Date Published: July 06, 2017
Publisher: John Wiley and Sons Inc.
Author(s): Emma Beard, Robert West, Susan Michie, Jamie Brown.
This paper estimates how far monthly changes in prevalence of cigarette smoking, motivation to quit and attempts to stop smoking have been associated with changes in prevalence of high‐risk drinking, and motivation and attempts to reduce alcohol consumption in England.
Data were used from the Alcohol and Smoking Toolkit Studies between April 2014 and June 2016. These involve monthly household face‐to‐face surveys of representative samples of ~1700 adults in England.
Autoregressive Integrated Moving Average with Exogeneous Input (ARIMAX) modelling was used to assess the association over time between monthly prevalence of (a) smoking and high‐risk drinking; (b) high motivation to quit smoking and high motivation to reduce alcohol consumption; and (c) attempts to quit smoking and attempts to reduce alcohol consumption.
Mean smoking prevalence over the study period was 18.6% and high‐risk drinking prevalence was 13.0%. A decrease of 1% of the series mean smoking prevalence was associated with a reduction of 0.185% of the mean prevalence of high‐risk drinking 2 months later [95% confidence interval (CI) = 0.033 to 0.337, P = 0.017]. A statistically significant association was not found between prevalence of high motivation to quit smoking and high motivation to reduce alcohol consumption (β = 0.324, 95% CI = –0.371 to 1.019, P = 0.360) or prevalence of attempts to quit smoking and attempts to reduce alcohol consumption (β = −0.026, 95% CI = –1.348 to 1.296, P = 0.969).
Between 2014 and 2016, monthly changes in prevalence of smoking in England were associated positively with prevalence of high‐risk drinking. There was no significant association between motivation to stop and motivation to reduce alcohol consumption, or attempts to quit smoking and attempts to reduce alcohol consumption.
In England in 2015, approximately 17% of the population were smokers and 20% were estimated to drink alcohol at high‐risk levels 1, 2. Smoking and high‐risk alcohol consumption are major causes of a number of fatal diseases including cancer and cardiovascular disease 3. In England, approximately 8000 deaths each year are alcohol‐related and 80 000 per year are attributed to smoking 4, 5. Smoking and high‐risk drinking have been found to be associated at an individual level; this study assessed whether a similar association holds true at a population level over time. Uniquely, England has such data collected monthly and so provides an important context in which to study this.
Figures 1, 2, 3 show the changes in monthly prevalence of (1) smoking and high‐risk drinking, (2) high motivation to quit smoking and high motivation to reduce alcohol consumption and (3) attempts to stop smoking and attempts to reduce alcohol consumption, while Table 1 shows the mean, end‐ and start‐points for these series.
The change in prevalence of smoking was associated positively with prevalence of high‐risk drinking during a monthly time–series between 2014 and 2016 in England. Statistically significant associations were not found between changes in motivation to stop smoking and to reduce alcohol consumption in high‐risk drinkers, or between attempts to stop smoking and attempts to reduce alcohol consumption.
Changes in prevalence of smoking in England from 2014 to 2016 across a monthly time–series were associated positively with changes in prevalence of high‐risk drinking. The temporal ordering of the association suggests that if there is a causal association it is in the direction of changes in smoking prevalence driving changes in alcohol use. No clear association was found between motivation to stop smoking and motivation to reduce alcohol consumption in high‐risk drinkers or attempts to stop smoking and attempts to reduce alcohol intake in high‐risk drinkers. This suggests that the association between changes in prevalence of smoking and high‐risk drinking may reflect capability and environmental factors rather than motivation to attempt a change in behaviour.