Association of substance use with stress-related sleep disturbance among adolescents in 76 countries: a global...

Stress-related sleep disturbance has emerged as a significant public health concern among adolescents worldwide. The independent and combined effects of substance use on stress-related sleep disturbance remain inconclusive. We aimed to explore the association of the use of substances such as tobacco and alcohol with stress-related sleep disturbance among adolescents in 76 countries.

We collected data from the global school-based student health survey, which comprised 302 181 adolescents aged 12-17 years from 76 countries. The frequency of tobacco and alcohol use in the past 30 days was categorised as follows: zero, one to two, three to nine, 10-29, and 30 days. Tobacco and alcohol use were classified into four categories: non-use, tobacco use alone, alcohol use alone, and combined use. We used multivariate logistic regression analyses to examine the independent and combined associations of tobacco and alcohol use with stress-related sleep disturbance.

As the frequency of tobacco use and alcohol use increases, the proportion of stress-related sleep disturbance among adolescents shows an upward trend (for tobacco use 8.3-27.4%, for alcohol use 6.7-28.9%). Compared to non-drinkers, the odds of having stress-related sleep disturbance increased with frequency of drinking from one to two days to 30 days (from odds ratio (OR) = 1.53; 95% confidence interval (CI) = 1.31-1.78 to OR = 3.13; 95% CI = 1.99-4.90), as well as with the frequency of tobacco use (from OR = 1.11; 95% CI = 0.88-1.39 to OR = 1.98; 95% CI = 1.39-2.81) during the past 30 days.

We found both tobacco and alcohol use, as well as their combination, were associated with stress-related sleep disturbance. These findings emphasise the need to strengthen the prevention and control of tobacco and alcohol use among adolescents in order to reduce stress-related sleep disturbance and improve sleep quality.