Changes In Tobacco Consumption Research Articles

Are we equally at risk of changing smoking behavior during a public health crisis? Impact of educational level on smoking from the TEMPO cohort

BackgroundThe COVID-19 pandemic as a public health crisis has led to a significant increase in mental health difficulties. Smoking is strongly associated with mental health conditions, which is why the pandemic might have influenced the otherwise decline in smoking rates. Persons belonging to socioeconomically disadvantaged groups may be particularly affected, both because the pandemic has exacerbated existing social inequalities and because this group was more likely to smoke before the pandemic. We examined smoking prevalence in a French cohort study, focusing on differences between educational attainment. In addition, we examined the association between interpersonal changes in tobacco consumption and educational level from 2018 to 2021.MethodsUsing four assessments of smoking status available from 2009 to 2021, we estimated smoking prevalence over time, stratified by highest educational level in the TEMPO cohort and the difference was tested using chi2 test. We studied the association between interpersonal change in smoking status between 2018 and 2021 and educational attainment among 148 smokers, using multinomial logistic regression.ResultsSmoking prevalence was higher among those with low education. The difference between the two groups increased from 2020 to 2021 (4.8–9.4%, p < 0.001). Smokers with high educational level were more likely to decrease their tobacco consumption from 2018 to 2021 compared to low educated smokers (aOR = 2.72 [1.26;5.89]).ConclusionCurrent findings showed a widening of the social inequality gap in relation to smoking rates, underscoring the increased vulnerability of persons with low educational level to smoking and the likely inadequate focus on social inequalities in relation to tobacco control policies during the pandemic.

Changes in tobacco and e-cigarette consumption in Spanish university students during the COVID-19 lockdown: Identification of vulnerable groups.

The objective of this study was to determine the changes in tobacco consumption in Spanish university students during the lockdown in 2020, and to identify vulnerable groups based on gender, age, and living situation. This was a cross-sectional descriptive study. From a sample of 1540 Spanish university students, 19.9% (n=306; 77.6% women; mean age=30.9 years; SD=8.3) reported having consumed tobacco. The frequency and average daily consumption of cigarettes and electronic nicotine delivery systems (ENDS) before the pandemic and during lockdown were analyzed. A total of 97.1% of students consumed only cigarettes, 2.9% only ENDS, and 3.3% were dual consumers. During lockdown, cigarette consumption was significantly reduced (5.3 before; 4.0 during; t(71)=3.6255; p<0.001) in the youngest group (aged 18-24 years). However, women daily users significantly increased their consumption (t(149)= -2.5461; p<0.05) and so did the 35-44 years age group (t(32)= -2.2285; p<0.05). Cigarette consumption significantly increased in those who were living alone (5.6 to 7.2; Z= -2.351; p<0.05) and with a partner (7.2 to 8.0; t(97)= -2.3771; p<0.05), but decreased in those who were living with their parents or other relatives (6.2 to 4.5; t(101)=3.4298; p<0.001). A total of 17.0% ceased consumption during lockdown, mainly women, younger students (aged 18-24 years), and those who lived with their parents. None of the people who used cigarettes daily during the pre-pandemic period stopped smoking during lockdown. Younger university students and those living with their parents decreased their tobacco use during the lockdown. Potentially vulnerable groups at risk of increasing their consumption were women who consumed tobacco daily before the pandemic and students aged 35-44 years who lived alone or with their partner.

Statistical Analysis of Changes in Tobacco Consumption amid the COVID-19 Pandemic

The author analyzed problems related to the prevalence of smoking and the need to combat the tobacco epidemic in Russia on the basis of current statistics and special surveys. Despite the fact that the number of smokers in Russia has been decreasing since 2009, there are new challenges for the authorities and society in their efforts to reduce the prevalence of smoking due to the emergence of new alternative tobacco and nicotine products, as well as changes in consumption habits due to the crisis caused by the COVID-19 pandemic. According to surveys carried out by the National Research University Higher School of Economics (from 2017 to 2020) and Rosstat (from 2011 to 2020), changes in tobacco consumption and smoking preferences have been identified, especially during the period of economic instability and the COVID-19 pandemic.The article explains the author’s position that despite the general decrease in the number of smokers (up to a quarter of adult population – according to data for 2020), their population is heterogeneous, and within it there were various processes, depending on the sex of the smoker, the intensity of smoking, preferences for nicotine-containing products. Firstly, over the period under review, the proportion of former smokers who have relinquished the habit has increased; secondly, the proportion of heavy smokers who used to consume a pack of cigarettes per day has decreased, and, conversely, the proportion of those who smoke about a quarter of a pack per day has increased. Smoking among women has two characteristics: lowering the age of onset of smoking to 19 years, along with increasing the daily consumption of cigarettes to an average of 12. Men, on the other hand, tend to reduce the daily consumption of cigarettes to 16 cigarettes on average. The proportion of smokeless tobacco products and electronic nicotine delivery systems is beginning to grow, but is still not a complete substitute for conventional cigarettes, which smoke about 95% of smokers. Finally, owing to the pandemic and crises in economy, the trend towards self-isolation has increased the number of people who smoke for the first time at a sufficiently mature age (30 years and older).Therefore, the results of the study revealed both certain patterns in tobacco consumption over the years preceding the pandemic and the impact of COVID-19 on social and economic processes involved in smoking that governance structures now need to take into account.

