Gender Differences in the Time-Varying Association between Cigarette Use and Weight Concerns across Adolescence

Introduction: Research has linked weight concerns and cigarette use during adolescence and documented stronger associations for girls than boys. Evidence also suggests that girls and boys have different motives for smoking cigarettes, with girls more likely to use cigarettes to control their weight. Developmental patterns of weight concerns and substance use also differ by gender: Girls’ weight concerns increase at a faster rate and are consistently higher than boys’, whereas the prevalence of cigarette use is higher among boys in mid to late adolescence. Understanding whether the direction and strength of the link between weight concerns and cigarette use changes across adolescence and whether this differs by gender will inform intervention. We hypothesized that the association between weight concerns and cigarette use would be positive throughout adolescence and stronger for girls than boys; study of changes in the strength of these linkages over time was exploratory.

Methods: Data came from 397 youth (50.5% female, European American) from 201 families who participated in a longitudinal study of family relationships and development. Youth reported their weight concerns and past-month cigarette use, and parents reported youths’ gender, age, and household income during annual home interviews. The analytic sample included youth between ages 11 and 20 years who provided data on up to 5 measurement occasions. Time-varying effect modeling, an innovative method that enables flexible estimation of change in regression coefficients across continuous time, was used to model gender differences in the dynamic association between weight concerns and past-month cigarette use across adolescence.

Results: Gender moderated the time-varying association between weight concerns and past-month cigarette use during adolescence. The association between weight concerns and past-month cigarette use was positive and statistically significant for girls from age 11 to 16 years, and non-significant from age 16 to 20. The strength of this association increased markedly between ages 11 to 13, then declined until age 16. In contrast, for boys, the association between weight concerns and past-month cigarette use was non-significant across adolescence except between ages 17.5 and 18.5 years when there was a small negative association.

Conclusions: Findings indicate that the strength of the association between weight concerns and cigarette use varied across age and differed by gender. There may be a sensitive period in early to mid-adolescence during which girls with weight concerns are at heightened risk for cigarette use. These findings have important implications for tailoring substance use interventions.