Adolescent Sleep and Lifestyle: A Citywide Cross-sectional Study of Behavioral and Psychosocial Correlates

Background Adolescence is a critical developmental stage characterized by increased vulnerability to sleep disturbances, which can adversely affect cognitive, emotional, and physical health. Poor sleep has been linked to psychological distress, unhealthy lifestyle behaviors, and impaired academic performance. Despite growing evidence on these associations, population-based data in Mediterranean adolescents remain limited. This study aimed to examine associations between lifestyle habits, psychosocial stress, and sleep-related outcomes in a large, citywide sample of Italian adolescents, to identify modifiable factors that may inform preventive strategies. Methods This cross-sectional study was conducted between March and May 2018 within the SAVe YOUTH project, including all public high schools in Savona, Italy. A total of 2,280 adolescents (mean age = 16.98 ± 1.75 years; 50.1% males) completed a structured survey assessing sociodemographic characteristics, digital media use, substance use, diet, physical activity, and perceived stress. Sleep quality, excessive daytime sleepiness, and chronotype were evaluated through validated self-report measures. Logistic and ordinal regression analyses were applied to explore associations between behavioral and psychosocial variables and sleep outcomes. Results Poor sleep quality affected 52% of adolescents, while 21.6% reported clinically relevant excessive daytime sleepiness and 32.2% exhibited an evening chronotype. Poor sleep was associated with male gender, daily online hours, keeping the phone on at night, cigarette smoking, and school- and family-related stress, positive peer relationships were protective for sleep quality. Excessive daytime sleepiness was linked to daily online hours, alcohol use, and school type, whereas mild school stress was protective. Evening chronotype was associated with daily online hours, smoking, alcohol and cannabis use, and family-related stress.. Conclusions Adolescent sleep health is shaped by modifiable lifestyle factors and psychosocial stressors. These findings underscore the need for school- and family-based interventions targeting digital habits, stress management, and substance use, and support the integration of sleep education within broader adolescent mental health promotion policies.