Smoking, getting drunk, and engaging in bulimic behaviors: In which order are the behaviors adopted?

Objective: To assess the relation between beginning to binge-eat or purge, beginning to smoke, and getting drunk for the first time. Method: Prospective study of 11,358 girls and boys, 10 to 15 years of age, in an ongoing cohort study who completed questionnaires in 1997 and 1998. The outcome measures were beginning to engage in bulimic behaviors, beginning to smoke, and getting drunk for the first time between 1997 and 1998. Results: During 1 year, 4.3% of girls and 3.6% of boys started smoking, 5.3% of girls and 4.8% of boys started getting drunk, and 2.4% of girls and 0.6% of boys started engaging in bulimic behaviors. Among the girls, weight concerns in 1997 were predictive of beginning to smoke (odds ratio [OR] = 2.2), get drunk (OR = 1.7), purge (OR = 3.8), and binge-eat (OR = 2.6). Adolescents who reported smoking in 1997 were more likely than nonsmokers to get drunk for the first time (girls: OR = 5.7: boys: OR = 7.1). The reverse association, getting drunk as a predictor of starting to smoke, was of lesser magnitude (OR = 2.3-2.6). Conclusions: The three unhealthy behaviors were associated prospectively with each other. The results suggest that prevention efforts should target weight concerns and multiple risk behaviors.