BACKGROUND: Nicotine and alcohol co-use synergistically increases dependence and worsens health outcomes. Co-users display distinct consumption patterns compared with single-substance users. This study examines usage patterns and attitudes towards tobacco End Game in tobacco and alcohol co-users.
METHODS: We included 5,600 randomly selected adult respondents from a 2024 population-based tobacco policy survey. Smoking behaviors included daily cigarette consumption, time to first cigarette, nicotine dependence, intention to quit within 30 days, and determination to quit. Alcohol behaviors included drinking frequency, binge drinking, and daily alcohol consumption over the past year. Support for the End Game on total bans of tobacco sales and use was evaluated. Associations between support for the End Game and usage groups were analyzed, adjusted for sociodemographics.
RESULTS: Among 5,600 participants, half were male and 44.9% were aged 30 to 49 years. Four groups were identified: co-users (882 [15.8%]), tobacco users (1,718 [30.7%]), alcohol users (1,242 [22.2%]), and non-users (1,758 [31.4%]). Co-use was more common among men, aged 30 to 49 years, with secondary education, and not living with children (all Ps<0.001). Compared with tobacco users, co-users reported increased cigarette consumption on drinking days (mean [SD] 5.50 [4.60]), more frequent smoking in the past month (25.3[8.4] vs. 22.9 [10.1], β=-2.37, P=0.001), and less likely to quit within 30 days (93.1% vs. 86.1%, AOR=0.48, P=0.03). Compared to alcohol user, co-users had higher drinking frequency (8.6% vs. 1.7%, AOR=0.13, P<0.001), more binge drinking (47.8% vs. 20.4%, AOR=0.33, P<0.001), and greater daily alcohol consumption (2.16[3.69] vs. 1.64[2.57], β=-0.63, P<0.001). Compared with non-user, co-users, tobacco users, and alcohol users were significantly less likely to support the End Game (ARR range, 0.04-0.41; 0.12-0.29; 0.76-1.52, respectively).
CONCLUSIONS: Co-use is associated with higher consumption levels and reduced support for tobacco endgame policy. Our findings highlighted the need for targeted interventions to address co-use behaviors and enhance policy acceptance.