Screen Use and Sleep Habits among Secondary School Students: A Cross-Sectional Study

Abstract

Background: Adolescence is a critical period of growth and development during which adequate sleep is essential for cognitive performance, emotional regulation, physical health, and overall well-being. Increasing exposure to smartphones, social media, and evening screen-based activities may further contribute to sleep disruption.

Objective: To assess sleep duration and sleep quality among secondary school students and determine their association with screen exposure, smartphone use, late-night studying, academic workload, physical activity, caffeine consumption, and perceived stress.

Methods: A school-based cross-sectional study was conducted in Karak, Pakistan, among 500 students aged 14–18 years selected from randomly chosen secondary schools using multistage cluster sampling. Data were collected using a structured questionnaire covering demographic characteristics, technology use, academic and lifestyle behaviors, and sleep patterns. Subjective sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI), with a PSQI score >5 indicating poor sleep quality. Descriptive statistics, independent-samples t-tests, chi-square tests, correlation analysis, multiple linear regression, and multivariable logistic regression were performed. Adjusted beta coefficients, odds ratios (ORs), 95% confidence intervals (CIs), and p-values were reported, with statistical significance defined as p<0.05.

Results: The mean age of participants was 15.8 ± 1.2 years, and females comprised 54.0% of the sample. Mean school-night sleep duration was 6.8 ± 1.1 hours, compared with 8.5 ± 1.2 hours on weekends (p<0.001), while only 15.0% of students achieved ≥8 hours of sleep on school nights. Poor sleep quality (PSQI >5) was identified in 35.0% of participants. Technology exposure was substantial, with mean total screen time of 5.1 ± 1.9 hours/day and evening screen exposure after 9:00 pm of 2.5 ± 1.0 hours. Smartphone use within 30 minutes of sleep was reported by 68.8%, while 60.0% used smartphones in bed and 72.2% kept their smartphone beside the bed during sleep. Evening screen time was inversely correlated with sleep duration (r=−0.42, p<0.001) and positively correlated with PSQI score (r=0.39, p<0.001). In multivariable linear regression, evening screen time (β=−0.30, p<0.001), smartphone use in bed (β=−0.42, p=0.001), social media use (β=−0.14, p=0.006), late-night studying (β=−0.20, p=0.014), high academic workload (β=−0.25, p=0.025), and high perceived stress (β=−0.31, p=0.012) were independently associated with shorter sleep duration. In logistic regression, high perceived stress (AOR=2.42, 95% CI: 1.56–3.76, p<0.001) and evening screen exposure ≥2 hours (AOR=2.31, 95% CI: 1.51–3.53, p<0.001) were the strongest independent predictors of poor sleep quality. Smartphone use in bed, social media use, high academic workload, and evening caffeine consumption were also associated with increased odds of poor sleep quality, whereas regular physical activity was associated with lower odds (AOR=0.64, 95% CI: 0.41–0.99, p=0.046).

Conclusion: Insufficient sleep and poor sleep quality were common among secondary school students, with substantial differences between school-night and weekend sleep duration. Evening screen exposure, bedtime smartphone use, late-night studying, academic workload, and perceived stress emerged as important modifiable factors associated with adverse sleep outcomes. School- and family-based interventions promoting healthy sleep hygiene, limiting evening technology exposure, encouraging regular physical activity, managing academic workload, and addressing psychosocial stress may help improve adolescent sleep health.