Cigarette use, anxiety, and insomnia from adolescence to early adulthood: A longitudinal indirect effects test

Abstract

Background: Cigarette use during adolescence has been linked to increased risk for insomnia symptoms, but limited work has examined factors that may account for this association. Adolescent cigarette use and anxiety symptoms characterized by physiological hyperarousal evidence bidirectional associations, as do anxiety symptoms and insomnia symptoms. This suggests that adolescent cigarette use, anxiety symptoms characterized by physiological hyperarousal, and insomnia symptoms may increase and maintain one another. The current study tests physiological hyperarousal anxiety symptoms as a potential indirect effect in the cigarette-insomnia symptoms link across adolescence and young adulthood.

Methods: We examined data from adolescents and young adults from Waves 1, 2, 3 and 4 of the National Longitudinal Study of Adolescent to Adult Health (N = 2,432 with full data). Insomnia symptoms were assessed at baseline (ages 12-16 years), 1 year later (13-17 years), and 14 years after baseline (26 - 30 years) among a nationally representative sample of adolescents. Cigarette use was assessed at baseline, 1 year later, 6 years after baseline, and 14 years after baseline. Anxiety symptoms were assessed at baseline and 1 year later.

Results: Structural equation models indicated that anxiety symptoms exerted an indirect effect on the longitudinal associations between adolescent cigarette use and adult insomnia symptoms. Anxiety symptoms and cigarette use evidenced bidirectional associations during adolescence.

Conclusions: These results suggest that increases in anxiety symptoms characterized by physiological hyperarousal may be one mechanism whereby cigarette use during adolescence is associated with increased insomnia symptoms during early adulthood. Prevention efforts aimed at reducing cigarette use during adolescence may have long term additional benefits for anxiety symptoms and insomnia symptoms.

Keywords: Adolescent; Anxiety; Bidirectional; Cigarette; Insomnia.

Figure 1

Anxiety exerts an Indirect Effect on the Longitudinal Associations between Cigarette Use and Insomnia Note. This figure depicts cross-lagged and autoregressive paths between study variables. Only cross-lagged and autoregressive paths are depicted in the figure, but in actual model, as depicted in Table 4, covariance paths were estimated, and covariates were included. Significant paths are depicted with solid lines, while dotted lines represent insignificant associations. * p <.05, ** p <.01, *** p <.001

Figure 2

Available Data at Each Wave of the Publicly Available Add Health Data Set for Adolescents between 12 and 16 Years Old at Wave 1 Note. In total, 2,432 participants had data for each variable, at every wave. Each participant who participated in Wave 1 of the Add health study was invited to participate in each follow up wave, even if they had not participated in the previous wave (e.g., they could participate in Wave 1, Wave 3, and Wave 4, even if they missed Wave 2).