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.     

Non-daily smoking predicts hazardous drinking and alcohol use disorders in young adults in a longitudinal U.S. sample

Background

It is known that daily smoking is associated with the development of alcohol use disorders. However, non-daily smoking is prevalent in young adults and is associated with increased rates of problematic alcohol use in cross-sectional data. It is unknown whether non-daily smoking is predictive of hazardous drinking and alcohol use disorders using longitudinal data. The primary aim of the present investigation was to explore the temporal relationship between non-daily smoking and drinking in young adults, and secondarily, whether college status modified this relationship.

Methods

Using Waves 1 (2001-2002) and 2 (2004-2005) of the National Epidemiological Survey on Alcohol and Related Conditions (NESARC), we examined the predictive relationship of smoking status at Wave 1 and change in college status between Waves on alcohol drinking, hazardous drinking, and alcohol abuse and dependence disorders at Wave 2. The sample was restricted to individuals aged 18-25 years at Wave 1.

Findings

Daily and non-daily smokers at Wave 1, compared to nonsmokers, were at a greater risk for hazardous drinking and alcohol use disorders at Wave 2, after controlling for Wave 1 drinking. College status did not modify smoking and drinking interactions.

Conclusions

The findings indicate non-daily smoking is predictive of increased, problematic alcohol use among young adults longitudinally and they support increasing evidence that non-daily smokers represent an important population. Future research should be conducted to continue developing targeted interventions. Early treatments for smoking behavior might have a beneficial effect on reducing the development of problematic patterns of alcohol use and alcohol use disorders.     

Predicting relapse among young adults: psychometric validation of the Advanced WArning of RElapse (AWARE) scale

Objective

Failure to maintain abstinence despite incurring severe harm is perhaps the key defining feature of addiction. Relapse prevention strategies have been developed to attenuate this propensity to relapse, but predicting who will, and who will not, relapse has stymied attempts to more efficiently tailor treatments according to relapse risk profile. Here we examine the psychometric properties of a promising relapse risk measure—the Advance WArning of RElapse (AWARE) scale (Miller &; Harris, 2000) in an understudied but clinically important sample of young adults.

Method

Inpatient youth (N = 303; Ages 18–24; 26% female) completed the AWARE scale and the Brief Symptom Inventory-18 (BSI) at the end of residential treatment, and at 1-, 3-, and 6-months following discharge. Internal and convergent validity was tested for each of these four timepoints using confirmatory factor analysis and correlations (with BSI scores). Predictive validity was tested for relapse 1, 3, and 6 months following discharge, as was incremental utility, where AWARE scores were used as predictors of any substance use while controlling for treatment entry substance use severity and having spent time in a controlled environment following treatment.

Results

Confirmatory factor analysis revealed a single, internally consistent, 25-item factor that demonstrated convergent validity and predicted subsequent relapse alone and when controlling for other important relapse risk predictors.

Conclusions

The AWARE scale may be a useful and efficient clinical tool for assessing short-term relapse risk among young people and, thus, could serve to enhance the effectiveness of relapse prevention efforts.     

Treatment seeking for smoking cessation among young adults

Young adult smokers (18–24 year olds) do not seek treatment for smoking cessation as often as older smokers. Two commonly hypothesized reasons for this are that younger smokers are not aware of treatments or cannot afford them. The State of Vermont provides free smoking cessation treatment, and most young smokers are aware of this; thus, we tested whether young adult smokers from Vermont would still underutilize treatment via a secondary analysis of the population-based 2005 VT Adult Tobacco Survey. Young adult smokers from Vermont were less likely to have used medication (24% vs. 58%; relative risk = 0.42) or psychosocial (28% vs. 53%; relative risk = 0.54) treatment than middle-aged smokers (25–44 year olds). We conclude that reasons other than awareness and cost cause young adult smokers to not seek treatment.     

