Smoking and drinking among college students: "It's a package deal"

Background: This paper reports on qualitative research on smoking in contexts associated with drinking among college students. Although a plethora of survey research has shown a positive association between smoking and alcohol use, little attention has been given to the utility functions of these co-occurring behaviors. Methods: Data are drawn from semi-structured interviews with college freshmen at a large Mid-western university in the U.S. (n = 35). In addition, eleven focus groups with fraternity and sorority members were conducted (n = 70). Interviews and focus groups focused on a range of issues including current smoking behavior, reasons for smoking, and smoking and drinking. Results: A review of qualitative responses reveals that smoking served multiple utility functions for this population including (1) facilitating social interaction across gender, (2) allowing one to structure time and space at a party, (3) enabling "party" smokers to smoke with fewer negative side effects, and (4) helping to calm one down when drunk. Conclusions: Whereas smoking was stigmatized during the context of one's everyday life as a student, at parties while consuming alcohol, smoking was viewed as normative and socially acceptable. Preventive interventions are needed on college campus that target co-substance use and address widespread misperceptions about the harm of tobacco use and addiction.