Potential for unintended consequences: The association between smoking and body mass index among public housing residents in Baltimore, MD

The U.S. Department of Housing and Urban Development (HUD) smokefree rule for public housing may prompt smokers to quit. Cessation, while desirable, can be associated with weight gain, and an excess burden of obesity already exists among public housing residents. Our objectives were to characterize the association between smoking and weight status prior to the policy implementation and to explore eating patterns. We conducted a cross-sectional analysis of survey data collected in 2014–2015 from randomly selected households in two public housing developments in Baltimore, MD. Our independent variable was self-reported smoking status, and dependent variables were measured body mass index (BMI) and uncontrolled/emotional eating scores. We used multivariable linear regression to examine the associations. Respondents included 266 heads of household with mean age 44.5 (SD 12.4). A majority (63.2%) were current smokers. Seventy-five percent were overweight or obese, with mean BMI 32.6 kg/m2 (SD 10.1). In the adjusted regression models, the mean BMI of smokers was significantly lower than that of former/never smokers (31.7 kg/m² vs. 34.2 kg/m²), and the mean uncontrolled eating score of smokers was significantly higher (24.4 vs 18.7). These results suggest that the new HUD smokefree rule has the potential to promote further weight gain among smokers prompted to quit, highlighting the need to simultaneously consider these two prevalent risk factors in the setting of policy changes.