Intensive online contact, sleep difficulties, and overweight among Swedish adolescents: findings from the 2017/18 and 2021/22 HBSC surveys

Digital media use has increased rapidly among adolescents, raising concerns about its impact on health. Prior evidence suggests that intensive online contact may disrupt sleep and contribute to unhealthy behaviors that increase the risk of being overweight. This study examined associations between intensive online contact, sleep difficulties, and overweight among Swedish adolescents. We analyzed data from the Swedish Health Behaviour in School-aged Children (HBSC) surveys conducted in 2017/18 and 2021/22. The sample included 8,861 students in grades 5, 7, and 9. Intensive online contact was defined as interacting “almost all the time throughout the day” with at least one peer or social group. Outcomes included self-reported sleep difficulties, and overweight defined according to the World Health Organization’s BMI-for-age criteria. Logistic regression models estimated crude and adjusted odds ratios (OR), controlling for sex, grade, family affluence scale, unhealthy food consumption, and vigorous physical activity. Intensive online contact was associated with higher odds of sleep difficulties in both crude (OR = 1.30; 95% CI: 1.16–1.45) and adjusted models (OR = 1.28; 95% CI: 1.14–1.44). Sleep difficulties were also more common in 2021/22 compared with 2017/18. No association was observed between intensive online contact and overweight after adjusting for sex, grade, Family Affluence scale, unhealthy food consumption and vigorous physical activity. (aOR = 0.96; 95% CI: 0.83–1.10). Girls reported more sleep difficulties but had lower odds of being overweight than boys. In this nationally representative sample of Swedish adolescents, intensive online contact was consistently associated with sleep difficulties, but not with overweight. Given evidence from previous studies linking sleep difficulties to overweight, these findings raise the possibility of longer-term implications that cannot be evaluated in cross-sectional analyses. The results align with existing recommendations to limit time spent on digital media use.