{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T14:23:30Z","timestamp":1790087010105,"version":"4.0.1"},"reference-count":31,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2021,1,30]],"date-time":"2021-01-30T00:00:00Z","timestamp":1611964800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>This study aimed at investigating the sleep status and its associated factors in Shaanxi province, China. We conducted a cross-sectional study among 11,399 subjects in Shaanxi Province, China. Data were collected via spot field questionnaire surveys. The contents included demographic characteristics, sleep status, lifestyles, disease history and other associated factors. Logistic regression analysis was used to estimate the effect of associated factors on sleep quality. A total of 11,036 subjects were included in the final analysis. In total, 12.8% of the participants had bad or very bad sleep. In the last month, 8.4% of the participants had difficulty in initiating sleep, 7.6% of the participants had difficulty in maintaining sleep, 8.8% of the participants suffered from awakening earlier and 10.3% of the participants had the problem of feeling sleepy during the day \u22653 times per week. Poorer sleep quality was associated with being female, being unmarried or without cohabiting with a boyfriend\/girlfriend, being divorced or widowed, heart diseases, musculoskeletal diseases, concerns about their own health, drinking alcohol, taking hypnotics, and a longer daily screen time. Better sleep quality was associated with medium education level, high family monthly income, good self-reported health status, and having breakfast regularly. In conclusion, more than one in ten people did not sleep well and suffered from different sleep problems in Shaanxi, China. Sleep quality was associated with sex, marital status, educational level, family monthly income, heart disease, musculoskeletal diseases, degree of concerning about their own health, self-reported health status, drinking alcohol, having breakfast, taking hypnotics and daily screen time.<\/jats:p>","DOI":"10.3390\/ijerph18031250","type":"journal-article","created":{"date-parts":[[2021,1,30]],"date-time":"2021-01-30T08:56:01Z","timestamp":1611996961000},"page":"1250","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":13,"title":["Sleep Status and the Associated Factors: A Large Cross-Sectional Study in Shaanxi Province, China"],"prefix":"10.3390","volume":"18","author":[{"given":"Yaxuan","family":"Zhang","sequence":"first","affiliation":[{"name":"School of Public Health, Fudan University, Shanghai 200032, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiwei","family":"Wang","sequence":"additional","affiliation":[{"name":"School of Public Health, Fudan University, Shanghai 200032, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xinyuan","family":"Lu","sequence":"additional","affiliation":[{"name":"School of Public Health, Fudan University, Shanghai 200032, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Beibei","family":"Che","sequence":"additional","affiliation":[{"name":"School of Public Health, Fudan University, Shanghai 200032, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jinming","family":"Yu","sequence":"additional","affiliation":[{"name":"School of Public Health, Fudan University, Shanghai 200032, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,1,30]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"2726","DOI":"10.1080\/02640414.2019.1662539","article-title":"The effects of a single night of complete and partial sleep deprivation on physical and cognitive performance: A Bayesian analysis","volume":"37","author":"Cullen","year":"2019","journal-title":"J. Sports Sci."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"841","DOI":"10.1016\/j.jacc.2016.11.069","article-title":"Sleep Apnea","volume":"69","author":"Javaheri","year":"2017","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"34","DOI":"10.1111\/obr.12499","article-title":"Sleep-obesity relation: Underlying mechanisms and consequences for treatment","volume":"18","year":"2017","journal-title":"Obes. Rev."},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Steiger, A., and Pawlowski, M. (2019). Depression and Sleep. Int. J. Mol. Sci., 20.","DOI":"10.3390\/ijms20030607"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"529","DOI":"10.2337\/dc14-2073","article-title":"Sleep Duration and Risk of Type 2 Diabetes: A Meta-analysis of Prospective Studies","volume":"38","author":"Shan","year":"2015","journal-title":"Diabetes Care"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"483","DOI":"10.1097\/YCO.0000000000000204","article-title":"Sleep and anxiety in late childhood and early adolescence","volume":"28","author":"McMakin","year":"2015","journal-title":"Curr. Opin. Psychiatry"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"387","DOI":"10.1089\/chi.2018.0319","article-title":"Associations between Sleep Pattern and Quality and Cardiovascular Risk Factors among Macao School Students","volume":"15","author":"Lo","year":"2019","journal-title":"Child. Obes."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"243","DOI":"10.1016\/j.psychres.2016.04.011","article-title":"Prevalence and risk factors of poor sleep quality among Inner Mongolia Medical University students: A cross-sectional survey","volume":"244","author":"Wang","year":"2016","journal-title":"Psychiatry Res."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1213","DOI":"10.1007\/s11325-018-1685-8","article-title":"Poor sleep quality and influencing factors among rural adults in Deqing, China","volume":"22","author":"Dong","year":"2018","journal-title":"Sleep Breath."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"134","DOI":"10.1016\/j.sleep.2018.10.031","article-title":"Gender-specific prevalence of poor sleep quality and related factors in a Chinese rural population: The Henan Rural Cohort Study","volume":"54","author":"Wang","year":"2019","journal-title":"Sleep Med."