Why Do Young Adults Sleep Less? A Comparative Analysis of Sleep Duration and Smoking Status among University Students of Karachi, Pakistan

Authors

  • Farhan Muhammad Qureshi Department of Community Medicine and Public Health, Karachi Institute of Medical Sciences, Malir Cantt, Karachi, Pakistan.
  • Samira Faiz Bari Department of Community Medicine and Public Health, Karachi Institute of Medical Sciences, Malir Cantt, Karachi, Pakistan.
  • Syeda Sehrish Zehra Department of Community Medicine and Public Health, Karachi Institute of Medical Sciences, Malir Cantt, Karachi, Pakistan.
  • Syed Hammad Ali Zaidi Department of Community Medicine, Jinnah Medical and Dental College.
  • Nadia Khlaid World Health Organization, Karachi Regional Office, Pakistan.
  • Sarwat Wajahat Shaikh World Health Organization, Karachi Regional Office, Pakistan.

DOI:

https://doi.org/10.47489/szmc.v40i1.837

Keywords:

Smoking, Electronic Cigarettes, Tobacco, Sleep, Sleep disorders

Abstract

Background: Smoking tobacco, either in the form of traditional combustion cigarettes (TCC) or electronic cigarettes (EC) are recognized for their long-term adverse health outcomes. In addition, tobacco smoking has been linked to sleep quality, which in turn undermines overall health and well-being. 

Objective: To examine the association between sleep duration and smoking status, distinguishing between exclusive TCC users, exclusive EC users, dual users of both products, and non-smokers among university students in Karachi, Pakistan.

Method: This cross-sectional study included 450 university students of Karachi, Pakistan, aged 18-25 years using non-probability multistage sampling technique. Participants were categorized as exclusive use of TCC, exclusive EC use, dual use or non-smoking. Structured questionnaire was used, focusing on duration and perceived changes. Data was analyzed using SPSS version 25.

Results: Out of 450 participants, 351(78%) reported use of smoking products. Multivariate logistic regression model revealed that dual users had significantly higher odds of less than six hours (AOR=9.60; 95% CI: 3.99–23.11, p<0.001). Traditional cigarette use was also strongly associated with short sleep duration (AOR=3.09; 95% CI: 1.31–7.28, p=0.010), whereas the relationship for EC users approached statistical significance (AOR=2.28; 95%; CI: 0.99–5.27, p=0.054).

Conclusion: Dual tobacco users are more likely to experience reduced sleep duration than non-smokers, highlighting an important public health concern. Longitudinal studies are essential in future to establish causality and to design interventions that address the behavioral and psychological factors of smoking behavior.

References

Singh L, Jain P, Kumar C, Sinha DN, Kabir Z, Huque R, et al. Trends in age of tobacco use initiation over time in Bangladesh, India and Pakistan: analysis of cross-sectional nationally representative surveys. BMJ Open. 2023;13:e067875. http://doi.org/10.1136/bmjopen-2022-067875

Song H, Yang X, Yang W, Dai Y, Duan K, Jiang X, et al. Cigarettes smoking and e-cigarettes using among university students: a cross-section survey in Guangzhou, China, 2021. BMC Public Health. 2023;23(1):438. http://doi.org/10.1186/s12889-023-15350-2

World Health Organization. WHO global report on trends in prevalence of tobacco use 2000–2025, fourth edition. Geneva: WHO; 2021. https://iris.who.int/bitstream/handle/10665/348537/9789240039322-eng.pdf

Shah MS, Qazi SU, Siddiqui AA, Iftikhar A, Wahid S, Siddiqui KA, et al. Prevalence of smoking habit and its associated factors among the students of public sector universities in Karachi. J Educ Soc Stud. 2023;4(3):578–84. http://doi.org/10.52223/jess.2023.4317

Qureshi M, Mumtaz M. Adult perceptions of cigarettes and e-cigarettes: a Pakistan focus group study. Prev Med Rep. 2024;38:102619. http://doi.org/10.1016/j.pmedr.2024.102619

Nayab D, Nasir M, Memon JA, Siddique O. The economic cost of tobacco-induced diseases in Pakistan. Pakistan Institute of Development Economics. 2021. https://file.pide.org.pk/pdfpideresearch/rr-041-the-economic-cost-of-tobacco-induced-diseases-in-pakistan.pdf

Riehm KE, Rojo-Wissar DM, Feder KA, Mojtabai R, Spira AP, Thrul J, et al. E-cigarette use and sleep-related complaints among youth. J Adolesc. 2019;76:48–54. http://doi.org/10.1016/j.adolescence.2019.08.009

Woo DH, Park M, Jang SY, Park S, Jang SI. Association between smoking status and subjective quality of sleep in the South Korean population: a cross-sectional study. Sleep Breath. 2023;27(4):1519–26. http://doi.org/10.1007/s11325-022-02726-8

