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Background  Sleep loss is increasingly recognized as a key public health issue among adolescents. Tobacco use is one of the leading causes of preventable disease and death in the world. Yet, the association between tobacco use and sleep loss has been understudied in the adolescent population. This study aimed to examine this association utilizing nationally representative samples of adolescents.    Methods  Cross-sectional data on 109 408 adolescents (12-15 years) from 38 countries were derived from the Global School-based Student Health Survey (GSHS). Weighted age- and sex-adjusted distribution of each sample characteristics was calculated. Multivariate logistic regression and meta-analyses were performed to assess the association of sleep loss over worry with any tobacco use, while controlling for important confounders, including age, gender, loneliness, physical attack victimization, parental knowledge/warmth, and perceived peer kindness/helpfulness.    Results  The weighted age- and sex-adjusted prevalence of SLOW and use of any tobacco product was 6.4% and 7.4% respectively across 38 countries. The overall odds of sleep loss over worry were 1.89 times (95% confidence interval (CI) = 1.75, 2.03) greater among tobacco users than among non-users, with low level of between-country heterogeneity ( I 2   = 24.0%,  P  = 0.095). The odds of sleep loss over worry were 1.61 times (95% CI = 1.52, 1.71) greater among those reporting physical attack victimization than among non-victims, and 5.55 times (95% CI = 4.95, 6.21) greater among those reporting frequent than less frequent loneliness.    Conclusions  Tobacco use, physical attack victimization, and loneliness can be key indicators of SLOW, and may be included in the assessment and prevention of SLOW to generate a more comprehensive picture. Further studies are needed to determine if reducing tobacco use, loneliness, or physical attack victimization would make a meaningful impact on reducing SLOW.

Tobacco use and sleep loss over worry among adolescents aged 12-15 years: A population-based study of 38 countries