ТЕКСТ B

HOW PREVALENT ARE ALCOHOL AND TOBACCO USE?

The National Institute on Alcohol Abuse and Alcoholism’s (NIAAA’s) 2001–2002 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), which is one of the largest comorbidity studies ever conducted, included extensive questions about alcohol and tobacco use and related disorders. NESARC data confirmed the widespread use of alcohol with tobacco: Approximately 46 million adults used both alcohol and tobacco in the past year, and approximately 6.2 million adults reported both an AUD and dependence on nicotine.

Alcohol and tobacco use varied according to gender, age, and ethnicity, with men having higher rates of co-use than women. Younger people tended to have a higher prevalence of AUDs, nicotine dependence, and co-use. Although Whites were more likely to drink alcohol, American Indians/Alaskan Natives were most likely to smoke, or to smoke and drink concurrently. Asians/Native Hawaiians/Pacific Islanders were least likely to smoke or drink, or smoke and drink concurrently.

Alcohol and tobacco use may lead to major health risks when used alone and together. In addition to contributing to traumatic death and injury (e.g., through car crashes), alcohol is associated with chronic liver disease, cancers, cardiovascular disease, acute alcohol poisoning (i.e., alcohol toxicity), and fetal alcohol syndrome. Smoking is associated with lung disease, cancers, and cardiovascular disease. Additionally, a growing body of evidence suggests that these substances might be especially dangerous when they are used together; when combined, alcohol and tobacco dramatically increase the risk of certain cancers.

The American Heart Association estimates that more than 34 percent of the United States population has some form of cardiovascular disease. Tobacco use and alcohol consumption both are major risk factors for various forms of cardiovascular disease. However, little evidence exists to suggest that drinking and smoking together raise the risk more than the sum of their independent effects.

Determining the risk factors for cardiovascular disease is difficult because the issues involved are extremely complex. First, cardiovascular disease encompasses a variety of conditions (such as heart attack, stroke, and hardening or narrowing of the arteries), which result from numerous factors. Second, although tobacco has been shown to raise the risk for cardiovascular disease in a dose-dependent manner – the more a person smokes, the more his or her risk of developing cardiovascular disease increases – alcohol’s effect on cardiovascular disease depends on many factors, including gender, age, and drinking patterns. Overall, moderate drinking appears to reduce the risk for many forms of cardiovascular disease, whereas drinking large amounts of alcohol generally increases the risk.