Unraveling factors associated with perceived difficulty in falling asleep in Italian adolescents: The role of personal, familial, and educational influences

Purpose: This study assesses the role of personal, family-related, and school-related factors in adolescence in the perception of the presence of difficulties in falling asleep. Methods: The study used data from the Italian 2022 Health Behavior in School-Aged Children (HBSC) study, focusing on 3201 participants (99.7% of response) from the Italian HBSC sample in Tuscany. Descriptive and hierarchical multivariable logistic regression models including personal, family- and school-related factors were used to assess perceived difficulties in falling asleep as reported by 11-, 13-, 15-, and 17-year-old adolescents. Results: Around 49.7% of the sample was female. Nearly a quarter of the adolescents reported sleep difficulty daily or more than once a week. Females reported significantly higher risk of sleep difficulty (odds ratio (OR) of 1.38, 95% CI 1.1-1.7), as did those with higher levels of perceived school pressure (OR 1.47, 95% CI 1.3-1.6) and lack of student support (OR 1.14, 95% CI 1.0-1.3). Those in the middle level of the Family Affluence and older adolescents reported lower risk of sleep difficulty falling asleep (OR 0.74, 95% CI 0.6-0.9 and 0.46, 95% CI 0.3-0.6, respectively). Conclusion: Since concurrent factors in different settings have shown to influence the expression of sleep problems, integrated intervention strategies should be applied to promote healthy sleep habits among adolescents. Therefore, it is necessary for invest in multidimensional intervention approaches, taking into account all the key stakeholders such as the individual, the family and the school into a more integrated perspective design.