Prevalence and correlates of co-use of alcohol and cigarettes among Chinese adolescents: a cross-sectional national survey in 2021.

Objective: Alcohol and cigarette use are prevalent among Chinese adolescents. This study examines the prevalence and correlates of co-use. Methods: Data were drawn from the 2021 China Adolescent Alcohol Use Survey targeting middle and high school students, conducted in seven provinces from China's seven geographic regions. We examined the past-month prevalence of alcohol and cigarettes co-use across sociodemographic and behavioral subgroups. Multivariable logistic regression was used to identify factors associated with co-use. Results: Past-month co-use prevalence was 1.7% (95% CI: 1.4%, 2.1%), and varied by peer substance use, with higher rates among those whose close friends smoked or drank. Co-use rates were higher among adolescents whose parents held favourable attitudes toward drinking (either parent: 4.0%, 95% CI: 3.1%, 4.9%; both parents: 3.7%, 95% CI: 2.9%, 4.5%) than among those whose parents did not (0.9%, 95% CI: 0.7%, 1.1%). Past-month e-cigarette users had a significantly higher co-use rate than non-users. Peer substance use, e-cigarette use, and parental attitudes were significantly associated with co-use. Conclusions: Although the prevalence of co-use among Chinese adolescents is low, the absolute number of affected youth is substantial given China's population size. Prevention should target peer influence and e-cigarette use.