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Journal of Epidemiology and Community Health logoLink to Journal of Epidemiology and Community Health
. 2005 Dec;59(12):1065–1071. doi: 10.1136/jech.2005.033183

Youth smoking risk and community patterns of alcohol availability and control: a national multilevel study

E Weitzman 1, Y Chen 1, S Subramanian 1
PMCID: PMC1732976  PMID: 16286496

Abstract

Study objective: To test whether college youth smoking risks are independently associated with community patterns of alcohol availability and control.

Design: Hierarchical multilevel multivariable modelling of cross sectional survey data. Outcomes included self reported current (past 30 day) cigarette smoking and heavy episodic (binge) drinking.

Setting: 120 nationally representative US colleges.

Participants: 10 924 randomly selected students.

Main results: Individual risks for smoking and binge drinking are independently associated with community patterns of alcohol availability, policy enforcement and control over and above individual perceptions about these factors, student and college characteristics, and school binge drinking rates. Youth exposed to high levels of alcohol availability are at higher risk of smoking (OR 3.61, 95% CI 1.75, 7.44) and binge drinking (OR 4.22, 95% CI 2.25, 7.93) than youth not so exposed; youth exposed to strongly enforced alcohol policy environments are at lower risk for smoking (OR 0.30, 95% CI 0.16, 0.57) and binge drinking (OR 0.17, 95% CI 0.10, 0.31) than youth not so exposed; youth exposed to communities with strong parental controls are at lower risk for smoking (OR 0.05, 95% CI 0.01, 0.23) and binge drinking (OR 0.06, 95% CI 0.01, 0.21) than youth not so exposed. Individual risks related to environmental exposures differ for youth with varying perceptions about alcohol availability and policy control.

Conclusions: Drinking environments in US college communities comprise strong independent risks for smoking. Smoking prevention models should be tested that include environmental drinking prevention strategies tailored to underlying perceptions and experiences of college youth.

