# Association of substance use with stress-related sleep disturbance among adolescents in 76 countries: a global population-based study

## TL;DR

This study shows that substance use like tobacco and alcohol is linked to more stress-related sleep problems in teens across 76 countries.

## Contribution

The study provides global evidence on the independent and combined effects of tobacco and alcohol use on stress-related sleep disturbance in adolescents.

## Key findings

- Higher frequency of tobacco and alcohol use correlates with increased stress-related sleep disturbance in adolescents.
- Combined use of tobacco and alcohol is associated with higher odds of stress-related sleep disturbance compared to non-use.
- The odds of sleep disturbance rise significantly with increased frequency of alcohol use.

## Abstract

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.