Rhythms and risks: Examining the relationship between circadian patterns and nicotine and alcohol use among medical students

Abstract

Objective: Chronotype refers to an individual’s natural preference for sleep and wake times, which reflects their internal circadian rhythm. It determines whether a person feels more alert and active in the morning, in the evening, or follows a more intermediate pattern. The aim of the study was to identify a potential association between chronotypes and the consumption of nicotine and highrisk alcohol use among medical students. Materials and Methods: The study was conducted between May 2024 and June 2024 via an online platform (Google Forms) among medical students in Marmara University. Horne-Ostberg’s Morningness-Eveningness Questionnaire form was used to determine the circadian rhythm characteristics. Univariate and multivariate analyses were performed to determine the associations of nicotine and high-risk alcohol use with chronotype. Results: A total of 323 medical students participated in the survey. Of the respondents, 198 (61.3%) had an intermediate chronotype, 69 (21.4%) had a morning chronotype, and 56 (17.3%) had an evening chronotype. It was observed that students with an evening chronotype had a statistically significantly higher rate of regular nicotine use compared to those with a morning chronotype (OR=3.62, p=0.04) and a high-risk alcohol use (OR=4.49, p=0.015). Conclusion: Assessing the evening type population among medical students may be a specific target for educational health promotion interventions aimed at preventing or reducing alcohol and nicotine consumption.

Keywords

• Circadian rhythm
• Chronotype
• Nicotine
• Alcohol
• Medical students

References

1. Waterhouse J. Introduction to chronobiology. In: Abacıoğlu N, Zengil H, editors. Fundamentals of Chronobiology and Chronotherapy. Ankara (Turkiye): Palme Publishing; 1999.
2. Weaver DR. The suprachiasmatic nucleus: a 25- year retrospective. J Biol Rhythms 1998;13:100-12. doi:10.1177/074873098128999952.
3. Duffy JF, Rimmer DW, Czeisler CA. Association of intrinsic circadian period with morningness-eveningness, usual wake time, and circadian phase. Behav Neurosci 2001;115:895-9. doi:10.1037/0735-7044.115.4.895.
4. Edgar RS, Green EW, Zhao Y, et al. Peroxiredoxins are conserved markers of circadian rhythms. Nature 2012;485(7399):459-64. doi:10.1038/nature11088.
5. Aschoff J, Gerecke U, Wever R. Desynchronization of human circadian rhythms. Jpn J Physiol 1967;17:450-7. doi:10.2170/ jjphysiol.17.450.
6. Kerkhof GA. Inter-individual differences in the human circadian system: a review. Biol Psychol 1985;20:83-112. doi:10.1016/0301-0511(85)90019-5.
7. Roenneberg T, Wirz-Justice A, Merrow M. Life between clocks: daily temporal patterns of human chronotypes. J Biol Rhythms 2003;18:80-90. doi:10.1177/0748730402239679.
8. Adan A, Archer SN, Hidalgo MP, Di Milia L, Natale V, Randler C. Circadian typology: a comprehensive review. Chronobiol Int 2012;29:1153-75. doi:10.3109/07420528.2012.719971.