Are we socially equally at risk of smoking during the COVID-19 pandemic? French data from 2009-2021

Abstract Background Since 2020, the COVID-19 pandemic has greatly affected people including a significant increase in mental health difficulties. Cigarette smoking is found to be strongly associated with mental health conditions, which is why the pandemic might have influenced the secular decline in smoking rates observed over recent years. Persons belonging to socioeconomically disadvantaged groups may be particularly affected, both because the pandemic is found to exacerbate existing social inequalities and because this group was more likely to smoke before the pandemic. We examined the prevalence of smoking in a French cohort study, focusing on differences between educational attainment. In addition, we examined the association between educational level and interpersonal changes in tobacco consumption from 2018 to 2021. Methods The TEMPO cohort study included 1785 French adults followed between 1991 and 2021. With four assessments of smoking status available before and two after the onset of COVID-19, we estimated the smoking prevalence over time stratified by highest obtained diploma. We studied interpersonal change in smoking status between 2018 and 2021 among 148 smokers, using multinomial logistic regression. Results The prevalence of smokers was higher among those with low educational attainment compared with those with higher diploma at all timepoints. The difference between the two groups increased from 2020 to 2021 (4.8% to 9.4%). Smokers with high educational level were more likely to decrease their tobacco consumption from 2018-2021 compared to low educated smokers (aOR=2.72 [1.26;5.89]). Conclusions Current findings showed a widening of the socioeconomic gap over time in smoking rates, which emphasizes the vulnerability of persons with low educational attainment to smoking, also during the pandemic. Key messages • The existing gap in smoking prevalence between lower and higher diploma groups has increased from 2020 to 2021, which may be a consequence of the COVID-19 pandemic. • From 2018 to 2021, people with high school as highest qualification were less likely to decrease their tobacco use compared to higher educated people.

The neighborhood environment and its association with the spatio-temporal footprint of tobacco consumption and changes in smoking-related behaviors in a Swiss urban area.

This study aimed to evaluate the association of the neighborhood environment with the spatio-temporal dependence of tobacco consumption and changes in smoking-related behaviors in a Swiss urban area. Data were obtained from the CoLaus cohort (2003-2006, 2009-2012, and 2014-2017) in Lausanne, Switzerland. Local Moran's I was performed to assess the spatial dependence of tobacco consumption. Prospective changes in tobacco consumption and the location of residence of participants were assessed through Cox regressions. Analyses were adjusted by individual and neighborhood data. The neighborhood environment was spatially associated with tobacco consumption and changes in smoking-related behaviors independently of individual factors.

Tobacco Use Depictions in Popular Soviet and Post-Soviet Movies from 1950 to 2019: The Possible Impact of Restrictive Policies

Background To reduce the initiation to smoking and its social acceptance, restrictive policies to decrease tobacco exposure in movies and television shows have been implemented in some countries around the world. What is not as clear is how effective these policies are in reducing tobacco exposure on screen. The objective of this study was to analyze trends in tobacco use in Soviet and post-Soviet films over time and also to assess the effectiveness of restrictive policies. Methods: 140 top commercially successful Soviet and Russian films released from 1950 to 2019 were content analyzed. The outcome data were transformed to approximate multivariate normality before being analyzed with one-way analyses of variance followed by Bonferroni multiple comparison post hoc tests. Results: Smoking rates in the top films fluctuated insignificantly in the 1950s–2000s. Yet, in the 2010s, the number of tobacco events in the movies declined significantly, compared to all other decades studied (p < 0.05). Conclusions: Changes in tobacco consumption in the Soviet Union and Russia did not have significant effects on tobacco use in domestic movies released from 1950 to 2009. The decrease in tobacco use rates found in Russian films in the 2010s can be explained by extensive public policies aiming to reduce tobacco exposure in newly released films.

