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Substance Use, Sleep Duration, and Health Among Adults in Ohio

Estefania Hernandez, MA1; Stephanie Griggs, PhD, RN1 (View author affiliations)

Suggested citation for this article: Hernandez E, Griggs S. Substance Use, Sleep Duration, and Health Among Adults in Ohio. Prev Chronic Dis 2024;20:230198. DOI: http://dx.doi.org/10.5888/pcd20.230198.

PEER REVIEWED

Summary

What is already known on this topic?

The relationship between substance use and disturbed sleep is complex and bidirectional. People who misuse substances often report unhealthy sleep-related behaviors.

What is added by this report?

We characterized the associations between short sleep duration and the use of 2 types of substances (marijuana and nonprescribed prescription pain medication) among adults living in Ohio.

What are the implications for public health practice?

Short sleep duration is often underassessed and underdiagnosed. A need exists to increase global interest and awareness in understanding how sleep duration can affect substance use behaviors and recovery and vice versa.

Abstract

Introduction

Substance use affects approximately 46.3 million people aged 12 years or older (16.5% of the US population) and is associated with poor sleep health overall.

Methods

We conducted a cross-sectional secondary analysis of data from the 2020 Behavioral Risk Factor Surveillance System survey in Ohio. The sample comprised 14,676 adults. We examined associations between the use of 2 types of substances (marijuana and nonprescribed prescription pain medication) and short sleep duration (<6 hours per night) and overall health (mental, physical, and general). We used linear and logistic regression modeling while adjusting for individual-level (age, sex, race and ethnicity, education, income, and body mass index) and area-level (socioeconomic deprivation) covariates.

Results

Of survey respondents who answered questions, 9.2% (1,140 of 12,362) reported using marijuana, and 1.4% (111 of 8,203) used nonprescribed prescription pain medication. Respondents who used marijuana used it an average 17.3 days per month. In adjusted logistic regression models, the odds of reporting short sleep duration were 2.4 times greater among respondents who used nonprescribed prescription pain medication (vs those who did not). The odds of reporting short sleep duration, poor mental health, poor physical health, and poor general health were 1.5, 1.3, 2.1, and 1.9 times greater, respectively, among respondents who reported marijuana use (vs those who did not). In the linear regression models (adjusted), more days of marijuana use were associated with longer sleep duration, worse mental health, and worse general health.

Conclusion

Understanding the connection between substance use and health outcomes is needed to improve trajectories of substance use and recovery. Sleep duration is often underassessed among people who use substances. Expanding diagnostics and treatment options for those who use substances may result in lower levels of substance use and improved overall health.

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Introduction

Substance misuse affects approximately 46.3 million people aged 12 years or older in the US (16.5% of the population) and is associated with poor sleep health overall (satisfaction, alertness, timing, efficiency, and duration) (1,2). More than one-third of adults do not achieve the 7 to 9 hours of sleep recommended by the National Sleep Foundation and report high rates of irritability, headaches, slow reaction time, hormonal changes, daytime sleepiness (hypersomnia), and poor overall health (3–5). To increase overall sleep duration and quality and next day alertness and sustain next-day medical, financial, and social responsibilities (eg, employment, friendships, family), people may self-medicate with alcohol, cannabis, and prescription and nonprescription pain medications (6,7).

The most common misused substances are cannabis (marijuana) (17.5% or 48.2 million people), followed by prescription pain relievers (3.5% or 9.7 million people), and prescription benzodiazepines (1.8% or 4.8 million people) among people aged 12 or older in the US (8). Among those who reported current alcohol use, 47% (65.8 million people) reported past-month binge drinking (8). Although substance use has increased over the years, the percentage of people diagnosed with a substance use disorder (ie, alcohol, cannabis, and prescription pain relievers) has remained stable from 2015 through 2019 (8).

Short sleep duration and substance use have a negative effect on emotional and mood regulation; therefore, a person’s mental health status is at risk (9–11). Mental health symptoms or conditions have a reciprocal relationship with sleep duration. For example, worse mental health symptoms are associated with shorter sleep duration and drug misuse, while sleep problems and drug use can further exacerbate mental health symptoms and affect recovery outcomes (12). However, the adverse consequences of short sleep duration due to substance use are not routinely assessed in clinical practice. Detoxification programs and mental health interventions should incorporate an assessment of sleep duration as a core function in primary care models.

