The COVID-19 pandemic generated large amounts of stress across the globe. While acute stress negatively impacts health, defining exact consequences and behavioral interventions can be difficult. We hypothesized that a generalized increase in stress and anxiety caused by continuation of the global pandemic would negatively impact sleep quality and that ever users of e-cigarettes and conventional tobacco would have more profound alterations over time. Participants were recruited via social media to complete an online survey in April 2020 (n = 554). Inhalant use was assessed through the UCSD Inhalant Questionnaire and sleep quality was gauged through the Pittsburgh Sleep Quality Index (PSQI). A set of participants (n = 217) retook the survey in June 2020. Inhalant users—historical or current e-cigarette vapers, conventional tobacco smokers, and dual users—had higher PSQI scores than never smoker/never vapers, demonstrating worse sleep quality in inhalant users. Non-smoking/non-vaping subjects who retook the survey in June 2020 had improvement in their PSQI scores by paired t test, indicating better sleep quality as the pandemic continued, while inhalant users of all types had persistently high PSQI scores (poor sleep quality). These data suggest that ever users of tobacco products may be susceptible to overall diminished sleep quality in the setting of stressful life circumstances. These data also suggest that pandemic-initiated lifestyle changes may have led to improvements in sleep quality. Finally, these findings raise concerns for correlations between either past or active e-cigarette use on sleep, and thus overall health.

Introduction Diet, exercise, and sleep are recognized as the three pillars of health, with the assertion that failure to address one will compromise the other two. We have previously observed an association between inhalant use on sleep in adolescents (JCSM 2021). Our previous data raised concern for disruption induced by nicotine among teenagers. Given the recent increase in THC consumption, we sought to test the hypothesis that THC use among teenagers and young adults would be associated with deleterious lifestyle factors including poor diet and minimal exercise. We further sought to test whether Hispanic/LatinX status was predictive of poor health practices. Methods We conducted a social media survey using Twitter and Instagram to gather data on willing participants. We obtained IRB approval and used validated instruments to gather data on variables of interest. We assessed past and current THC use including in what form (inhalant, edible etc) and concurrently obtained data on diet and exercise patterns using standardized questionnaires. People self reported race, ethnicity, gender, and other factors. Results Of the 471 responders who provided data, we removed suspicious data based on identical responses at a given time suggestive of ‘bots’. We isolated the n=58 (37.3% Hispanic LatinX) who were in our target age range (13-25yrs) with complete data. For THC use, 27/58 participants (46.6%) responded “yes” to current usage, whereas 0 reported previous usage and 31 reported “no” (53.4%). Among people who self-identified as Hispanic/Latinx, 81.8% reported using THC currently whereas among people self-identifying as non-Hispanic, only 24.3% reported current THC use. Among the people reporting regular THC use, diet and exercise tended to be non-favorable compared to non-THC users. Of the 58 participants, only 19 reported never vaping (32.8%) while 15 (25.9%) reported vaping daily or weekly. For cigarettes only 20 people (34.5%) reported never using cigarettes whereas 14 (24.1%) reported using daily or weekly. Conclusion Based on our social media survey, we observed a high prevalence of vaping, cigarette smoking and THC use among adolescents and young adults. People who self-identified as Hispanic/LatinX reported high rates of THC use compared to non-Hispanic people. The implications of these findings for the sleep health of teenagers and young adults are unclear, but may provide a therapeutic target for future research. Support (If Any) Dr. Crotty-Alexander is funded by VA Merit award and by NIH.