The co-occurrence of smoking and drinking among young adults in college: national survey results from the United States

BACKGROUND: In US colleges, alcohol and tobacco pose substantial health risks but little is known about their co-occurrence, limiting development and use of appropriately targeted prevention efforts. METHODS: Data from the 2001 HSPH College Alcohol Study (student n = 10,924; college n = 120) were analyzed using multivariate logistic regression. Co-occurring smoking/drinking risks were examined in aggregate, by gender, and by age of onset of regular drinking and smoking across 10 measures of drinking style, three categories of transitional drinking behavior, and by treatment behavior. RESULTS: Over 98% of current smokers drink; a fraction (<1%) of lifetime and 7% of past year alcohol abstainers smoke. Across drinking pattern measures, 44-59% of drinkers smoke. Co-occurrence risks are greatest among youth reporting high total alcohol consumption (adjusted OR 4.21, p < 0.0001), drinking problems (adjusted OR 3.31, p < 0.0001) or symptoms of diagnosable alcohol abuse (adjusted OR 3.02, p < 0.0001). Risks are sharply elevated among students who self-medicate for drinking problems and do not seek/receive help (adjusted OR 1.87, p < 0.0001), and those reporting symptoms of diagnosable alcohol abuse who may or may not seek/receive help (adjusted OR 2.67, p < 0.01 and 2.96, p < 0.01, respectively). Females and students reporting early adolescent onset of regular smoking are at greatest risk. CONCLUSIONS: Virtually all college smokers drink, and smoking and drinking are powerfully interrelated across drinking measures. Efficiency argues for jointly targeting both behaviors and developing interventions tailored to the special vulnerabilities of young women, students experiencing difficulties adjusting to college, and students reporting early onset of regular smoking.     

Experimenting and daily smokers: Episodic patterns of alcohol and cigarette use

Alcohol use may facilitate the development of nicotine dependence. Alcohol is often paired with cigarette smoking, particularly in those experimenting with smoking. However, little research has examined episodic patterns of alcohol and cigarette use. This study examined patterns of alcohol and cigarette use in a college-aged sample (n = 237) designated as experimenters or smokers based on their smoking history. Participants reported their consumption of drinks and cigarettes by hour, for each hour, of a typical drinking and smoking episode. Self-reported pleasure and desire associated with smoking generally and while drinking was assessed. No group difference was observed in total number of drinks. However, experimenters delayed smoking until more drinks were consumed, suggesting they smoked after reaching binge levels of alcohol. By contrast, smokers smoked after fewer drinks. Both groups reported increased smoking while drinking and increased pleasure and desire when smoking while drinking. The increase was greater in experimenters. Concurrent alcohol and cigarette use may facilitate the development of tobacco dependence and interventions interrupting their pairing might impede the transition from experimenter to smoker.     

Relationship of onset of cigarette smoking during college to alcohol use, dieting concerns, and depressed mood: results from the Young Women's Health Survey

To investigate the issue of smoking initiation during college, we administered a survey of women's health behavior to college women during freshman orientation, at the end of their freshman year and again during their senior year. Never smokers (NS; n=374), early-onset smokers (EOS; n=52), and late-onset smokers (LOS; n=64) were compared on dieting concerns, mood problems, alcohol-related problems, and frequency of binge drinking episodes. By the senior year of college, 55% (64/116) of those who had smoked in the past month had started smoking during college, although they were more likely than never smokers to have experimented with cigarettes prior to college. Escalating depression during the first year of college, dieting concerns, and alcohol-related problems were significant risk factors for smoking initiation during college, while binge drinking appeared to covary with cigarette smoking. Results suggest that prevention efforts should target nonsmokers with high dieting concerns and escalating depression early in college, while intervention efforts may need to target not only smoking but also problematic alcohol use among smoking college women.     

