Use of tobacco, alcohol impacts sleep duration in sexual minority young adults

The use of tobacco is associated with sleeping 7–9 h among young adult sexual minority men, while excessive alcohol consumption may worsen sleep patterns, according to a recent study presented at EPI Lifestyle 2025.

“This study highlights the complex relationships between tobacco use, alcohol consumption, and sleep duration in young adult sexual minority men,” said lead author Tania de Jesus Espinosa, School of Nursing, Yale University, New Haven, Connecticut, US. 

“The association of tobacco use with sleeping 7–9 h is controversial, as tobacco is not cardioprotective and is linked to adverse health outcomes,” she added.

Espinosa and her team obtained and analysed secondary data from an HIV prevention behavioural trial involving 322 young adult sexual minority men aged 18–34 years. They sought to test their hypothesis that tobacco use and excessive alcohol consumption would correlate with sleep duration and vary by sleep duration category (7–9 vs >9 h).

The associations of tobacco use and alcohol consumption with sleep duration were explored by performing a stepwise multinomial logistic regression analysis, comparing individuals sleeping 7–9 h and those sleeping >9 h (reference category). Multiple imputation by chained equations were used to address the missing data.

Of the participants, 21 percent reported using tobacco, while 90 percent reported consuming alcohol. Tobacco use showed a significant relationship with a higher likelihood of having 7–9 h of sleep (estimate, 0.978; p=0.003), while alcohol consumption demonstrated a significantly negative association with sleep duration (estimate, –0.182; p=0.038). [EPI Lifestyle 2025, abstract P1101]

Among participants who reported sleeping for more than 9 h, tobacco use appeared to significantly contribute to an extended sleep (estimate, 0.846; p=0.005), while alcohol consumption approached significance (estimate, 0.164; p=0.050). On the other hand, age and income showed no significance.

Stress reduction

“Smoking may fulfil stress-reducing needs, affecting sleep patterns,” Espinosa said. “Additionally, excessive alcohol consumption negatively impacts sleep duration and may worsen cardiovascular risks.”

These findings were consisted with those of a previous study, which observed a higher cardiovascular risk among young adult sexual minority men due to social behaviours, including tobacco use and alcohol consumption. [MDPI 2021;18:22]

Furthermore, Espinosa noted that behavioural interventions grounded in Life’s Essential 8 could prove beneficial in this population by lowering cardiovascular risk behaviours.

“The American Heart Association's Life's Essential 8 provides a framework to enhance cardiovascular health,” she said. “Tobacco use and excessive drinking are associated with significant cardiovascular risks, with tobacco linked to about one-third of all deaths from heart disease and excessive drinking increasing the risk of liver and heart disease.”

Cardiovascular disease (CVD) has been the leading cause of death in the US for the last century, according to a recent study. [Circulation 2025;151:1]

Earlier studies also suggested that short sleep duration (<7 h) significantly correlated with an increased risk of CVD, obesity, and even mental health problems. [Circulation 2022;146:5]