You MA, Choi J, Son YJ. Associations of dual use of tobacco cigarettes and e?cigarettes, sleep duration, physical activity and depressive symptoms among middle?aged and older Korean adults. Nurs Open. 2023;10(6):4071–82. http://doi.org/10.1002/nop2.1667

Advani I, Gunge D, Boddu S, Mehta S, Park K, Perera S, et al. Dual use of e-cigarettes with conventional tobacco is associated with increased sleep latency in cross-sectional study. Sci Rep. 2022;12(1):2536. http://doi.org/10.1038/s41598-022-06445-8

Watson NF, Badr MS, Belenky G, Bliwise DL, Buxton OM, Buysse D, et al. Recommended amount of sleep for a healthy adult: a joint consensus statement of the American Academy of Sleep Medicine and Sleep Research Society. J Clin Sleep Med. 2015;11(6):591–2. http://doi.org/10.5664/jcsm.4758

Dever JA. Combining probability and nonprobability samples to form efficient hybrid estimates: An evaluation of the common support assumption. In: Proceedings of the 2018 Federal Committee on Statistical Methodology (FCSM) Research Conference. 2018. p. 1–15. https://www.fcsm.gov/assets/files/docs/A4_Dever_2018FCSM.pdf

Bari SF, Zehra S, Qureshi FM, Aziz A. Profiles of childhood trauma: epidemiological survey results of an educated young community cohort. Int J Community Med Public Health. 2024;11(5):1822. http://doi.org/10.18203/2394-6040.ijcmph20241174

Alzalabani AA, Eltaher SM. Perceptions and reasons of E-cigarette use among medical students: an internet-based survey. J Egypt Public Health Assoc. 2020;95(1):21. http://doi.org/10.1186/s42506-020-00051-0

Balogh E, Wagner Z, Faubl N, Riemenschneider H, Voigt K, Terebessy A, et al. Increasing prevalence of electronic cigarette use among medical students: repeated cross-sectional multicenter surveys in Germany and Hungary, 2016–2018. Subst Use Misuse. 2020;55(13):2109–15. http://doi.org/10.1080/10826084.2020.1790011

Qanash S, Alemam S, Mahdi E, Softah J, Touman A, Alsulami A. Electronic cigarette among health science students in Saudi Arabia. Ann Thorac Med. 2019;14(1):56–62. http://doi.org/10.4103/atm.ATM_76_18

Merianos AL, Jandarov RA, Choi K, Fiser KA, Mahabee-Gittens EM. Combustible and electronic cigarette use and insufficient sleep among US high school students. Prev Med. 2021;147:106505. http://doi.org/10.1016/j.ypmed.2021.106505

Kwon M, Park E, Dickerson SS. Adolescent substance use and its association to sleep disturbances: a systematic review. Sleep Health. 2019;5(4):382–94. http://doi.org/10.1016/j.sleh.2019.06.001

Dunbar MS, Tucker JS, Ewing BA, Pedersen ER, Rodriguez A, Shih RA, et al. Frequency of e-cigarette use, health status, and risk and protective health behaviors in adolescents. J Addict Med. 2017;11(1):55–62. http://doi.org/10.1097/ADM.0000000000000272

Kwon M, Seo YS, Park E, Chang Y. Association between substance use and insufficient sleep in U.S. high school students. J Sch Nurs. 2020. http://doi.org/10.1177/105984051990116

Legleye S, Bricard D, Khlat M. Roles of parental smoking and family structure for the explanation of socio?economic inequalities in adolescent smoking. Addiction. 2023;118(1):149–59. http://doi.org/10.1111/add.16026

Mercken L, Snijders TA, Steglich C, Vartiainen E, de Vries H. Dynamics of adolescent friendship networks and social behavior. Soc Netw. 2012;32:72–81. http://doi.org/10.1016/j.socnet.2009.02.005

Mercken L, Steglich C, Sinclair P, Holliday J, Moore L. A longitudinal social network analysis of peer influence, peer selection, and smoking behavior among adolescents in British schools. Health Psychol. 2012;31:450–9. http://doi.org/10.1037/a0026876

Moor I, Rathmann K, Lenzi M, Pförtner TM, Nagelhout GE, de Looze M, et al. Socioeconomic inequalities in adolescent smoking across 35 countries: a multilevel analysis of the role of family, school and peers. Eur J Public Health. 2015;25:457–63. http://doi.org/10.1093/eurpub/cku244

Published

2026-04-11

How to Cite

1.
Qureshi FM, Bari SF, Zehra SS, Zaidi SHA, Khlaid N, Shaikh SW. Why Do Young Adults Sleep Less? A Comparative Analysis of Sleep Duration and Smoking Status among University Students of Karachi, Pakistan. Proceedings S.Z.M.C [Internet]. 2026 Apr. 11 [cited 2026 Sep. 14];40(1):102-9. Available from: https://www.proceedings-szmc.org.pk/index.php/szmc/article/view/837