Associations between adolescent sleep difficulties and active versus passive screen time across 38 countries

Background: High screen use has been adversely linked with mental wellbeing; however, little is known about how active versus passive screen time are associated with sleep-onset difficulties among adolescents. Methods: We analysed data from 38 European and North American countries that participated in the 2014 Health Behaviour in School-aged Children (HBSC) survey. Difficulties in falling sleep were assessed using a self-reported item with a 5-point Likert scale, and then dichotomised. Participants reported h/day of discretional time spent watching television, electronic gaming, and computer use. Results: Of the 195,668 participants (Mage 13.59 [1.62] years; 51 % girls), about 25 % of girls reported sleep-onset difficulties, while the rate was 18 % in boys. Adolescents who played electronic games >4 h/day (≤1 h/day as reference) had 30 % higher odds in boys (OR 1.30; 95 % CI: 1.23–1.38) and 38 % higher odds in girls (OR 1.38; 95 % CI: 1.31–1.45) of reporting sleep difficulties. High computer use (>4 h/day) increased the odds of sleep difficulties by 41 % in boys (OR 1.41, 95 % CI: 1.33–1.49) and 61 % in girls (OR 1.61, 95 % CI: 1.53–1.69). Similarly, high television time (>4 h/day) had increased the odds of sleep difficulties by 15 % in boys (OR 1.15, 95 % CI: 1.08–1.22) and 19 % in girls (OR 1.19, 95 % CI: 1.12–1.25). Limitations: Cross-sectional analyses cannot establish causality of the associations. Conclusions: Higher levels of recreational screen use of any type were associated with sleep-onset difficulties among adolescents with adverse effects being more prevalent in active than passive screen time. Prospective research with objective measures is warranted to understand causality of these relationships.