1225 The sociodemographic determinants of adolescent sleep in Europe and North America

Abstract

<h3>Aims</h3> Adolescent sleep health is a growing public health issue and has been reported to significantly influence various short-term and long-term health outcomes, including academic performance, substance use and cardiovascular disease. Inequalities in adolescent sleep thus have the potential to perpetuate health inequalities across the life course. However, the sociodemographic determinants of adolescent sleep remain relatively unexplored. We conducted a narrative review to study: the sociodemographic determinants of adolescent sleep in Europe and North America; the mechanisms by which these sociodemographic factors influence adolescent sleep; and the implications of these findings for sleep interventions and further research. <h3>Methods</h3> An online literature search of PubMed, APA Psychnet, Scopus, and Web of Science was conducted between April and July 2021, using appropriate keywords to identify relevant articles. Only articles in English language peer-reviewed journals that were relevant to Europe or North America were included. <h3>Results</h3> The search yielded 197 articles. This review found that disparities in adolescent sleep are complex and rooted in the wider social and biological context of sleep. Sociodemographic factors had a significant influence and exposure to stressors was a key mechanism identified across all the sociodemographic determinants. Additionally, sociodemographic factors intersecting with one another was seen to result in overlapping forms of discrimination and disadvantage, which compounded and contributed to widening health inequalities. As adolescents aged their sleep duration decreased, influenced by stressors such as school start times, noisy neighbourhoods and living in high crime areas. Less affluent adolescents were found to encounter various physiological and psychosocial stressors that contributed to poorer sleep health. The influence of gender on sleep outcomes was unclear with mixed evidence. Poorer sleep outcomes were reported in ethnic minorities and gender and sexual minorities, with minority stress being a key mechanism. However, there was a dearth of evidence exploring sleep in gender and sexual minority adolescents. Population-based interventions such as delaying school times have been reported to improve adolescent sleep outcomes. However, there is a limited evidence base for school-based and digital interventions. <h3>Conclusion</h3> Disparities in adolescent sleep health can contribute to disparities in health behaviours, daily functioning, and general health. Sociodemographic determinants like age, gender, ethnicity, gender and sexual minority status and socioeconomic status influence adolescent sleep health, with exposure to external stressors being a key mechanism. Moreover, these sociodemographic factors can interact with each other to compound sleep health inequalities. Given that adolescent sleep is influenced by factors beyond individual control, the current focus on sleep hygiene practices alone may not adequately address the influence of an adolescent’s circumstances and existing inequalities on their ability to maintain good sleep health. Further research is required to effectively address this public health issue, including a focus on interventions that address the wider context of adolescent sleep health. Additionally, sleep in gender and sexual minority adolescents should be a priority for future research.