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Selected References

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  1. Burton S. M., Tiffany S. T. The effect of alcohol consumption on craving to smoke. Addiction. 1997 Jan;92(1):15–26. [PubMed] [Google Scholar]
  2. Chang Hsiao Wen, Ling Guang Sheng, Wei William Ignace, Yuen Anthony Po-Wing. Smoking and drinking can induce p15 methylation in the upper aerodigestive tract of healthy individuals and patients with head and neck squamous cell carcinoma. Cancer. 2004 Jul 1;101(1):125–132. doi: 10.1002/cncr.20323. [DOI] [PubMed] [Google Scholar]
  3. Cooper A. M., Sobell M. B., Sobell L. C., Maisto S. A. Validity of alcoholic's self-reports: duration data. Int J Addict. 1981 Apr;16(3):401–406. doi: 10.3109/10826088109038841. [DOI] [PubMed] [Google Scholar]
  4. Douglas K. A., Collins J. L., Warren C., Kann L., Gold R., Clayton S., Ross J. G., Kolbe L. J. Results from the 1995 National College Health Risk Behavior Survey. J Am Coll Health. 1997 Sep;46(2):55–66. doi: 10.1080/07448489709595589. [DOI] [PubMed] [Google Scholar]
  5. Gledhill-Hoyt J., Lee H., Strote J., Wechsler H. Increased use of marijuana and other illicit drugs at US colleges in the 1990s: results of three national surveys. Addiction. 2000 Nov;95(11):1655–1667. doi: 10.1046/j.1360-0443.2000.951116556.x. [DOI] [PubMed] [Google Scholar]
  6. Gulliver S. B., Rohsenow D. J., Colby S. M., Dey A. N., Abrams D. B., Niaura R. S., Monti P. M. Interrelationship of smoking and alcohol dependence, use and urges to use. J Stud Alcohol. 1995 Mar;56(2):202–206. doi: 10.15288/jsa.1995.56.202. [DOI] [PubMed] [Google Scholar]
  7. Hawkins J. D., Catalano R. F., Miller J. Y. Risk and protective factors for alcohol and other drug problems in adolescence and early adulthood: implications for substance abuse prevention. Psychol Bull. 1992 Jul;112(1):64–105. doi: 10.1037/0033-2909.112.1.64. [DOI] [PubMed] [Google Scholar]
  8. Hoffman J. H., Welte J. W., Barnes G. M. Co-occurrence of alcohol and cigarette use among adolescents. Addict Behav. 2001 Jan-Feb;26(1):63–78. doi: 10.1016/s0306-4603(00)00089-7. [DOI] [PubMed] [Google Scholar]
  9. Istvan J., Matarazzo J. D. Tobacco, alcohol, and caffeine use: a review of their interrelationships. Psychol Bull. 1984 Mar;95(2):301–326. [PubMed] [Google Scholar]
  10. Jones S. E., Oeltmann J., Wilson T. W., Brener N. D., Hill C. V. Binge drinking among undergraduate college students in the United States: implications for other substance use. J Am Coll Health. 2001 Jul;50(1):33–38. doi: 10.1080/07448480109595709. [DOI] [PubMed] [Google Scholar]
  11. Kessler R. C., McGonagle K. A., Zhao S., Nelson C. B., Hughes M., Eshleman S., Wittchen H. U., Kendler K. S. Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States. Results from the National Comorbidity Survey. Arch Gen Psychiatry. 1994 Jan;51(1):8–19. doi: 10.1001/archpsyc.1994.03950010008002. [DOI] [PubMed] [Google Scholar]
  12. Koopmans J. R., van Doornen L. J., Boomsma D. I. Association between alcohol use and smoking in adolescent and young adult twins: a bivariate genetic analysis. Alcohol Clin Exp Res. 1997 May;21(3):537–546. [PubMed] [Google Scholar]
  13. Kumar Revathy, O'Malley Patrick M., Johnston Lloyd D., Schulenberg John E., Bachman Jerald G. Effects of school-level norms on student substance use. Prev Sci. 2002 Jun;3(2):105–124. doi: 10.1023/a:1015431300471. [DOI] [PubMed] [Google Scholar]
  14. Lantz P. M., Jacobson P. D., Warner K. E., Wasserman J., Pollack H. A., Berson J., Ahlstrom A. Investing in youth tobacco control: a review of smoking prevention and control strategies. Tob Control. 2000 Mar;9(1):47–63. doi: 10.1136/tc.9.1.47. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Ling Pamela M., Glantz Stanton A. Why and how the tobacco industry sells cigarettes to young adults: evidence from industry documents. Am J Public Health. 2002 Jun;92(6):908–916. doi: 10.2105/ajph.92.6.908. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Lonczak H. S., Huang B., Catalano R. F., Hawkins J. D., Hill K. G., Abbott R. D., Ryan J. A., Kosterman R. The social predictors of adolescent alcohol misuse: a test of the social development model. J Stud Alcohol. 2001 Mar;62(2):179–189. doi: 10.15288/jsa.2001.62.179. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Menvielle G., Luce D., Goldberg P., Bugel I., Leclerc A. Smoking, alcohol drinking and cancer risk for various sites of the larynx and hypopharynx. A case-control study in France. Eur J Cancer Prev. 2004 Jun;13(3):165–172. doi: 10.1097/01.cej.0000130017.93310.76. [DOI] [PubMed] [Google Scholar]
  18. Midanik L. T. Validity of self-reported alcohol use: a literature review and assessment. Br J Addict. 1988 Sep;83(9):1019–1030. doi: 10.1111/j.1360-0443.1988.tb00526.x. [DOI] [PubMed] [Google Scholar]
  19. Mintz J., Boyd G., Rose J. E., Charuvastra V. C., Jarvik M. E. Alcohol increases cigarette smoking: a laboratory demonstration. Addict Behav. 1985;10(3):203–207. doi: 10.1016/0306-4603(85)90001-2. [DOI] [PubMed] [Google Scholar]
  20. Palfai T. P., Monti P. M., Ostafin B., Hutchison K. Effects of nicotine deprivation on alcohol-related information processing and drinking behavior. J Abnorm Psychol. 2000 Feb;109(1):96–105. doi: 10.1037//0021-843x.109.1.96. [DOI] [PubMed] [Google Scholar]