The objective of this study was to quantify substance use (use of marijuana and nonprescribed prescription pain medication) and examine the associations among substance use, sleep duration, and health (mental, physical, and general) among a sample of adults residing in Ohio, while adjusting for individual (age, sex, race and ethnicity, education, income, and body mass index [BMI]) and area-level (socioeconomic deprivation) covariates. We used a conceptual model of sleep health to guide this study (13). We hypothesized that higher levels of marijuana and nonprescribed prescription pain medication use would be associated with short sleep duration, and poor physical, mental, and general health.

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Methods

We conducted a cross-sectional secondary analysis of data from the 2020 Behavioral Risk Factor Surveillance System (BRFSS). BRFSS is a system of health-related telephone surveys that collect data from civilian, noninstitutionalized US residents on their health-related risk behaviors, chronic health conditions, and use of preventive services (14). BRFSS collects data in all 50 states as well as the District of Columbia and 3 US territories. In addition, states have the option to add health questions as they pertain to the state; these questions help inform local programs and advocacy groups on the current scope of their interested issue or need. The state-added questions asked about prescription pain medication that had not been prescribed. The questions about marijuana use were asked as part of the core module.

The Ohio BRFSS is conducted by the Ohio Department of Health with support from the Centers for Disease Control and Prevention (CDC). Data are available to state and local decision makers, legislators, researchers, students, and the general public. Data are collected from a random probability sample representative of the 14 geographic regions in Ohio; our analytic sample consisted of 14,676 adults. The institutional review board at Case Western Reserve University reviewed and approved the study (IRB no. 20221217).

Variables and measures

We selected all covariates a priori on the basis of the scientific literature: age (years), sex at birth (male or female), race and ethnicity (Hispanic, non-Hispanic American Indian or Alaskan Native, non-Hispanic Asian, non-Hispanic Black, Non-Hispanic White, and non-Hispanic Other race), education (less than high school diploma, high school diploma, some college or technical school, college or technical school graduate), BMI, and social deprivation. The 6 domains of the composite Social Deprivation Index (SDI) are 1) income (percentage of the population living in poverty), 2) education (percentage with <12 years of education), 3) housing (percentage living in rented housing unit and percentage living in overcrowded housing unit), 4) household characteristics (percentage of single-parent households with dependents aged <18 y), 5) transportation (percentage of households without a car), and 6) employment (percentage of unemployed adults aged <65) (15). SDI data help shed light on various social determinants of health and are used to visualize and quantify socioeconomic differences in health outcomes by location. We used zip code tabulation areas (ZCTAs) based on generalized US Postal Service zip codes to calculate the SDI (15). The SDI is based on data from 5-year estimates from 2015–2019 (15). The BRFSS also asks about annual household income from all sources; we categorized these data into 7 categories of income, ranging from less than $15,000 to more than $75,000.

The independent variables of interest were 2 commonly used substances: marijuana and prescription pain medication not prescribed. The dependent variables of interest were self-reported sleep duration and health (physical, mental, and general).

Sleep duration. Self-reported sleep duration was a single-item BRFSS measure. Respondents were asked, “On average, how many hours of sleep do you get in a 24-hour period?” Responses ranged from 1 to 24 hours.

Physical health. Data on physical health were derived from the number of days the respondent reported that physical health was not good in the previous 30 days. Respondents selected 1 of the following response options: 0 days, 1 to 13 days, more than 14 to 30 days, or don’t know.

Mental health. Mental health status was self-rated in the BRFSS on the same 3 levels as physical health: 0 days, 1 to 13 days, or 14 to 30 days when mental health was not good. Other factors related to difficulty concentrating because of physical, mental, or emotional conditions were included by asking, “Do you have serious difficulty concentrating, remembering, or making decisions?” Respondents answered yes or no. Data on poor physical or mental health were derived by asking how many days in the past 30 days poor physical or mental health prevented the respondent from doing their usual activities, such as self-care, work, or recreation.

General health. Data on general health were derived from the BRFSS question that asked, “Would you say that in general your health is excellent, very good, good, fair, poor, or don’t know?” Respondents who reported having excellent, very good, or good health were allocated to the good or better health category. Respondents who reported having fair or poor health were allocated to the fair or poor health category.

