Frequency of cigarette and/or e-cigarette use and its associations with sleep health among Canadian adolescents
Hopkins, D. Brett
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Though the prevalence of cigarette use among Canadian adolescents has declined in recent decades, the prevalence of e-cigarette use is high and increasing. Both cigarettes and e-cigarettes usually contain nicotine, and this may impact adolescent sleep health. In Canada, 1 in 3 adolescents is not getting enough sleep. Both cigarette and e-cigarette use have been previously investigated with respect to sleep health, but previous studies have not considered both frequency of use and dual use of cigarettes and e-cigarettes. The primary objectives of this study were to determine the associations between frequency of cigarette and/or e-cigarette use and: (1) Self-reported sleep duration; (2) Fulfilment of the national recommended sleep duration (8-10 hours per night); (3) Intensity of sleep-related problems (e.g., falling asleep during class). A fourth objective was to determine whether the associations between frequency of cigarette and/or e- cigarette use and sleep duration, fulfilment of the sleep recommendation, and sleep- related problems differ by sex. This study was a secondary analysis of the 2018-19 Canadian Student Tobacco, Alcohol, and Drugs Survey (CSTADS), a cross-sectional survey that collects data on substance use behaviours and other national health priorities. The 2018-19 iteration included 62,850 students in grades 7-12 in all ten Canadian provinces, though only students grades 9-12 were included in this analytic sample (N = 38,229). Respondents were grouped by frequency and dual use of cigarettes and/or e-cigarettes in the past 30 days and this was used as the exposure variable. The association between the exposure and sleep duration was analyzed using multiple linear regression, the exposure and the fulfilment of the national sleep duration using multiple logistic regression, and the exposure and sleep- related problems using multiple linear regression of three separate dimensions of sleep- related problems: tiredness/fatigue, late sleeping, and falling asleep during class. An interaction of the exposure and sex was used to determine sex-specific interaction effects in each of the analyses. All analyses controlled for sex, alcohol use, cannabis use, illicit drug use to get high, prescription drug use to get high, and median household income. This study contributes four major findings to the literature: (1) High-frequency e- cigarette only, low-frequency cigarette only, and high-frequency dual users report fewer minutes of sleep per night on average than non-users; (2) High frequency e- cigarette only and e-cigarette dual using adolescents are the least likely group of cigarette and/or e-cigarette users to meet the national sleep duration recommendation of 8-10 hours per night compared to non-users; (3) Frequency of cigarette and/or e-cigarette use is associated with more reports of tiredness/fatigue among adolescents, but fewer reports of late sleeping and falling asleep during class; (4) The association between frequency of cigarette and/or e-cigarette use and sleep duration, meeting the national sleep duration recommendation, and sleep-related problems among adolescents is not modified by sex. These findings highlight the importance of addressing two public health concerns: adolescent cigarette and/or e-cigarette use and sleep health. The evidence from this study can be used to address both concerns in an effort to improve adolescent health.