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Khorrami M, Khorrami F, Haghani K, Fathy Karkaragh F, Khodashenas A, Souri S. Gender differences in sleep quality among Iranian traditional and industrial drug users. Neurobiol Sleep Circadian Rhythms 2024; 17:100104. [PMID: 39070941 PMCID: PMC11283124 DOI: 10.1016/j.nbscr.2024.100104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Revised: 06/20/2024] [Accepted: 06/28/2024] [Indexed: 07/30/2024] Open
Abstract
•The findings emphasize gender differences in sleep quality among different cultures, races, and ethnicities.•There are gender differences in sleep quality in Iranian traditional and industrial drug users.•Industrial drug users have a lower quality of sleep than traditional drug users.•The sleep quality of drug users (traditional and industrial) is lower than that of healthy people.
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Affiliation(s)
- Mohammad Khorrami
- Islamic Azad University, Tehran Science & Research Branch (Isfahan), Isfahan, Iran
| | - Fatemeh Khorrami
- Faculty of Paramedicine, Golestan University of Medical Sciences, Gorgan, Iran
| | - Kosar Haghani
- Department of Social Sciences University of Mazandaran Babolsar, Iran
| | | | - Ayda Khodashenas
- Clinical Psychology, Department of Psychology, Ferdowsi University of Mashhad, Mashhad, Iran
| | - Sara Souri
- General Psychology in Payam Nour University, Branch Amol, Amol, Iran
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Jung J, Fenelon A. Do later school start times improve adolescents' sleep and substance use? A quasi-experimental study. Prev Med 2024; 185:108028. [PMID: 38849057 PMCID: PMC11269004 DOI: 10.1016/j.ypmed.2024.108028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Revised: 06/01/2024] [Accepted: 06/03/2024] [Indexed: 06/09/2024]
Abstract
OBJECTIVE A later school start time policy has been recommended as a solution to adolescents' sleep deprivation. We estimated the impacts of later school start times on adolescents' sleep and substance use by leveraging a quasi-experiment in which school start time was delayed in some regions in South Korea. METHODS A later school start time policy was implemented in 2014 and 2015, which delayed school start times by approximately 30-90 minutes. We applied difference-in-differences and event-study designs to longitudinal data on a nationally representative cohort of adolescents from 2010 to 2015, which annually tracked sleep and substance use of 1133 adolescents from grade 7 through grade 12. RESULTS The adoption of a later school start time policy was initially associated with a 19-minute increase in sleep duration (95% CI, 5.52 to 32.04), driven by a delayed wake time and consistent bedtime. The policy was also associated with statistically significant reductions in monthly smoking and drinking frequencies. However, approximately a year after implementation, the observed increase in sleep duration shrank to 7 minutes (95% CI, -12.60 to 25.86) and became statistically nonsignificant. Similarly, the observed reduction in smoking and drinking was attenuated a year after. CONCLUSIONS Our findings suggest that policies that increase sleep in adolescents may have positive effects on health behaviors, but additional efforts may be required to sustain positive impacts over time. Physicians and education and health policymakers should consider the long-term effects of later school start times on adolescent health and well-being.
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Affiliation(s)
- Jilli Jung
- Department of Education Policy Studies, Pennsylvania State University, PA, USA.
| | - Andrew Fenelon
- School of Public Health, University of Minnesota-Twin Cities, MN, USA
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Mmethi TG, Modjadji P, Mathibe M, Thovhogi N, Sekgala MD, Madiba TK, Ayo-Yusuf O. Substance Use among School-Going Adolescents and Young Adults in Rural Mpumalanga Province, South Africa. Behav Sci (Basel) 2024; 14:543. [PMID: 39062366 PMCID: PMC11274307 DOI: 10.3390/bs14070543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2024] [Revised: 06/17/2024] [Accepted: 06/25/2024] [Indexed: 07/28/2024] Open
Abstract
The ongoing public health crisis of substance use among school adolescents and young adults (AYAs) in South Africa is not new in research parlance, amidst the national policy of drug abuse management in schools. In view of no tangible progress to reduce substance use in high schools in the country, we conducted a cross-sectional quantitative study aimed at investigating substance use among adolescents and young adults in the four public high schools selected through multi-stage sampling in rural Mpumalanga province, South Africa. Data on substance use, demographics, household socio-demographics, and related factors were collected via a validated self-administered questionnaire. Hierarchical logistic regression was performed using STATA 18. The study included 402 AYAs aged between 14 and 23 years (18 ± 1 years), and 45% reported substance use in the last twelve months. Alcohol was the most used substance (74%), followed by cigarettes (12%) and cannabis (11%). AYAs used substances out of social influence, curiosity, to find joy, and to eliminate stress, especially in social events, on the streets, and at home, and reported negative physical health outcomes, mainly hallucinations, sleeping disorders, body weakness, and dry mouths. Hierarchical logistic regression showed that the likelihood of substance use was three times in a particular high school (S4) (AOR = 3.93, 95%CI: 1.72-8.99), twice among the grade 12s (AOR = 2.73, 95%CI: 1.46-5.11), over twenty times in the communities with substance availability (AOR = 22.45, 95%CI: 2.75-183.56), almost ten times among AYAs participating in recreational/sports activities (AOR = 9.74, 95%CI: 4.21-22.52), and twice likely to happen in larger households (AOR = 2.96, 95%CI: 1.57-5.58). Prevention and intervention efforts should consider these specific health concerns to develop targeted strategies for mitigating substance use and its adverse consequences in this vulnerable population towards achieving the United Nations' Sustainable Development Goal Target 3.5, which aims to strengthen the prevention and treatment of substance abuse, including narcotic drug abuse and the harmful use of alcohol.
