Body mass index and tobacco-product use among US youth: Findings from wave 1 (2013-2014) of the Population Assessment of Tobacco and Health (PATH) Study

Introduction: Tobacco and obesity are leading contributors to mortality in the United States. Due to emerging changes in youth tobacco use, further examination of co-occurrence of these issues is warranted. Methods: This study examined associations between body mass index (BMI) and tobacco-product use and whether these varied by gender in a nationally representative sample of 12,416 Wave 1 (2013-2014) U.S. youth (12-17 years) from the Population Assessment of Tobacco and Health Study. Multivariable logistic regression analyses examined the odds of past 30-day tobacco-product use according to BMI. BMI was analyzed categorically using the Centers for Disease Control and Prevention (CDC) BMI-for-age weight status categories (underweight/healthy weight, overweight, and obese) and as a continuous variable. Results: Youth classified as overweight or obese were not more likely to use any tobacco, cigarettes, e-cigarettes, any cigar, or hookah. However, youth who were obese were more likely to use smokeless tobacco (Adjusted Odds Ratio (AOR) = 1.68, 95% Confidence Interval (CI): 1.01, 2.81). There were no significant gender interactions for these associations. When BMI was analyzed continuously, a 5-unit and 10-unit increase was significantly associated with using any tobacco, cigarettes, any cigar, and smokeless tobacco. This linear association was supported by similar results for a log-transformed BMI variable. Conclusions: Findings suggest a continuum between weight increase and tobacco-product use among American youth. Clinicians should consider screening for tobacco use among youth who gain weight within any weight class, not just those considered overweight or obese.