Alcohol and tobacco use covary at multiple levels of analysis, and co-use of the two substances may have profound health consequences. In order to characterize the motivationally relevant processes contributing to co-use, the current study used Ecological Momentary Assessment (EMA) to examine the subjective consequences of naturally occurring simultaneous use of alcohol and tobacco. Current smokers who reported frequently drinking alcohol (N = 259) monitored their daily experiences for 21 days using electronic diaries. Participants responded to prompted assessments and also initiated recordings when they smoked a cigarette or completed the first drink in a drinking episode. Momentary reports of smoking and alcohol consumption were associated with one another, and these effects remained after adjustment for occasion-and personlevel covariates. When participants consumed alcohol, they reported increased pleasure and decreased punishment from the last cigarette. Smoking was associated with small increases in pleasure from the last drink. Ratings of "buzzed" and "dizzy" were synergistically affected by couse of alcohol and tobacco. Co-use was also followed by higher levels of craving for both alcohol and tobacco. Results point to the importance of reward and incentive processes in ongoing drug use and suggest that alcohol intensifies real-time reports of the motivational consequences of smoking more strongly than smoking affects corresponding appraisals of alcohol effects. Keywordsalcohol; cigarettes; electronic diary; craving; reward; reinforcement Alcohol drinkers are more likely to smoke cigarettes than teetotalers and smokers are more likely to report drinking alcohol than nonsmokers (Falk, Yi & Hiller-Sturmhofel, 2006; Shiffman & Balabanis, 1995). Moreover, heavy drinkers are likely to be heavy smokers and vice versa (Shiffman & Balabanis, 1995). In psychiatric epidemiology, alcohol use disorders show substantial comorbidity with tobacco dependence (Falk, et al., 2006;Jackson, Sher, Wood, & Bucholz, 2003). The probability of smoking is strongly related to the number of alcohol dependence criteria endorsed (Madden, Bucholz, Martin & Heath, 2000). Indeed, this overlap is so robust that it could be argued alcoholism is most often a disorder involving problematic use of alcohol and tobacco. The covariation of the two substances is practically and clinically important. For instance, abuse of both alcohol and tobacco confers synergistic risk for some forms of cancer (e.g., Castellsague, et al., 1999). Even though alcoholism is associated with devastating medical consequences, a follow-up study of treated alcoholics found they were even more likely to die of tobacco-related disease (Hurt, et al., 1996).Alcohol and tobacco not only tend to be used by the same individuals, but also tend to be used at the same time. In the laboratory, alcohol administration spurs tobacco use (e.g., Mello, Mendelson, & Palmieri, 1987;Mintz, Boyd, Rose, Charuvastra, & Jarvik, 1985). Some evidence suggests nicotine administration i...

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Objective To examine the efficacy of four individually-delivered Motivational Interviewing counseling sessions for smoking cessation versus a matched intensity comparison condition. Method From 2006–2009, students attending college in the Midwest smoking at least 1 of 30 days were recruited regardless of their interest in quitting. 30 fraternities and sororities were randomized, resulting in 452 participants. Results No significant differences were found for 30-day cessation between treatment and comparison at end of treatment (31.4% vs 28%, OR=1.20, 95% CI .72,1.99) or at follow-up (20.4% vs 24.6%, OR=.78, 95% CI .50,1.22). Predictors of cessation at follow-up, regardless of condition, included more sessions attended (OR 1.2, 95% CI 1.1,1.8) and more cigarettes smoked in 30 days at baseline (OR 4.7, 95% CI 2.5,8.9). The odds of making at least one quit attempt were significantly greater for those in the smoking group at end of treatment (OR 1.75, 95% CI 1.11,2.74) and follow-up (OR 1.66, 95% CI 1.11,2.47). Modeling showed reduction in days smoked for both groups. At end of treatment, more frequent smokers in the treatment condition had greater reductions in days smoked. Conclusion Motivational Interviewing for smoking cessation is effective for increasing cessation attempts and reducing days smoked in the short run.

Methods assessing non-daily smoking are of concern because biochemical measures can not verify self-reports beyond 7 days. This study compares two self-reported smoking measures for non-daily smokers. A total of 389 college students, (48% female, 96% white, mean age of 19) smoking between 1 and 29 days out of the past 30, completed computer assessments in three cohorts with the order of administration of the measures counterbalanced. Values from the two measures were highly correlated. Comparisons of Timeline Follow-Back (TLFB) with the global questions for the total sample of non-daily smokers yielded statistically significant differences (p<.001), albeit small, between measures with the TLFB resulting on average in 2.38 more total cigarettes smoked out of the past 30 days, 0.46 less smoking days, and 0.21 more cigarettes smoked per day. Analyses by level of smoking showed that the discordance between the measures differed by frequency of smoking. Global questions of days smoked resulted in frequent reporting in multiples of five days, suggesting digit bias. Overall the two measures of smoking were highly correlated and equally effective for identifying any smoking in a 30-day period among non-daily smokers. KeywordsAssessment; Timeline Follow-back; tobacco; smoking; college students Correspondence concerning this article should be addressed to: Kari Jo Harris, 32 Campus Drive, School of Public and Community Health Sciences, The University of Montana, Missoula, Montana 59812., Kari.Harris@umontana.edu;. Publisher's Disclaimer: The following manuscript is the final accepted manuscript. It has not been subjected to the final copyediting, fact-checking, and proofreading required for formal publication. It is not the definitive, publisher-authenticated version. The American Psychological Association and its Council of Editors disclaim any responsibility or liabilities for errors or omissions of this manuscript version, any version derived from this manuscript by NIH, or other third parties. The published version is available at www.apa.org/journals/adb NIH Public Access Methods to assess non-daily smoking have been a topic of concern and debate among researchers particularly because there are no biochemical methods to verify self-reported smoking over a 30-day period (Mermelstein et al., 2002). Similar to younger students and an increasing proportion of adult smokers, many college students smoke irregularly and infrequently. Of the college students who smoked at least once in the past 30 days, only about one in four smoked every day Wetter et al., 2004). Researchers have used multiple methods to assess self-reported smoking among college students, including the use of single-item global questions. Single-item global questions have focused on establishing any smoking in the past 30 days (Substance Abuse and Mental Health Services Administration, 2007) and assessing days of smoking (Core Institute, 1999). Single-item questions that conflate smoking days and number of cigarettes smoked in one question (Wechsle...