Smoking and drinking are often complementary behaviors: smokers are more likely than non-smokers to drink alcohol, and heavy smokers are more likely to be heavy drinkers. While increasing state cigarette excise taxes and strengthening smoke-free air laws are known to reduce smoking prevalence, it is less clear if such policies may also reduce alcohol use. A new study has found that increases in state cigarette prices and restrictions on indoor smoking can lead to decreases in state per capita consumption of beer and spirits, but not wine.
Results will be published in the October 2014 online-only issue of Alcoholism: Clinical & Experimental Research and are currently available at Early View.
"In situations when smokers are drinking alcohol, it tends to trigger cravings for a cigarette," explained Melissa J. Krauss, senior statistical data analyst at Washington University School of Medicine as well as corresponding author for the study. "Some people even tend to smoke only when they drink, but not at any other time."
"Tobacco can enhance the subjective effects of alcohol and has been shown to increase the risk for heavy and problematic drinking," added Kelly Young-Wolff, a research scientist at Kaiser Permanente Division of Research. "Smokers drink more frequently and more heavily than non-smokers, and are more likely than non-smokers to meet the criteria for alcohol abuse or dependence."
"In the late 1990s and early 2000s, youth smoking rates dropped in the U.S. at least partly in response to rising cigarette prices," said Krauss. "Higher cigarette prices also increase the likelihood of smoking cessation among adult smokers: every 10-percent increase in cigarette prices leads to a two-percent reduction in the number of people who smoke. In addition, stricter smoke-free air laws have not only reduced exposure to secondhand smoke, but have increased smoking cessation, reduced cigarette consumption among smokers, and decreased prevalence of smoking. For example, Missouri has the lowest cigarette excise tax in the country and weak statewide clean indoor air laws, and we have 50 percent more smokers than New York, which has the highest cigarette tax and strong clean indoor air laws."
For this study, Krauss and her colleagues analyzed state per capita alcohol consumption from 1980 to 2009 as a function of state price per pack of cigarettes, as well as smoke-free air policy scores, while controlling for secular trends and pertinent state covariates. Total alcohol, beer, wine, and spirits consumption per capita were examined separately.
"We found that during 1980 to 2009, increases in state cigarette prices and restrictions on indoor smoking led to decreases in state per capita alcohol consumption," said Krauss. "This was true for beer and spirits, but not wine. For example, our results suggest that a 20-percent increase in cigarette price would lead to a two-percent decrease in per capita beer consumption. Adoption of a complete statewide ban on smoking in bars, restaurants and worksites, compared to no restrictions, would reduce per capita beer consumption by four percent and spirits consumption by 11 percent. These estimates are averaged across the entire population – not just smokers. Effects among only smokers would likely be much larger than for the population as a whole."
Krauss was not surprised to find a much larger impact on beer and spirits rather than wine. "People who prefer beer or liquor are more likely to be smokers than people who prefer wine," she said. "In fact, people who prefer wine are not only less likely to smoke but are also more likely to have other healthier lifestyle habits and have more years of education than people who prefer other types of alcoholic beverages."
"Results from this study … highlight the importance of research that targets the interactions of tobacco and alcohol," said Young-Wolff. "These findings can pave the way for a productive line of future research aimed to identify secondary public-health benefits that accrue following increases in cigarette taxes, such as alcohol-related violence, drunk driving, and alcohol-related morbidity and mortality."
Richard A. Grucza, associate professor of psychiatry at Washington University School of Medicine and co-author of the paper, is aware of potential difficulties associated with increasing taxes. "Excluding tobacco, alcohol is by far the deadliest drug in the U.S.," he said. "Raising taxes on alcohol would go a long way toward reducing excessive alcohol consumption, but there has been a lot of resistance to doing this. Our study shows that strengthening tobacco-control policies might be another way to accomplish this. By raising cigarette taxes and strengthening clean indoor air laws, states may not only reduce health detriments related to smoking, but also those related to drinking."
Until that happens, Krauss had some practical advice. "Because smoking may be a trigger for drinking, people who want to cut down on their drinking may find it easier if they also stop smoking," she said.