Substance use. Frequency of marijuana use, method of use and purchase, and reason for use were addressed with questions such as, “During the past 30 days, on how many days did you use marijuana or hashish?” “During the past 30 days, which one of the following ways did you use marijuana the most often? Did you usually smoke it, eat it, drink it, vaporize it, dab it, use it some other way, or don’t know? When you used marijuana or cannabis during the past 30 days, was it usually for medical reasons, nonmedical reasons, for both medical and nonmedical reasons, or don’t know/not sure.” The survey did not ask about the use of electronic vaping products for marijuana use. Prescription pain medication was assessed with the question, “In the past year did you use prescription pain medication that was not prescribed to you?” Response options were yes or no.

Statistical analysis

We used a quantitative descriptive approach to characterize substance use (prescription pain medication and marijuana use), sleep duration, and health (mental, physical, and general) among the study population. We used bivariate correlations, multivariable logistic regression models, and multivariable linear regression models to examine the relationships among substance use, sleep duration, and mental, physical, and general health.

To assess exposure in the logistic regression models, we dichotomized substance use into 2 groups (yes and no) for each substance (prescription pain medication and marijuana). We defined marijuana use as yes (1–30 days) or no (0 days). We defined short sleep duration as 6 hours or less (based on the National Sleep Foundation recommendations) and poor mental and physical health as 14 days or more of poor mental and physical health in the past 30 days (16–18). For the logistic regression models, we used the single item about prescription pain medication use (yes or no). For poor general health, we collapsed fair and poor into poor and compared this category with excellent, good, and very good. We calculated unadjusted and adjusted odds ratios (ORs) and adjusted for the following covariates: age, sex, race and ethnicity, education, income, BMI, and socioeconomic deprivation.

For linear regression, we used the single item about marijuana use: “During the past 30 days, on how many days did you use marijuana or hashish?” To evaluate explanatory contributions of substance use (marijuana) to sleep duration and health (mental, physical, and general), we performed a series of multivariable linear regression models. The linear regression models were run unadjusted (model 1) and adjusted with covariates (model 2): age, sex, race and ethnicity, education, income, BMI, and socioeconomic deprivation. Significance was set at P < .05.

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Results

The study population of 14,676 adults aged 18 to 99 (mean [SD], 53.6 [19.3]) years resided across 1,101 ZCTAs (Table 1). About half (54.3%) identified as female at birth, and most (85.0%) identified as non-Hispanic White, followed by 6.7% non-Hispanic Black, 2.2% non-Hispanic Asian, 2.1% other race, 1.9% non-Hispanic multiracial, and 2.1% Hispanic. The mean (SD) BMI was 28.9 (7.2). The mean (SD) number of poor mental health and physical health days were 4.5 (8.7) days and 12.4 (11.3) days, respectively.

Of the respondents who answered the questions, 1,140 (9.2%) reported using marijuana, and 111 (1.4%) used prescription pain medication not prescribed. People who reported use of nonprescribed prescription pain medication had 2.8 times and 2.4 times higher odds of short sleep duration (OR = 2.78; 95% CI, 1.80–4.30; adjusted OR [AOR] = 2.37; 95% CI, 1.50–3.76) in the unadjusted and adjusted models, respectively (Table 2), than people who did not report use of nonprescribed prescription pain medication. People who reported use of nonprescribed prescription pain medication had 1.7 times higher odds of poor general health in the unadjusted model than who did not report such use; however, the association was no longer significant after adjusting for covariates (age, sex, race and ethnicity, education, income, BMI, and socioeconomic deprivation). The associations between prescription pain medication use and mental or physical health were not significant.

People reporting use of marijuana had 1.7 times and 1.5 times higher odds of short sleep duration (OR = 1.70; 95% CI, 1.46–1.97; AOR = 1.46; 95% CI, 1.24–1.73), 1.6 and 1.3 times higher odds of poor mental health, 1.7 and 2.1 times higher odds of poor physical health, and 1.5 and 1.9 times higher odds of poor general health in the unadjusted and adjusted models than people not reporting use of marijuana, respectively (Table 2).

