Association of dual electronic cigarettes and marijuana use with sleep duration among adults from the United States, NHANES 2015-2018

Electronic cigarette (e-cigarette) use is becoming more widespread, and studies show that they are not absolutely harmless. To investigate the association between the dual use of e-cigarettes and marijuana with sleep duration among adults in the United States, this cross-sectional study used data from 6,573 participants aged 18-64 years from 2015 to 2018 from the National Health and Nutrition Examination Survey database. Chi-square tests and analysis of variance were used for bivariate analyses of binary and continuous variables, respectively. Multi-nomial logistic regression models were used for univariate and multivariate analyses of e-cigarette use, mari-juana use, and sleep duration. Sensitivity analyses were conducted in populations with dual e-cigarette and traditional cigarette use and dual marijuana and traditional cigarette use. People who concurrently use e -ciga-rettes and marijuana had higher odds of not having the recommended sleep duration than neither users (short sleep duration: odds ratio [OR], 2.34; 95% confidence interval [CI], 1.19-4.61; P = 0.014; long sleep duration: OR, 2.09; 95% CI, 1.53-2.87; P < 0.001) and a shorter sleep duration than e-cigarette only users (OR, 4.24; 95% CI, 1.75-4.60; P < 0.001). Concurrent traditional cigarette and marijuana users had higher odds of long sleep duration than neither users (OR, 1.98; 95% CI, 1.21-3.24; P = 0.0065). Almost half of the people who concurrently use e-cigarettes and marijuana had both short and long sleep durations compared to neither users and short sleep duration compared to e-cigarette only users. Longitudinal randomized controlled trials are needed to explore the joint effect of dual tobacco use on sleep health.