Exploring Sleep Outcomes in Youth Across Settings: Are There Differences Based on Rurality or Medically Underserved Status in the ECHO Cohort?

ORCID

Lancaster: https://orcid.org/0000-0001-7556-743X

MSU Affiliation

College of Arts and Sciences; Department of Psychology

Creation Date

2026-01-15

Abstract

Objective: To evaluate associations between rurality and medically underserved status with sleep outcomes (e.g., duration, bed and wake times, latency) among youth in the United States. Methods: The study sample included 22,234 youth (aged 1-17 years) from the Environmental influences on Child Health Outcomes (ECHO) Program. Sleep was measured by parent-report questionnaire for children ages 7 and under and child-report for older children. Residential addresses and Federal Information Processing Standards codes were utilized to classify participants into two binary exposure variables: rural vs. nonrural and medically underserved vs. not medically underserved. Differences between groups for each developmental period were compared using t-tests and chi-squared tests. Results: Across children ages 1-12, rural youth went to bed significantly earlier (mean differences [MD] range from 18 to 52 min) and woke earlier (MD range 15-52 min) compared to non-rural youth. Children aged 1-12 living in medically underserved areas were significantly less likely to meet sleep recommendations (MD range 3.2 %-6.6 % less), and youth of all ages tended to have later bedtimes (MD range 7-30 min) compared to youth not living in medically underserved areas. Discussion: This study is novel because it evaluates differences in youth sleep health based on rurality and medically underserved status in the United States. Multiple variations in children's sleep health were identified based on living in medically underserved areas while minimal differences were noted based on rurality. Future research should focus on the development or dissemination of effective programs into pre-established resources (e.g., daycares, community centers) for youth in medically underserved areas.

Publication Date

12-30-2025

Publication Title

Sleep Medicine

Publisher

Elsevier

Creative Commons License

Creative Commons Attribution 4.0 International License
This work is licensed under a Creative Commons Attribution 4.0 International License.

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Digital Object Identifier (DOI)

https://doi.org/10.1016/j.sleep.2025.108754