In the linear regression models, higher rates of marijuana use were associated with longer sleep duration (unadjusted, β = 0.93, P = .001, R2 = .009; adjusted, β = 0.08, P = .003, R2 = .016) (Table 3), worse mental health symptoms (adjusted, β =.077 , P = .01, R2 =.025), and poorer general health (adjusted, β = 0.06, P = .03 , R2 = 0.126) only after adjusting for covariates.

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Discussion

We investigated the associations among substance use, sleep duration, and health (mental, physical, and general) among a sample of adults residing in Ohio while adjusting for individual and area-level covariates. People reporting use of nonprescribed prescription pain medication or marijuana had 3-fold and 2-fold higher odds of short sleep, respectively, even after considering both individual and area-level covariates. People reporting marijuana use had higher odds of poor health across all outcomes (sleep, mental, physical, and general health) even after considering covariates. These findings support the body of evidence that marijuana use is associated with mental health symptoms (19), irritability, sleep difficulties, anxiety, and learning and memory functioning deficits, particularly if use begins during adolescence or young adulthood (20). Moreover, substance use has been shown to exacerbate preexisting conditions (21).

Our findings align with previous evidence of the association between higher levels of substance use and shorter sleep duration and poorer general health overall (22). However, these associations vary and are often confounded by types of substances as well as underlying experiences and illnesses or treatment trajectories (23, 24). Our results indicate that people who use pain medication have higher odds of short sleep duration and higher odds of poor general health. The association between use of pain medication and odds of short sleep duration remained significant after accounting for the covariates age, sex, education, BMI, and socioeconomic deprivation. However, the association between use of pain medication and poor general health was no longer significant after adjusting for age, sex, education, BMI, and socioeconomic deprivation. These findings differ from other work that controlled for covariates and found that men were more likely than women to opt for alcohol; younger people were more likely than older people to opt for marijuana than alcohol; and people with low levels of education consumed more substances than people with higher levels of education (25,26).

Our findings also support the literature on the association between higher levels of marijuana use and poorer mental and general health (27). In our study, people who reported any marijuana use had higher odds of short sleep duration and more days of poor mental, physical, and general health in both the unadjusted and adjusted models. Our findings on marijuana use and short sleep duration are consistent with findings from a study based on data from the 2005–2018 National Health and Nutrition Examination Surveys in which people who reported using marijuana were 1.3 times more likely than people not reporting marijuana use to report short sleep duration (28). Our results are also consistent with the results of studies that showed an association between sleep disturbance and marijuana use among adolescents and adults (29,30). Contrary to our hypothesis, in our linear models, higher levels of marijuana use were associated with longer sleep duration. These findings are supported by findings of the NHANES study in which people who reported using marijuana were 1.6 times more likely than people not reporting marijuana use to report long sleep duration (28).

The 2020 Franklin County Community Needs Assessment in Ohio argued for prioritizing mental health and substance use programs because of the rising rate of emergency department admissions and the increasing demand for addiction specialists (31). The priorities did not include short sleep duration or sleep hygiene interventions. Sleep duration is a modifiable health behavior: improvement in this behavior could lead to decreases in rates of substance use and improve the health trajectories for people using substances. Sleep duration should be addressed in primary care and at the community level by expanding diagnostic and treatment options that cover a range of sleep problems and sleep disorders (eg, insomnia, sleep apnea, snoring, circadian rhythms, restless leg syndrome, narcolepsy). Services should help assess patients regardless of their age, sex and gender, race and ethnicity, or socioeconomic position. Community interventions based on an assessment of self-reported health, mental health, work–life balance, and sleep–wake habits may help identify people at high risk of inadequate sleep and how it may perpetuate other physical or behavioral health concerns.

The rate of unintentional deaths caused by drug use, including use of nonprescribed prescription pain medication, increased from 16.0 per 100,000 people in 2016 to 24.1 per 100,000 people in 2019 in Franklin County, Ohio (31). This rate is equal to approximately 24 residents dying annually due to nonprescribed drug or medication use — 36.8 times lower than the rate in Ohio overall but 19.7 times higher than the national average (8). New data provided by CDC’s National Center for Health Statistics indicate a substantial increase in overdose deaths from opioids, particularly synthetic opioids (fentanyl), psychostimulants such as methamphetamine, and semisynthetic opioids (nonprescribed prescription pain medication). Poverty, isolation, and social deprivation caused by COVID-19 and worsened socioeconomic hardship may have exacerbated existing drug and alcohol use. Socioeconomic hardship may also have led to increased periods of mental health symptoms and insufficient sleep, which may also have exacerbated existing substance use behaviors and encouraged unhealthy coping mechanisms. Therefore, addressing sleep disturbance and quality in the context of substance use may not only deter the increased prevalence of substance use but may also reduce the severity of substance use and poor health outcomes.

