OBJECTIVE: Over the past decade, concurrent with increasing social media use (SMU), there has been a shift toward poorer sleep among adolescents in many countries. The purpose of this study was to examine the cross-national associations between adolescent SMU and sleep patterns, by comparing 4 different categories of SMU (nonactive, active, intense, and problematic use). DESIGN, SETTING, AND PARTICIPANTS: Data were from 86,542 adolescents in 18 European and North American countries that participated in the 2017/18 Health Behaviour in School-aged study. MEASUREMENTS: Mixed-effects linear regression models were used to examine cross-national associations between 4 SMU categories and adolescent sleep duration, bedtime and social jetlag derived from self-reported data. RESULTS: For all countries combined, nonactive SMU was associated with longer sleep, earlier bedtimes, and less social jetlag, compared to active SMU, although the differences were minor. By comparison, intense and problematic SMU were associated with less sleep and later bedtimes on both school and nonschool days, and greater social jetlag, compared to active SMU. While findings were relatively consistent between countries, some differences were observed, suggesting that the national and cultural context may be important in interpreting results. CONCLUSIONS: These findings suggest that both intense and problematic SMU are associated with poorer sleep patterns in adolescents across most countries. Further research is needed to identify effective policies, programs, and messaging to promote the healthy use of social media and prevent potential negative impacts on adolescent sleep.

Department of Developmental and Social Psychology University of Padova Padova Italy

Department of Educational Counselling The Max Stern Academic College of Emek Yezreel Emek Yezreel Israel

Department of Public Health and Epidemiology Institute of Public Health Riga Stradins University Riga Latvia

Department of Public Health and Epidemiology Riga Stradins University Riga Latvia

Faculty of Sport and Health Sciences University of Jyvaskyla Jyvaskyla Finland

Interdisciplinary Social Science Utrecht University Utrecht The Netherlands

MRC CSO Social and Public Health Sciences Unit University of Glasgow Glasgow UK

National Institute of Public Health Ljubljana Slovenia

Olomouc University Social Health Institute Palacky University Olomouc Olomouc Czech Republic

Public Health Agency of Canada Ottawa Canada

Public Health Agency of Canada Ottawa Canada; Department of Social and Preventive Medicine School of Public Health University of Montreal Montreal Canada

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