Comparative utility of a single-item versus multiple-item measure of self-efficacy in predicting relapse among young adults

Single-item measures of psychological experiences are often viewed as psychometrically suspect. The purpose of this study was to evaluate the validity and utility of a single-item measure of self-efficacy in a clinical sample of treatment-seeking young adults. Inpatient young adults (N = 303, age = 18–24, 26% female) were assessed at intake to residential treatment, end of treatment, and at 1, 3, and 6 months following discharge. The single-item measure of self-efficacy consistently correlated positively with a well-established 20-item measure of self-efficacy and negatively with temptation scores from the same scale, demonstrating convergent and discriminant validity. It also consistently predicted relapse to substance use at 1-, 3-, and 6-month assessments postdischarge, even after controlling for other predictors of relapse (e.g., controlled environment), whereas global or subscale scores of the 20-item scale did not. Based on these findings, we encourage the use of this single-item measure of self-efficacy in research and clinical practice.     

Peer pressure and alcohol use in young men: A mediation analysis of drinking motives

BackgroundPeer pressure (PP) has been shown to play a major role in the development and continuation of alcohol use and misuse. To date, almost all the studies investigating the association of PP with alcohol use only considered the PP for misconduct but largely ignored other aspects of PP, such as pressure for peer involvement and peer conformity. Moreover, it is not clear whether the association of PP with alcohol use is direct or mediated by other factors. The aim of the present study was to investigate the association of different aspects of peer pressure (PP) with drinking volume (DV) and risky single-occasion drinking (RSOD), and to explore whether these associations were mediated by drinking motives (DM).MethodsA representative sample of 5521 young Swiss men, aged around 20 years old, completed a questionnaire assessing their usual weekly DV, the frequency of RSOD, DM (i.e. enhancement, social, coping, and conformity motives), and 3 aspects of PP (i.e. misconduct, peer involvement, and peer conformity). Associations between PP and alcohol outcomes (DV and RSOD) as well as the mediation of DM were tested using structural equation models.ResultsPeer pressure to misconduct was associated with more alcohol use, whereas peer involvement and peer conformity were associated with less alcohol use. Associations of drinking outcomes with PP to misconduct and peer involvement were partially mediated by enhancement and coping motives, while the association with peer conformity was partially mediated by enhancement and conformity motives.ConclusionsResults suggest that PP to misconduct constitutes a risk factor, while peer conformity and peer involvement reflect protective factors with regard to alcohol use. Moreover, results from the mediation analyses suggest that part of the association of PP with alcohol use came indirectly through DM: PP was associated with DM, which in turn were associated with alcohol use.     

Energy drinks and alcohol-related risk among young adults

Background: Energy drink consumption, with or without concurrent alcohol use, is common among young adults. This study sought to clarify risk for negative alcohol outcomes related to the timing of energy drink use. Methods: The authors interviewed a community sample of 481 young adults, aged 18–25, who drank alcohol in the last month. Past-30-day energy drink use was operationalized as no-use, use without concurrent alcohol, and concurrent use of energy drinks with alcohol (“within a couple of hours”). Negative alcohol outcomes included past-30-day binge drinking, past-30-day alcohol use disorder, and drinking-related consequences. Results: Just over half (50.5%) reported no use of energy drinks,18.3% reported using energy drinks without concurrent alcohol use, and 31.2% reported concurrent use of energy drinks and alcohol. Relative to those who reported concurrent use of energy drinks with alcohol, and controlling for background characteristics and frequency of alcohol consumption, those who didn't use energy drinks and those who used without concurrent alcohol use had significantly lower binge drinking, negative consequences, and rates of alcohol use disorder (P < .05 for all outcomes). There were no significant differences between the no-use and energy drink without concurrent alcohol groups on any alcohol-related measure (P > .10 for all outcomes). Conclusions: Concurrent energy drink and alcohol use is associated with increased risk for negative alcohol consequences in young adults. Clinicians providing care to young adults could consider asking patients about concurrent energy drink and alcohol use as a way to begin a conversation about risky alcohol consumption while addressing 2 substances commonly used by this population.     

Alcohol problems in young adults transitioning from adolescence to adulthood: The association with race and gender

Race and gender may be important considerations for recognizing alcohol related problems in Black and White young adults. This study examined the prevalence and age of onset of individual alcohol problems and alcohol problem severity across race and gender subgroups from a longitudinal study of a community sample of adolescents followed into young adulthood (N=166; 23-29 yrs. old who were drinkers). All alcohol problems examined first occurred when subjects were in their late teens and early 20s. Drinking in hazardous situations, blackouts, and tolerance were the most common reported alcohol problems. In race and gender comparisons, more males than females experienced alcohol problems. Blacks generally had a later age of onset of alcohol problems. Multivariate regressions showed greater alcohol problem severity in males compared to females, but no significant differences between Blacks and Whites. Education, family environment and earlier alcohol use behaviors and expectancies were reliable predictors of alcohol problem severity in young adulthood. White males were at particular risk for experiencing more severe alcohol problems. Findings may inform the design of more targeted interventions for alcohol problems in different populations.     