Characteristics associated with smoking in a Hispanic college student sample

This study examined the smoking related behaviors of Hispanic young adult college students as part of a larger study that assessed characteristics of Hispanic smokers in a metropolitan area on the U.S./México border. One hundred seventy-four English-speaking Hispanic college students completed questionnaires that assessed tobacco use, drug/alcohol use, body mass index, weight concerns, acculturation, depressive symptoms, and expired carbon monoxide level. Of the 74 smoking participants (42.5% of the sample), 77% reported light or intermittent smoking. Univariate analyses and a backward elimination logistic regression model were used to compare smokers' and nonsmokers' characteristics. Significant univariate differences between smokers and nonsmokers were higher reported weekly alcohol use and ever use of marijuana. Logistic regression findings indicated smokers reported heightened odds of being younger, lower acculturation, ever use of drugs, and weekly drinking. These results suggest a drug and alcohol use component is important to cessation interventions targeted toward Hispanic college student smokers.     

Alcohol consumption and quitting smoking in the International Tobacco Control (ITC) Four Country Survey

Although greater alcohol consumption has been associated with decreased odds of quitting smoking in prospective studies, the aspects of drinking most strongly associated with quitting have not been fully explored and examination of potential confounder variables has been limited. Further studies are needed to inform efforts to enhance smoking cessation among the substantial portion of smokers who drink alcohol. The present study examines: (a) drinking frequency, average weekly quantity of alcohol consumption, and frequency of heavy drinking as prospective predictors of quit smoking behaviors, (b) difference across countries in this prediction, and (c) third variables that might account for the association between alcohol consumption and quitting smoking. Data were drawn from the International Tobacco Control Four Country Survey, a prospective cohort study of smokers in Australia, Canada, the UK, and the US. A total of 4831 participants provided alcohol data at one study wave and were re-interviewed 1 year later. Individuals who drank heavily (4+/5+ drinks for women and men, respectively) more than once a week had significantly lower rates of quitting smoking than all other participants, in part due to the fact that a significantly lower proportion of those making a quit attempt remained quit for more than 1 month at follow-up. The role of frequent heavy drinking did not differ by country or sex and was not accounted for by demographics, smoking dependence, or attitudes regarding quitting smoking. Neither drinking frequency nor weekly quantity of consumption showed robust associations with quitting behaviors. Results indicate further study of interventions to address heavy drinking among smokers is warranted.     

Differences between daily smokers, chippers, and nonsmokers with co-occurring anxiety and alcohol-use disorders

Tobacco use is disproportionately represented among both alcohol-use disorders (AUDs) and anxiety disorders (ANX) compared to the general population [Kalman, D. A., Morissette, S. B., & George, T. P. (2005). Co-morbidity of nicotine and tobacco use in psychiatric and substance use disorders. The American Journal on Addictions, 14, 1-18]. Despite this common overlap, little is known about how smokers with co-occurring AUD-ANX differ from their nonsmoking counterparts. Seventy-two patients participated in a larger clinical trial evaluating the efficacy of venlafaxine and cognitive-behavioral therapy for AUD-ANX. Differences between daily smokers (n=23), chippers (n=12) and nonsmokers (n=37) with AUD-ANX were examined with respect to intensity and frequency of alcohol use, anxiety symptoms, depressed mood, and stress. Point prevalence of current daily smoking was 31.9%, which is considerably lower than traditionally reported in AUD studies. Consistent with predictions, daily smokers reported higher levels of alcohol dependence, average drinks per drinking occasion, and peak blood concentration levels in a day than nonsmokers during the 90 days prior to assessment. Chippers were nonsignificantly different from either smokers or nonsmokers. Smokers and nonsmokers did not differ with respect to percent heavy drinking days or emotional symptoms.     

Drinking as a risk factor for sustained smoking

Data from a nationally representative sample of US adults (n=42862) were used to explore the associations between drinking and smoking, on a lifetime and past-year basis, and between drinking and smoking cessation for a subsample of past-year smokers (n=12586). Smoking cessation was defined as current nonsmoking (as of the time of interview) that had lasted at least 3 months. The proportions of both lifetime and past-year smokers increased with volume of alcohol intake and frequency of heavy drinking and were greater for individuals with DSM-IV alcohol abuse or dependence than for individuals without these disorders. For example, the proportion of past-year smokers rose from 22.5% of lifetime abstainers to 53.0% of heavy drinkers, from 23.8% of those who never drank 5+ drinks on any drinking day to 61.8% of those who drank 5+ drinks weekly or more often and from 27.6% of individuals without past-year DSM-IV alcohol abuse or dependence to 55.5% of those with either of these disorders. The proportion of past-year smokers who had stopped smoking decreased from 7.8% of former drinkers to 4.6% of heavy drinkers, from 7.3% of those who never drank 5+ drinks to 3.4% of those who did so weekly or more often and from 6.7% among individuals without past-year abuse or dependence compared to 4.4% among those with either disorder. In a multivariate analysis that adjusted for background variables and smoking history, average daily ethanol intake was not significantly associated with the odds of smoking cessation, but drinking 5+ drinks at least once a month reduced the odds of cessation by 42%. Having an alcohol use disorder increased the odds of smoking cessation below the age of 30 (an effect that disappeared after adjusting for the interaction between age group and having children in the home), but had an increasingly negative effect on smoking cessation at older ages.     

