title: Associations between alcohol, smoking, socioeconomic status and comorbidities: evidence from the 45 and Up Study.
abstract: OBJECTIVE
  Understanding how tobacco, alcohol and mental health are related is important for developing population-level policies and individual-level treatments that target comorbidities. The current study aimed to examine sociodemographic characteristics and mental health comorbidities associated with the odds of using tobacco and harmful levels of alcohol concurrently.
  
  
  METHODS
  Data were drawn from the 45 and Up Study, a large cohort study with 267 153 adults aged 45 years and over in New South Wales, Australia. Participants completed a survey assessing alcohol, smoking, psychological distress, treatment for depression and anxiety, and a range of socioeconomic status indicators. Univariate analyses and three multiple-logistic regression models were used to determine associations with (i) tobacco but not alcohol use; (ii) alcohol but not tobacco use; and (iii) concurrent tobacco and risky levels of alcohol use.
  
  
  RESULTS
  Being female, younger, lower individual and area-level socioeconomic status (SES) and depression and psychological distress were associated with tobacco use alone. Factors associated with alcohol use alone were older age, male gender, higher SES, and lower psychological distress and no recent depression treatment. Factors associated with concurrent risky alcohol consumption and tobacco use included being 45-64, being male, less education, earning <$30 000, being employed, and living in lower-SES areas, treatment for depression, and high distress on the Kessler-10.
  
  
  CONCLUSIONS
  Results suggest strong links between SES, treatment for depression, psychological distress, and concurrent tobacco and alcohol use. This has implications for public health policies and clinical treatment for tobacco and alcohol use, suggesting greater emphasis on addressing multiple health and social concerns. [Bonevski B, Regan T, Paul C, Baker AL, Bisquera A. Associations between alcohol, smoking, socioeconomic status and comorbidities: Evidence from the 45 and Up Study. Drug Alcohol Rev 2014;33:169-176].
authors.affiliation: Faculty of Health and Medicine, School of Medicine and Public Health, The University of Newcastle, Newcastle, Australia.
authors.forename: Billie
authors.initials: B
authors.lastname: Bonevski
authors.forename: Tim
authors.initials: T
authors.lastname: Regan
authors.forename: Chris
authors.initials: C
authors.lastname: Paul
authors.forename: Amanda L
authors.initials: AL
authors.lastname: Baker
authors.forename: Alessandra
authors.initials: A
authors.lastname: Bisquera
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000428:Alcohol Drinking / Q000453:epidemiology*; D015897:Comorbidity; D005260:Female; D006306:Health Surveys; D006801:Humans; D008297:Male; D008603:Mental Health; D008875:Middle Aged; D009517:New South Wales; D012737:Sex Factors; D012907:Smoking / Q000453:epidemiology*; D012923:Social Class; D013315:Stress, Psychological / Q000453:epidemiology*; D014029:Tobacco Use Disorder / Q000453:epidemiology*
keywords: alcohol consumption; comorbidity; mental health; smoking cessation; socioeconomic status