Co-occurring obesity and smoking among U.S. women of reproductive age: Associations with educational attainment and health biomarkers and outcomes

Abstract

Introduction Obesity and smoking are independently associated with socioeconomic disadvantage and adverse health effects in women of reproductive age and their children, but little is known about co-occurring obesity and smoking. The purpose of this study was to investigate relationships between co-occurring obesity and smoking, socioeconomic status, and health biomarkers and outcomes in a nationally representative sample. Methods Data from non-pregnant women of reproductive age were obtained from the U.S. National Health and Nutrition Examination Surveys reported between 2007-2010. Linear and logistic regressions were used to examine associations between obesity and smoking alone and in combination with educational attainment and a range of health biomarkers and outcomes. Results Prevalence of co-occurring obesity and smoking was 8.1% (~4.1 million U.S. women of reproductive age) and increased as an inverse function of educational attainment, with the least educated women being 11.6 times more likely to be obese smokers than the most educated. Compared to women with neither condition, obese smokers had significantly poorer cardiovascular and glycemic biomarker profiles, and higher rates of menstrual irregularity, hysterectomy, oophorectomy, physical limitations, and depression. Obese smokers also had significantly worse high-density lipoprotein (HDL) cholesterol levels, physical mobility, and depression scores than those with obesity or smoking alone. Conclusions Co-occurring obesity and smoking is highly associated with low educational attainment, a marker of socioeconomic disadvantage, and a broad range of adverse health biomarkers and outcomes. Interventions specifically targeting co-occurring obesity and smoking are likely necessary in efforts to reduce health disparities among disadvantaged women and their children.

Associations of maternal obesity and smoking status with perinatal outcomes

“…13 We have recently characterized the co-occurrence of smoking and obesity among disadvantaged women and their significant association with adverse health biomarkers in a nationally representative sample. 14 We have also shown that among women who quit smoking during pregnancy, breastfeeding rates are lower in obese compared to normal weight women, suggesting that maternal BMI moderates the effects of smoking cessation on breastfeeding. 15 In this study, we sought to examine possible moderating effects of maternal BMI on associations of smoking cessation on short-term perinatal outcomes.…”

E-cigarette use among women of reproductive age: Impulsivity, cigarette smoking status, and other risk factors

“…This may limit the generality of the observations to younger age women and adolescents. Second, generality to women with less than a high school education may be limited as they were underrepresented in this sample compared to nationally representative samples (e.g., Vurbic et al, 2015). Finally, this study used a relatively new online data collection platform and a somewhat more educated sample, which has the potential to introduce reporting or sample biases such as the somewhat higher prevalence rates of e-cigarette use mentioned above (Nayak, Pechacek, Weaver, & Eriksen, 2016).…”

“…Smoking during pregnancy is the leading preventable cause of poor pregnancy outcomes in the US and other developed countries (Bonnie, Stratton, & Wallace, 2007; Cnattingius, 2004; Pauly & Slotkin, 2008). The adverse consequences of smoking during pregnancy or raising children in a smoking environment have led researchers to target women of reproductive age as an important population to study in understanding risk from use of tobacco and nicotine delivery products (e.g., Ahluwalia, Mack, & Mokdad, 2004; Hand, Heil, Sigmon, & Higgins, 2015; Vurbic et al, 2015). …”

Editorial: 2nd Special Issue on behavior change, health, and health disparities

“…This problem too is coming to be overrepresented among more socioeconomically disadvantaged populations, especially women (Vurbic et al, 2015–in this issue). …”

“…Further driving home the need to be mindful of co-morbid conditions and risk factors, Vurbic et al (2015–in this issue) report an original study on the prevalence of co-morbid obesity and cigarette smoking in a nationally representative sample of U.S. women of reproductive age. Each of those conditions alone is overrepresented in socioeconomically disadvantaged women, and a risk factor for pregnancy complications, poor birth outcomes, and other poor health biomarkers and outcomes.…”