摘要：Objectives. We examined the impact of smoking cessation on weight change in a population of women prisoners. Methods. Women prisoners (n = 360) enrolled in a smoking cessation intervention; 250 received a 10-week group intervention plus transdermal nicotine replacement. Results. Women who quit smoking had significant weight gain at 3- and 6-month follow-ups, with a net difference of 10 pounds between smokers and abstainers at 6 months. By the 12-month follow-up, weight gain decreased among abstainers. Conclusions. We are the first, to our knowledge, to demonstrate weight gain associated with smoking cessation among women prisoners. Smoking cessation interventions that address postcessation weight gain as a preventative measure may be beneficial in improving health and reducing the high prevalence of smoking in prisoner populations. Smoking and obesity are the 2 major causes of mortality and morbidity in the United States. 1 , 2 Although smoking is the leading preventable cause of death, resulting in approximately 440 000 deaths each year, 3 obesity is a growing epidemic and is the second leading cause of preventable death, resulting in more than 300 000 deaths annually. 4 , 5 Whereas smoking rates have declined from their peak in the 1960s, obesity rates have been steadily climbing each year, and obesity is expected to soon eclipse smoking as the most preventable cause of mortality in the United States. 1 The relationship between smoking and weight is complex, and the mechanisms by which smoking influences weight are not fully understood. Smoking affects weight by increasing metabolic rate and decreasing caloric absorption, which is thought to help suppress appetite. 6 Sympathoadrenal activation by nicotine is thought to be primarily responsible for the metabolic effect of smoking. 7 Smoking is also associated with increased energy expenditure. 8 Smoking a single cigarette also decreases caloric consumption by 3% within 20 minutes. 9 Compared with light smokers and nonsmokers, heavy smokers tend to have greater body weight, which likely reflects a clustering of risk behaviors (i.e., little physical activity and poor diet) and increased insulin resistance and accumulation of abdominal fat. 6 , 10 , 11 Overall, smokers tend to be less physically active than nonsmokers, which may confound explanations of weight differences between smokers and nonsmokers. 12 Most studies on weight and smoking have reported postcessation weight gain. Smoking cessation has been associated with approximately 10 pounds of weight gain after 1 year of abstinence, 13 suggesting that health benefits from smoking cessation may be mitigated to some degree by increased health risks associated with weight gain. 14 To prevent or reduce weight gain, those administering cessation programs are recommended to integrate follow-up support for weight control, provide regular body weight measurement, provide recommendations for dietary change, and encourage increased physical activity. 14 Despite concerns about weight, few studies have systematically investigated weight gain following smoking cessation, particularly with underserved populations such as prisoners. Correctional populations especially are vulnerable to the negative health consequences of smoking. Smoking rates are 3 to 4 times higher among correctional populations than among the general population, and smoking is normative within the correctional environment. 15 – 17 Smoking prevalence is 70% to 80% among male and female prisoners, 15 – 20 while almost half (46%) of adolescents in juvenile justice are daily smokers. 21 This compared to about 21% of adults in the general population who are current smokers. 22 However, in the research literature, the emphasis on smoking prevalence, prevention, cessation, and policies is much greater among other populations than it is among criminal justice populations—despite the human, health, and economic costs that occur in prison and in the community. 20 , 23 In addition to the larger prevalence of smoking in prisons, there is less access to interventions for smoking cessation in correctional facilities. Lack of resources amplifies the negative health risks associated with smoking, such as heart, circulatory, and respiratory problems. Over the past 2 decades, correctional facilities in the United States have implemented tobacco-control policies ranging from restrictions on indoor smoking to complete tobacco bans. 24 Tobacco restrictions and bans have not succeeded in suppressing smoking, and reduced access to programs and materials that might increase long-term smoking cessation have paralleled them. 16 , 17 , 24 , 25 We recently conducted a randomized controlled trial of smoking cessation with women prisoners and found 7-day point prevalence cessation rates comparable to those seen in community smoking cessation interventions. 15 The intervention combined nicotine replacement with a 10-week group therapy intervention. 26 The community-tested intervention was modified for the prison environment and included a discussion of weight gain and weekly monitoring of weight during the intervention and follow-up assessments. 15 Point prevalence quit rates for intervention participants were 18% at end of treatment, 17% at 3-month follow-up, 14% at 6-month follow-up, and 12% at 12-month follow-up, compared with less than 1% at these same time points for control participants. 15 We examined differences in weight change over time for (1) women in the intervention condition compared with women in the control condition and (2) women in the intervention condition who quit smoking compared with those who continued to smoke. To our knowledge, ours is the first study to conduct such a trial among women prisoners.