Young adult non-daily smokers: patterns of alcohol and cigarette use

Binge drinking and non-daily cigarette smoking are behaviors that are both problematic and prevalent in young adults. Although the relationship between drinking and daily smoking has been well categorized, the intersection between drinking and smoking in non-daily smokers has not been heavily researched. Past 30-day and within-episode patterns of alcohol and cigarette use were collected in young adult non-daily smokers (N=40). Results demonstrated that 79% of smoking occurred on drinking days. Alcohol use was significantly greater on smoking days with the result that drinking to risky binge levels was more likely to occur on a smoking day. Smoking typically occurred after a certain level of alcohol pre-load (2.87 drinks). Together these results confirm that young adult non-daily smokers often concurrently use alcohol and cigarettes. Research is needed to identify possible mechanisms underlying the association between binge drinking and cigarette use in this vulnerable population.     

Efficacy of an online intervention to reduce alcohol-related risks among community college students

Problems associated with alcohol use are well-documented among traditional 4-year college students, but less is known about community college students' alcohol use. The few published articles that have investigated alcohol consumption among community college students suggest that risky alcohol consumption is a concern. Online alcohol-related risk reduction programs may be well-suited to community college campuses, due to reduced cost and labour effort, as well as increased accessibility for students. The aim of the current study was to test the efficacy of an online intervention designed to reduce risks associated with alcohol use among community college students. Three hundred and nineteen community college students were randomised to one of two treatment conditions: reviewing the online alcohol-related risk reduction program or reviewing online educational newsletters. Generalised linear mixed models were conducted, testing for mean differences between conditions over time on each outcome (primary analyses: alcohol and other drug use, protective behaviours and consequences of substance use). Exploratory analyses for moderating effects of covariates and user engagement were also conducted. Twelve months after the intervention, students who reviewed the online intervention reported a reduction in the maximum number of drinks consumed on one occasion within the past week and a greater reduction in total drinks consumed within the past week, as compared to students who received educational e-newsletters. Online alcohol-related risk reduction programs for students beginning community college may offer a practical and effective way to reduce alcohol consumption, and may have the potential to increase the wellbeing of a largely underserved population.     

Drinking on campus: self-reports and breath tests

OBJECTIVE: Concern about excessive alcohol consumption by college students has been raised by surveys indicating that more than 40% of students are "heavy" drinkers. This definition is based on students' reports of consuming five or more drinks (four or more for women) on an occasion sometime during the past 2 weeks. The present survey examines the degree to which this 2-week 5+/4+ drink criterion characterizes a student's pattern of alcohol use, and whether a 5+/4+ criterion for a drinking occasion is a valid indicator of high blood alcohol concentration (BAC). METHOD: Students (N = 856, 70% male) were interviewed as they returned home between 10 PM and 3 AM. Students reported their drinking of the past 2 weeks and of the night they were interviewed, then provided breath samples to determine their BAC. RESULTS: Among the students in the sample classified as "heavy" drinkers on the basis of self-reports, 49% had zero BAC on the night they were interviewed. Those who reported consuming 5+/4+ drinks the evening of the interview had a mean BAC <0.08%. The distribution of BACs in the entire sample showed 74.4% of students had a BAC of zero and 11.8% had a BAC <0.05%. Very high BACs (i.e., > or =0.15%) were rare (1.3%). CONCLUSIONS: Self-reports of consuming 5+/4+ drinks on at least one occasion during the previous 2 weeks did not reliably identify a pattern of heavy drinking. Moreover, reports of 5+/4+ drinks on an occasion were not necessarily associated with high BACs.     