Limitations

Our study has several limitations. First, we used self-reported data on sleep duration and substance use. Both are subject to social desirability bias, and both, according to previous research, may have been underestimated (32,33). However, data on self-reported sleep and substance use have been shown to be reliable (34). Our findings should be corroborated with objective measures of sleep duration and substance use. Second, the cross-sectional design of our study prevented us from investigating whether short sleep duration precedes substance use or vice versa. Third, survey respondents may have underestimated or overestimated mental, physical, or general health status. Finally, the racial and ethnic composition of our study population, which was primarily non-Hispanic White, may raise concerns about generalizability.

Conclusions

Our research suggests a need to increase global interest and awareness in understanding how sleep duration can affect substance use behaviors and recovery and vice versa. Sleep duration is often underassessed and ultimately underdiagnosed among people who misuse substances. Furthermore, people with inadequate sleep duration may rely solely on willpower to mitigate poor or insufficient sleep without realizing it may be linked with another underlying chronic condition. If sleep problems or disorders are left untreated, people may experience difficulties in several areas of health such as memory, concentration, mood regulation, sex drive, and cardiovascular and immune system health.

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Acknowledgments

Dr Griggs is funded by the National Institute of Nursing Research (R00NR018886). The contents of this article are solely the responsibility of the authors and do not necessarily represent the official view of the National Institutes of Health or CDC. The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. No copyrighted materials were used in this article.

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Author Information

Corresponding Author: Estefania Hernandez, MA, Case Western Reserve University, Frances Payne Bolton School of Nursing, 10900 Euclid Ave, Cleveland, OH 44106 (Estefania.hernandez@case.edu).

Author Affiliations: 1Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio.

