BACKGROUND: There are few large-scale epidemiologic studies examining the 
associations between sleep problems, gastroesophageal reflux disease (GERD) 
symptoms, lifestyle and food habits and problem behaviors (PB) in adolescents. 
The aim of this study was to evaluate the associations among these factors in 
Japanese adolescents.
METHODS: A cross-sectional survey of 1840 junior high school students was 
carried out using questionnaires. The subjects were classified into PB or normal 
behavior (NB) groups using the Pediatric Symptom Checklist (PSC). The scores of 
the sleep-related factors, sleep bruxism, lifestyle and food habits, and GERD 
symptoms were compared. Logistic regression analysis was used to determine the 
factors related to PB.
RESULTS: Mean subject age was 13.3 ± 1.8 years. The PB group had significantly 
longer sleep latency and higher GERD symptom score (P < 0.001). Furthermore, the 
PB group was significantly more likely to experience absence of the mother at 
dinner time, skip breakfast, and have <30 min of conversation among family at 
dinner time. The PB group had significantly higher frequencies of sleep bruxism, 
difficulty falling asleep within 30 min, nightmares, feeling of low sleep 
quality, daytime somnolence, and daytime lack of motivation. Feelings of low 
sleep quality had the strongest association with PB, with an adjusted odds ratio 
of 12.88 (95% confidence interval: 8.99-18.46).
CONCLUSIONS: PB in adolescents are associated with sleep problems, including 
sleep bruxism, as well as lifestyle and food habits and GERD symptoms.