Chinese adolescents living in rural areas and female adolescents experience a greater burden of poor sleep quality, with mental health and physical fitness appearing as protective factors while BMI, sedentary time, and screen time are risk factors, and these associations are moderated by residence and gender.
One-third of Chinese adolescents exhibited poor sleep quality overall.
Rural adolescents had a significantly higher prevalence of poor sleep quality compared to urban adolescents.
Female adolescents had a significantly higher prevalence of poor sleep quality compared to male adolescents.
BMI, Physical Fitness Index, MVPA, sedentary time, screen time, and mental health scores all significantly affected PSQI global and component scores.
Residence and gender significantly moderated the associations between sleep quality and several health-related factors.
Declining sleep quality among Chinese adolescents is characterized as a nationwide public health concern.
This research suggests that poor sleep is widespread among Chinese teenagers, with about one in three adolescents aged 13–18 experiencing poor sleep quality as measured by a standardized questionnaire called the Pittsburgh Sleep Quality Index. The study of over 5,700 young people found that where teenagers live and their sex matter significantly: teenagers in rural areas and girls were both more likely to report poor sleep compared to their urban and male counterparts. The study also identified several factors that appear to be linked to sleep quality. Being physically fit and having better mental health were associated with better sleep, while having a higher body mass index (BMI), spending more time sitting, and spending more time on screens were associated with worse sleep. Importantly, these relationships were not the same for everyone — the influence of physical fitness, body weight, activity levels, and mental health on sleep differed depending on whether a teenager lived in a rural or urban area and whether they were male or female. This research suggests that efforts to improve adolescent sleep in China may need to be tailored to account for differences between rural and urban environments and between boys and girls. Addressing mental health and promoting physical fitness may be particularly important strategies, while reducing sedentary and screen time could also help. The findings highlight the need for targeted public health approaches rather than one-size-fits-all interventions.
Kang X, Li J, Wu H. (2026). Gender and residential differences in sleep quality among Chinese adolescents aged 13-18 years.. PloS one. https://doi.org/10.1371/journal.pone.0349681