Reciprocal effects of alcohol and nicotine in smoking cessation treatment studies

Objective

Smoking and alcohol use are highly related; as such the present study investigated whether alcohol use is associated with failure in tobacco cessation attempts. We first examined the self-reported drinking behavior and smoking over the course of a year at a basic level. Next, we addressed two hypotheses to characterize this relationship at a deeper level: (Hypothesis 1) Alcohol use would be lower for those who attempted to quit smoking (quit for one or more days) during the year compared to those who never quit, and (Hypothesis 2) for those who relapsed to smoking after a quit increases in alcohol consumption would be positively associated with increases in smoking.

Method

Subjects were participants in two smoking cessation programs. One group of participants (N = 139) was part of a smoking cessation study in alcohol dependent smokers in early recovery and the other group of participants (N = 163) was drawn from a smoking cessation study for HIV positive smokers.H1 was tested using t-tests. For H2, a time series analysis examined relationships between smoking and alcohol use within person over a one year period. For H1 and for H2, the analyses utilized bivariate time series procedures. Timeline follow-back data allowed for detailed daily reports of both tobacco and alcohol use.

Results

In the overall sample, there was no difference in alcohol use between those who stopped smoking and those who never stopped. However, when broken up by study, a difference was found in the alcohol dependent sample such that mean drinks were higher for those who stopped compared to those who never stopped smoking (H1). The results indicated a high number of positive significant cross-correlations between tobacco and alcohol use such that one substance predicted current, as well as past and future use of the alternate substance. Same-day cross-correlations were the most common, and dissipated with time (H2).

Conclusions

This analysis provided insights into the proximal influence of one substance on the other. Alcohol is related to relapse in smoking cessation attempts. It is important that smoking cessation efforts in alcohol using populations consider alcohol use in treatment.     

Alcohol mixed with energy drinks: Are there associated negative consequences beyond hazardous drinking in college students?

Objective

The consumption of alcohol mixed with energy drinks (AmED) is prevalent among college students as is hazardous drinking, a drinking pattern that places one at risk for alcohol-related harm. The present study, therefore, examined associations between AmED use, hazardous drinking, and alcohol-related consequences in college students.

Methods

Based on a probability sample conducted in 2010, participants were 606 undergraduate students aged 18–25. AmED consumption included lifetime and past year use. Hazardous drinking and alcohol-related consequences were measured during the past year. Point prevalence was used to estimate rates of AmED use, and chi-square, ANOVA, and logistic regression were used to examine associations between AmED use, hazardous drinking, and alcohol-related consequences.

Results

Lifetime and past year AmED use prevalence rates were 75.2% and 64.7%, respectively. Hazardous drinkers who engaged in AmED use were significantly more likely than past year hazardous drinkers who did not engage in AmED use to have had unprotected sex (OR = 2.35, CI 1.27–4.32).

Conclusions

AmED use appears to be highly prevalent among college students, and AmED use may confer additional risk for unprotected sex beyond hazardous drinking. Unprotected sex has implications for public health, and students who drink hazardously and consume AmED may be at greater risk.     

Smoking expectancies for flavored and non-flavored cigarettes among college students

Several tobacco companies have introduced specially flavored cigarettes, yet little is known about their appeal among college student nonsmokers, regular smokers, and those susceptible to smoking. Undergraduates (N=424) rated 12 brands of cigarettes on multiple attributes based on manufacturer advertisements. This paper focused on two brands with flavored and non-flavored versions (Camel and Salem). Despite brand, regular smokers and those susceptible to smoking initiation had higher positive expectancies and lower negative expectancies about smoking than nonsmokers. Flavored cigarettes elicited higher positive expectancies than non-flavored counterparts across all groups, including nonsmokers. Indeed, the degree to which flavored Camels had higher positive expectancies than Camel Lights was at least as large in a group of susceptible nonsmokers and experimenters (susceptible/experimenters). Despite being present in nonsmokers and susceptible/experimenters, negative expectancies were significantly lower for flavored versus non-flavored brands. Logistic regressions revealed that positive expectancies predicted "intention to try" each brand for regular smokers and susceptible/experimenters. These findings suggest that targeting the marketing of positive attributes may be useful in preventing smoking behavior.     

