Tobacco and Public Health - TCSC Indonesia

Introduction
Chapter 36
Tobacco and alcohol interaction
Albert B. Lowenfels and Patrick Maisonneuve
Throughout the world, tobacco and alcohol abuse are responsible for an appreciable
proportion of avoidable deaths. Alcohol has been used in all cultures throughout
recorded history, but tobacco only became widely available after the discovery of the
New World. At first, tobacco use was restricted to the wealthy class, but by the beginning
of the seventeenth century, combined exposure to alcohol and tobacco was
common in all classes (Figure 36.1). Both agents are addictive, although nicotine, the
major addictive compound contained in tobacco, is probably more so than alcohol.
Both agents are widely used: nearly 80% of Americans over age 12 have consumed
alcohol at some time, which is similar to the percentage of persons who report ever
using tobacco. However, less than one-third of adults are current smokers—much
smaller than the proportion of current alcohol users.
Tobacco use creates an enormous health burden because of its well-known association
with numerous diseases, but increased consumption of alcohol is also known to have
deleterious health effects and there are several diseases where exposure to both substances
can be harmful. Table 36.1 lists background information and societal covariates
for these two substances. Since both substances are so widely used and since tobacco
users often consume alcohol, some of the adverse health effects of tobacco may be caused
by drinking. Furthermore, there is a real possibility that combined exposure to these
two substances may be more harmful than a single exposure to only one of these agents.
Combined use of tobacco and alcohol
Epidemiology
We can estimate the frequency of the combined use of tobacco and alcohol at the
population level from survey data. For the United States, the 1997 National Household
Survey on Drug Abuse (1997) provides age-specific estimates of exposure to these
agents. Overall, as shown in Table 36.2, smoking is much more common in alcohol
consumers than in teetotalers: this difference is striking in the younger age groups.
With respect to the combined use of alcohol and tobacco, approximately 20% of
responders to the survey report exposure to both substances during the month prior to
the survey.