Abstract
BACKGROUND: Neighborhood disadvantage may adversely affect adolescent sleep health, yet causal evidence is limited and whether these effects differ by sex and pubertal development remain unclear. This study examined the potential causal effect of neighborhood disadvantage on adolescent sleep duration and variability over a two-year period. METHODS: This cohort study analyzed data from 5045 adolescents (mean age 9.96 years at baseline) in the Adolescent Brain Cognitive Development (ABCD) Study, a longitudinal, population-based sample in the United States. Three indicators of neighborhood disadvantage were assessed: Area Deprivation Index (ADI), air pollution, and nighttime noise, each dichotomized at the 80th percentile to indicate high exposure. Sleep outcomes were derived from Fitbit devices worn continuously for 21 days two years after baseline, including sleep duration and night-to-night variability (defined as the standard deviation of sleep duration across nights). Bayesian causal forests were used to estimate average treatment effects (ATEs) and subgroup-specific effects by sex and pubertal status. Analyses adjusted for the propensity to reside in a high-advantage neighborhood, accounting for individual and household factors including income-to-needs ratio, parental education, and race/ethnicity. FINDINGS: Adolescents living in neighborhoods with high ADI (ATE -0.11, 10th percentile: -0.18, 90th percentile: -0.05), high air pollution (ATE -0.08, -0.14 to -0.02), and high nighttime noise (ATE -0.07, -0.13 to -0.01) had shorter sleep duration two years after baseline. High ADI was also associated with greater night-to-night sleep variability (ATE 0.17, 0.10-0.23). Stratified analyses revealed that boys were more susceptible to reduced sleep duration, girls to greater sleep variability, and adolescents with more advanced pubertal status were more affected across both outcomes. INTERPRETATION: Neighborhood disadvantage has lasting adverse effects on adolescent sleep health, with differential vulnerability by sex and pubertal stage. These findings underscore the need for developmentally tailored policies and interventions that address neighborhood environments to promote healthy sleep during adolescence. FUNDING: This study was supported by the National Natural Science Foundation of China, the Fundamental Research Funds for the Central Universities, the National Institute of Mental Health, and the American Foundation for Suicide Prevention.