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Wu, W., Wang, W., Dong, Z., Xie, Y., Gu, Y., Zhang, Y., Li, M., and Tan, X. (2018). Sleep Quality and Its Associated Factors among Low-Income Adults in a Rural Area of China: A Population-Based Study. Int. J. Environ. Res. Public Health, 15.","DOI":"10.3390\/ijerph15092055"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"125","DOI":"10.1007\/s40520-019-01171-0","article-title":"Prevalence and associated factors of poor sleep quality among Chinese older adults living in a rural area: A population-based study","volume":"32","author":"Wang","year":"2019","journal-title":"Aging Clin. Exp. Res."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"237","DOI":"10.1016\/j.archger.2012.08.002","article-title":"Characterization and factors associated with sleep quality among rural elderly in China","volume":"56","author":"Li","year":"2013","journal-title":"Arch. Gerontol. Geriatr."},{"key":"ref_14","first-page":"1","article-title":"Guidelines for Prevention and Control of Overweight and Obesity in Chinese Adults","volume":"26","author":"Chen","year":"2004","journal-title":"Acta Nutr. Sin."},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"American Psychiatric Association (2014). Diagnostic and Statistical Manual of Mental Disorders, American Psychiatric Publishing. [5th ed.].","DOI":"10.1176\/appi.books.9780890425596"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"18","DOI":"10.15280\/jlm.2017.7.1.18","article-title":"Behavioral Factors Related to Sleep Quality and Duration in Adults","volume":"7","author":"Shim","year":"2017","journal-title":"J. Lifestyle Med."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"397","DOI":"10.1002\/gps.5035","article-title":"Association of age and gender with anxiety disorders in older adults: A systematic review and meta-analysis","volume":"34","author":"Grenier","year":"2019","journal-title":"Int. J. Geriatr. Psychiatry"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"401","DOI":"10.1016\/j.jpsychores.2013.01.005","article-title":"Testing bidirectional relationships between marital quality and sleep disturbances: A 4-year follow-up study in a Korean cohort","volume":"74","author":"Yang","year":"2013","journal-title":"J. Psychosom. Res."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1002\/gps.2295","article-title":"Incidence and persistence of sleep complaints in a community older population","volume":"25","author":"Fok","year":"2009","journal-title":"Int. J. Geriatr. Psychiatry"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"965","DOI":"10.5665\/SLEEP.1138","article-title":"The Natural History of Insomnia in the Ibadan Study of Ageing","volume":"34","author":"Gureje","year":"2011","journal-title":"Sleep"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"109","DOI":"10.5664\/jcsm.6894","article-title":"Sleep Quality, Sleep Duration, and the Risk of Coronary Heart Disease: A Prospective Cohort Study With 60,586 Adults","volume":"14","author":"Lao","year":"2018","journal-title":"J. Clin. Sleep Med."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"e008552","DOI":"10.1161\/JAHA.118.008552","article-title":"Self-Reported Sleep Duration and Quality and Cardiovascular Disease and Mortality: A Dose-Response Meta-Analysis","volume":"7","author":"Kwok","year":"2018","journal-title":"J. Am. Hear. Assoc."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1385","DOI":"10.1111\/j.1532-5415.2011.03544.x","article-title":"Characteristics of Chronic Pain Associated with Sleep Difficulty in Older Adults: The Maintenance of Balance, Independent Living, Intellect, and Zest in the Elderly (MOBILIZE) Boston Study","volume":"59","author":"Chen","year":"2011","journal-title":"J. Am. Geriatr. Soc."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"536","DOI":"10.1093\/alcalc\/agv046","article-title":"The Association of Alcohol Severity and Sleep Quality in Problem Drinkers","volume":"50","author":"Hartwell","year":"2015","journal-title":"Alcohol Alcohol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"689","DOI":"10.1017\/S1368980017003536","article-title":"Sleep indices and eating behaviours in young adults: Findings from Project EAT","volume":"21","author":"Ogilvie","year":"2018","journal-title":"Public Health Nutr."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"nzy074","DOI":"10.1093\/cdn\/nzy074","article-title":"Breakfast Consumption Augments Appetite, Eating Behavior, and Exploratory Markers of Sleep Quality Compared with Skipping Breakfast in Healthy Young Adults","volume":"2","author":"Gwin","year":"2018","journal-title":"Curr. Dev. Nutr."},{"key":"ref_27","first-page":"46","article-title":"Sleep Quality in Medical Students; the Impact of Over-Use of Mobile CellPhone and Social Networks","volume":"16","author":"Mohammadbeigi","year":"2016","journal-title":"J. Res. Health Sci."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"50","DOI":"10.1016\/j.smrv.2014.07.007","article-title":"Screen time and sleep among school-aged children and adolescents: A systematic literature review","volume":"21","author":"Hale","year":"2015","journal-title":"Sleep Med. Rev."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"srep43690","DOI":"10.1038\/srep43690","article-title":"Gender and Regional Differences in Sleep Quality and Insomnia: A General Population-based Study in Hunan Province of China","volume":"7","author":"Tang","year":"2017","journal-title":"Sci. Rep."},{"key":"ref_30","first-page":"433","article-title":"A Survey on Sleep Quality of the People Aged over 18 in Liaoning Province","volume":"8","author":"Xiaoli","year":"2013","journal-title":"Jian Kang Jiao Yu Yu Jian Kang Cu Jin"},{"key":"ref_31","first-page":"498","article-title":"Sleep status of adult residents aged 18-64 in 15 provinces (autonomous regions or municipalities) of China in 2015","volume":"3","author":"Chang","year":"2020","journal-title":"Wei Sheng Yan Jiu"}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/18\/3\/1250\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T05:17:36Z","timestamp":1760159856000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/18\/3\/1250"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,1,30]]},"references-count":31,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2021,2]]}},"alternative-id":["ijerph18031250"],"URL":"https:\/\/doi.org\/10.3390\/ijerph18031250","relation":{"has-preprint":[{"id-type":"doi","id":"10.21203\/rs.3.rs-55325\/v1","asserted-by":"object"}]},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,1,30]]}}}