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References

  1. Chakravorty S, Vandrey RG, He S, Stein MD. Sleep management among patients with substance use disorders. Med Clin North Am. 2018;102(4):733–743. PubMed doi:10.1016/j.mcna.2018.02.012
  2. Roehrs T, Sibai M, Roth T. Sleep and alertness disturbance and substance use disorders: A bi-directional relation. Pharmacol Biochem Behav. 2021;203:173153. PubMed doi:10.1016/j.pbb.2021.173153
  3. National Sleep Foundation. Sleep by the numbers: interesting sleep facts and statistics that we can learn from. 2021. Accessed March 1, 2023. https://www.thensf.org/sleep-facts-and-statistics/#:~:text=The%20National%20Sleep%20Foundation%20recommends%20seven%20to%20nine,day%20at%20least%20half%20the%20week%20or%20more
  4. Filbey FM, Aslan S, Calhoun VD, Spence JS, Damaraju E, Caprihan A, et al. . Long-term effects of marijuana use on the brain. Proc Natl Acad Sci USA. 2014;111(47):16913–16918. PubMed doi:10.1073/pnas.1415297111
  5. Mireku MO, Rodriguez A. Sleep duration and waking activities in relation to the National Sleep Foundation’s recommendations: an analysis of US population sleep patterns from 2015 to 2017. Int J Environ Res Public Health. 2021;18(11):6154. PubMed doi:10.3390/ijerph18116154
  6. Goodhines PA, Wedel AV, Dobani F, Zaso MJ, Gellis LA, Park A. Cannabis use for sleep aid among high school students: Concurrent and prospective associations with substance use and sleep problems. Addict Behav. 2022;134:107427. PubMed doi:10.1016/j.addbeh.2022.107427
  7. Mike TB, Shaw DS, Forbes EE, Sitnick SL, Hasler BP. The hazards of bad sleep-Sleep duration and quality as predictors of adolescent alcohol and cannabis use. Drug Alcohol Depend. 2016;168:335–339. PubMed doi:10.1016/j.drugalcdep.2016.08.009
  8. Substance Abuse and Mental Health Services Administration. Results from the 2019 National Survey on Drug Use and Health (NSDUH): Key Substance Use and Mental Health Indicators in the United States. 2020. Accessed February 1, 2023. https://store.samhsa.gov/product/key-substance-use-and-mental-health-indicators-in-the-united-states-results-from-the-2019-national-survey-on-Drug-Use-and-Health/PEP20-07-01-001
  9. Geoffroy PA, Tebeka S, Blanco C, Dubertret C, Le Strat Y. Shorter and longer durations of sleep are associated with an increased twelve-month prevalence of psychiatric and substance use disorders: Findings from a nationally representative survey of US adults (NESARC-III). J Psychiatr Res. 2020;124:34–41. PubMed doi:10.1016/j.jpsychires.2020.02.018
  10. Czeisler MÉ, Wiley JF, Facer-Childs ER, Robbins R, Weaver MD, Barger LK, et al. . Mental health, substance use, and suicidal ideation during a prolonged COVID-19-related lockdown in a region with low SARS-CoV-2 prevalence. J Psychiatr Res. 2021;140:533–544. PubMed doi:10.1016/j.jpsychires.2021.05.080
  11. Bishop TM, Walsh PG, Ashrafioun L, Lavigne JE, Pigeon WR. Sleep, suicide behaviors, and the protective role of sleep medicine. Sleep Med. 2020;66:264–270. PubMed doi:10.1016/j.sleep.2019.07.016
  12. Fortuna LR, Cook B, Porche MV, Wang Y, Amaris AM, Alegria M. Sleep disturbance as a predictor of time to drug and alcohol use treatment in primary care. Sleep Med. 2018;42:31–37. PubMed doi:10.1016/j.sleep.2017.12.009
  13. Buysse DJ. Sleep health: can we define it? Does it matter? Sleep. 2014;37(1):9–17. PubMed doi:10.5665/sleep.3298
  14. Centers for Disease Control and Prevention. Behavioral Risk Factor Surveillance System (BRFSS) 2020. Accessed January 1, 2023. https://www.cdc.gov/brfss/index.html
  15. Butler DC, Petterson S, Phillips RL, Bazemore AW. Measures of social deprivation that predict health care access and need within a rational area of primary care service delivery. Health Serv Res. 2013;48(2 Pt 1):539–559. PubMed doi:10.1111/j.1475-6773.2012.01449.x
  16. Asdigian NL, Bear UR, Beals J, Manson SM, Kaufman CE. Mental health burden in a national sample of American Indian and Alaska Native adults: differences between multiple-race and single-race subgroups. Soc Psychiatry Psychiatr Epidemiol. 2018;53(5):521–530. PubMed doi:10.1007/s00127-018-1494-1
  17. Centers for Disease Control and Prevention (CDC). Self-reported frequent mental distress among adults–United States, 1993-2001. MMWR Morb Mortal Wkly Rep. 2004;53(41):963–966. PubMed
  18. Fernandez-Mendoza J, He F, Calhoun SL, Vgontzas AN, Liao D, Bixler EO. Objective short sleep duration increases the risk of all-cause mortality associated with possible vascular cognitive impairment. Sleep Health. 2020;6(1):71–78. PubMed doi:10.1016/j.sleh.2019.09.003
  19. Kort-Butler LA. Health-related strains and subsequent delinquency and marijuana use. Youth Soc. 2017;49(8):1077–1103.
  20. Volkow ND, Baler RD, Compton WM, Weiss SR. Adverse health effects of marijuana use. N Engl J Med. 2014;370(23):2219–2227. PubMed doi:10.1056/NEJMra1402309
  21. Schuckit MA. Comorbidity between substance use disorders and psychiatric conditions. Addiction. 2006;101(s1)(suppl 1):76–88. PubMed doi:10.1111/j.1360-0443.2006.01592.x
  22. Navarro-Martínez R, Chover-Sierra E, Colomer-Pérez N, Vlachou E, Andriuseviciene V, Cauli O. Sleep quality and its association with substance abuse among university students. Clin Neurol Neurosurg. 2020;188:105591. PubMed doi:10.1016/j.clineuro.2019.105591
  23. Conroy DA, Arnedt JT. Sleep and substance use disorders: an update. Curr Psychiatry Rep. 2014;16(10):487. PubMed doi:10.1007/s11920-014-0487-3
  24. Kaplan KA, McQuaid J, Primich C, Rosenlicht N. An evidence-based review of insomnia treatment in early recovery. J Addict Med. 2014;8(6):389–394. PubMed doi:10.1097/ADM.0000000000000052
  25. Blanco C, Flórez-Salamanca L, Secades-Villa R, Wang S, Hasin DS. Predictors of initiation of nicotine, alcohol, cannabis, and cocaine use: Results of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). Am J Addict. 2018;27(6):477–484. PubMed doi:10.1111/ajad.12764
  26. Dokkedal-Silva V, Fernandes GL, Morelhão PK, Pires GN, Rowlett JK, Galduróz JCF, et al. . Sleep, psychiatric and socioeconomic factors associated with substance use in a large population sample: A cross-sectional study. Pharmacol Biochem Behav. 2021;210:173274. PubMed doi:10.1016/j.pbb.2021.173274
  27. Hines LA, Freeman TP, Gage SH, Zammit S, Hickman M, Cannon M, et al. . Association of high-potency cannabis use with mental health and substance use in adolescence. JAMA Psychiatry. 2020;77(10):1044–1051. PubMed doi:10.1001/jamapsychiatry.2020.1035
  28. Diep C, Tian C, Vachhani K, Won C, Wijeysundera DN, Clarke H, et al. . Recent cannabis use and nightly sleep duration in adults: a population analysis of the NHANES from 2005 to 2018. Reg Anesth Pain Med. 2022;47(2):100–104. PubMed doi:10.1136/rapm-2021-103161
  29. Conroy DA, Kurth ME, Strong DR, Brower KJ, Stein MD. Marijuana use patterns and sleep among community-based young adults. J Addict Dis. 2016;35(2):135–143. PubMed doi:10.1080/10550887.2015.1132986
  30. Bolla KI, Lesage SR, Gamaldo CE, Neubauer DN, Funderburk FR, Cadet JL, et al. . Sleep disturbance in heavy marijuana users. Sleep. 2008;31(6):901–908. PubMed doi:10.1093/sleep/31.6.901
  31. Alcohol, Drug and Mental Health Board of Franklin County. Community needs assessment 2020. Accessed December 3, 2022. https://adamhfranklin.org/wp-content/uploads/2021/08/2021-ADAMH-Community-Needs-Assessment.pdf
  32. Griggs S, Conley S, Batten J, Grey M. A systematic review and meta-analysis of behavioral sleep interventions for adolescents and emerging adults. Sleep Med Rev. 2020;54:101356. PubMed doi:10.1016/j.smrv.2020.101356
  33. Lauderdale DS, Knutson KL, Yan LL, Liu K, Rathouz PJ. Self-reported and measured sleep duration: how similar are they? Epidemiology. 2008;19(6):838–845. PubMed doi:10.1097/EDE.0b013e318187a7b0
  34. Krueger PM, Friedman EM. Sleep duration in the United States: a cross-sectional population-based study. Am J Epidemiol. 2009;169(9):1052–1063. PubMed doi:10.1093/aje/kwp023

