Role of Sleep Duration in the Association Between Socioecological Protective Factors and Health Risk Behaviors in Adolescents.
Monica Roosa Ordway, Guanghai Wang, Sangchoon Jeon and 1 others
PMID 31524842WHAT IT FOUND
Sleep duration and protective factors independently lowered the odds of high-risk behavior clusters in 10th graders, but not 12th graders.
The interaction between sleep and protective factors was not significant. These cross-sectional data do not prove that increasing sleep reduces risk behaviors.
Key findings
01In 10th graders, short sleep (≤7 hours) was associated with higher odds of moderate-risk (OR 1.16) and high-risk (OR 1.26, marginal) behavior classes compared to recommended sleep (8-9 hours).
02In 12th graders, there was no significant association between sleep duration and risk behavior classes, despite higher overall incidence of risk behaviors.
03There was no significant interaction between sleep duration and cumulative protective factors on risk behavior class membership in either grade.
STILL TO COME
How it was doneWhat they found
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What it does not show
Cross-sectional design prevents causal inference; associations do not prove that changing sleep duration alters risk behavior. Sleep duration was self-reported and limited to school nights, missing weekend sleep and naps, which may affect total sleep burden and circadian rhythm. Data were de-identified, preventing analysis of individual trajectories from 10th to 12th grade or matching students across years. The sample is from a single, socioeconomically diverse school district, limiting generalizability to other populations. Lack of data on socioeconomic status, detailed race/ethnicity, and mental health history limits control for potential confounders. Two protective factor subscales had low internal consistency (Cronbach's alpha < 0.6).
Declared interests
All authors report no conflicts of interest. The study used publicly available archival data from Fairfax County Public Schools.
The easy way to misread this
Do not interpret the significant associations in 10th graders as evidence that prescribing sleep extension will reduce risk behaviors. The cross-sectional design cannot distinguish whether poor sleep contributes to risk-taking or whether adolescents engaged in high-risk behaviors sleep less due to lifestyle or underlying factors. The lack of interaction between sleep and protective factors also suggests sleep does not simply buffer the effects of low protective factors in this dataset.