Cigarette Use and Adolescent Metabolic and Bariatric Surgery

Objective This study aimed to track conventional cigarette smoking behaviors and associated correlates in adolescents with severe obesity who did or did not undergo metabolic and bariatric surgery to 4 years after surgery/baseline. Methods Utilizing a prospective controlled design, surgical (n = 153; mean BMI = 52) and nonsurgical (n = 70; mean BMI = 47) groups that completed assessments before surgery/at baseline and at Years 2 and 4 post surgery (Year 4: n = 117 surgical [mean BMI = 38]; n = 56 nonsurgical [mean BMI = 48]) were compared. Separate logistic regression models tested correlates of Year 4 current smoking. Results More than half of participants (surgical: 55%; nonsurgical: 60%) had ever smoked a cigarette, with current smoking increasing with time. Groups did not differ in Year 4 current smoking (surgical: 23%; nonsurgical: 33%), with approximate to 50% meeting criteria for heavy smoking (>= half pack/day) and approximate to 40% smoking their first cigarette before ninth grade. Factors associated with higher odds of Year 4 current smoking included dysregulation (P < 0.001), internalizing symptoms (P = 0.01), alcohol use (P = 0.04), caregiver smoking (P < 0.001), friend smoking (P = 0.001), and perceiving low harm (P = 0.02), plus greater percent weight loss (P = 0.03) in the surgical group. Conclusions Smoking is a clinical health challenge for adolescents and young adults with severe obesity, including those who have undergone metabolic and bariatric surgery. Upstream identification, monitoring, and intervention to prevent smoking uptake and escalation in youth with obesity across settings should be prioritized.

Automated summary

This study tracked conventional cigarette smoking behaviors and correlates in adolescents with severe obesity who underwent or did not undergo metabolic and bariatric surgery up to 4 years after surgery/baseline. Results showed that factors associated with current smoking in Year 4 included dysregulation, internalizing symptoms, alcohol use, caregiver and friend smoking behavior, perception of low harm, and greater percent weight loss in the surgical group. Upstream identification, monitoring, and intervention to prevent smoking uptake and escalation in youth with obesity should be prioritized.