Insufficient Sleep in Adolescence May Be A Driver of Risky Behaviors Interview with:

Matthew D. Weaver, PhD Instructor in Medicine · Harvard Medical School Associate Epidemiologist · Division of Sleep and Circadian Disorders Brigham and Women's Hospital Boston, MA 02215

Dr. Weaver

Matthew D. Weaver, PhD
Instructor in Medicine · Harvard Medical School
Associate Epidemiologist · Division of Sleep and Circadian Disorders
Brigham and Women’s Hospital
Boston, MA 02215 What is the background for this study?

Response: We were interested whether high school students who tended to sleep less than 8 hours per night reported more risk-taking behaviors compared to high school students who slept at least 8 hours per night on a school night. We utilized a nationally representative dataset from the CDC of surveys that were completed by high school students between 2007 and 2015. Over that time, approximately 67,000 students were surveyed. Students were asked about the hours of sleep that they obtained on an average school night. They were also asked how often, in the month prior to the survey, they engaged in a number of risk-taking behaviors. Some behaviors were related to driving, like driving without a seatbelt or driving drunk, while others were related to using alcohol, doing drugs, or being involved in a fight. They were also asked about their mood, including whether they felt sad or hopeless, considered suicide, and whether they had attempted suicide. What are the main findings?

Response: We found that only 30% of students reported sleeping at least 8 hours per night, which would be the minimum amount of sleep considered to be sufficient for most of this age group. There was a dose-dependent relationship between hours of sleep and the likelihood of reporting these risk-taking behaviors. Those reporting fewer hours of sleep were significantly more likely to report risk-taking behaviors.

Compared to students who reported sleeping eight hours at night, high school students who slept less than six hours were twice as likely to self-report using alcohol, tobacco, marijuana or other drugs, and driving after drinking alcohol. They were also nearly twice as likely to report carrying a weapon or being in a fight.

The strongest associations were related to mood and self- harm. Compared to students who reported sleeping eight hours at night, those who slept less than six hours were more than three times as likely to consider or attempt suicide, and four times as likely to attempt suicide, resulting in treatment. What should readers take away from your report?

Response: Insufficient sleep in youth may be a driver of several significant public health concerns, including mental health, substance abuse, and motor vehicle crashes. These behaviors are common precursors to accidents and suicides, which are the leading causes of death for teens in the US. Our findings suggest that we should continue to support efforts to promote healthy sleep habits and decrease barriers to sufficient sleep in this vulnerable population. What recommendations do you have for future research as a result of this work?

Response: There are several areas which deserve further study. A better understanding of the causes of sleep deficiency is needed. Some of these may be behavioral factors, like screen time and self-selected bedtimes, but others are likely structural factors, including school start times, assignment deadlines, and after-school activities. A better understanding of these factors would inform the design of strategies to improve sleep in this population, which could then be tested to see whether improvements in sleep can improve student mood, health, and safety. Is there anything else you would like to add?

Response: Our data reveal an association between sleep and these behaviors, but do not show a causal relationship. There could be a bi-directional relationship in which engaging in these behaviors also impacts sleep duration. In addition, these data were collected via self-report, which is subject to several limitations. We controlled for potentially confounding factors, such as age, gender, race, ethnicity, and year in the analysis, but residual confounding may still be present. Other confounders which may be relevant, such as the environmental factors, were not collected. Further study of these relationships is warranted. 


Weaver MD, Barger LK, Malone SK, Anderson LS, Klerman EB. Dose-Dependent Associations Between Sleep Duration and Unsafe Behaviors Among US High School Students. JAMA Pediatr. Published online October 01, 2018. doi:10.1001/jamapediatrics.2018.2777

Oct 1, 2018 @ 4:05 pm 

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