Trajectories of body mass index and combustible and electronic cigarette use across adolescence: Findings from the PATH study

Purpose: Associations between empirically-generated body mass index (BMI) trajectories and risk of current use of combustible cigarettes and e-cigarettes across adolescence were examined using longitudinal data from the Population Assessment of Tobacco and Health (PATH) study.Methods: The PATH study is an ongoing annual longitudinal population-based study of adolescents. We utilized Waves 1-4 conducted from 2013 to 2017. Adolescents completed self-reported surveys of their height, weight, and current tobacco use at Waves 1-4 and their tobacco weight control beliefs at Waves 1-2.Results: Using latent growth mixture modeling, six trajectories of BMI were identified. The largest group (normal weight increasing; n = 4,858; 86.6 %), which was used as the comparator in subsequent analyses, consisted of adolescents ages 12-17 who were normal weight at Wave 1 with a significant increase in BMI across Waves 2--4. The overweight early increasing, overweight late increasing, and obesity stable classes had greater likelihood of current combustible cigarette use during the study compared to the normal weight increasing class. The overweight early increasing, overweight late increasing, and overweight increasing then decreasing classes showed elevated risk for e-cigarette use during the study. Compared to those in the normal weight increasing class, those in the overweight increasing then decreasing and obesity stable classes had greater weight control beliefs at Wave 1 and those in the obesity stable class had greater weight control beliefs at Wave 2.Conclusions: Findings highlight the importance of weight trajectories and weight control beliefs by tobacco product use across adolescence and the need for mechanistic and intervention research.

Automated summary

This study examined the associations between empirically-generated body mass index (BMI) trajectories and the risk of current use of combustible cigarettes and e-cigarettes among adolescents. The findings showed that overweight and obese adolescents were more likely to use combustible cigarettes and e-cigarettes compared to those with normal weight trajectories. Additionally, adolescents with fluctuating BMI trajectories were associated with higher weight control beliefs. These results highlight the importance of considering weight trajectories and weight control beliefs in understanding tobacco product use among adolescents.