ArticleNature and science of sleep2026
Sleep and Substance Use Among Firefighters: Associations with Alcohol, Caffeine, and Nicotine Use.
Article in Nature and science of sleep, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper, 1 of them a synthesis that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
1 citing paper in PubMed, 1 synthesis or guideline pooled it.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
12 authors.
Funding
Abstract
Purpose: Firefighters are at high risk for sleep disruption due to shift work. Use of alcohol, caffeine, and nicotine can also affect sleep. Thus, we evaluated daily, bidirectional associations between substance use and actigraphy-assessed sleep among firefighters. Patients and methods: Micro-longitudinal data were drawn from 120 firefighters participating in the Shiftwork in Firefighters (SWIFT) Study. Participants completed surveys on daily alcohol and caffeine use, current and lifetime tobacco use, and wore actigraphy devices to assess sleep timing, duration, and quality (2,617 observations). Multilevel models were used to examine both between- and within-person associations between substance use and subsequent sleep, and between sleep and next-day substance use. Models were adjusted for covariates (shift schedule, on-shift status, nighttime call volume, and naps). Results: Alcohol use demonstrated strong bidirectional associations with sleep. Greater within-person alcohol consumption predicted shorter sleep and earlier waketimes, while later sleep timing and shorter sleep predicted greater next-day alcohol use. Unexpectedly, greater caffeine consumption was associated with higher sleep efficiency and fewer nighttime awakenings at the between-person level and longer total sleep time at the within-person level. Current between-person use of smokeless tobacco was associated with approximately 30 minutes shorter total sleep time, whereas lifetime cigarette use showed no association with sleep outcomes. Conclusion: Substance use among firefighters exhibited substance-specific and temporally dynamic relationships with sleep. Nicotine and caffeine effects were largely person-dependent, whereas daily alcohol showed consistent bidirectional effects on sleep. These findings highlight potential intervention targets aimed at improving sleep and reducing alcohol-related risk among firefighters.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.