Sleep Duration, Mental Health, and Increased Difficulty Doing Schoolwork Among High School Students During the COVID-19 Pandemic

Sarah A. Sliwa, PhD; Anne G. Wheaton, PhD; Jingjing Li, MD, PhD, MPH; Shannon L. Michael, PhD, MPH

Prev Chronic Dis. 2023;20(3):E14

Abstract and Introduction

Abstract

We estimated the prevalence of short sleep duration (<8 h/average school night) among high school students (grades 9–12) during the COVID-19 pandemic by using data from the Adolescent Behaviors and Experiences Survey (January–June 2021; N = 7,705). An adjusted logistic regression model predicted prevalence ratios for more difficulty doing schoolwork during the pandemic compared with before the pandemic. Most (76.5%) students experienced short sleep duration, and two-thirds perceived more difficulty doing schoolwork. Students who slept less than 7 hours per school night or experienced poor mental health were more likely to report increased difficulty doing schoolwork. Addressing students' sleep duration could complement efforts to bolster their mental health and learning.

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Abstract and Introduction
Objective
Methods
Results
Discussion
References
Sidebar

Table 1. Analytic Variables Derived from the Adolescent Behaviors and Experiences Survey, United States, January–June 2021
Type	Variable name	Survey item	Variable construction
Primary outcome	More difficulty doing schoolwork during pandemic	Do you agree or disagree that doing your schoolwork was more difficult during the COVID-19 pandemic than before the pandemic started?	More difficulty doing schoolwork: strongly agree or agree vs not sure or disagree or strongly disagree
Primary predictor	Sleep duration	On an average school night, how many hours of sleep do you get?	• ≤4 hours • 5 hours • 6 hours • 7 hours • Meets recommended ≥8 hours (8 hours, 9 hours, or ≥10 hours)
Covariate	Self-reported hunger	During the COVID-19 pandemic, how often did you go hungry because there was not enough food in your home?	Experienced self-reported hunger: always or most of the time or sometimes vs never or rarely
	Poor mental health	During the COVID-19 pandemic, how often was your mental health not good? (Poor mental health includes stress, anxiety, and depression.)	Experienced poor mental health: always or most of the time vs sometimes or rarely or never
	High screen time	On an average school day, how many hours do you spend in front of a TV, computer, smart phone, or other electronic device watching shows or videos, playing games, accessing the Internet, or using social media (also called "screen time")? (Do not count time spent doing schoolwork.)	• High level of screen time (≥5 hours/day)^a • <5 hours/day (<1 hour/day, 1 hour/day, 2 hours/day, 3 hours/day, or 4 hours/day)
	Sex	What is your sex?	• Female • Male
	Grade	In what grade are you?	• 9th grade • 10th grade • 11th grade • 12th grade • Ungraded or other grade
	Race and ethnicity	Developed fromQ4. Are you Hispanic or Latino?Q5. What is your race? (Select 1 or more responses.)	• Hispanic • Non-Hispanic Black • Non-Hispanic White • Non-Hispanic American Indian or Alaska Native; Asian, Native Hawaiian or Other Pacific Islander, and multiracial

^aRather than setting a time limit, the American Academy of Pediatrics recommends placing consistent limits on the time spent using media and the types of media for adolescents and ensuring that media does not take the place of adequate sleep, physical activity, and other behaviors essential to health. From previous studies, we defined high level of screen time by using the largest response category: ≥5 hours per day.

