S2441 Psychosocial Determinants of Concurrent Alcohol Use and Active Smoking in Adults With HCV in the Last Decade: An Analysis of NHANES

Introduction: Co-occurring alcohol consumption and cigarette smoking accelerate liver injury and hepatocarcinogenesis among persons with hepatitis C virus (HCV). Contemporary estimates of the combined prevalence and determinants of concurrent alcohol use and active smoking are needed to inform prevention strategies. Methods: Pooled National Health and Nutrition Examination Survey (NHANES) data from 2007–2018 were analyzed of adults ≥20 years with serologic evidence of HCV (weighted n = 3,312,914). Participants were categorized as having (1) concurrent alcohol use and active smoking, (2) either behavior alone, or (3) neither behavior (reference). Survey-weighted multinomial logistic regression generated adjusted odds ratios (aORs), 95% confidence intervals (CIs) for associations between demographic/clinical variables and behavior category. Results: Concurrent alcohol use and active smoking was observed in 39.5% (95% CI 32.3–47.0) of HCV-infected U.S. adults, representing 1,308,364 individuals; whereas, 44.4% reported only 1 behavior. Lifetime substance use (aOR = 5.98, 95% CI 5.87–6.10), current marijuana use (aOR = 2.88, 2.84–2.92), depression (aOR = 2.59, 2.55–2.63), and a history of cancer (aOR = 1.50, 1.45–1.54) increased the likelihood of active smoking. Older age (per-year aOR = 0.97, 0.97–0.98), non-Hispanic Black ethnicity (aOR = 0.78, 0.76–0.79), health-insurance coverage (aOR = 0.18, 0.18–0.19), middle or high income (aOR = 0.34, 0.34–0.34), and obesity (aOR = 0.25, 0.25–0.26) were protective. Conclusion: Nearly 2 in 5 U.S. adults with HCV simultaneously drink alcohol and smoke, driven chiefly by broader substance-use patterns and depressive symptoms, whereas socioeconomic stability and health-care access mitigate this dual exposure. Embedding addiction and mental-health services within HCV management pathways may curb these behaviors and, in turn, reduce preventable progression to cirrhosis and hepatocellular carcinoma.