Abstract
ObjectivesThe purpose of this study was to identify the impact of chronic, unhealthy sleep practices in adolescence on substance use in young adulthood. Unhealthy sleep practices in adolescent samples exhibit a bidirectional relationship with substance use. The relationship is further complicated if we consider that confounders such as depression vary over time and are often in response to adolescents’ prior poor sleep practice, which can be addressed by a counterfactual approach using a marginal structural model.MethodsData in this study are from the Taiwan Youth Project, a longitudinal study that started in 2000 and surveyed 2,690 7th grade students at age 13. Outcomes include frequency of cigarette smoking and alcohol drinking at age 21. Three unhealthy sleep practices were included in this study: short sleep, social jetlag, and sleep disturbance. We used a marginal structural model with stabilized inverse probability-of-treatment weights to address time-varying confounders in each wave and a total sample of 1,678 adolescents with complete information for this study.ResultsAccumulated waves of sleep disturbance and social jetlag in adolescence were significantly associated with cigarette use in young adulthood. Accumulated social jetlag but not sleep disturbance was also associated with alcohol use in adulthood. Accumulated waves of short sleep were not associated with later alcohol use, but were negatively correlated with cigarette use.ConclusionInterventions that aim to reduce the likelihood of substance use in young adulthood should consider confronting unhealthy sleep practices, in particular the discrepancy between bedtimes on school days and weekends and sleep disturbance.
Highlights
Unhealthy sleep practices, such as sleep insufficiency and social jetlag, are common problems in adolescents related to adverse consequences such as depression, mood disturbances, obesity, and risk-taking behaviors by causing poor judgment and decision-making skills, lack of motivation, and inattention (Owens and Group, 2014; Shochat et al, 2014; Diaz-Morales and Escribano, 2015)
At wave 1, sleep disturbance was significantly correlated with social jetlag and short duration of sleep; short duration of sleep was not correlated with social jetlag
We found that the larger social jetlag was, the higher the frequency of cigarette smoking and alcohol use (Table 5)
Summary
Unhealthy sleep practices, such as sleep insufficiency and social jetlag, are common problems in adolescents related to adverse consequences such as depression, mood disturbances, obesity, and risk-taking behaviors by causing poor judgment and decision-making skills, lack of motivation, and inattention (Owens and Group, 2014; Shochat et al, 2014; Diaz-Morales and Escribano, 2015). Factors that contribute to poor sleep practices in adolescents include but are not limited to increasing media screen time (Twenge et al, 2017), mental health (Lund et al, 2010), and school start time (Gradisar et al, 2011). Social jetlag refers to the differences in the timing of sleep that has been interfered with by social schedules, such as the discrepancy between school and free days (Diaz-Morales and Escribano, 2015). The negative impact of poor sleep practices among adolescents is receiving more global attention due to the alarmingly low average sleep time (i.e., less than 8 h) and poor sleep quality (Mesquita and Reimao, 2010; Gradisar et al, 2011; Chen and Gau, 2016; Zhang et al, 2017; Lima and Silva, 2018), especially in Asian samples (Yang et al, 2005; Chung and Cheung, 2008; Liu et al, 2008; Xu et al, 2012)
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