Smoking and Drinking: Sociocultural Influences

by National Institute of Health

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.

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 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 ("never drinker"). 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. Adults who reported episodes of binge drinking within the past 30 days 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, siblings, or friends smoke. In addition, adolescents whose friends, siblings, or parents smoke are more likely to smoke at an earlier age than are other adolescents. Adolescent alcohol use is also associated with drinking by peers, parents and siblings. Together these findings demonstrate that family and peers exert similar influences on adolescent smoking and drinking.

Among teens, parent-child relationship factors - such as limited or poorquality familial attachments; low levels of parental supervision and strictness; inadequate parental monitoring; and lack of parental affection, concern, and involvement - have also been related to smoking and drinking. Data from the Adverse Childhood Experiences Study have further shown that any one of eight childhood stressors, including verbal, physical, or sexual abuse, significantly increases both a youth's risk of smoking by age 14 and continued tobacco use as an adult.

Demographic Factors

National student surveys show that white students, overall, are more likely than Hispanic and African-American students to report engaging in smoking or drinking within the previous 30 days. Hispanic students also are more likely to smoke or drink compared with African-American students. In addition, males generally are more likely than females to report current and frequent smoking as well as current and heavy drinking.

In their review of multiple studies on teen smoking, Conrad and colleagues found that lower socioeconomic status consistently predicted smoking onset among teens. D'Onofrio found that alcohol use was also disproportionately concentrated among economically disadvantaged youth. Similar demographic factors have also been associated with adolescent smoking and drinking and may contribute to the relationship between smoking and drinking among adults.

About the Author

NIH is the nation's medical research agency - making important medical discoveries that improve health and save lives. The National Institutes of Health (NIH), a part of the U.S. Department of Health and Human Services, is the primary Federal agency for conducting and supporting medical research.