Trends in sleeping difficulties among European adolescents: Are these associated with physical inactivity and excessive screen time?

Int J Public Health. 2019 May;64(4):487-498. doi: 10.1007/s00038-018-1188-1. Epub 2018 Dec 10.


Objectives: We examined changes in sleep-onset difficulties over time and associations with physical activity and screen time behavior among adolescents.

Methods: We used data from last four survey waves of the Health Behavior in School-Aged Children (HBSC) study (2002-2006-2010-2014). Multilevel logistic regression analyses were conducted to explore associations between regular sleeping difficulties, excessive screen time exposure and being insufficiently physically active (i.e., < 60 min daily) among 33 European and non-European countries.

Results: Findings indicate an increase in the prevalence of sleep-onset difficulties and in excessive screen time exposure and a small but significant increase in physical activity levels. Additionally, adolescents exceeding 2-h daily screen time had 20% higher odds of reporting sleep-onset difficulties, while no association was found for physical activity. The strength of the association between screen time and sleep-onset difficulties increased over time, which may reflect a change in type of screen time use (e.g., the increased use of easy accessible screens such as smartphones and tablets).

Conclusions: Effective strategies to reduce screen time are key to reverse the detrimental trend in sleep-onset difficulties among adolescents.

Keywords: 24-h approach; Adolescents; Physical activity; Sedentary behavior; Sleep; Trend.

Publication types

  • Comparative Study

MeSH terms

  • Adolescent
  • Adolescent Behavior*
  • Age Factors
  • Chronobiology Disorders / physiopathology*
  • Europe / epidemiology
  • Female
  • Humans
  • Male
  • Population Surveillance*
  • Prevalence
  • Screen Time*
  • Sedentary Behavior*
  • Sex Factors
  • Sleep Initiation and Maintenance Disorders / epidemiology*
  • Sleep Initiation and Maintenance Disorders / physiopathology*
  • Surveys and Questionnaires