摘要：Objectives. We investigated tobacco companies’ knowledge about concurrent use of tobacco and alcohol, their marketing strategies linking cigarettes with alcohol, and the benefits tobacco companies sought from these marketing activities. Methods. We performed systematic searches on previously secret tobacco industry documents, and we summarized the themes and contexts of relevant search results. Results. Tobacco company research confirmed the association between tobacco use and alcohol use. Tobacco companies explored promotional strategies linking cigarettes and alcohol, such as jointly sponsoring special events with alcohol companies to lower the cost of sponsorships, increase consumer appeal, reinforce brand identity, and generate increased cigarette sales. They also pursued promotions that tied cigarette sales to alcohol purchases, and cigarette promotional events frequently featured alcohol discounts or encouraged alcohol use. Conclusions. Tobacco companies’ numerous marketing strategies linking cigarettes with alcohol may have reinforced the use of both substances. Because using tobacco and alcohol together makes it harder to quit smoking, policies prohibiting tobacco sales and promotion in establishments where alcohol is served and sold might mitigate this effect. Smoking cessation programs should address the effect that alcohol consumption has on tobacco use. Smoking remains the leading preventable cause of premature mortality in the United States, accounting for more than 440 000 deaths annually. 1 Alcohol consumption is the third-leading cause of mortality in the nation. 2 Each year, approximately 79 000 deaths are attributable to excessive alcohol use. 3 The concurrent use of cigarettes and alcohol further increases risks for certain cancers, such as cancer of the mouth, throat, and esophagus. 4 , 5 In addition, the use of both tobacco and alcohol makes it more difficult to quit either substance. 6 Smoking and drinking are strongly associated behaviors. 7 – 13 Smokers are more likely to drink alcohol, 11 drink more frequently, 8 , 11 consume a higher quantity of alcohol, 8 , 11 , 14 and demonstrate binge drinking (5 or more drinks per episode) than are nonsmokers. 9 , 11 , 12 Alcohol drinkers, especially binge drinkers, are also more likely to smoke 7 , 8 , 10 and are more likely to smoke half a pack of cigarettes or more per day. 10 The association between tobacco use and alcohol use becomes stronger with the heavier use of either substance. 8 , 15 , 16 Alcohol consumption increases the desire to smoke, 17 , 18 and nicotine consumption increases alcohol consumption. 19 Experimental studies have demonstrated that nicotine and alcohol enhance each other's rewarding effects. 16 , 18 Alcohol increases the positive subjective effects of smoking, 8 , 15 , 16 , 20 and smoking while using alcohol is more reinforcing than is smoking without concurrent alcohol use. 8 Smokers smoke more cigarettes while drinking alcohol, 8 , 15 , 18 especially during binge-drinking episodes. 8 , 15 This behavior has also been observed among nondaily smokers 8 , 15 and light smokers. 17 The concurrent use of alcohol and tobacco is common among young adults, 8 , 10 , 12 , 21 including nondaily smokers, 19 , 22 – 24 nondependent smokers, 8 and novice smokers. 13 Young adult smokers have reported that alcohol increases their enjoyment of and desire for cigarettes 8 , 25 and that tobacco enhances the effect of alcohol: it “brings on the buzz” or “gave you a double buzz.” 13 , 23 , 26 Young adult nondaily smokers described the pairing of alcohol and cigarettes as resembling “milk and cookies” or “peanut butter with jelly.” 24 Young adults have also been the focus of aggressive tobacco promotional efforts in places where alcohol is consumed, such as bars and nightclubs. 27 , 28 Consumer products often fall into cohesive groups (sometimes referred to as “Diderot unities”) that may reinforce certain patterns of consumption, 29 and these groupings may be influenced by marketing activities. In the case of tobacco and alcohol, these product links may have been further enhanced by cooperation between tobacco and alcohol companies (e.g., cosponsorship) or corporate ownership of both tobacco and alcohol companies (e.g., Philip Morris's past ownership of Miller Brewing Company). We used tobacco industry documents to explore tobacco companies’ knowledge regarding linked tobacco and alcohol use and the companies’ marketing strategies that linked cigarettes with alcohol. We were interested in 3 basic issues: (1) what tobacco companies knew about the association between drinking and smoking, especially about smokers’ drinking behaviors, (2) how tobacco and alcohol companies developed cross promotions featuring cigarettes and alcohol, and (3) how tobacco companies linked cigarettes with alcohol in their marketing activities and the benefits they expected to gain from those activities.