How the COVID-19 pandemic impacts tobacco addiction: Changes in smoking behavior and associations with well-being

This research investigated (1) how the coronavirus pandemic impacted tobacco addiction, (2) which smoker segments were more vulnerable, and (3) how the changes in tobacco consumption were associated with smokers’ satisfaction with physical health and psychological well-being. Data from a large-scale cross-sectional study of adults in China were analyzed. Outcome measures were the quantity of cigarettes consumed per day prior to the COVID-19 pandemic, the quantity after the nationwide outbreak had been contained, satisfaction with physical health, and emotional well-being. Analyses revealed that, after the nationwide outbreak, more individuals quit (vs. started) smoking. Compared to their pre-COVID-19 consumption levels, smokers significantly reduced the quantity of cigarettes they consumed after the nationwide outbreak had been contained. However, there were substantial disparities across individuals: male (vs. female) smokers were less able to curb their smoking; smokers residing in urban (vs. rural) areas or with a longer smoking history were also less able to reduce their smoking. Importantly, a greater reduction in smoking was associated with higher satisfaction with physical health and better emotional well-being. Furthermore, a follow-up investigation revealed that concerns about increased COVID-19 health risks due to smoking were a primary factor driving smokers’ behavior change. Overall, these results suggest that, to help smokers fight tobacco addiction and improve well-being, pandemic health policies need to take account of the differences in vulnerability across individuals and leverage the psychological factors that can facilitate behavior change.

Lifestyle behavior of patients with noncommunicable diseases during COVID-19 pandemic: An observational study

CONTEXT: Coronavirus disease (COVID-19) poses an unprecedented challenge and adversely affects the lifestyle of people with noncommunicable diseases (NCDs) due to enforced restrictions by the governments. AIMS: The study aimed to assess the physical activity and prophylactic behavior, along with change in sleep, alcohol intake, and tobacco consumption during the enforced lockdown. MATERIALS AND METHODS: The study was conducted in August 2020 and recruited NCD patients visiting the institute's outpatient department. Questions were formed on prophylactic behavior, changes in sleep, and alcohol and tobacco consumption along with a validated scale of International Physical Activity Questionnaire (IPAQ) Short Form. RESULTS: The study recruited 413 patients with a mean age of 54.34 years. The median IPAQ score was 536 metabolic equivalent task-minutes/week, with 41.96% of the patients demonstrating low physical activity. A statistically significant difference between the IPAQ scores was found among different NCD groups (P = 0.009). There was a statistically significant decrease in number of hours of sleep during the pandemic as compared to before the pandemic (P = 0.000). Furthermore, there was a significant change in tobacco consumption (P = 0.000) and alcohol consumption (P = 0.000) during the pandemic. The patients followed preventive practices to a larger extent. CONCLUSION: The study highlighted that the NCD patients should follow an optimal physical activity schedule, take proper sleep, and continue following prophylactic behavior.

Tobacco consumption trends and correlates of successful cessation in Indian females: Findings of Global Adult Tobacco Surveys

BackgroundFemale gender is being affected disproportionately by tobacco use. The correlates of tobacco use among women are different from men, which has not been studied in India. To develop gender-sensitive interventions and policies in tobacco control, it's essential to ascertain the factors that affect tobacco consumption and successful cessation among Indian women. MethodsThis secondary data analysis was done for females respondents aged >15 years using the data generated from the GATS-1 (2009–2010) and GATS-II (2016–2017). The primary dependent variables included interest in quitting smoking/SLT, attempt to quit smoking/SLT, successful quitting. The independent variables were broadly categorized as a community, household, and individual level. Simple descriptive analysis using % age relative change was used to calculate the change in tobacco consumption between two rounds of GATS, whereas; bivariate and multivariable logistic regression were used to calculate the unadjusted and adjusted odds ratio for cessation related variables (GATS-2). ResultsThere was a 29.5% relative reduction in the prevalence of tobacco use in round-2 among females. A maximum reduction in the prevalence was observed in the 15–29 years (−51.3%), those not exposed the media advertisements (−19.9%). While unadjusted OR depicted that unmarried women, young age, asked by health workers about tobacco use, and advice given by them increased the interest in quitting smoking, none of them emerged to be significant on a multivariable logistic regression except the advice given by the health care provider. Successful cessation (>6 months) of SLT products is possible in urban areas, with decreased exposure to media advertisements. ConclusionThere is an urgent need for gender-sensitive policies in tobacco control and the integration of these policies with relevant national health programs. This shall help to synergize efforts and obtain better outcomes that would support the overarching goal of tobacco-free India.

