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Exploration of Sex and Age as Moderators Between Social Cumulative Risk and Sleep in a Representative Sample of Children and Adolescents Living in the United States

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Youth who face adversity are at a disproportionate risk for poor sleep health across the life course. Identifying whether the association between adversity and poor sleep varies based upon age and sex is needed. This study aims to explore sex and age as moderators between social risk and sleep in a sample of U.S. youth.


This study analyzed data of 32,212 U.S. youth (6–17 years) whose primary caregiver participated in the 2017–2018 National Survey of Children’s Health. A social cumulative risk index (SCRI) score was calculated from 10 parental, family, and community risk indicators. Nighttime sleep duration was the number of hours the child slept during the past week. Weeknight sleep irregularity was operationalized as whether the child sometimes/rarely/never went to bed at the same time. Generalized logistic regression models estimated associations between SCRI and sleep duration/irregularity, with age and sex as moderators.


Age moderated the association between SCRI and short sleep (OR = 1.12, p < 0.001), such that the magnitude of the SCRI-sleep relationship was 12% greater in school-age children. Sex was not a significant moderator. In stratified models by age group, age was positively associated with short sleep in both groups, with a greater magnitude in school-age children. Female school-age children were less likely to have short sleep than males.


Younger children with greater social cumulative risk factors may be more vulnerable to short sleep duration. Further research into the mechanisms underlying the relationships between social risk and sleep health in school-age children is needed.

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Data Availability

This manuscript uses secondary data from the publicly available dataset NSCH. Data and materials to replicate the findings here are available at the following URL: The analytic code necessary to reproduce the analyses presented in this paper is available from the second author.


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Dr. Patterson's work was partially supported by the Centers of Biomedical Research Excellence (COBRE) in cardiovascular health (P20GM113125).

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Correspondence to Lauren B. Covington.

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This study was deemed exempt by University of Delaware and Delaware State University Institutional Review Boards. This decision was made in accordance with the ethical stands of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Covington, L.B., Ji, X., Laurenceau, JP. et al. Exploration of Sex and Age as Moderators Between Social Cumulative Risk and Sleep in a Representative Sample of Children and Adolescents Living in the United States. Int.J. Behav. Med. (2023).

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