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Associations of Insufficient Sleep with Substance Use among U.S. Youth: Mediational Processes of Depressive Symptoms

Aaron Kim and Megan Mannell

While sleep problems and substance use are prevalent among U.S. youth and appear interrelated, relatively little research has explored the possible mediational process to explain associations between insufficient sleep and substance use. This study explored associations of insufficient sleep with the use of nicotine products, alcohol, and marijuana and whether depressive symptoms would mediate the relations. A cross-sectional analysis of binary logistic regression models for each substance use outcome (yes/no) was conducted using the 2019 Youth Risk Behavior Survey, including a nationally representative sample of U.S. high school students. Among the analytic sample (N=13,677), 77.9% of youth reported insufficient sleep (7 or fewer hours), which was significantly associated with increased odds of past 30 day use of cigarettes (OR=1.33; 95% CI=1.05, 1.63; p=.007), e-cigarettes (OR=1.73; 95% CI=1.56, 1.92; p<.001), alcohol (OR=1.79; 95% CI=1.60, 1.99; p<.001), and marijuana (OR=1.50; 95% CI=1.33, 1.68; p<.001) by 33% to 79%. In subsequent mediation tests, we adjusted for insufficient sleep and depressive symptoms simultaneously, and depressive symptoms were significantly associated with the odds of each substance use outcome after controlling for the effects of insufficient sleep. The results indicated that the main effects of insufficient sleep on substance use were significantly explained (i.e., mediated) by depressive symptoms. This study highlights the potential for depressive symptoms to explain the connection between youth insufficient sleep and substance use. Findings from this study may provide insight into the risk of insufficient sleep for mental health and substance use problems, which can facilitate targeted interventions and psycho education for professionals who work with adolescents.