Perceived risk, attitudes, and behavior of cigarette smokers and nicotine vapers receiving buprenorphine treatment for opioid use disorder during the COVID-19 pandemic

BackgroundCigarette smoking may increase the risk of COVID-19 complications, reinforcing the urgency of smoking cessation in populations with high smoking prevalence such as individuals with opioid use disorder (OUD). Whether the COVID-19 pandemic has altered perceptions, motivation to quit, or tobacco use among cigarette smokers and nicotine e-cigarette vapers with OUD is unknown. MethodsA telephone survey was conducted in March-July 2020 of current cigarette smokers or nicotine vapers with OUD who were stable on buprenorphine treatment at five Boston (MA) area community health centers. The survey assessed respondents’ perceived risk of COVID-19 due to smoking or vaping, interest in quitting, quit attempts and change in tobacco consumption during the pandemic. Results222/520 patients (43 %) completed the survey, and 145 were asked questions related to COVID-19. Of these, 61 % smoked cigarettes only, 13 % vaped nicotine only, and 26 % were dual users. Nearly 80 % of participants believed that smoking and vaping increased their risk of COVID-19 infection or complications. Smokers with this belief reported an increased interest in quitting (AOR 4.6, 95 % CI:1.7–12.4). Overall, 49 % of smokers and 42 % of vapers reported increased interest in quitting due to the pandemic; 24 % and 20 %, respectively, reported attempting to quit since the pandemic. However, 35 % of smokers and 27 % of vapers reported increasing smoking and vaping, respectively, during the pandemic. ConclusionsMost patients with OUD believed that smoking and vaping increased their vulnerability to COVID-19, half reported increased interest in quitting, but others reported increasing smoking and vaping during the COVID-19 pandemic.

Changes in tobacco consumption in cannabis dependent patients with schizophrenia versus non-psychiatric controls during 28-days of cannabis abstinence

BackgroundTobacco and cannabis are highly co-morbid in the general population and in patients with schizophrenia. Given the putative causal mechanisms facilitating co-use, it is important to determine how cannabis cessation may influence concurrent tobacco use. Using a 28-day cannabis abstinence paradigm, we prospectively examined changes in tobacco consumption in patients with schizophrenia and controls with cannabis dependence and daily cigarette use. MethodsCannabis dependent patients with schizophrenia (n = 19) and controls (n = 20) completed the study with abstinence rates of 42% and 55%, respectively. Participants completed measures of substance use, withdrawal, and clinical symptoms weekly. Urine samples were collected twice weekly to biochemically verify abstinence. ResultsPatients reported a greater increase in cigarettes smoked per day (CPD) on Day 7 relative to baseline (2.97 cigarette increase for abstinent subgroup, p < .01) compared to controls (.06 cigarette increase for abstinent subgroup, p = .95). Initially, greater reductions in cannabis use related to greater increases in CPD relative to baseline in the patient subsample (simple slope = −2.31, p = .05), but by Day 28, CPD returned to baseline levels independent of cannabis use. CPD changes were unrelated to cannabis withdrawal. Results were similar for changes in caffeine consumption, but not for alcohol. ConclusionsFindings suggest transient tobacco substitution for cannabis in patients with schizophrenia. This provides further support for a strong association between cannabis and tobacco in schizophrenia. Future studies should focus on targeting underlying mechanisms that promote co-use to better address potential changes in concurrent substance use during treatment interventions.

Tobacco and anti-psychotics side effects

IntroductionIt's known that, patients with schizophrenia smoke more tobacco than general population, and that tobacco is a potent inducer of cythocrome P450 isoenzyme 1A2 (CYP 1A2). In addition, clozapine and quetiapine, drugs frequently used in the treatment of schizophrenia, are CYP1A2 substrates. So, tobacco smoking may reduce blood levels of clozapine and quetiapine.ObjectiveTo revisit the influence of changes in tobacco consumption in clozapine and quetiapine side effects.MethodsCase report.ResultsA 48-year-old male diagnosed of schizophrenia following DSM IV-TR criteria. He required five hospital admissions from 2008 to 2013 because of psychotic episodes. Since 2013, he was asymptomathic receiving clozapine, 600 mg/day, and quetiapine, 1200 mg/day. Recently, he came to the emergency service due to sudden extreme sedation, thinking impairment, sialorrhea, and walking disability. The patient denied treatment abuse and his family confirmed this statement. When asked about toxics he referred progressive tobacco reduction in the last 3 months (from 60 to 20 cigarettes/day). Bearing in mind the relationship between clozapine and quetiapine metabolism and tobacco, treatment was slowly reduced until the doses of clozapine 500 mg/day and quetiapine 400 mg/day. One week after admission, side effects disappeared, psychotic symptoms were not detected, and the patient was discharged.ConclusionsInquiring about changes in tobacco consumption may be useful when anti-psychotics side effects appear suddenly without an alternative explanation.Disclosure of interestThe authors have not supplied their declaration of competing interest.

