title: The association between active smoking, smokeless tobacco, second-hand smoke exposure and insufficient sleep.
abstract: BACKGROUND
  Studies have shown that cigarette smoking is associated with sleep disorders in the general population. But studies examining the association between smokeless tobacco use, second-hand smoke exposure and insufficient rest/sleep are limited.
  
  
  METHODS
  We examined the association between smoking, smokeless tobacco use (n=83,072), second-hand smoke exposure (n=28,557) and insufficient rest/sleep among adults aged ≥20 years in the state-based 2008 Behavioral Risk Factor Surveillance System. Exposure to second-hand smoke was defined as >1 day of exposure to cigarette smoking either at home or in the workplace in the preceding 7 days. Insufficient rest/sleep was defined as not getting enough rest/sleep everyday in the preceding 30 days.
  
  
  RESULTS
  Compared to never smokeless tobacco users, the odds ratio (OR; 95% confidence interval [CI]) of insufficient rest/sleep was 1.16 (1.00-1.36) and 1.74 (1.37-2.22) among former and current users. Compared to non-smokers/non-smokeless tobacco users, the OR (95% CI) of insufficient rest/sleep for those who were both current smokers and current smokeless tobacco users was 2.21 (1.66-2.94). Regarding second-hand smoke exposure among non-smokers, those with second-hand smoke exposure had higher odds for insufficient rest/sleep than those without. In contrast, the odds of insufficient rest/sleep were similar among current smokers with or without second-hand smoke exposure.
  
  
  CONCLUSIONS
  In a multiethnic sample of US adults, compared to non-smokers/non-smokeless tobacco users, those who were both current smokers and current smokeless tobacco users had twice the odds of insufficient sleep. Second-hand smoke exposure was associated with insufficient rest/sleep among non-smokers.
authors.affiliation: Department of Community Medicine, West Virginia University School of Medicine, Morgantown, WV 26506, USA.
authors.forename: Charumathi
authors.initials: C
authors.lastname: Sabanayagam
authors.forename: Anoop
authors.initials: A
authors.lastname: Shankar
mesh_terms: D000328:Adult; D016001:Confidence Intervals; D005260:Female; D006306:Health Surveys; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D012307:Risk Factors; D012893:Sleep Wake Disorders / Q000453:epidemiology / Q000209:etiology*; D012907:Smoking / Q000009:adverse effects* / Q000453:epidemiology; D014028:Tobacco Smoke Pollution / Q000009:adverse effects* / Q000706:statistics & numerical data; D014030:Tobacco, Smokeless / Q000009:adverse effects*; D014481:United States / Q000453:epidemiology
chemical_list: D014028:Tobacco Smoke Pollution