IMPORTANCE: Sleep problems are common in adolescence and are associated with poorer mental and physical health. Parental factors may be associated with adolescent sleep, providing potential targets for sleep health interventions. Whether these associations are mediated through emotional regulation and screen use and whether they vary by adolescent sex remain unclear.
OBJECTIVE: To investigate prospective associations between modifiable parental factors and sleep outcomes among adolescents 4 years later, with examination of the mediating roles of screen use and emotional regulation and the moderating role of adolescent sex.
DESIGN, SETTING, AND PARTICIPANTS: This preregistered prospective cohort study collected data from 3 waves (ages 9-11 [wave 1], ages 12-13 [wave 2], and ages 13-14 years [wave 3]) in the US-based Adolescent Brain Cognitive Development (ABCD) Study from June 1, 2016, to October 15, 2018. Data were analyzed from February 20 to November 13, 2024. Participants include a nationally representative sample of 3419 youths with sleep data available at wave 3.
EXPOSURES: Parental factors, mediating variables (emotional regulation and screen use), and the moderator variable (adolescent sex).
MAIN OUTCOMES AND MEASURES: Adolescent duration, timing, chronotype, quality, and regularity of sleep were assessed using actigraphy or questionnaires at wave 3.
RESULTS: Among 3419 adolescents included in the analysis (1806 [52.8%] male; mean [SD] age, 9.49 [0.50] years), greater parental monitoring was associated with better sleep quality (β = 0.04; 95% CI, 0.01-0.07; P = .04). Higher family conflict was associated with later chronotype (β = 0.04; 95% CI, 0.01-0.08; P = .04) and poorer sleep quality (β = -0.04; 95% CI, -0.07 to -0.01; P = .04). Parental psychopathology was associated with later sleep timing (β = 0.06; 95% CI, 0.02-0.11; P = .03), later chronotype (β = 0.06; 95% CI, 0.03-0.09; P = .01), and poorer sleep quality (β = -0.29; 95% CI, -0.31 to -0.26; P < .001). Adolescent screen use partially mediated most of these associations, while the mediating role of emotional regulation was limited to sleep quality. Sex moderated the association between parental warmth and earlier chronotype in girls (β = -0.14; 95% CI, -0.22 to -0.06; P = .007).
CONCLUSIONS AND RELEVANCE: In this prospective study of the ABCD cohort, modifiable parental factors in early adolescence were associated with specific adolescent sleep outcomes 4 years later, with screen use and emotional regulation serving as mediators. Adolescent sex moderated the association between parental warmth and sleep chronotype. These findings highlight potential targets for evidence-based interventions to improve adolescent sleep health.