The development of alcohol use and outcome expectancies among American Indian young adults: a growth mixture model

Adolescence is an important developmental period for understanding alcohol use. American Indian youth are a group for whom various preventive interventions focusing on alcohol use have been implemented but have not necessarily been widely successful, highlighting the need to further refine our approaches. In the work reported here, we followed 464 14- to 18-year-old American Indian youth annually for seven years. We examined the development of alcohol use and positive alcohol outcome expectancies in parallel, using growth mixture modeling to identify classes with different trajectories of alcohol use and expectancies. We found five classes; the largest (n = 198) was made up of youth who experienced increases in both alcohol use and positive outcome expectancies. Initial levels of outcome expectancies were related to subsequent changes in alcohol use, while the reverse was not true, suggesting that interventions focusing on outcome expectancies are appropriate for a substantial number of youth. However, class heterogeneity in the relationships between the two processes pointed out that changes in expectancies may not always precede changes in alcohol use. Thus, intervention design implications are discussed for the class structures.     

Integrated smoking cessation and binge drinking intervention for young adults: A pilot efficacy trial

Alcohol consumption is strongly associated with cigarette smoking in young adults. The primary aim of this investigation was to complete a pilot evaluation of the efficacy of an integrated intervention that targets both cigarette smoking and binge drinking on the cigarette smoking and binge behavior of young adults at 6-month follow-up. Participants were 95 young adult (M = 24.3; SD = 3.5 years) smokers (≥ 1 cigarettes per day) who binge drink (≥ 1 time per month) and who were randomly assigned to standard treatment (n = 47) involving six individual treatment visits plus eight weeks of nicotine patch therapy or the identical smoking cessation treatment integrated with a binge drinking intervention (integrated intervention; n = 48). Using an intent-to-treat analysis for tobacco abstinence, at both 3 month end of treatment and 6 month follow-up, more participants who received integrated intervention were biochemically confirmed abstinent from tobacco than those who received standard treatment at 3 months (19% vs. 9%, p = 0.06) and 6 months (21% vs. 9%, p = 0.05). At 6 months, participants who completed the study and who received integrated intervention consumed fewer drinks per month (p < 0.05) and number of binge drinking episodes per month (p < 0.05) than those who received standard treatment. Preliminary data supports that integrated intervention enhances smoking cessation and reduces binge drinking compared to standard treatment.     

Drinking to reach the top: Young adults' drinking patterns as a predictor of status within natural drinking groups

In this study we examined associations between young adults' drinking patterns and social status within their natural drinking groups (NDGs) and assessed gender differences in these relationships. Same-sex NDGs (n = 104) on route to a bar district were recruited and completed a peer-nominated measure of within-NDG status. In a follow-up online survey, participants (n = 293; 174 men and 119 women) reported their usual drinking pattern within the past year. Hierarchical Linear Modeling revealed that men who engaged in more frequent heavy episodic drinking (HED) (both for 5 + and 8 + drinks in one sitting) and women who drank more frequently were nominated as occupying higher-status positions within their NDGs compared to their peers who drank less. Further, for both men and women, drinking more than one's peers during one's heaviest drinking occasion in the past year was also associated with higher within-NDG status. These findings suggest that higher social status is associated with riskier drinking patterns and have important implications for prevention programming.     

Relationship between smoking status and body weight in a military population of young adults

The purpose of the present study was to determine the association between smoking and body weight in a cohort of young U.S. Air Force recruits (mean age = 20 years) enrolled in basic military training (N = 35 986). Twenty-two percent of recruits smoked daily prior to basic military training (n = 8087) and were compared to never smokers, former smokers, and experimental or nondaily smokers. A three-way interaction among smoking status, gender and ethnicity suggested a small effect for daily smoking among White male recruits only and no significant differences for female recruits or members of any other ethnic group. Although there was a statistically significant relationship between smoking and body weight in White males, the effect size was ~ 1 kg. These results suggest that the energy balance differences in body weight between young smokers and nonsmokers are minimal and that it would take decades to accrue the differences typically seen in adult smokers.     

