Published online January 3, 2005
PEDIATRICS Vol. 115 No. 1 January 2005, pp. 257-265 (doi:10.1542/peds.2004-0815H)
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SUPPLEMENT ARTICLE

The Relationship Between Reported Sleep Quality and Sleep Hygiene in Italian and American Adolescents

Monique K. LeBourgeois, PhD*, Flavia Giannotti, MD{ddagger}, Flavia Cortesi, MD{ddagger}, Amy R. Wolfson, PhD§ and John Harsh, PhD||

* Department of Psychiatry and Human Behavior, Sleep and Chronobiology Research Laboratory, E. P. Bradley Hospital/Brown Medical School, Providence, Rhode Island
{ddagger} Department of Developmental Neurology and Psychiatry, Center of Pediatric Sleep Disorders, University of Rome "La Sapienza," Rome, Italy
§ Department of Psychology, College of the Holy Cross, Worcester, Massachusetts
|| Department of Psychology, University of Southern Mississippi, Hattiesburg, Mississippi

Objective. The purpose of the study was to examine the relationship between self-reported sleep quality and sleep hygiene in Italian and American adolescents and to assess whether sleep-hygiene practices mediate the relationship between culture and sleep quality.

Methods. Two nonprobability samples were collected from public schools in Rome, Italy, and Hattiesburg, Mississippi. Students completed the following self-report measures: Adolescent Sleep-Wake Scale, Adolescent Sleep Hygiene Scale, Pubertal Developmental Scale, and Morningness/Eveningness Scale.

Results. The final sample included 776 Italian and 572 American adolescents 12 to 17 years old. Italian adolescents reported much better sleep hygiene and substantially better sleep quality than American adolescents. A moderate-to-strong linear relationship was found between sleep hygiene and sleep quality in both samples. Separate hierarchical multiple regression analyses were performed on both samples. Demographic and individual characteristics explained a significant proportion of the variance in sleep quality (Italians: 18%; Americans: 25%), and the addition of sleep-hygiene domains explained significantly more variance in sleep quality (Italians: 17%; Americans: 16%). A final hierarchical multiple regression analysis with both samples combined showed that culture (Italy versus United States) only explained 0.8% of the variance in sleep quality after controlling for sleep hygiene and all other variables.

Conclusions. Cross-cultural differences in sleep quality, for the most part, were due to differences in sleep-hygiene practices. Sleep hygiene is an important predictor of sleep quality in Italian and American adolescents, thus supporting the implementation and evaluation of educational programs on good sleep-hygiene practices.

Key Words: adolescence • sleep quality • sleep hygiene • cultural differences

Abbreviations: SES, socioeconomic status • ASWS, Adolescent Sleep-Wake Scale • ASHS, Adolescent Sleep Hygiene Scale • PDS, Pubertal Development Scale • M/E, Morningness/Eveningness

Accepted Aug 5, 2004.


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