Sleep disturbances among young adult dual users of cigarettes and e-cigarettes: Analysis of the 2020 National Health Interview Survey

Abstract

Background: The increasing use of conventional cigarettes and e-cigarettes among young adults (18-35 years) in the US raises significant health concerns, including impacts on sleep. While smoking's adverse health effects are well-documented, the combined effects of conventional cigarette and e-cigarette use on sleep remain under explored, particularly in young adults. This study investigates the association between dual cigarette and e-cigarette use and sleep outcomes in a nationally representative US sample.

Methods: We utilized self-reported data from the 2020 National Health Interview Survey (NHIS) on young adults (N = 6128, Unweighted). Descriptive statistics and chi-squared tests and t-tests, where appropriate, compared socio-demographic, clinical, behavioral, and sleep-related characteristics by conventional cigarette/e-cigarette use status. Multinomial logistic regression estimated the odds of reporting short (<7 hours) or long sleep ( ≥ 9 hours) compared to normal sleep (7-8 hours) across different smoking categories.

Result: Of the total sample, 51.0% were females, mean age: 26.6 years (SD = 4.8). Cigarette smokers were the oldest (mean age 29.2 years), while e-cigarette users were the youngest (mean age 24.7 years) (p < .0001). Poor or long sleep was reported by 72.8% of cigarette smokers, 69.4% of e-cigarette users, and 71.9% of dual users (p < 0.001). Trouble falling asleep daily, or most days was reported by 49.9% of cigarette smokers, 63.6% of e-cigarette users, and 58.5% of dual users (p < 0.001). Difficulty staying asleep daily for most days was reported by 38.0% of cigarette smokers, 45.0% of e-cigarette users, and 44.6% of dual users (p < 0.0001). Furthermore, 13.7% of cigarette smokers, 5.9% of e-cigarette users, and 12.3% of dual users reported never waking up well-rested (p < 0.001). Multinomial logistic regression revealed that cigarette-only users (aOR:1.40, 95%CI:1.06-1.85), e-cigarette users (aOR:1.32, 95%CI:1.06-1.66), and dual users (aOR:1.81, 95%CI:1.46-2.24) had 40%, 32%, and 81% higher odds, respectively, of having poor sleep compared to non-users.

Conclusion: Cigarette and e-cigarette use is associated with poor sleep patterns and quality, with dual users having the greatest odds of having poor sleep outcomes among young adults.

Fig 1. Weighted proportions of sleep duration by cigarette/e-cigarette use status among U.S. young adults (18-35-years-old), 2020 NHIS (N = 6,128).