The Nature, Determinants and Consequences of the School-Level Tobacco-Alcohol Use Association

Jason D. Boardman, University of Colorado at Boulder

It is widely recognized that stage of the life course and school health environments are key determinants of trajectories of health behaviors, yet investigations rarely combine these approaches. Furthermore, the strong relationship between different health behaviors is acknowledged but rarely studied jointly. Our investigation identifies a key feature of the school health environment, the school-specific association of tobacco and alcohol use, and investigates its influence on patterns of alcohol and tobacco co-use through young adulthood. We find that this feature is strongly associated with long-term patterns of tobacco and alcohol co-use, even when key individual demographic and school compositional and structural characteristics are controlled. We conclude that this is a widely variable and key feature of the social environment that influences long-term health behavioral trajectories.