Beyond Sleep Duration: Bidirectional Associations Among Chronotype, Social Jetlag, and Drinking Behaviors in a Longitudinal Sample of US High School Students

Inadequate sleep and problematic drinking are prevalent among high school students and are significant public health issues. Inadequate sleep may contribute to alcohol use through impairments in emotion regulation or cognitive functioning, whereas alcohol use may lead to inadequate sleep through the biological effects of alcohol or social influences. However, the directionality of the associations between sleep and drinking variables remains unclear as most prior studies were cross-sectional. This study utilizes longitudinal data from the NEXT Generation Health Study to examine bidirectional associations between alcohol use and sleep adequacy in a nationally representative sample across 3 years of high school. Students reported usual bedtimes and waketimes for scheduled- and free-days, alcohol use, and heavy episodic drinking. Estimates of sleep duration, chronotype, and social jetlag were calculated. Cross-lagged autoregressive models revealed evidence of alcohol use predicting subsequent sleep duration and timing, and sleep timing predicting subsequent alcohol use. Specifically, previous-wave alcohol use predicted shorter free-day sleep duration and later chronotype at 11th and 12th grade, and more social jetlag at 12th grade; similar results were obtained for heavy episodic drinking. Eleventh grade social jetlag predicted subsequent year current alcohol use; eleventh grade chronotype and social jetlag predicted subsequent year heavy episodic drinking. Bidirectional findings suggest that alcohol use and sleep may reflect mutually reinforcing life style choices. Understanding these bidirectional associations could inform risk prevention interventions. Given the implications of poor sleep for adolescents, further research on possible social influences on the alcohol-sleep relations is merited. Clinical Trial Registration: NCT01031160.