BACKGROUND: Difficulty awakening is a common concern among adolescents and contributes to school absenteeism. Although cross-sectional studies suggest that commuting times, internet usage, and sleep disturbances are associated with school attendance problems, few have specifically focused on adolescents. We aimed to examine the factors contributing to school absenteeism due to difficulty awakening in Japanese high school students. METHODS: In this longitudinal cohort study, data were prospectively collected between 2016 and 2018 from 54 high schools in a prefecture of Western Japan. Tenth-grade students (n = 6,121) without tardiness (n = 5,812) or absences (n = 5,946) at baseline were recruited. The outcome of interest was school absenteeism due to difficulty awakening, which included both tardiness and absences (≥2 days/month). Cox proportional hazards models were used to assess the associations between commuting time and lifestyle factors after adjusting for confounders. RESULTS: The incidence rates of tardiness and absences due to difficulty awakening were 19.3 and 9.6 per 1,000 person-years, respectively. Common risk factors for absenteeism included prolonged internet usage (≥5 h) and dissatisfaction with school. Protective factors for school tardiness included study time and participation in extracurricular sports activities (both ≥2 h). Long commuting time (≥1 h) was associated with a higher risk of school absences. CONCLUSIONS Long commuting times, prolonged internet usage, and poor school satisfaction increased the risk of school absenteeism due to difficulty awakening. Promoting academic engagement and extracurricular activities may help reduce absenteeism. Interventions that increase school satisfaction, such as providing learning opportunities outside of school, supporting extracurricular activities, and improving the school environment, may be effective prevention strategies.
Humans ; Absenteeism ; Japan/epidemiology* ; Adolescent ; Male ; Female ; Prospective Studies ; Schools/statistics & numerical data* ; Students/psychology* ; Longitudinal Studies ; Risk Factors ; Transportation/statistics & numerical data* ; East Asian People