Regional contextual influences on short sleep duration: a 50 universities population-based multilevel study in China

BACKGROUND Ecological models have emphasized that short sleep duration (SSD) is influenced by both individual and environmental variables. However, few studies have considered the latter. OBJECTIVES The present study explores the influence of urban and regional contextual factors, net of individual characteristics, on the prevalence of SSD among university students in China. METHODS Participants were 11,954 students, who were identified through a multistage survey sampling process conducted in 50 universities. Individual data were obtained through a self-administered questionnaire, and contextual variables were retrieved from a national database. Multilevel logistic regression models were used to examine urban and regional variations in high and moderate levels of SSD. RESULTS Overall the prevalence of high SSD (<6 hours sleep duration) was 2.8% (95% CI: 1.7%,3.9%) and moderate SSD (<7 hours) 24.7% (95% CI: 19.5%, 29.8%). Multilevel logistic regressions confirmed that home region gross domestic product (GDP) and the university regional unemployment rate were associated with SSD, net of other individual- and city-level covariates. Students attending high-level universities also recorded the highest levels of SSD. Of the individual characteristcs, only mother's occupation and student mental health status were related to SSD. CONCLUSIONS The results of this study add important insights about the role of contextual factors affecting SSD among young adults and indicate the need to take into account both past, as well as present, environmental influences to control SSD.