Prevalence of physical activity, sedentary screen time, and sleep duration among non-Saudi adolescents in Saudi Arabia: a cross-sectional study

Background Non-Saudi residents constitute nearly 44% of Saudi Arabia’s population, yet non-Saudi adolescents have been almost entirely absent from national school-health surveillance, including studies using the Global School-based Student Health Survey (GSHS). This study aimed to determine the prevalence of physical activity, sedentary screen time, and sleep duration among non-Saudi adolescents across five Saudi cities, and to examine variation by sex and city of residence. Methods A cross-sectional survey using a modified, Arabic-translated GSHS questionnaire was administered to students in 40 public intermediate schools across Riyadh, Jeddah, Dammam, Khamis Mushait, and Tabuk. This analysis was restricted to non-Saudi students with complete data ( n = 1,036). Physical activity (linear regression) and three binary outcomes, 7-day activity attainment, high sedentary screen time, and very short sleep (logistic regression) were each modeled with sex, city of residence, and age as simultaneous covariates, using cluster-robust standard errors to account for students nested within 36 schools. Adjusted estimates and 95% confidence intervals are reported, with a Bonferroni-corrected threshold (α = 0.006) applied across eight tests (sex and city for each of four outcomes). Results Only 14.0% of participants reported ≥60 min of physical activity on all 7 days, 26.8% reported no active days, 48.9% reported high sedentary screen time, and 37.1% reported very short sleep duration (≤6 h, below the 8–10 h recommended for this age group). After adjustment for city, age, and school clustering, males reported more physical activity days than females (adjusted mean difference = 0.66 days/week, 95% CI 0.23–1.09, p = 0.003) and were less likely to report very short sleep (aOR = 0.59, 95% CI 0.47–0.74, p < 0.001); both associations survived Bonferroni correction. Males were also more likely to report ≥60 min of activity on all 7 days (aOR = 1.55, p = 0.035) and less likely to report high sedentary screen time (aOR = 0.74, p = 0.012), but neither survived correction. City of residence was not significantly associated with physical activity days, high sedentary time, or very short sleep, but showed a nominally significant, non-corrected association with 7-day activity attainment (driven by Dammam vs. Riyadh). Older age was independently associated with fewer physical activity days (adjusted difference = −0.14 days/year, p = 0.036). Conclusion Physical inactivity, high sedentary screen time, and very short sleep were common among non-Saudi adolescents attending public schools in Saudi Arabia. Sex differences were robust for physical activity days and short sleep, while differences in 7-day activity attainment and sedentary time were smaller and did not survive correction for multiple comparisons. City of residence contributed little to this variation. These findings, among the first population-specific estimates for this substantial and previously understudied group, support further surveillance and consideration of non-Saudi students in school health programming; the effectiveness of sex-specific interventions should be evaluated in future research rather than assumed from these cross-sectional findings.