Co-occurrence
of Alcohol and Cigarette Use Among Adolescents
Joseph
H. Hoffman, John W. Welte, Ph.D., and
Grace M. Barnes, Ph.D.
Abstracted
from Addictive Behaviors, 26, 63-78, 2001.
Results of
a RIA study by Joseph H. Hoffman, statistician and project
director, and John W. Welte, Ph.D. and Grace M. Barnes,
Ph.D., senior research scientists, have demonstrated that adolescents
who use both alcohol and cigarettes are at increased risk of personal
and social problems, poor grades in school, and delinquency, compared
to adolescents who use only one or neither of these substances.
The Objectives
Concurrent
use of alcohol and cigarettes refers to the use of these two substances
during the same period of time, for example, during the last month.
The first objective of this study was to determine the trends in prevalence
of adolescent concurrent use of alcohol and cigarettes in New York
State from the 1980s to the 1990s. The second objective was to determine
whether these trends were different for gender, age, and racial/ethnic
groups. The third objective was to compare the characteristics of
those adolescents who both smoke cigarettes and drink alcohol with
those of students who use only one substance, or neither substance.
The Data
Three comparable
surveys of seventh to twelfth-grade students included samples of 27,335
students in 1983, 23,860 students in 1990, and 19,321 students in
1994. In order to conduct the survey, permission was secured from
the administrators of the selected school districts and the private
schools, and a combination of active and passive parental consent
procedures were also used. The surveys were both voluntary and anonymous.
All participants
were randomly selected from public and private schools throughout
New York State. Each student represented a number of his or her peers
in a particular type of school, grade level, ethnic category, and
region of the state. In-class, anonymous questionnaires were self-administered
within one class period. The questionnaires included demographic information
as well as comparable information about alcohol consumption and use
of other substances, including cigarettes.
Questions
were asked about students’ usual frequency of drinking alcoholic beverages
- beer, wine or wine coolers, and liquor. They were also asked about
how many cigarettes they had smoked in the previous 30 days. In addition,
they were asked about how their parents felt about adolescents their
age drinking beer or using marijuana. Other information requested
of the students included their grades in school, school misconduct,
illicit drug use, drug problems, delinquency, and carrying weapons.
The adolescents
ranged in age from 12 to 18. Their race/ethnicity was classified into
European American, African American, West Indian, Hispanic, Asian,
and Native American.
The Results
The study
found that adolescents who use both alcohol and cigarettes during
the same 30 day period are at risk of personal and social problems,
poor grades in school, and delinquency, compared to adolescents who
use only one or neither of these substances. Also, adolescents who
are concurrent users of alcohol and cigarettes have risks of illicit
drug use and drug problems that are greater than expected based only
on their drinking and smoking separately. “The finding of a synergistic,
or greater than additive, effect of the combination of drinking and
smoking on illicit drug use has not been previously reported,” according
to Hoffman, the lead author. “This means that the effect of concurrent
use is greater than that due to either drinking or smoking alone.
Our analysis also showed that this synergistic effect remained constant
over the time periods of the three surveys.”
Figure
1.
Trends in prevalence
of drinking, smoking, and concurrent drinking and smoking for
7-12th-grade school students in New York State, 1983, 1990, and 1994.
Reprinted from Addictive Behaviors 26, J. H. Hoffman et al,
Co-occurrence of alcohol and cigarette use among adolescents, p. 70,
(2001), with permission from Elsevier Science.
The study
found a significant co-occurrence of adolescent drinking and smoking
in the three surveys. The prevalence of concurrent drinking and smoking
decreased from 1983 (23%) to 1990 (19%), and increased by 1994 (22%).
This trend closely paralleled the trend in prevalence of current smoking
over the same time points (25%, 20%, and 24%, respectively). In each
survey, about one third of drinkers were current smokers, and very
few nondrinkers were smokers. Almost all current smokers in each survey
also drank alcohol. These results on the extent of ‘overlap’ between
drinking and smoking among adolescents are generally consistent with
national survey data on U.S. high school seniors from the Monitoring
the Future Project (U. S. Department of Health and Human Services,
1994).
The study
also examined differences in the trends of concurrent use of alcohol
and cigarettes in gender, age, and racial/ethnic groups. Hoffman explained,
“Between 1990 and 1994, we found that the prevalence of concurrent
use of alcohol and cigarettes increased more among younger adolescents
than among older adolescents, and also increased more among African
Americans, Hispanic Americans, and Asian Americans than among European
Americans. These increases raise a special concern for these groups
of young people.”
Finally The
present study has extended previous research on adolescent cigarette
smoking in several ways. First, this study examined the patterns of
concurrent use of alcohol and cigarettes by adolescents among demographic
groups, including the sizeable racial/ethnic groups available in these
surveys. Second, using a unique analytical approach, the characteristics
of concurrent users were examined, and both the separate effects of
drinking and smoking on these characteristics, as well as the interaction
of drinking and smoking, were determined.
The Implications
References
-
U.S.
Department of Health and Human Services. (1994). Preventing
tobacco use among young people: A report of the Surgeon General.
(Superintendent of Documents Stock No. 017-001-00491-0). Washington,
DC: U.S. Government Printing Office.
This research
was funded by CSAT Contract 270-92-0005, and by NIAAA grant R21 AA11263
to Principal Investigator Grace M. Barnes and Co-Principal Investigator
John W. Welte.
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