LAUSR

OBJECTIVE Adults with HIV have greater sleep difficulties and are more likely to smoke cigarettes. We tested whether current smoking plays a role in sleep difficulties experienced by young adults with HIV. DESIGN Cross-sectional. SETTING Data were from the 2011-2014 waves of the National College Health Assessment, an annual survey conducted by the American College Health Association. PARTICIPANTS 108,159 (including N = 224 HIV positive) college students provided data for this study. MEASUREMENTS Health conditions (including HIV positive status) were self-reported. Participants were also asked whether "sleep difficulties" were "traumatic or difficult for you to handle" over the past 12 months. Smoking was self-reported (smokers reported smoking on at least 20 of the last 30 days). Logistic regression models were adjusted for age, sex, survey year, current alcohol use or current marijuana use, diagnosis and/or treatment of anxiety or depression in last year. RESULTS HIV positive students were more likely to be smokers (OR = 2.0, SE = 0.43, 95% CI [1.31, 3.05], P = .001) and were more likely to experience sleep difficulties (OR = 2.02, SE = 0.29, 95% CI [1.52, 2.68], P < .0001). While a significant HIV-x-smoking interaction was not found, when models were stratified by smoking, the relationship between HIV status and sleep difficulties was seen among non-smokers (OR = 1.97), and this relationship was stronger among smokers (OR = 2.64). CONCLUSIONS Among college students, HIV positive status is associated with increased sleep difficulties. These problems are worse among smokers. Sleep interventions are warranted in this vulnerable group, and could potentially enhance smoking cessation efforts.