Alcohol problems as a signal for sensitivity to nicotine dependence and future smoking

Background

Alcohol use is a well-documented risk factor for the emergence of chronic smoking behavior. Very little is known, however, about the mediating pathways through which alcohol and/or alcohol-related problems influence future smoking.

Methods

Data were drawn from the longitudinal Social and Emotional Contexts of Adolescent Smoking Patterns Study (SECASPS). Adolescents who had smoked under 100 cigarettes in their lifetime (n = 898; experimenters) and adolescents who had smoked over 100 cigarettes, but fewer than 5 cigarettes per day (n = 152: current smokers) were examined separately (grouping variable). Path analysis was performed to investigate the association between alcohol related problems at baseline (primary predictor) and smoking regularity at the 48 month follow-up (primary outcome), both directly and through mediating variables of smoking quantity and frequency, and nicotine dependence (averaged across these measures at 6-, 15-, and 24-month assessment waves).

Results

Among experimenters, after controlling for smoking and alcohol use, the association between alcohol-related problems at baseline and smoking frequency 48 months later was fully mediated by nicotine dependence symptoms. Among current smokers, only past smoking behavior was associated with 48-month smoking frequency.

Conclusions

Alcohol-related problems are a risk factor for future smoking among novice adolescent smokers above and beyond drinking or smoking per se. By signaling sensitivity to nicotine dependence symptoms, alcohol related problems represent an easily measureable risk factor that can be used to identify and intervene with adolescents before more chronic smoking behaviors emerge.     

The relation between alcohol consumption and smoking abstinence: results from the Working Well Trial

The current study examined the relation between drinking and smoking abstinence in a community-based sample from the Working Well Trial (WWT). At baseline, drinking level was related to smoking history (never, former, or current smoker; P < .0001) and abstinence history. Mean monthly alcohol consumption increased linearly with decreases in duration of recent abstinence (i.e., longest period quit in the past year among current smokers; P < .05) and current abstinence (i.e., time since quitting among former smokers; P < .0001), even controlling for relevant demographic factors. Among baseline smokers, lower beer consumption predicted smoking abstinence at 4-year follow-up (P< .01). A trend towards significance was found for total alcohol consumption (P = .06). The results suggest (a) a dose-response relation between baseline drinking and duration of smoking abstinence, and (b) that heavier drinkers are less likely to quit smoking over a 4-year period.     

Alcohol assessment using wireless handheld computers: a pilot study

The present study sought to test the feasibility of measuring quantity and frequency of self-reported alcohol consumption among college students using the Handheld Assisted Network Diary (HAND) by comparing results to a retrospective Timeline Followback (TLFB). A total of 40 undergraduate college students completed a HAND assessment during the two-week study period and completed a TLFB at follow-up. The HAND recorded similar levels of alcohol consumption compared to the TLFB. There were no significant differences in overall alcohol consumption, drinks per drinking day, or heavy drinking days between the two methods of assessment. Handheld computers may represent a useful tool for assessing daily alcohol use among college students.     

Alcohol Use,Drug Use,and Sexual Activity among Pharmacy Students at Three Institutions

ObjectiveTo determine alcohol and drug use and sexual activity among pharmacy students at three colleges of pharmacy.Design and SettingA survey to obtain self-reported information on alcohol and drug use, and sexual activity was administered to professional pharmacy students at the University of Iowa (UI), Massachusetts College of Pharmacy, and Texas Southern University.Main Outcome MeasuresInformation on sexual activity and condom use, alcohol and drug consumption, and the effect of alcohol on unintended sexual activity.Results848 students (50% response rate) completed the survey. Alcohol use was high at all three institutions, and most students had consumed five or more drinks on one or more occasions within the last three months. The extent of drug use among pharmacy students was similar to that reported in other college students. The majority of students were sexually active. More men than women reported having been sexually active with one or more partners. Most students reported having had sexual intercourse without a condom. Significant numbers of students had engaged in unintended sex after alcohol use, especially at UI (χ² = 12.6, p = 0.002). Sexual contact and drinking were strongly correlated (Pearson r = 0.31, p = 0.0001).ConclusionAlcohol consumption among pharmacy students was high. Heavy drinking (five or more drinks on one occasion) was associated with unintended sexual contact. Given low condom use and increased sexual contact, pharmacy students are at an increased risk for HIV infection. Strategies should be developed to reduce alcohol intake and unprotected sexual activity among pharmacy students.     

