Co-occurring risk factors for current cigarette smoking in a U.S. nationally representative sample

Stephen T. Higgins, Allison N. Kurti, Ryan Redner, Thomas J. White, Diana R. Keith, Diann E. Gaalema, Brian L. Sprague, Cassandra A. Stanton, Megan E. Roberts, Nathan J. Doogan, Jeff S. Priest

Research output: Contribution to journalArticlepeer-review

65 Scopus citations


Introduction Relatively little has been reported characterizing cumulative risk associated with co-occurring risk factors for cigarette smoking. The purpose of the present study was to address that knowledge gap in a U.S. nationally representative sample. Methods Data were obtained from 114,426 adults (≥ 18 years) in the U.S. National Survey on Drug Use and Health (years 2011–13). Multiple logistic regression and classification and regression tree (CART) modeling were used to examine risk of current smoking associated with eight co-occurring risk factors (age, gender, race/ethnicity, educational attainment, poverty, drug abuse/dependence, alcohol abuse/dependence, mental illness). Results Each of these eight risk factors was independently associated with significant increases in the odds of smoking when concurrently present in a multiple logistic regression model. Effects of risk-factor combinations were typically summative. Exceptions to that pattern were in the direction of less-than-summative effects when one of the combined risk factors was associated with generally high or low rates of smoking (e.g., drug abuse/dependence, age ≥ 65). CART modeling identified subpopulation risk profiles wherein smoking prevalence varied from a low of 11% to a high of 74% depending on particular risk factor combinations. Being a college graduate was the strongest independent predictor of smoking status, classifying 30% of the adult population. Conclusions These results offer strong evidence that the effects associated with common risk factors for cigarette smoking are independent, cumulative, and generally summative. The results also offer potentially useful insights into national population risk profiles around which U.S. tobacco policies can be developed or refined.

Original languageEnglish (US)
Pages (from-to)110-117
Number of pages8
JournalPreventive Medicine
StatePublished - Nov 1 2016
Externally publishedYes


  • Adults
  • Cigarette smoking
  • Classification and regression tree (CART)
  • Co-occurring risk factors
  • Current smokers
  • Educational attainment
  • Multiple logistic regression
  • Risk factors
  • U.S. nationally representative sample

ASJC Scopus subject areas

  • Epidemiology
  • Public Health, Environmental and Occupational Health


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