The effect of policies regulating tobacco consumption on smoking initiation and cessation in Spain: is it equal across socioeconomic groups?

BackgroundIn Spain, the Law 28/2005, which came into effect on January 2006, was a turning point in smoking regulation and prevention, serving as a guarantee for the progress of future strategies in the direction marked by international organizations. It is expected that this regulatory policy should benefit relatively more to lower socioeconomic groups, thus contributing to a reduction in socioeconomic health inequalities. This research analyzes the effect of tobacco regulation in Spain, under Law 28/2005, on the initiation and cessation of tobacco consumption, and whether this effect has been unequal across distinct socioeconomic levels.MethodsMicro-data from the National Health Survey in its 2006 and 2011 editions are used (study numbers: 4382 and 5389 respectively; inventory of statistical operations (ISO) code: 54009), with a sample size of approximately 24,000 households divided into 2,000 census areas. This allows individuals’ tobacco consumption records to be reconstructed over five years before the initiation of each survey, as well as identifying those individuals that started or stopped smoking. The methodology is based on “time to event analysis”. Cox’s proportional hazard models are adapted to show the effects of a set of explanatory variables on the conditional probability of change in tobacco consumption: initiation as a daily smoker by young people or the cessation of daily smoking by adults.ResultsInitiation rates among young people went from 25% (95% confidence interval (CI), 23–27) to 19% (95% CI, 17–21) following the implementation of the Law, and the change in cessation rates among smokers was even greater, with rates increasing from 12% (95% CI, 11–13) to 20% (95% CI, 19–21). However, this effect has not been equal by socioeconomic groups as shown by relative risks. Before the regulation policy, social class was not a statistically significant factor in the initiation of daily smoking (p > 0.05); however, following the implementation of the Law, young people belonging to social classes IV-V and VI had a relative risk of starting smoking 63% (p = 0.03) and 82% (p = 0.02) higher than young people of higher social classes I-II. On the other hand, lower social class also means a lower probability of smoking cessation; however, the relative risk of cessation for a smoker belonging to a household of social class VI (compared to classes I-II) went from 24% (p < 0.001) lower before the Law to 33% (p < 0.001) lower following the law’s implementation.ConclusionLaw 28/2005 has been effective, as after its promulgation there has been a decrease in the rate of smoking initiation among young people and an increase in the rate of cessation among adult smokers. However, this effect has not been equal by socioeconomic groups, favoring relatively more to those individuals belonging to higher social classes.

Factors associated with self-assessed increase in tobacco consumption among over-indebted individuals in Germany: a cross-sectional study

BackgroundOver-indebtedness is an increasing phenomenon in industrialised nations causing individual hardship and societal problems. Nonetheless, few studies have explored smoking among over-indebted individuals.MethodsA cross-sectional survey (n=949) on retrospectively assessed changes in tobacco consumption was carried out in 2006 and 2007 among clients of 84 officially approved debt and insolvency counselling centres in Germany (response rate 39.7%). Logistic regressions were performed to explore factors associated with reports of increased smoking after onset of over-indebtedness.Results63% of all respondents stated daily or occasional tobacco consumption. Almost one fifth reported an increase in smoking after becoming over-indebted. Females were less likely to report increased smoking than men (aOR 0.66, 95% CI 0.44-0.99) whereas respondents who had been over-indebted for more than 10 years were more likely to report increased smoking than those who had been over-indebted for less than five years (aOR 1.66; 95%-CI 1.00-2.76). The odds of increased smoking were also elevated among those who reported that their families and friends had withdrawn from them as a consequence of their over-indebtedness (aOR 1.82; 95%-CI 1.06-3.14).ConclusionsThe study identifies over-indebted individuals and particularly over-indebted men as a high-risk group of smokers. Low levels of social embeddedness/support were associated with a further increase in smoking after becoming over-indebted. Given recent increases of over-indebtedness, the findings highlight the need to develop appropriate public health policies.

