Association between smoking and alcohol use in the general population: stable and unstable odds ratios across two years in two different countries.

AIMS: The main objective of this article was to compare alcohol and tobacco consumption in the US and the Basque Country (the North of Spain) with particular attention to the association between alcohol and tobacco use. The consistency of findings was considered by analyzing data from two different years. These comparisons may provide a rational basis for exploring the associations between alcohol and cigarette use that are influenced by changes in use prevalences.
METHODS: Two epidemiological samples from the US, obtained in 1992 and 1996, and two from the Basque Country, obtained in the same years, were used. Sampling methodologies were similar. Questionnaires were self-administrated with the help of interviewers, and were used to define ever smokers, ex-smokers, current smokers, heavy smokers, ever drinkers, ex-drinkers, current drinkers and weekly drinkers. The associations between smoking and alcohol drinking were explored through logistic regressions.
RESULTS: The associations between current smoking and current drinking in the general population, and between ever smoking and weekly drinking among current drinkers appear very stable. In 1992 and 1996, US subjects who decided to try alcohol tended to try smoking and vice versa. In US Caucasians (particularly in 1996), heavy smoking was strongly associated with ever drinking among current smokers. In the Basque Country in 1992, there was a significant association between smoking cessation and drinking cessation among ever drinkers who also were ever smokers.
CONCLUSIONS: Our analyses suggest that some associations between alcohol drinking and smoking behaviours are likely to be detected in Western countries where alcohol and nicotine are legal and easily available. On the other hand, other associations may be detected only in certain social contexts. These social contexts make the associations in subpopulations who are vulnerable to addiction, influence the results in the general population. In social contexts that exert considerable social pressure to quit smoking, such as in US Caucasians (particularly in 1996), heavy smoking was strongly associated with ever drinking among current smokers. When a social environment strongly discourages smoking and alcohol initiation (as in the US in 1992 and 1996), subjects who decide to try alcohol tend to try smoking and vice versa. The lack of social stigmatization of smoking and drinking in the Basque Country in 1992 may help to explain the significant association between smoking cessation and drinking cessation among ever drinkers who also were ever smokers.