文章基本信息

标题：Gender as a Moderator in the Association of Body Weight to Smoking and Mental Health
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作者：Eunkyung Park
期刊名称：American journal of public health
印刷版ISSN：0090-0036
出版年度：2009
卷号：99
期号：1
页码：146-151
DOI：10.2105/AJPH.2007.132225
语种：English
出版社：American Public Health Association
摘要：Objectives. I sought to examine gender's role as a moderator in the association of relative body weight to smoking and mental health. Methods. Data came from the 2004–2005 Minnesota Survey on Adult Substance Use, a statewide telephone survey (N = 16 289). Current smoking and mental health problems were examined in relation to relative body weight across genders, with control for covariates. Results. Relative to their healthy-weight counterparts, overweight or obese men were less likely to smoke, whereas overweight women were more likely to smoke. Mental health problems were not related to relative body weight among men. However, overweight or obese women were more likely than were their healthy-weight counterparts to have a negative self-assessment of mental health, and obese women were more likely to have a mental health problem. In addition, underweight women had increased odds of being a smoker and having mental health problems. Conclusions. The results indicate that gender has a moderating role in the association between body weight and both smoking and mental health. Gender-specific analysis rather than adjustment for the impact of gender in analyses is a promising avenue for future research. The prevalence of overweight and obesity in the United States has increased sharply since the mid-1970s for both adults and children. Data from the National Health and Nutrition Examination Surveys (NHANES) show that, among adults aged 20 to 74 years, the prevalence of obesity increased from 15.0% in the 1976–1980 survey to 32.9% in the 2003–2004 survey.¹ Between 1980 and 2002, overweight prevalence tripled for children and adolescents aged 6 to 19 years. Many experts have referred to an “obesity epidemic,” and a recent survey commissioned by the Trust for America's Health found that 85% of the general public thinks that obesity in the United States has reached “epidemic proportions.”² As a stigmatized condition, obesity is among the easiest to recognize and the most difficult to treat of medical conditions.^{3 – 5} Obese individuals face social exclusion and discrimination in many areas of their lives in addition to the physical health issues that are related to obesity. Escalating rates of obesity, accompanied by the prevalence of extreme dieting and the use of smoking or other unhealthy means of weight control, have raised concern among both public health experts and the general public.^{6 – 9} Being overweight or obese increases the risk of many physical health conditions, including hypertension, type 2 diabetes, coronary heart disease, and some cancers. However, the association between obesity and other behavioral health issues such as smoking and mental disorders is not as conclusive; some studies found no direct relationship, whereas others found a significant relationship or even an inverse relationship between obesity and depression or other behavioral health problems.^{10 – 13} Similarly, research on the association between smoking and body weight has yielded inconsistent results, with many studies reporting an inverse relationship between smoking and body weight, and others showing smokers to be heavier than nonsmokers in many Western populations.^{14 – 18} Various theses have been proposed to explain these inconsistent findings. Friedman and Brownell¹⁹ have noted that the inconsistencies might be attributed to methodological and sampling limitations. Mustillo et al.¹² have suggested that they might be caused by failure to consider the developmental trajectories of obesity—that is, to distinguish between the transiently obese, the chronically obese, and those whose obesity is confined to childhood or adolescence. Other scholars have suggested that the inconsistencies were caused by effect modifications by various factors, including demographic and socioeconomic characteristics.^{20 , 21} Body image and weight concerns have been found to be more important for females than for males, and numerous studies have found that dieting behaviors and weight concerns are related to current smoking and prospectively related to smoking initiation among young girls, but not boys.^{7 , 16 , 22 , 23} Although the relationship between smoking and body weight per se has not been established, literature reviews^{16 , 22} show a rather consistent association between concern about one's weight and current smoking or smoking initiation among adolescent girls and an association between greater weight concern and higher rates of smoking relapse or reduced likelihood of quitting among women. Several studies have found a difference by gender in the relationship between obesity and depressive mood.^{24 , 25} For example, in their NHANES study, Onyike et al.²⁶ found that obesity was associated with past-month depression in women but not in men. Additional support for gender's function as a possible moderator comes from a study on genetic variants of the obesity gene: Comings et al.²⁷ found that genetic factors were more likely to be involved in obesity among females than males and were causally involved not only in obesity but in its associated behavioral disorders, such as anxiety and depression. Following the framework of effect modifications, I examined gender's role in the association of body weight to smoking and mental health. I hypothesized that (1) overweight or obese women were more likely to smoke than their healthy-weight counterparts, (2) overweight or obese women were more likely to have mental health problems than their healthy-weight counterparts, and (3) the association between body weight and both smoking and mental health would be stronger among women than among men.