Sleep Duration and Injury-Related Risk Behaviors Among High School Students — United States, 2007–2013

Abstract

Insufficient sleep is common among high school students and has been associated with an increased risk for motor vehicle crashes (1), sports injuries (2), and occupational injuries (3). To evaluate the association between self-reported sleep duration on an average school night and several injury-related risk behaviors (infrequent bicycle helmet use, infrequent seatbelt use, riding with a driver who had been drinking, drinking and driving, and texting while driving) among U.S. high school students, CDC analyzed data from 50,370 high school students (grades 9-12) who participated in the national Youth Risk Behavior Surveys (YRBSs) in 2007, 2009, 2011, or 2013. The likelihood of each of the five risk behaviors was significantly higher for students who reported sleeping ≤7 hours on an average school night; infrequent seatbelt use, riding with a drinking driver, and drinking and driving were also more likely for students who reported sleeping ≥10 hours compared with 9 hours on an average school night. Although insufficient sleep directly contributes to injury risk, some of the increased risk associated with insufficient sleep might be caused by engaging in injury-related risk behaviors. Intervention efforts aimed at these behaviors might help reduce injuries resulting from sleepiness, as well as provide opportunities for increasing awareness of the importance of sleep. The national YRBS monitors health-risk behaviors among students in public and private high schools and is conducted by CDC in the spring of odd-numbered years. Each national YRBS uses an independent, three-stage cluster sample design to obtain a nationally representative sample of students in grades 9-12. The overall response rates* were 68% in 2007, 71% in 2009, 71% in 2011, and 68% in 2013, and sample sizes ranged from 13,583 (2013) to 16,410 (2009). † Students * Overall response rate = (number of participating schools/number of eligible sampled schools) × (number of usable questionnaires/number of eligible students sampled). † Data users manuals (http://www.cdc.gov/healthyyouth/yrbs/data/index.htm). completed the anonymous, self-administered questionnaires during a single class period. The combined analytic sample was composed of 50,370 high school students who responded to questions about sleep duration on an average school night (≤4 hours, 5 hours, 6 hours, 7 hours, 8 hours, 9 hours, ≥10 hours); demographic characteristics (sex, grade, and race/ethnicity); and how frequently they used a bicycle helmet (among students who had ridden a bicycle during the past 12 months; responses = never or rarely versus sometimes, most of the time, or always); wore a seatbelt when riding in a car driven by someone else (never or rarely versus sometimes, most of the time, or always); rode in a car or other vehicle with a driver who had been drinking alcohol (i.e., rode with a drinking driver; at least one time during the INSIDE