link between actual body weight, BMI and smoking.

The authors recommend that MPP and similar adolescent tobacco programs introduce a supplement to their usual program curriculum that deals with the principles of healthy eating and exercise.

Guneet Kaur Jasuja, Chih-Ping Chou, Nathaniel R Riggs, Mary Ann Pentz, “Early cigarette use and psychological distress as predictors of obesity risk in adulthood” Nicotine and Tobacco Research, February 2008, pp 325-35