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Tables

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Table 1. Characteristics of Study Population (N = 14,676), Ohio Behavioral Risk Factor Surveillance System Survey, 2020
Characteristic No. of respondents who answered question Value
Age group, y, no. (%)
18–24 14,274 875 (6.1)
25–34 1,540 (10.8)
35–44 1,818 (12.7)
45–54 2,219 (15.5)
55-64 2,952 (20.7)
≥65 4,870 (34.1)
Age, mean (SD), y 14,274 53.6 (19.3)
Sex, no. (%)
Female 14,676 7,970 (54.3)
Male 6,706 (45.7)
Race and ethnicity, no. (%)
Hispanic 14,676 310 (2.1)
Non-Hispanic Asian 329 (2.2)
Non-Hispanic Black 983 (6.7)
Non-Hispanic White 12,468 (85.0)
Non-Hispanic multiracial 281 (1.9)
Non-Hispanic Other race 305 (2.1)
Education
Less than high school diploma 14,626 903 (6.2)
High school diploma 4,932 (33.7)
Some college or technical school 4,068 (27.8)
College graduate 4,723 (32.3)
Annual household income, no. (%), $
<15,000 14,382 1,051 (7.3)
15,000–19,999 939 (6.5)
20,000–24,999 1,172 (8.1)
25,000–34,999 1,261 (8.8)
35,000-49,999 1,704 (11.8)
50,000–74,999 1,897 (13.2)
≥75,000 3,666 (25.5)
Social Deprivation Index, mean (SD)a 13,527 47.0 (25.8)
Body mass index, mean (SD), kg/m2 13,314 28.9 (7.2)
Sleep duration, mean (SD), hours 14,449 7.0 (1.5)
Mean no. (SD) of days of poor health in previous 30 days
Poor mental health 14,182 4.5 (8.7)
Poor physical health 12.4 (11.3)
Poor general health 12.6 (10.6)
Mean no. (SD) of days of marijuana use of respondents who reported using marijuana 12,342 17.3 (12.2)
Substance use
Used marijuana 12,362 1,140 (9.2)
Used nonprescribed prescription pain medication 8,203 111 (1.4)
General health
Excellent 14,644 2,686 (18.3)
Very good 4,925 (33.6)
Good 4,486 (30.6)
Fair 1,917 (13.1)
Poor 630 (4.3)