  21. Rigotti N. A., Lee J. E., Wechsler H. US college students' use of tobacco products: results of a national survey. JAMA. 2000 Aug 9;284(6):699–705. doi: 10.1001/jama.284.6.699. [DOI] [PubMed] [Google Scholar]
  22. Rigotti Nancy A., Moran Susan E., Wechsler Henry. US college students' exposure to tobacco promotions: prevalence and association with tobacco use. Am J Public Health. 2005 Jan;95(1):138–144. doi: 10.2105/AJPH.2003.026054. [DOI] [PMC free article] [PubMed] [Google Scholar]
  23. Rohsenow D. J., Monti P. M., Colby S. M., Gulliver S. B., Sirota A. D., Niaura R. S., Abrams D. B. Effects of alcohol cues on smoking urges and topography among alcoholic men. Alcohol Clin Exp Res. 1997 Feb;21(1):101–107. [PubMed] [Google Scholar]
  24. Sepe Edward, Ling Pamela M., Glantz Stanton A. Smooth moves: bar and nightclub tobacco promotions that target young adults. Am J Public Health. 2002 Mar;92(3):414–419. doi: 10.2105/ajph.92.3.414. [DOI] [PMC free article] [PubMed] [Google Scholar]
  25. Simons-Morton B., Haynie D. L., Crump A. D., Eitel S. P., Saylor K. E. Peer and parent influences on smoking and drinking among early adolescents. Health Educ Behav. 2001 Feb;28(1):95–107. doi: 10.1177/109019810102800109. [DOI] [PubMed] [Google Scholar]
  26. Stokols D. Establishing and maintaining healthy environments. Toward a social ecology of health promotion. Am Psychol. 1992 Jan;47(1):6–22. doi: 10.1037//0003-066x.47.1.6. [DOI] [PubMed] [Google Scholar]
  27. Subramanian S. V., Kim Daniel, Kawachi Ichiro. Covariation in the socioeconomic determinants of self rated health and happiness: a multivariate multilevel analysis of individuals and communities in the USA. J Epidemiol Community Health. 2005 Aug;59(8):664–669. doi: 10.1136/jech.2004.025742. [DOI] [PMC free article] [PubMed] [Google Scholar]
  28. Toomey Traci L., Wagenaar Alexander C. Environmental policies to reduce college drinking: options and research findings. J Stud Alcohol Suppl. 2002 Mar;(14):193–205. doi: 10.15288/jsas.2002.s14.193. [DOI] [PubMed] [Google Scholar]
  29. Wechsler H., Davenport A., Dowdall G., Moeykens B., Castillo S. Health and behavioral consequences of binge drinking in college. A national survey of students at 140 campuses. JAMA. 1994 Dec 7;272(21):1672–1677. [PubMed] [Google Scholar]
  30. Wechsler H., Dowdall G. W., Davenport A., Rimm E. B. A gender-specific measure of binge drinking among college students. Am J Public Health. 1995 Jul;85(7):982–985. doi: 10.2105/ajph.85.7.982. [DOI] [PMC free article] [PubMed] [Google Scholar]
  31. Wechsler H., Kelley K., Weitzman E. R., SanGiovanni J. P., Seibring M. What colleges are doing about student binge drinking. A survey of college administrators. J Am Coll Health. 2000 Mar;48(5):219–226. doi: 10.1080/07448480009599308. [DOI] [PubMed] [Google Scholar]
  32. Wechsler H., Lee J. E., Gledhill-Hoyt J., Nelson T. F. Alcohol use and problems at colleges banning alcohol: results of a national survey. J Stud Alcohol. 2001 Mar;62(2):133–141. doi: 10.15288/jsa.2001.62.133. [DOI] [PubMed] [Google Scholar]
  33. Wechsler H., Lee J. E., Kuo M., Lee H. College binge drinking in the 1990s: a continuing problem. Results of the Harvard School of Public Health 1999 College Alcohol Study. J Am Coll Health. 2000 Mar;48(5):199–210. doi: 10.1080/07448480009599305. [DOI] [PubMed] [Google Scholar]
  34. Wechsler H., Lee J. E., Rigotti N. A. Cigarette use by college students in smoke-free housing: results of a national study. Am J Prev Med. 2001 Apr;20(3):202–207. doi: 10.1016/s0749-3797(00)00313-5. [DOI] [PubMed] [Google Scholar]
  35. Wechsler H., Rigotti N. A., Gledhill-Hoyt J., Lee H. Increased levels of cigarette use among college students: a cause for national concern. JAMA. 1998 Nov 18;280(19):1673–1678. doi: 10.1001/jama.280.19.1673. [DOI] [PubMed] [Google Scholar]
  36. Wechsler Henry, Lee Jae Eun, Kuo Meichun, Seibring Mark, Nelson Toben F., Lee Hang. Trends in college binge drinking during a period of increased prevention efforts. Findings from 4 Harvard School of Public Health College Alcohol Study surveys: 1993-2001. J Am Coll Health. 2002 Mar;50(5):203–217. doi: 10.1080/07448480209595713. [DOI] [PubMed] [Google Scholar]
  37. Weitzman Elissa R., Folkman Alison, Folkman M. P. H. Kerry Lemieux, Wechsler Henry. The relationship of alcohol outlet density to heavy and frequent drinking and drinking-related problems among college students at eight universities. Health Place. 2003 Mar;9(1):1–6. doi: 10.1016/s1353-8292(02)00014-x. [DOI] [PubMed] [Google Scholar]
  38. Weitzman Elissa R., Nelson Toben F., Lee Hang, Wechsler Henry. Reducing drinking and related harms in college: evaluation of the "A Matter of Degree" program. Am J Prev Med. 2004 Oct;27(3):187–196. doi: 10.1016/j.amepre.2004.06.008. [DOI] [PubMed] [Google Scholar]
  39. Weitzman Elissa R., Nelson Toben F., Wechsler Henry. Taking up binge drinking in college: the influences of person, social group, and environment. J Adolesc Health. 2003 Jan;32(1):26–35. doi: 10.1016/s1054-139x(02)00457-3. [DOI] [PubMed] [Google Scholar]
  40. Weitzman Elissa R. Poor mental health, depression, and associations with alcohol consumption, harm, and abuse in a national sample of young adults in college. J Nerv Ment Dis. 2004 Apr;192(4):269–277. doi: 10.1097/01.nmd.0000120885.17362.94. [DOI] [PubMed] [Google Scholar]

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