Is there a relationship between victim and partner alcohol use during an intimate partner violence event? Findings from an urban emergency department study of abused women

OBJECTIVE: This study sought to identify factors associated with drinking during an intimate partner violence (IPV) event among abused women presenting to an urban emergency department (ED). METHODS: We use a cross-sectional study of IPV cases among adult female patients seen at an urban ED. Bivariate and logistic regression analyses were performed to identify substance use factors associated with an abused woman drinking while victimized or perpetrating IPV. RESULTS: Among the 182 cases, an increased number of drinks per week, consuming five or more drinks per occasion, alcohol abuse and dependence, and illicit drug use were significantly associated with the abused woman's drinking while victimized or perpetrating IPV Partner's drinking five or more drinks per occasion was associated only with the woman's drinking while victimized. Partners were more likely to drink while perpetrating IPV in the relationship whether or not the woman drank while victimized. Among couples in which the abused woman also perpetrated violence, the partner's drinking more closely paralleled the woman's drinking in events perpetrated by the woman. Independent risk factors associated with the abused woman drinking during victimization included number of drinks she consumed per week (adjusted odds ratio [adj. OR] = 1.31 for every five drinks) and her illicit drug use (adj. OR = 4.3). The odds of an abused woman drinking while perpetrating IPV increased 1.4 times for every five drinks she consumed per week. CONCLUSIONS: These findings suggest that alcohol-related behavior by both couples and individuals are important factors to consider in the relationship between IPV and alcohol use in this population.     

Smoking among High School Students in 10 Italian Towns: Patterns and Covariates

The associations between tobacco smoking and demographic, socioeconomic, environmental, and behavioral factors among adolescents were investigated by administering an anonymous questionnaire to 5,221 ninth (aged 14–15 years) and 4,154 thirteenth grade (aged 18–19 years) students in 10 Italian towns. Using logistic regression analysis, both current smoking and experimental smoking were statistically associated with sibling, best friend, and partner smoking, alcohol drinking, and frequency of drunkenness in both grades and sexes. Attitude of parents toward children's smoking was also found to be associated with the probability of being a current smoker, especially among ninth graders. Parental smoking was associated with current smoking among females only. Socioeconomic factors and level of knowledge of the health consequences of smoking were not associated with either experimental or regular smoking. In conclusion, this survey suggests that social environment plays a fundamental role in both first experimentation with smoking and the process of becoming a regular smoker among adolescents. Students with one or more siblings who smoke, and especially those with best friends and a partner who smoke, were much more likely to have tried smoking and to be current smokers than students without smokers in their environment.     

Understanding college drinking: assessing dose response from survey self-reports

OBJECTIVE: One of the most difficult challenges confronting alcohol researchers is the assessment of specific risks associated with specific drinking levels (one, two or three or more drinks). In this article, a model-based method is presented that provides specific measures of dose, exposures and risks related to drinking and enables adequate assessment of dose-response relationships using survey data. METHOD: Survey data collected from 2,102 college students on drinking patterns and related problems were analyzed using a mathematical model that extracts separable measures of dose (number of drinks consumed per occasion) and exposures (numbers of occasions) for every respondent. A constrained class of quadratic risk models was estimated that relates units of exposure at each dose (e.g., number of occasions drinking five drinks) to problem outcomes (e.g., number of hangovers). The resulting dose-response functions provided an estimate of the rate of problems produced on each occasion of drinking at a given drinking level. Population risks were estimated by reintegrating dose response with the population distribution of drinking exposures. RESULTS: The distribution of drinking exposures among college drinkers was markedly peaked at a modal dose of two drinks, with variations in light and heavy drinking between demographic groups. Multivariate analyses showed relative rates of heavier drinking were greatest among white male freshmen and unrelated to residential settings. Most drinking problems showed a marked dose-response relationship to drinking levels. Population risks, however, were typically unimodal, with many problems reported at moderate drinking levels (two or three drinks). CONCLUSIONS: Distributed across a large number of drinkers and drinking occasions, problems reported by students occurred most often at moderate drinking levels (two to three drinks). Nevertheless, heavier drinking remained substantively related to many drinking problems. These observations encourage aview of college drinking that supports interventions related to both moderate and heavy drinking.