a The 6 domains of the composite Social Deprivation Index are 1) income (percentage of the population living in poverty), 2) education (percentage with <12 years of education), 3) housing (percentage living in rented housing unit and percentage living in overcrowded housing unit), 4) household characteristics (percentage of single-parent households with dependents aged <18 y), 5) transportation (percentage of households without a car), and 6) employment (percentage of unemployed adults aged <65) (15). The index is scaled from 1 to 100, with higher scores indicating higher levels of social deprivation.

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Table 2. Results of Logistic Regression Models for Use of Nonprescribed Prescription Pain Medications, Marijuana, and Outcomes, Ohio Behavioral Risk Factor Surveillance System Survey, 2020
Outcome OR (95% CI) P value Adjusted OR (95% CI)a P value
Use of nonprescribed prescription pain medication
Short sleep duration (<6 hours per night) 2.78 (1.80–4.30) <.001 2.37 (1.50–3.76) <.001
Poor mental health (>14 poor mental health days in past 30 days) 1.38 (0.91–2.11) .13 1.37 (0.88–2.12) .17
Poor physical health (>14 poor physical health days in past 30 days) 1.30 (0.75–2.25) .35 1.06 (0.57–1.98) .86
Poor general health (fair/poor health) 1.75 (1.14–2.66) .01 1.60 (0.99–2.58) .05
Use of marijuana
Short sleep duration (<6 hours per night) 1.70 (1.46–1.97) <.001 1.46 (1.24–1.73) <.001
Poor mental health (>14 poor mental health days in past 30 days) 1.55 (1.36–1.78) <.001 1.34 (1.16–1.55) <.001
Poor physical health (>14 poor physical health days in past 30 days) 1.68 (1.43–1.98) <.001 2.14 (1.78–2.57) <.001
Poor general health (fair/poor health) 1.53 (1.33–1.75) <.001 1.92 (1.64–2.24) <.001

Abbreviation: OR, odds ratio.
a Covariates adjusted for age, sex at birth, race and ethnicity, education, annual household income, body mass index (individual level), and socioeconomic deprivation (area level).

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Table 3. Results of Linear Regression Models for Marijuana Use and Covariates to Sleep, Mental, and Physical Health Outcomes, Ohio Behavioral Risk Factor Surveillance System Survey, 2020
Model Dependent variable B (SE) β P value R2
Model 1 (unadjusted) Sleep duration 0.007 (0.002) 0.093 .001 0.009
Mental health 0.027 (0.02) 0.055 .06 0.003
Physical health 0.007 (0.01) 0.016 .58 0.000
General health 0.002 (0.001) 0.031 .28 0.001
Model 2 (adjusted for covariates)a Sleep duration 0.008 (0.003) 0.089 .003 0.016
Mental health 0.04 (0.02) 0.077 .01 0.025
Physical health 0.01 (0.01) 0.023 .45 0.050
General health 0.003 (0.002) 0.063 .03 0.126

Abbreviations: B, unstandardized regression coefficient; β, standardized regression coefficient; R2, coefficient of determination.
a Covariates adjusted for age, sex at birth, race and ethnicity, education, annual household income, body mass index (individual level), and socioeconomic deprivation (area level).

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