Is post-smoking-cessation weight-gain a significant trigger for relapse?

While the Surgeon General's Consumer Guide lists weight-gain as an important relapse trigger, the 2001 Surgeon General's Report on Women and Smoking concludes, paradoxically, that actual weight-gain during cessation does not appear to predict relapse. This dichotomous view reflects longstanding scientific uncertainty about the role of weight-gain in triggering relapse. This scientific uncertainty, which stems from mixed clinical trial results, is problematic for insurance coverage decisions such as state Medicaid programme decisions to cover or exclude smoking-cessation and weight-control pharmaceuticals. Analysts hypothesize that selection bias may explain the inconsistency between the negative clinical results and the persistent view that weight-gain triggers relapse, if weight-concern is both a key determinant of the transition from ‘smoker’ to ‘ex-smoker,’ and a key moderating variable in the relationship between weight-gain and relapse. We therefore use the nationally representative 1997 National Longitudinal Survey of Youth (NLSY97) to test the relapse-trigger hypothesis, and conclude that post-smoking-cessation weight-gain triggers relapse among weight-concerned white women, but it is associated with quitting success among Hispanic women. In addition, our results do not support the hypothesis that the mixed clinical trial results reflect selection bias based on weight-concern.