Transitions in cigarette smoking among heavy drinking college students: A longitudinal study

This study examines smoking patterns and predictors of change in smoking among 895 students from five universities who participated in a trial to reduce harms from high risk drinking. Baseline smoking rate was 46%. After two years, 39% of smokers quit, 19% reduced their smoking, 18% increased and 24% remained the same; 13% of non-smokers initiated tobacco use. Only 9% of those who quit were daily smokers at baseline, compared with 38% of those who continued to smoke (p<.001). Average baseline drinking level was the same in both groups, but those who quit smoking had reduced their drinking by 45%, compared with a 25% reduction among continuing smokers (p<.001). In regression analyses, smokers who were less tobacco dependent at baseline, increased weekly exercise, and decreased monthly alcohol intake were more likely to be quit (all p<.001). Among baseline non-smokers, predictors of smoking at follow-up included class year and past month drinking level (both p<.03). Gender, age, depression, RAPI score and risky driving practices were not predictive of changes in smoking behavior. Assignment to treatment group was associated with reductions in drinking, however, there was no effect on smoking. Instead, a large share of smokers in both groups reported quitting, suggesting that simply monitoring smoking status among college students may affect quitting, especially among lighter smokers. These findings point to a role for student health clinicians in screening for tobacco use, and addressing other behavioral risk factors, such as drinking and fitness, along with smoking in the context of routine care.