Intrapersonal Level Unhealthy Behaviors (Smoking, Drinking Alcohol, and Tobacco Use) and Their Association With Body Mass Index Among School-Aged Children and Adolescents in Pakistan

Purpose: The association between Unhealthy Behaviors (Smoking, Drinking Alcohol, and Tobacco Use) and body mass index (BMI) is a significant public health concern due to their roles as preventable risk factors for cardiovascular disease and various other conditions. Despite numerous previous studies, no consensus has emerged regarding the effect of Unhealthy Behaviors on BMI. Therefore, we conducted a novel study to evaluate the relationship between Unhealthy Behaviors and BMI in Pakistani school-aged children and adolescents aged 9 to 17 years. Methods: A cross-sectional study was conducted involving 4108 Pakistani schoolchildren aged 9 to 17 years from 62 schools across seven districts in central Punjab province. Body mass index (BMI) categories were defined using the CDC US 2000 growth charts: underweight as 85th to < 95th percentile, and obese as equal to or greater than the 95th percentile. The Chi-square test was employed to analyze categorical variables, and the Pearson correlation coefficient (r) was used to determine correlations. 95% confidence intervals (CI) were calculated, and statistical significance was set at p < 0.05. Results: The prevalence of weight, overweight, and obesity among the participants was 19.4%, 10.7%, and 10.7%, respectively. Smoking within the last 7 days showed an odds ratio (OR) of 1.79 (95% CI: 0.91-3.55) for overweight status, while the use of tobacco products other than cigarettes demonstrated an OR of 1.61 (95% CI: 1.03-2.52) for overweight. Drinking alcohol within the last 7 days was associated with an OR of 2.78 (95% CI: 0.43-5.05) for obesity. Witnessing someone smoke in front of students for three or more days was associated with an OR of 0.90 (95% CI: 0.76-1.07) for overweight. Additionally, having a father or male guardian who smokes showed higher odds ratios for overweight, with an OR of 1.21 (95% CI: 1.02-1.44). Conclusion: This study sheds light on the alarming prevalence of overweight and obesity among Pakistani school-aged children and adolescents, emphasizing the need for urgent intervention. Nonetheless, it is reassuring to find relatively low rates of smoking and alcohol consumption within this demographic. The majority of students are not involved in these unhealthy behaviors, and importantly, no significant associations were observed between these behaviors and weight status. These findings underscore the effectiveness of ongoing initiatives aimed at promoting healthy lifestyles and discouraging smoking and alcohol consumption among young individuals.