Examining the association between tobacco use and binge drinking and the effects of tobacco interventions on binge drinking behaviors

Abstract

Background: Binge drinking is a significant public health problem. Although effective alcohol control policies exist, many have eroded over time or face strong political opposition to their implementation. Other mechanisms to reduce binge drinking need to be found. Tobacco and alcohol use share similar biological, personal, and environmental characteristics and research has shown that among alcohol dependent population reducing smoking can lead to decreases in alcohol use. Objectives: The purpose of this dissertation was to assess: (1) the extent that binge drinking and smoking are associated in a non-alcohol dependent population, (2) how this observed association may be modified by individual- and environmental-level factors, and (3) the effect of tobacco interventions on binge drinking. Methods: The first study examined the association between binge drinking and smoking behaviors using a representative sample of active duty military personnel. Additionally, multivariate logistic regression tested whether frequency of deployment and the perception of an alcohol promoting environment moderated the association between binge drinking and smoking. The second study assessed the effect of an individual-level tobacco intervention (health education versus motivational interviewing counseling) on binge drinking and average daily alcohol use in a group of African American light smokers over a six-month period. Generalized linear models assessed the mediation effect of smoking cessation on the relationship between counseling intervention and drinking. The third study used pooled-time-series analyses to assess the effects of two state-level tobacco control policies (tobacco taxes and smoking bans in bars) on state-level binge drinking behaviors from 1998 to 2010. Results: In the first study, binge drinking was found to be significantly higher among current smokers than former and nonsmokers. The frequency of deployment (but not the perception of an alcohol-promoting environment) moderated this relationship although effects varied by branch of service. In the second study, individuals randomly assigned to receive health education counseling decreased their binge drinking at week 8 of the study, but these results diminished within six months. Smoking cessation did not appear to mediate the relationship between counseling type and binge drinking; however, individuals who quit smoking (regardless of counseling type) also decreased their binge drinking at week 8 of the study; these results were not significant at the end of the study. For the third study, neither tobacco taxes nor smoking bans in bars was associated with a decrease in binge drinking outcomes at the state level. Conclusions: Smoking and binge drinking are strongly associated in non-alcohol dependent populations and some evidence suggests that decreasing smoking leads to initial reductions in binge drinking; however, the evidence presented is not strong enough to advocate for a reliance on smoking interventions as a way to reduce and prevent binge drinking. Alcohol advocates need to continue to support and educate lawmakers about the effectiveness of alcohol control policies in order to reduce binge drinking.