9. Mecacci L, Rocchetti G. Morning and evening types: stressrelated personality aspects. Pers Individ Dif 1998;25:537-42. doi:10.1016/S0191-8869(98)00087-7.
10. Fabbian F, Zucchi B, De Giorgi A, et al. Chronotype, gender and general health. Chronobiol Int 2016;33:863-82. doi:10.108 0/07420528.2016.1176927.
11. Schneider ML, Vasconcellos DC, Dantas G, et al. Morningnesseveningness, use of stimulants, and minor psychiatric disorders among undergraduate students. Int J Psychol 2011;46:18-23. doi:10.1080/00207594.2010.513414.
12. Prat G, Adan A. Influence of circadian typology on drug consumption, hazardous alcohol use, and hangover symptoms. Chronobiol Int 2011;28:248-57. doi:10.3109/07420.528.2011.5 53018.
13. Van den Berg JF, Kivelä L, Antypa N. Chronotype and depressive symptoms in students: an investigation of possible mechanisms. Chronobiol Int 2018;35:1248-61. doi:10.1080/07 420528.2018.1470531.
14. Horne JA, Ostberg O. A self-assessment questionnaire to determine morningness-eveningness in human circadian rhythms Int J Chronobiol 1976;4:97-110
15. Pündük Z, Gür H, Ercan I. Sabahçıl-Akşamcıl Anketi Türkçe uyarlamasında güvenilirlik çalışması [A reliability study of the Turkish version of the mornings-evenings questionnaire]. Turk Psikiyatri Derg 2005;16:40-5.
16. World Health Organization, U.S. Centers for Disease Control and Prevention. Tobacco Questions for Surveys of Youth (TQS-Youth): A Subset of Key Questions from the Global Youth Tobacco Survey (GYTS). Geneva: World Health Organization; 2019. Licence: CC BY-NC-SA 3.0 IGO.
17. Cetin E, Cantürk N, Dağalp R. Alcohol Scale: Validity and reliability study in cigarette addict students. Journal of Dependence 2019;20:72-9.
18. Saunders JB, Aasland OG, Babor TF, de la Fuente JR, Grand M. Development of the Alcohol Use Disorders Identification Test (AUDIT): WHO collaborative project on early detection of persons with harmful alcohol consumption – II. Addiction 1993;88: 791-804.
19. Johnston LD, O’Malley PM, Bachman JG, Schulenberg JE. Monitoring the future national survey results on drug use, 1975–2003. Volume II: College Students and Adults Ages 19– 45. Bethesda (MD): National Institute on Drug Abuse; 2004. NIH Publication No. 04–5508.
20. Picton A, Greenfield S, Parry J. Why do students struggle in their first year of medical school? A qualitative study of student voices. BMC Med Educ 2022;22(1):100. doi: 10.1186/ s12909-022-03158-4.
21. Tanriover O, Peker S, Hidiroglu S, et al. The emotions experienced by family medicine residents and interns during their clinical trainings: a qualitative study. Prim Health Care Res Dev 2023;24:e25. doi:10.1017/S1463423623000051.
22. Chinwong D, Mookmanee N, Chongpornchai J, Chinwong S. A comparison of gender differences in smoking behaviors, ıntention to quit, and nicotine dependence among thai university students. J Addict 2018;2018:8081670. doi: 10.1155/2018/8081670.
23. Schwarzbold ML, Haas GM, Barni RS, et al. At-risk drinking and current cannabis use among medical students: a multivariable analysis of the role of personality traits. Braz J Psychiatry 2020;42:136-44. doi:10.1590/1516-4446-2018- 0318.
24. Freire BR, Castro PASV, Petroianu A. Alcohol consumption by medical students. Rev Assoc Med Bras (1992) 2020;66:943-7. doi:10.1590/1806-9282.66.7.943.
25. Siudej K, Malinowska-Borowska J. Relationship between chronotype and consumption of stimulants. Chronobiol Int 2021;38:1549-56. doi:10.1080/07420528.2021.1935989.
26. Sirtoli R, Mata GDG, Rodrigues R, et al. Is evening chronotype associated with higher alcohol consumption? A systematic review and meta-analysis. Chronobiol Int 2023;40:1467-79. doi:10.1080/07420528.2023.2256899.
27. Giannotti F, Cortesi F, Sebastiani T, Ottaviano S. Circadian preference, sleep and daytime behaviour in adolescence. J Sleep Res 2002;11:191-9. doi:10.1046/j.1365-2869.2002.00302.x.
28. Urbán R, Magyaródi T, Rigó A. Morningness-eveningness, chronotypes and health-impairing behaviors in adolescents. Chronobiol Int 2011;28:238-47. doi:10.3109/07420528.2010. 549599.
29. Evans SL, Norbury R. Associations between diurnal preference, impulsivity and substance use in a young-adult student sample. Chronobiol Int 2021;38:79-89. doi:10.1080/07 420528.2020.1810063.
30. Wang L, Chartrand TL. Morningness–eveningness and risk taking. J Psychol 2015;149:394-411. doi:10.1080/00223980.2 014.885874.
31. Caci H, Robert P, Boyer P. Novelty seekers and impulsive subjects are low in morningness. Eur Psychiatry 2004;19:79- 84. doi:10.1016/j.eurpsy.2003.09.007.
32. Foulds JA, Boden JM, Newton-Howes GM, Mulder RT, Horwood LJ. The role of novelty seeking as a predictor of substance use disorder outcomes in early adulthood. Addiction 2017;112:1629-37. doi:10.1111/add.13838.
33. Hisler GC, Rothenberger SD, Clark DB, Hasler BP. Is there a 24-hour rhythm in alcohol craving and does it vary by sleep/ circadian timing? Chronobiol Int 2021;38:109-21. doi:10.1080 /07420528.2020.1838532.
34. Wittmann M, Paulus M, Roenneberg T. Decreased psychological well-being in late ‘chronotypes’ is mediated by smoking and alcohol consumption. Subst Use Misuse 2010;45:15-30. doi:10.3109/10826080903498952.
35. Zhang Y, Liu D, Sheng L, et al. Chronotype and sleep duration are associated with stimulant consumption and BMI among Chinese undergraduates. Sleep Biol Rhythms 2018;16:211-22. doi:10.1007/s41105.017.0142-6.
36. Wittmann M, Dinich J, Merrow M, Roenneberg T. Social jetlag: misalignment of biological and social time. Chronobiol Int 2006;23:497-509. doi:10.1080/07420520500545979.
37. Adan A, Natale V. Gender differences in morningnesseveningness preference. Chronobiol Int 2002;19:709-20. doi:10.1081/CBI-120005390.
38. Danielsson K, Sakarya A, Jansson-Fröjmark M. The reduced morningness–eveningness questionnaire: psychometric properties and related factors in a young Swedish population. Chronobiol Int 2019;36:530-40. doi:10.1080/07420528.2018.1 564322.
39. Carrier J, Monk TH, Buysse DJ, Kupfer DJ. Sleep and morningness-eveningness in the ‘middle’ years of life (20-59 y). J Sleep Res. 1997;6:230-7. doi:10.1111/j.1365- 2869.1997.00230.x.
40. Adan A, Almirall H. Horne & Östberg morningnesseveningness questionnaire: a reduced scale. Pers Individ Dif 1991;12:241-53. doi:10.1016/0191-8869(91)90110-W.