Mentholated cigarettes or weight problems, which came first

Abstract

Background: Despite the old myth that smokers are skinnier, obesity is reaching epidemic proportions among smokers living with HIV, and particularly among women. We have previously observed an association between the use of mentholated cigarettes and obesity, but it is unclear whether obesity was a result from menthol inducedalterations, or if weight problems were a pre-existing condition. Methods: Smokers living with HIV and ready to quit were consecutively enrolled in our clinical trial. With a response rate of 98%, 154 female smokers were enrolled until 12/2018. Smoking history was obtained and participants were grouped into users of mentholated cigarettes=Group 1, or Group 2 if non-mentholated users. The study visit includes collection of anthropometrics, along with a history of weight problems. Two main outcomes were examined: (1) the relationship between Body Mass Index (BMI) and proximal predictor variables derived from the Socio-Ecological Model: socioeconomic status, and unhealthy habits (dietary intakes, physical activities, sleep and smoking); and (2) the prevalence of overweight and obesity (BMI >30) and the history of obesity as a function of the type of cigarette used. Result: The prevalence of obesity among this group was 51%, whereas in the general population is 38.3% (NHANES). An association was found between obesity and one SES component, race/ethnicity. Two behavioral factors were significant: high consumption of sugars and use of mentholated cigarettes. The age of smoking onset did not differ between groups 1 and 2, suggesting that smoking onset was not triggered by their weight concerns. Weight gain associated with pregnancies tended to affect the development of obesity in women during midlife and beyond (OR=2.1 95% CI 0.7-7.1, p=0.07). However, the history of obesity did not differ between Groups 1 and 2. Binary regression confirmed in the adjusted model the effects of history of obesity during childbearing years, use of mentholated cigarettes, and limited physical activity on current obesity trends. Conclusion: Data points to the primacy of behavioral factors, such as the use of mentholated cigarettes. Analyses confirmed that obesity was not a precondition linked to start smoking, indicating that it is likely to be the consequence of using mentholated cigarettes. Reduced physical activity also is contributing to the rising obesity rates.