Relationship between BMI, body image, and smoking in Korean women as determined by urine cotinine: Results of a nationwide survey

Background: This study examined the influence of body mass index (BMI), subjective body perception (SBP), and the differences between BMI and SBP influence on smoking among women. Methods: This study used the Korea National Health and Nutrition Examination Survey IV-2, 3 2008-2009. A urinary cotinine test was administered to 5485 women at least 19 years of age. Individuals whose cotinine level was at least 50 ng/mL were categorized as smokers. A multiple logistic regression analysis was performed to estimate the extent to which body-related variables affect female smoking. Results: Women with a lower BMI who perceived themselves to be normal or very fat were 2.09 times (1.14-3.83) more likely to smoke than women with a normal BMI and SBP. Women who were never married with a low BMI and thin SBP were 3.11 times (1.47-6.55) more likely to smoke than women with a normal BMI and SBP. Married women with a high BMI who considered themselves very fat were 0.63 times (0.43-0.94) less likely to smoke than women with a normal BMI and SBP. In contrast, divorced and widowed women with a low or normal BMI who considered themselves very fat were 26.1 times (1.35-507.3) more likely to smoke. Conclusions: Discrepancies between the objective physical condition (BMI) and the subjective body image (SBP) influence the female smoking rate. To reduce the number of female smokers, public education on the association between smoking behavior and weight issues is needed, especially among women with low BMI and distorted weight perception.