Alcohol and tobacco use are highly correlated behaviors and each are associated with significant morbidity, mortality, and economic costs. Further, their combined use has been associated with a number of deleterious effects, including exacerbated health risk (Rosengren et al., 1988), increased risk of alcohol abuse and tobacco dependence (e.g., Sher et al., 1996), and poor smoking cessation and alcohol drinking outcomes (Shiffman et al., 1997; Sobell et al., 1995). Although there is strong epidemiological evidence supporting the association between alcohol and nicotine dependence (Grant et al., 2004), relatively little attention has been paid to associations between other indices of alcohol and tobacco use. For example, significant proportions of the US population engage in hazardous drinking (21% to 94% of current drinkers, e.g., Dawson 200; Reid et al., 1999), non-daily smoking (19%-24% of current smokers, e.g., Hassmiller et al., 2003), and use of various other tobacco products (cigars, pipe, chew, snuff) either singularly or in combination. However, no epidemiological investigation has yet examined their inter-relationships. Moreover, studies have documented that alcohol recoveries are associated with tobacco use (e.g., Dawson et al., 2005; Sobell et al., 1995), yet there have been no investigations examining whether various indices of tobacco use (e.g., daily vs. non-daily smoking) are associated with transitions in alcohol-related diagnoses. For the current application we are proposing to address this knowledge gap by conducting a thorough examination of alcohol-tobacco interactions across the continuum of use, using the NESARC Wave 1 (2001- 2002) dataset. Specifically, we plan to examine associations between various indices of alcohol use (i.e., quantity/frequency, hazardous vs. non-hazardous, presence or absence of alcohol-related diagnoses, and transitions from lifetime diagnoses to the presence or absence of current alcohol-related diagnoses) and tobacco use (i.e., daily, non-daily, past-users, never-users across tobacco products). Importantly, we will examine socio-demographic (e.g., age, sex, marital status, education, income, ethnicity) and clinical characteristics (e.g., other Axis I & II disorders) as correlates of alcohol-tobacco interactions. The results generated from this application will have important clinical and public health implications, and further our understanding of alcohol-tobacco interactions.
