Association between electronic cigarettes-marijuana dual use and sleep duration among US adults: NHANES 2015–2018

Background: Electronic cigarettes (e-cigarettes) use was reported associated with sleep disturbances, and marijuana was a double-edged sword to sleep. Literature about their dual use is limited. This study aimed to investigate the association between dual use of,e-cigarettes and marijuana and sleep duration among US adults.Methods: This cross-sectional study included 6,573 participants aged 18–64 years from 2015 to 2018. Data were obtained from the National Health and Nutrition Examination Survey database. The chi-square test and analysis of variance were used for analyses of binary and continuous variables, respectively. Multinomial logistic regression models were used for univariate and multivariate analyses of e-cigarettes, marijuana use, and sleep duration. Sensitivity analyses were conducted in populations with dual e-cigarette and traditional cigarette use and those with dual marijuana and traditional cigarette use.Results: Dual e-cigarette and marijuana users had significantly higher odds of not having the recommended sleep duration than those who were using neither (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, respectively) and short sleep duration than only e-cigarette users (OR, 4.24; 95% CI, 1.75–4.60; P < 0.001) in the adjusted model. Dual traditional cigarette and marijuana users had significantly higher odds of long sleep duration than neither users.Conclusions: The study suggested that the dual use of tobacco products and marijuana was associated with sleep duration, which is not recommended, and results differ based on the type of tobacco products. Since the majority of tobacco users use not only one kind of tobacco product, it is important to conduct longitudinal RCTs to explore the joint effect of dual tobacco use on human health.