Screen time, BMI, and mental health may be linked to sleep quality in Chinese adolescents

A teen’s mental health, as well as their body mass index (BMI) and screen time, are significantly associated with their sleep quality, according to a new paper published June 10, 2026 in the open access journal PLOS One by Jianying Li of Shanxi University, China, and colleagues. The study also found that girls and adolescents living in more rural areas tend to have lower sleep quality.

Sleep quality is increasingly recognized as a critical lifestyle determinant of physical and mental health during adolescence, yet declining sleep quality among adolescents has become a growing public health concern. Factors such as screen use, sedentary behavior, and mental health problems have been linked to poor sleep in young people, but there were few systematic evaluations of how these factors interact with residential location and gender. In China, specifically, improving sleep quality and mental health has become a mainstream focus of the government, with programs like Healthy China 2030 prioritizing sleep duration and the National Health Commission designating 2025-2027 as Years of Pediatric and Mental Health Services.

In the new study, researchers surveyed 5,713 adolescents aged 13 to 18 years across six cities in China: Shanghai, Suzhou, Taiyuan, Wuyuan, Xingyi, and Urumqi. They collected data on sleep quality using the Pittsburgh Sleep Quality Index (PSQI), as well as data on BMI, physical fitness, sedentary time, screen time, and mental health. Data was also available on each participant’s residential location (urban or rural) and their gender.

Overall, 33.71% of participants had poor sleep quality. Mental health emerged as the strongest protective factor, with higher mental health scores associated with lower risk of poor outcomes across all sleep measures. Higher BMI, more sedentary time, and more screen time were associated with greater odds of poor sleep outcomes.

The researchers also found significant disparities by residence and gender. Rural adolescents had higher rates of poor sleep quality than their urban peers (35.78% vs. 31.90%, p<0.001), and fared worse on sleep latency, sleep duration, and sleep disturbances. Female adolescents fared worse than males across nearly all sleep measures, with 38.40% of girls classified as having poor sleep quality compared with 29.20% of boys (p<0.001). Rurality and gender also moderated how strongly behavioral and health factors affected sleep: the adverse effects of higher BMI on sleep were more pronounced in girls, while the protective effects of good mental health were stronger among rural adolescents.

The study is limited by its cross-sectional design, which does not allow causal conclusions. Sleep quality and behavioral indicators were assessed by self-report, which could have introduced bias, and nuances in the daily timings of sleep, screen time, and sedentary time were not available.

The researchers conclude that Chinese adolescents living in rural areas and female adolescents may experience a greater burden of poor sleep quality, and that addressing screen time, BMI, and mental health might be key to improving sleep across the adolescent population.

***

Press preview: https://plos.io/3QbTCJa

In your coverage, please use this URL to provide access to the freely available article in PLOS One: https://plos.io/4u39onA

Citation: Kang X, Li J, Wu H (2026) Gender and residential differences in sleep quality among Chinese adolescents aged 13–18 years. PLOS One 21(6): e0349681. https://doi.org/10.1371/journal.pone.0349681

Author countries: China

Funding: The author(s) received no specific funding for this work.

About PLOS

PLOS is a non-profit organization on a mission to drive open science forward with measurable, meaningful change in research publishing, policy, and practice. We believe in a better future where science is open to all, for all.

PLOS journals cover all scientific disciplines across life, health, and sustainability. All of our journals are peer reviewed and follow a rigorous editorial screening and assessment process. PLOS journals have a range of publication metrics available.

We place scientific rigor and integrity at the center of everything that we do. All contributors to our journals must follow best practices for authorship and publication ethics, comply with our research ethics policies, and agree to uphold our codes of conduct. 

PLOS WeChat: https://mp.weixin.qq.com/s/AXuXZh8wr8bm2I4nFL2h7QI

About PLOS One

PLOS One accepts research in over two hundred subject areas across science, engineering, medicine, and the related social sciences and humanities. We evaluate research on the basis of scientific validity, strong methodology, and high ethical standards, selecting for research that contributes to academic knowledge.

We encourage inter-and multidisciplinary studies, and accept a range of submissions from primary research to protocols and systematic reviews, including research with negative or null results.

As PLOS One marks its 20th anniversary, explore how the journal continues to advance rigorous, open research across disciplines: https://plos.io/3P8QiOz

Media and Copyright Information

For information about PLOS One relevant to journalists, bloggers and press officers, including details of our press release process and embargo policy, visit https://plos.org/media/. 

PLOS journals publish under a Creative Commons Attribution License, which permits free reuse of all materials published with the article, so long as the work is cited. 

­­Disclaimer

This press release refers to upcoming articles in PLOS One. The releases have been provided by the article authors and/or journal staff. Any opinions expressed in these are the personal views of the contributors, and do not necessarily represent the views or policies of PLOS. PLOS expressly disclaims any and all warranties and liability in connection with the information found in the release and article and your use of such information.