title: Co-occurring obesity and smoking among U.S. women of reproductive age: Associations with educational attainment and health biomarkers and outcomes.
abstract: BACKGROUND
  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 and 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.
authors.affiliation: Vermont Center on Behavior and Health, University of Vermont, USA; Department of Psychiatry, University of Vermont, USA; Department of Psychology, University of Vermont, USA.
authors.forename: Drina
authors.initials: D
authors.lastname: Vurbic
authors.affiliation: Department of Psychiatry, University of Vermont, USA; Department of Psychology, University of Vermont, USA; Department of Pediatrics, University of Vermont, USA.
authors.forename: Valerie S
authors.initials: VS
authors.lastname: Harder
authors.affiliation: Vermont Center on Behavior and Health, University of Vermont, USA; Department of Psychiatry, University of Vermont, USA.
authors.forename: Ryan R
authors.initials: RR
authors.lastname: Redner
authors.affiliation: Vermont Center on Behavior and Health, University of Vermont, USA; Department of Psychiatry, University of Vermont, USA; Department of Psychology, University of Vermont, USA.
authors.forename: Alexa A
authors.initials: AA
authors.lastname: Lopez
authors.affiliation: Vermont Center on Behavior and Health, University of Vermont, USA; Department of Obstetrics, Gynecology and Reproductive Sciences, University of Vermont, USA.
authors.forename: Julie K
authors.initials: JK
authors.lastname: Phillips
authors.affiliation: Vermont Center on Behavior and Health, University of Vermont, USA; Department of Psychiatry, University of Vermont, USA; Department of Psychology, University of Vermont, USA. Electronic address: Stephen.Higgins@uvm.edu.
authors.forename: Stephen T
authors.initials: ST
authors.lastname: Higgins
mesh_terms: D000328:Adult; D015415:Biomarkers / Q000097:blood*; D015897:Comorbidity; D004522:Educational Status; D005260:Female; D006801:Humans; D016015:Logistic Models; D008875:Middle Aged; D009749:Nutrition Surveys; D009765:Obesity / Q000453:epidemiology*; D015995:Prevalence; D060728:Reproductive Health; D012307:Risk Factors; D012907:Smoking / Q000453:epidemiology*; D014481:United States / Q000453:epidemiology; D055815:Young Adult
chemical_list: D015415:Biomarkers
keywords: Cardiovascular disease; Cigarette smoking; Co-occurring smoking–obesity; Depression; Diabetes; Education; Obesity; Physical mobility; Reproductive health; Women's health