In this blog, Dr Claire Garnett, Research Fellow at University of Bristol, talks us through her latest study looking at the prevalence and characteristics of adults in England who both smoke and drink alcohol at risky levels, the health impacts and the need for targeted support.
There are over 10 million adults in England who are at-risk drinkers. This means that they are at risk of harm to their physical and mental health and may have negative social and financial consequences from their drinking. There are 5.3 million adults in England who are currently smoking meaning they have a wide range of health risks including cancer and heart disease.
When combined, these behaviours increase a person’s risk of poor mental health, heart conditions, and cancer. While the number of people who smoke and drink alcohol is regularly reported in England, there is little known about the group who engage in both behaviours.
Despite the well-known risks, there’s limited knowledge about how big this group of people who are both current smokers and at-risk drinkers is, and the sociodemographic and health characteristics of this group. This information is crucial for reducing health inequalities, especially as those who both drink heavily and smoke are often left out of smoke-free interventions.
What we did
We conducted a study using data from over 150,000 adults in England from 2014 to 2022. This survey was representative of the national population and we used it to describe the number of adults who were both current smokers and at-risk drinkers, and to characterise their sociodemographic and health characteristics.
We also focused on the period since the start of the Covid-19 pandemic (April 2020 onwards) as we know that there has been a sustained rise in at-risk drinking, potentially leading to more people taking part in both smoking and at-risk drinking.
What we found
Since the start of the Covid-19 pandemic, 1 in 20 people (4.6%) in England engaged in both smoking and at-risk drinking, multiplying the risk of harm to their health. This is around 2 million people in England alone.
Smokers have been more likely to engage in at-risk drinking, rising from 21% in 2019 to 30% in 2022.
This group also had substantially higher rates of mental health conditions, compared with adults who neither smoke nor drink at-risk. About half reported experiencing psychological distress in the last month (49%), and been diagnosed since the age of 16 with a mental health condition (45%), drug use or dependence (7%), alcohol dependence (7%), or problems with gambling (1.3%).
Around half of this group were trying to cut down on smoking, though only around a quarter were doing so for their drinking. A quarter had received advice from their GP on their smoking but only 9% had received this advice for their drinking. People who were both smokers and at-risk drinkers were less likely to be trying to cut down on their drinking or smoking than those who only engaged in one of the behaviours (either smoking or at-risk drinking, but not both).
People who both engaged in smoking and at-risk drinking, compared with those who did neither, were more likely to be younger, male, white and have a higher level of education qualifications.
What does this mean
People who engaged in smoking and at-risk drinking have higher rates of having been diagnosed with a mental health disorder compared with those who do not. This means they are less likely to be successful at quitting smoking, and either the individual or their health care practitioner may not prioritise quitting smoking, and this is concerning.
The need for targeted support
Given the high rates of smoking among at-risk drinkers, and vice versa, this study shows that there is a substantial group of people who engage in both smoking and at-risk drinking who are a priority group for targeted support. This group is not just dealing with the physical health risks of both smoking and at-risk drinking such as cancer, stoke and heart disease, but also higher rates of mental health conditions.
We need a coherent, targeted approach to supporting this group with their smoking, drinking and mental health. This could involve linking the support for their smoking, drinking and mental health. For example, targeting all behaviours in a single intervention or always following one type of intervention with the other so that people are given support for all of these behaviours. Or could involve always assessing and treating smoking, drinking and mental health regardless of which brings someone to a healthcare professional. By ensuring a targeted, coherent approach to support, we can improve the outcomes of successfully addressing their smoking and/or drinking and significantly reduce the health risks within this group.
Funding: This study was funded by Cancer Research UK and the National Institute for Health and Care Research.
Written by Dr Claire Garnett, Research Fellow, School of Psychological Science, University of Bristol
@ClaireVGarnett / @BristolUniPsych
This blog was published with the permission of the author. The views expressed are solely the author’s own and do not necessarily represent the views of the Alcohol Health Alliance or its members.