Pediatrics · Medical Literature
Insufficient Sleep Among US Adolescents—Reply
Abstract
In Reply In his thoughtful comments on our Research Letter examining trends in insufficient sleep among US adolescents, Dr White raises an important point regarding the comparability of the 2021 and 2023 screen time measures with those used in prior years (2007-2019).
Clinical relevance
This correspondence directly addresses a methodological concern central to interpreting the parent Research Letter (Bommersbach, Olfson, Rhee; JAMA 2026): whether changes in the YRBS screen-time questionnaire wording between 2019 and 2021–2023 compromise the comparability of trend data spanning 2007–2023. The study population encompasses US high school adolescents, a group in which insufficient sleep (defined as <8 hours/night) has reached epidemic proportions—approximately 76.8% by 2023. Clinicians caring for adolescents must interpret sleep-behavior associations with awareness of surveillance instrument heterogeneity, which may affect conclusions about screen-time as a causal driver.
Key findings
1. Prevalence of insufficient sleep ( 30% in 2007 to <25% in 2023, based on YRBS data from approximately 120,950 students. 3. Increases in insufficient sleep were broad-based, observed across all demographic subgroups regardless of age, sex, or race/ethnicity, with Black students showing comparatively greater increases than white students. 4. Very short sleep (≤5 hours/night) was the primary driver of the overall trend, increasing across all behavioral risk subgroups. 5. Insufficient sleep increased as much or more among students without behavioral risk factors (no mental health symptoms, no substance use, low screen time) as among those with risk factors, implicating structural/environmental determinants over individual behavioral ones. 6. A critical methodological caveat identified by Dr. White—and acknowledged in this Reply—is that the 2021 and 2023 YRBS screen-time question differed substantially from the 2007–2019 version, limiting direct comparability of screen-time-stratified sleep trend analyses across the full study period; specific quantitative adjustments or sensitivity analyses are not reported in the available abstract.
Practice implications
Pediatricians and adolescent medicine specialists should counsel all high-school-aged patients about sleep hygiene regardless of behavioral risk profile, as sleep loss is now a population-level phenomenon not confined to at-risk subgroups; later school start times and reduced evening academic or extracurricular demands represent evidence-informed structural interventions worth advocating for at the institutional level. When interpreting research linking screen time to adolescent sleep outcomes, clinicians should scrutinize the screen-time measurement instrument used, as the YRBS questionnaire revision between 2019 and 2021–2023 introduces potential bias that may attenuate or distort observed associations. Until measurement-adjusted analyses are available, clinical guidance should emphasize consistent sleep schedules, limiting pre-sleep light and device exposure, and prioritizing sleep as a core component of adolescent mental and physical health.