Disparities in sleep among diverse adolescents in two large statewide samples: A need for intersectional interventions

Objectives: Examine very short sleep among adolescents across multiple intersecting social positions and experiences of sexual orientation-based bullying and cyberbullying in two statewide samples.

Methods: A harmonization of two large statewide school-based datasets from grades 9-12 (2019 Minnesota Student Survey, and 2018-2019 California Healthy Kids Survey) was utilized for the analysis (N = 379,710). Exhaustive chi-square automatic interaction detection (an approach for quantitative intersectionality research) explored variability in very short sleep (≤5 hours/night) among adolescents from multiple intersecting social positions (race/ethnicity, gender identity, sexual orientation, and sex assigned at birth), grade, state, and two types of bullying experiences (sexual orientation-based bullying and cyberbullying). Intersectional groups reporting the highest prevalence of very short sleep were identified. We compared very short sleep rates among adolescents from the same social positions who experienced bullying with those who did not experience bullying.

Results: Very short sleep was common among this sample of adolescents (19.2%), especially among those holding multiple marginalized social positions (36.9%-51.4%). Adolescents who were transgender or gender diverse or questioning gender identity, and with minoritized sexual and racial/ethnic identities were overrepresented among high prevalence groups of very short sleep. Bullying experiences were reported by all highest prevalence groups. Adolescents who were bullied had 24.9%-51.3% higher rates of very short sleep than adolescents from the same intersecting social positions who were not bullied.

Conclusions: Very short sleep is pervasive among marginalized adolescents. Findings suggest that victimization contributes to adolescents' very short sleep rates. Individual-level interventions may fall short of promoting better sleep among adolescents; systemic interventions addressing bullying are needed.

Clinical trial registration: N/A.