Numerous research studies have shown that sociocultural factors influence the initiation and continued use of alcohol and tobacco among adolescents and adults. Few studies have examined the effects of sociocultural factors on the tendency of smokers to drink and drinkers to smoke. However, the limited evidence available suggests that such factors exist and that the strength of the association between alcohol and tobacco use behaviors varies with the levels of alcohol use. Public health interventions focused on concurrent tobacco and alcohol use could yield further reductions in the morbidity and mortality associated with these substances. KEY WORDS: sociocultural AODC (causes of alcohol or other drug [AOD] use, abuse, and dependence); sociocultural aspects of AOD use; smoking; AOD use initiation; adolescent; family as an AODC; peer group; adult; AOD abstinence; public health
Research indicates that sociocultural factors influence the initiation and continued use of alcohol and tobacco among adolescents and adults. Few studies have examined the effects of sociocultural factors on the tendency of smokers to drink and drinkers to smoke. However, the limited evidence available suggests that such factors exist and that the strength of the association between alcohol and tobacco use behaviors varies with the levels of alcohol use.
This article first reviews research on the sociocultural factors that influence whether adolescents begin smoking and/or drinking. The article then discusses similar mechanisms that may sustain alcohol and tobacco use among adults. Some sociocultural factors influence smoking and drinking across much of the adult population. Other factors that predict continued tobacco use among adults might differ for alcohol abstainers, moderate drinkers, heavy drinkers, and recovering alcoholics.
Although this article discusses adolescent and adult populations separately, a strong, positive relationship exists between alcohol and tobacco use in both age groups. Results from the 1997 National Household Survey on Drug Abuse (Substance Abuse and Mental Health Services Administration [SAMHSA] 1998) indicated that among the respondents ages 12 to 17 as well as ages 18 and older, current drinkers were much more likely to be current smokers compared with former drinkers or people who had never consumed alcohol (i.e., never drinker") (see table 1). The survey results also showed an especially strong relationship between binge drinking (defined as consuming five or more drinks per occasion) and current smoking among adolescents. Adolescents who reported engaging in binge drinking within the past 30 days were more than five times more likely to smoke than were adolescents who denied participating in binge drinking (76.8 versus 14.1 percent). Adults who reported episodes of binge drinking within the past 30 day s were approximately twice as likely as were non-binge-drinking adults to be current smokers.
INITIATION AND CONTINUED TOBACCO AND ALCOHOL USE AMONG ADOLESCENTS
The strong association between binge drinking and smoking among adolescents may be attributable, in part, to the fact that both adolescent alcohol use and tobacco use share a number of sociocultural risk factors. Researchers have found that these factors--including family and peer influences, demographics, advertising, economics, and alcohol and tobacco availability--are associated with adolescents' initial and continued tobacco and alcohol use.
Family and Peer Influences
Adolescents are more likely to smoke cigarettes if their parents (Gritz et al. 1998; Flay et al. 1998), siblings (Mittelmark et al. 1987), or friends (Flay et al. 1998; Conrad et al. 1992) smoke. In addition, adolescents whose friends, siblings, or parents smoke are more likely to smoke at an earlier age than are other adolescents (Unger and Chen 1999). Adolescent alcohol use is also associated with drinking by peers (Botvin et al. …