# Association between smoking behavior and sleep health among South Korean adolescents: A cross-sectional study 2020–2023

## TL;DR

This study finds that smoking multiple tobacco products is linked to worse sleep in South Korean teens.

## Contribution

The study identifies a graded association between poly tobacco use and poor sleep health in adolescents.

## Key findings

- 40.3% of tobacco users reported insufficient sleep with poor satisfaction.
- Triple tobacco users had 2.32 times higher odds of poor sleep outcomes.
- Poly tobacco use shows a graded pattern with worsening sleep health.

## Abstract

Tobacco use has been associated with poor sleep quality among adolescents. Given the rising prevalence of poly tobacco use among South Korean adolescents, it is crucial to examine its cumulative impact on sleep health. This study aims to assess the association between various smoking behaviors and sleep health outcomes in this population.

This cross-sectional pooled secondary data analysis utilized data from the 2020–2023 Korea Youth Risk Behavior Web-based Survey (KYRBS), comprising 172457 middle and high school students (aged 12–18 years). Information was collected via a self-administered web-based questionnaire. Multinomial logistic regression models were employed to evaluate the relationship between smoking behaviors with sleep health, adjusting for potential confounders.

Overall, 40.3% of tobacco users and 25.3% of non-users reported insufficient sleep accompanied by poor satisfaction. Adolescents engaged in triple use (concurrent use of conventional cigarettes, e-cigarettes, and heated tobacco products) demonstrated the highest odds of insufficient and poor sleep (adjusted odds ratio, AOR=2.32; 95% confidence interval CI: 2.01–2.67). A graded pattern was observed whereby increased poly tobacco use corresponded to poorer sleep outcomes.

Poly tobacco use is significantly associated with poor sleep health among South Korean adolescents. Future longitudinal studies are needed to establish causal pathways and provide sufficient evidence to guide effective interventions and policies.