Multiple variations in children's sleep health were identified based on living in medically underserved areas while minimal differences were noted based on rurality.
Rural youth ages 1-12 went to bed significantly earlier than non-rural youth.
Rural youth ages 1-12 also woke earlier than non-rural youth.
Children ages 1-12 living in medically underserved areas were significantly less likely to meet sleep recommendations compared to those not living in medically underserved areas.
Youth of all ages living in medically underserved areas tended to have later bedtimes compared to youth not living in medically underserved areas.
Minimal sleep differences were noted based on rurality alone, while medically underserved status was associated with multiple variations in children's sleep health.
The authors recommend future research focus on development or dissemination of effective sleep programs into pre-established community resources for youth in medically underserved areas.
This research examined whether where children live — specifically in rural areas or in areas with limited access to medical care (called 'medically underserved areas') — is related to how well they sleep. The study used data from over 22,000 children and teenagers across the United States, ages 1 to 17, drawn from a large research program called ECHO (Environmental influences on Child Health Outcomes). Sleep information was collected through questionnaires completed by parents for younger children and by the children themselves for older youth. The study found that children ages 1-12 living in rural areas tended to go to bed and wake up earlier than children in non-rural areas — by roughly 15 to 52 minutes — but otherwise showed few significant sleep differences. In contrast, children living in medically underserved areas showed more widespread sleep concerns: they were less likely to get the recommended amount of sleep (by about 3-7 percentage points) and tended to go to bed later across all age groups studied. This suggests that limited access to healthcare and community resources may have a broader impact on children's sleep health than simply living in a rural location. This research suggests that efforts to improve children's sleep should pay particular attention to communities with limited medical resources, not just rural areas. The authors propose that sleep health programs could be integrated into existing community spaces like daycares and community centers, which may already be accessible to families in underserved areas. Better understanding of why medically underserved status is linked to poorer sleep could help guide targeted public health efforts to support children's overall health and development.
Lancaster B, Wallisch A, Knapp E, Li X, McCormack L, Hirko K, et al.. (2026). Exploring sleep outcomes in youth across settings: Are there differences based on rurality or medically underserved status in the ECHO cohort?. Sleep medicine. https://doi.org/10.1016/j.sleep.2025.108754