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Obese teenage girls are more than twice as likely to have high-level nicotine addiction, compared with their non-obese peers when they reach young adulthood, a new study suggests.

The researchers studied more than 4,000 teen girls in the United States who responded to a survey that included a section on nicotine dependence. Medical News Today reports that obese girls in the study were more likely to report low self-esteem, depression and poor academic performance, compared with non-obese teen girls. The study was published in the Journal of Adolescent Health.

The study authors note that obesity and cigarette smoking are two of the most frequent and preventable causes of disease and death in the U.S., and both are often established during youth. “Obese, adolescent females may require targeted interventions to address their risk of subsequent high-level nicotine addiction, especially if risk factors such as parental smoking and poor school performance are present,” they wrote.

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