Table 2. Demographic Characteristics, Behaviors, and Experiences of Participants in Adolescent Behaviors and Experiences Survey (ABES) (N = 7,705), United States, January–June 2021 ^a
Characteristic	No. of participants	% (95% CI)
Sex
Female	7,677	50.4 (46.9–53.9)
Male	7,677	49.6 (46.1–53.1)
Race and ethnicity
Hispanic or Latino	7,632	25.4 (20.1–31.6)
Non-Hispanic AIAN, Asian, NHPI, and multiracial		11.9 (8.3–16.9)
Non-Hispanic Black		12.9 (9.3–17.5)
Non-Hispanic White		49.8 (41.5–58.1)
Grade
9	7,682	26.7 (24.0–29.6)
10		25.5 (23.1–28.0)
11		24.3 (22.3–26.4)
12		23.5 (21.2–26.1)
Perceived more difficulty doing schoolwork than before the pandemic started^b	7,171	66.6 (64.5–68.6)
Sleep duration on average school night, h
≤4	7,074	11.6 (9.8–13.7)
5		13.9 (12.5–15.4)
6		24.8 (23.3–26.3)
7		26.2 (24.8–27.6)
≥8 (met sleep recommendation)		23.5 (21.6–25.7)
Experienced self-reported hunger during the COVID-19 pandemic^c	7,181	8.4 (7.2–9.8)
Experienced poor mental health during the COVID-19 pandemic^d	7,207	37.1 (34.6–39.6)
High level of screen time (≥5 h on average school day)^e	7,210	48.6 (46.1–51.2)

Abbreviations: AIAN, American Indian or Alaska Native; NHPI, Native Hawaiian or Other Pacific Islander.
^aNs are unweighted, percentages are weighted.
^bRespondents answered "agree" or "strongly agree."
^cRespondents answered "always," "most of the time," or "sometimes."
^dRespondents answered "always" or "most of the time."
^eHours of screen time encompass time spent "in front of a TV, computer, smart phone, or other electronic device watching shows or videos, playing games, accessing the Internet, or using social media (also called screen time)," not including time spent doing schoolwork.

Table 3. Association Between High School Students' Sleep Duration and Greater Difficulty Doing Schoolwork During the COVID-19 Pandemic — Adolescent Behaviors and Experiences Survey, United States, January–June 2021
Variable	Unadjusted^a,b prevalence ratio (95% CI)	Adjusted^b,c prevalence ratio (95% CI)
Sex
Female	1.08 (1.03–1.13)^d	1.03 (0.98,1.09)
Male	Reference	Reference
Race and ethnicity
Hispanic or Latino	1.06 (1.00–1.13)^d	1.08 (1.01–1.15)^d
Non-Hispanic AIAN, Asian, NHPI, and multiracial	0.99 (0.91–1.09)	0.98 (0.89,1.08)
Non-Hispanic Black	1.03 (0.96–1.11)	1.03 (0.96–1.1)
Non-Hispanic White	Reference	Reference
Grade
9	Reference	Reference
10	1.01 (0.94–1.07)	1.00 (0.94–1.07)
11	0.98 (0.92–1.05)	0.97 (0.90–1.04)
12	1.00 (0.92–1.08)	0.98 (0.91–1.05)
Sleep duration on average school night, h
≤4	1.26 (1.14–1.38)^d	1.20 (1.08–1.33)^d
5	1.21 (1.12–1.31)^d	1.18 (1.09–1.28)^d
6	1.19 (1.10–1.28)^d	1.17 (1.08–1.27)^d
7	1.08 (1.00–1.18)	1.08 (1.00–1.18)
≥8 (met sleep recommendation)	Reference	Reference
Self-reported hunger during the COVID-19 pandemic
Always/most of the time/sometimes	1.11 (1.04–1.19)^d	1.07 (0.99–1.16)
Rarely/never	Reference	Reference
Poor mental health during COVID-19 pandemic
Always/most of the time	1.21 (1.14–1.27)^d	1.17 (1.10–1.25)^d
Sometimes/rarely/never	Reference	Reference
High level of screen time on average school day
Yes (≥5 h)	0.99 (0.95–1.04)	0.95 (0.91–1.00^e)
No (<5 h)	Reference	Reference

Abbreviations: AIAN, American Indian or Alaska Native; NHPI, Native Hawaiian or Other Pacific Islander.
^aModels present prevalence ratios calculated from predicted marginals from univariate logistic regressions. Each row presents the value from a regression model specific to that variable.
^bSample size fluctuates for univariate models and is smaller for the fully adjusted model (N = 6,903) because of missing values.
^cSingle model adjusted for self-reported hunger, poor mental health, screen time, sex, race or ethnicity, and grade.
^d P < .05 as indicated by Wald F test in logistic regression models.
^eNonrounded value is 0.997, P = .03.