Race differences in predictors of weight gain among a community sample of smokers enrolled in a randomized controlled trial of a multiple behavior change intervention

Abstract

African Americans have disproportionate rates of post-cessation weight gain compared to non-Hispanic whites, but few studies have examined this weight gain in a multiracial sample of smokers receiving evidence-based treatment in a community setting. We examined race differences in short-term weight gain during an intervention to foster smoking cessation plus weight management. Data were drawn from the Best Quit Study, a randomized controlled trial conducted via telephone quitlines across the U.S. from 2013 to 2017. The trial tested the effects on cessation and weight gain prevention of adding a weight control intervention either simultaneously with or sequentially after smoking cessation treatment. African Americans (n = 665) and whites (n = 1723) self-reported smoking status and weight during ten intervention calls. Random effects longitudinal modeling was used to examine predictors of weight change over the intervention period (average 16 weeks). There was a significant race × treatment effect; in the simultaneous group, weight increased for African Americans at a faster rate compared to whites (b = 0.302, SE = 0.129, p < 0.05), independent of smoking status, age, baseline obesity, and education. After stratifying the sample, the effect of treatment group differed by race. Education level attenuated the rate of weight gain for African Americans in the simultaneous group, but not for whites. African Americans receiving smoking and weight content simultaneously gained weight faster than whites in the same group; however, the weight gain was slower for African Americans with higher educational attainment. Future studies are needed to understand social factors associated with treatment receptivity that may influence weight among African American smokers.

Keywords: Health behavior; Health disparities; Multiple behavior change; Smoking cessation; Weight gain.

Fig. 1

Results of a mixed effects multilevel model examining change in weight over time for participants receiving a multiple behavior change intervention administered through the telephone quitline in the U.S. from 2013 to 2017. This graph is a visual representation of the effect of race on weight gain and illustrates the predicted values for African American and white participants receiving a smoking cessation and weight management treatment simultaneously.

Fig. 2

This graph is a visual representation of an interaction effect of education level and intervention group on weight gain over time for African American quitline callers. This graph illustrates the predicted values for African Americans in each intervention group of a randomized controlled trial testing efficacy of adding a weight management intervention to a telephone quitline tobacco cessation intervention in the U.S. from 2013 to 2017.