The social context of change in tobacco consumption following the introduction of ‘smokefree’ England legislation: A qualitative, longitudinal study

Legislation implemented in England on 1st July 2007 to prohibit smoking in enclosed public places aimed primarily to limit exposure to second-hand smoke, thereby reducing smoking-related morbidity and mortality. We conducted a qualitative study between April 2007 and December 2008 in six contrasting localities in two metropolitan areas in the north and south of England, which examined the impact of the legislation on individuals, families and communities. Using a multi-level longitudinal case study design, we collected data at community and individual levels, from three months prior to the legislation to a year after its enactment through a range of methods, including semi-structured interviews with panel informants and observations in locality settings. Drawing on theoretical understandings of the relationship between structure, agency and practice, this paper examines the social and cultural contexts of change in tobacco consumption. Observations in a variety of community settings identified reduced smoking in public places post-legislation. More than half of panel informants reported decreased consumption at one year post-legislation; a minority had quit, maintained or increased their smoking levels. The dominant pattern of reduced consumption was attributed primarily to constraints imposed by the legislation. This suggests that the law may have provided an impetus for some smokers to cut down or quit. Smoking behaviour was, however, strongly influenced by the social networks in which smokers were embedded, indicating that, while individuals had the power to act, any changes they made were largely shaped by social structural factors. Our findings support the need for a comprehensive tobacco control strategy that takes account of the complex array of contextual factors that constrain and enable smoking.

In a prospective study in young people, associations between changes in smoking behavior and risk factors for cardiovascular disease were complex

Objective This study investigates how voluntary changes in tobacco consumption are related to changes in biological risk factors for cardiovascular disease in 21- to 36-year-old men and women. Study Design and Setting Data of the Amsterdam Growth and Health Longitudinal Study (AGAHLS) were used to study the association between voluntary changes in tobacco consumption and changes in biological risk factors for cardiovascular disease (CVD) during 4–6 years of follow-up in 165 men and 195 women aged 21–36 years. We used multiple linear regression analyses with corrections for age and changes in other lifestyles. Results In both sexes, we found trends for a reduction in blood pressure, high-density lipoprotein cholesterol (HDL-C), body weight, and waist-to-hip ratio (WHR) and a rise in the ratio between total serum cholesterol (TC) and HDL-C (TC/HDL-C) with increasing tobacco consumption. Opposite trends were found with reducing tobacco consumption. In women, body weight, WHR, and waist circumference reduced significantly and independently with increasing tobacco consumption and increased significantly with decreasing tobacco consumption. Conclusion These results suggest that voluntary changes in tobacco consumption go together with both healthy and unhealthy changes in biological risk factors for CVD.

Patterns and distribution of tobacco consumption in India: cross sectional multilevel evidence from the 1998-9 national family health survey

Objective To investigate the demographic, socioeconomic, and geographical distribution of tobacco consumption in India.Design Multilevel cross sectional analysis of the 1998-9 Indian national family health survey of 301 984 individuals...

Episodic cluster headache. II: High tobacco and alcohol consumption in males.

Forty-nine out of 51 consecutive male patients with episodic cluster headache were studied with regard to their smoking and drinking habits in general and in relation to cluster headache periods. Questionnaires were constructed for data regarding tobacco intake. Situation-related smoking behavior was registered according to Frith (1971). Screening for alcohol over-consumption was made using the Malmö modification of the brief Michigan Alcoholism Screening Test (Mm-MAST). Eighty-three percent of the patients used tobacco on a regular basis at the time of the study, with an average consumption of 20 cigarettes per day. Only 3% had never used tobacco regularly. The smoking-related desire to smoke in different situations was consistent with what is found in a general population of smokers. Sixty-seven percent of the patients had scores on the Mm-MAST indicative of alcohol over-consumption (i.e. heavy social drinking or alcoholism). During active headache periods 79% decreased their alcohol intake, whereas no consistent change in tobacco consumption was reported for the group as a whole. These findings were further corroborated by the fact that alcohol, but not tobacco intake, was reported by the majority of patients to elicit headache attacks during periods. Thus, our study showed high alcohol and tobacco consumption to be prominent features in male patients with episodic cluster headache. Since neither alcohol nor tobacco appear to have properties of ameliorating headache periods or attacks, the addictive behavior in our patients more likely reflects certain personality characteristics.