The association between combustible tobacco use, panic attacks, and insomnia symptoms among adolescents

Previous research suggests that individuals who experience panic attacks are more likely to engage in combustible tobacco use and report higher levels of insomnia symptoms. However, no studies to date have examined this association among adolescents. Additionally, no work has examined if adolescent panic attacks may be indirectly associated with insomnia through nicotine dependence among adolescents who use combustible tobacco and experience panic attacks. The current study aims to address these gaps in the literature by examining the following among adolescents: (1) the level of insomnia symptoms with varying combustible tobacco use and panic attack reports; (2) if nicotine dependence partially accounts for the relations between panic attacks and insomnia symptoms among adolescent combustible tobacco users; and (3) and an exploratory post hoc analysis examined if panic attacks partially account for the relations between nicotine dependence and insomnia symptoms among adolescent combustible tobacco users. A total of 10,148 adolescents aged (M_age = 15.18, SD = 1.51; 51.07% female) within the unweighted sample of the National Comorbidity Survey-Adolescent Supplement (NCS-A) were included in analyses. Adolescents who reported combustible tobacco use and panic attacks indicated higher levels of insomnia symptoms than adolescents who do not smoke or experience panic attacks. Also, adolescent panic attacks were indirectly associated with insomnia symptoms through nicotine dependence among adolescent combustible tobacco users, while nicotine dependence was indirectly associated with insomnia symptoms via panic attacks. These findings are the first step towards understanding the complex association between combustible tobacco use, panic attacks, and insomnia symptoms among adolescents.