Needle-sharing among young IV drug users and their social network members: The influence of the injection partner's characteristics on HIV risk behavior

Injection drug use is a risk factor for HIV among adolescents and young adults, yet the interpersonal dynamics of needle-sharing among young injectors remain poorly understood. Research has focused on identifying the characteristics of individual IV drug users (IVDUs) that increase their risk of needle-sharing. Most studies have not taken into consideration IVDUs' decisions to share needles with certain partners but not with other partners. This study examined partner characteristics associated with needle-sharing among 96 male and 77 female young adult IV drug users who had shared needles previously. Men were most likely to share needles with partners who gave them emotional support, partners who they injected or who injected them, and partners with whom they had had sex. Women were most likely to share needles with partners who they injected or who injected them, partners with whom they had discussed HIV risk, and partners with whom they had had sex. Results indicate that needle-sharing occurs within the context of mutual injection rituals and close emotional and sexual relationships. Public health interventions are needed to help young IVDUs to avoid needle-sharing with intimate partners.     

Ups and downs of alcohol use among first-year college students: Number of drinks, heavy drinking, and stumble and pass out drinking days

Given the dynamic fluctuating nature of alcohol use among emerging adults (Del Boca, Darkes, Greenbaum, & Goldman, 2004), patterns of alcohol use were modeled across 70 days in an intensive repeated-measures diary design. Two hundred first-year college students provided 10 weekly reports of their daily alcohol consumption via computer-assisted telephone interviews. Multi-level models demonstrated large within-person variability across days in drinks consumed, binge drinking, and days exceeding self-reported limits for stumbling around and passing out; these outcome variables were predicted by weekdays vs. weekend days (within-person) and gender, age of drinking initiation, fraternity/sorority membership, and alcohol motivations (between-persons). Repeated measurement of alternate indicators of alcohol use permits the examination of novel and important questions about alcohol use and abuse particularly in young adult and other erratically drinking populations.     

Risk factor profiles among intravenous drug using young adults: A latent class analysis (LCA) approach

Using data from a cross-sectional study that examined health risk behaviors among urban intravenous drug-using (IDU) adolescents and young adults, this study investigated risk profiles among a high-risk sample (n = 274). Risk profiles were empirically derived through latent class analysis based on indicators of engagement in health-risking behaviors, experience of abuse and violence as well as individual and family risk factors. The best fitting model was a 3-class model. Class 1 (n = 95) captured participants with the lowest risk across all indicators. Compared to Class 1, Class 2 (n = 128) and Class 3 (n = 51) had elevated rates of engagement in health-risking behaviors as well as individual and family risk factors; however, Class 3 had the highest rate of engagement in sexual risk behavior, and backgrounds of substantial abuse and violence as well as familial psychopathology. Class 2 was the group most socioeconomically disadvantaged, with the highest percentage of participants coming from poor backgrounds, spending the longest time homeless and working the fewest months. Identifying subgroups of IDU has the potential to guide the development of more targeted and effective strategies for prevention and treatment of this high-risk population.     

The role of therapeutic alliance in substance use disorder treatment for young adults

The therapeutic alliance is deemed to be integral to psychotherapeutic interventions, yet little is known about the nature of its role in treatment for substance use disorders (SUD), especially among young people. We investigated baseline predictors of the therapeutic alliance measured midtreatment and tested whether the alliance influenced during-treatment changes in key process variables (psychological distress, motivation, self-efficacy, coping skills, and commitment to Alcoholics Anonymous/Narcotics Anonymous [AA/NA]) independent of these baseline influences. Young adults in residential treatment (N = 303; age 18-24 years) were assessed at intake, midtreatment, and discharge. Older age and higher baseline levels of motivation, self-efficacy, coping skills, and commitment to AA/NA predicted a stronger alliance. Independent of these influences, participants who developed a stronger alliance achieved greater reductions in distress during treatment. Findings clarify a role for alliance in promoting during-treatment changes through reducing distress.