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This study examined sleep patterns and sleep problems in relation to smoking and alcohol use in Chinese adolescents. A questionnaire survey of 2090 adolescent students was conducted in Lijin County, Shandong, China. A self-administered questionnaire was used to collect the data. After adjustment for demographics and internalizing and externalizing problems, poor sleep quality was associated with increased risk of smoking (odds ratio [OR], 2.59; 95% confidence interval [CI], 1.24–5.40), alcohol use (OR, 2.65; 95% CI, 2.81–3.89), and getting drunk (OR, 2.81; 95% CI, 1.72–4.57); sleeping 7 hours (OR, 1.64; 95% CI, 1.20–2.43) and sleeping 6 hours or less per night on weekdays (OR, 1.97; 95% CI, 1.25–3.10) were significantly associated with increased risk for alcohol use, and sleeping 6 hours or less per night on weekends (OR, 2.09; 95% CI, 1.18–3.70) were significantly associated with increased risk for getting drunk; and hypnotic medication use was significantly associated with ever smoking (OR, 1.80; 95% CI, 1.08–2.99). These findings highlight the potential role of sleep intervention in the prevention of adolescent substance use.