Predicting transitions in alcohol use among adolescents and young adults by nicotine and tobacco products used.

OBJECTIVE

To characterize transitions in alcohol consumption behaviors by nicotine and tobacco products (NTPs) used across a diverse cohort of adolescents and young adults.

METHODS

A three-state Markov model was applied to six waves of data (2019-2021) collected biannually for 2608 (Nobs=14,152) participants in the Texas Adolescent Tobacco and Marketing Surveillance System 2.0. We examined nine possible transitions across three exclusive states of alcohol use (none, past 30-day drinking, and past 14-day binge drinking). We estimated the probability of transitioning between alcohol use behaviors by NTPs used (none, exclusive e-cigarette, exclusive combustible tobacco, dual use), controlling for age, race/ethnicity, sex, depression symptoms, and current cannabis use. Results were additionally stratified by sex.

RESULTS

Any NTP use resulted in a significantly greater risk of transitioning from non-drinking to binge drinking. Combustible tobacco and dual use predicted a lower risk of transitioning from binge drinking to current drinking. Dual use among females predicted onset of current or binge drinking from non-drinking. In contrast, female dual use also predicted discontinuation of binge drinking to non-drinking. Among males, the rapid onset of binge drinking from non-drinking was predicted by exclusive combustible or e-cigarette use.

CONCLUSIONS

Given findings that combustible tobacco use diminishes the probability of alcohol de-escalation among young adults, interventions should address both substances. Further research is needed to understand the moderating effect of sex on the relationship between NTP use and alcohol consumption.