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Affiliation(s)
- Tabeho Godfrey Mmethi
- Department of Public Health, School of Health Care Sciences, Sefako Makgatho Health Sciences University, Pretoria 0208, South Africa; (T.G.M.)
- Department of Community Dentistry, School of Dentistry, University of Pretoria, Pretoria 0208, South Africa
| | - Perpetua Modjadji
- Department of Public Health, School of Health Care Sciences, Sefako Makgatho Health Sciences University, Pretoria 0208, South Africa; (T.G.M.)
- Non-Communicable Diseases Research Unit, South African Medical Research Council, Tygerberg, Cape Town 7505, South Africa
- Department of Life and Consumer Sciences, College of Agriculture and Environmental Sciences, University of South Africa, Roodepoort, Johannesburg 1709, South Africa
- Africa Centre for Tobacco Industry Monitoring and Policy Research (ATIM), School of Health Systems and Public Health, University of Pretoria, Pretoria 0028, South Africa;
| | - Mmampedi Mathibe
- Department of Public Health, School of Health Care Sciences, Sefako Makgatho Health Sciences University, Pretoria 0208, South Africa; (T.G.M.)
| | - Ntevhe Thovhogi
- Non-Communicable Diseases Research Unit, South African Medical Research Council, Tygerberg, Cape Town 7505, South Africa
| | - Machoene Derrick Sekgala
- Non-Communicable Diseases Research Unit, South African Medical Research Council, Tygerberg, Cape Town 7505, South Africa
| | - Thomas Khomotjo Madiba
- Department of Community Dentistry, School of Dentistry, University of Pretoria, Pretoria 0208, South Africa
| | - Olalekan Ayo-Yusuf
- Africa Centre for Tobacco Industry Monitoring and Policy Research (ATIM), School of Health Systems and Public Health, University of Pretoria, Pretoria 0028, South Africa;
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Hasler BP, Schulz CT, Pedersen SL. Sleep-Related Predictors of Risk for Alcohol Use and Related Problems in Adolescents and Young Adults. Alcohol Res 2024; 44:02. [PMID: 38500552 PMCID: PMC10948113 DOI: 10.35946/arcr.v44.1.02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/20/2024] Open
Abstract
PURPOSE Growing evidence supports sleep and circadian rhythms as influencing alcohol use and the course of alcohol use disorder (AUD). Studying sleep/circadian-alcohol associations during adolescence and young adulthood may be valuable for identifying sleep/circadian-related approaches to preventing and/or treating AUD. This paper reviews current evidence for prospective associations between sleep/circadian factors and alcohol involvement during adolescence and young adulthood with an emphasis on the effects of sleep/circadian factors on alcohol use. SEARCH METHODS The authors conducted a literature search in PsycInfo, PubMed, and Web of Science using the search terms "sleep" and "alcohol" paired with "adolescent" or "adolescence" or "young adult" or "emerging adult," focusing on the title/abstract fields, and restricting to English-language articles. Next, the search was narrowed to articles with a prospective/longitudinal or experimental design, a sleep-related measure as a predictor, an alcohol-related measure as an outcome, and confirming a primarily adolescent and/or young adult sample. This step was completed by a joint review of candidate article abstracts by two of the authors. SEARCH RESULTS The initial search resulted in 720 articles. After review of the abstracts, the list was narrowed to 27 articles reporting on observational longitudinal studies and three articles reporting on intervention trials. Noted for potential inclusion were 35 additional articles that reported on studies with alcohol-related predictors and sleep-related outcomes, and/or reported on candidate moderators or mediators of sleep-alcohol associations. Additional articles were identified via review of relevant article reference lists and prior exposure based on the authors' previous work in this area. DISCUSSION AND CONCLUSIONS Overall, the review supports a range of sleep/circadian characteristics during adolescence and young adulthood predicting the development of alcohol use and/or alcohol-related problems. Although sleep treatment studies in adolescents and young adults engaging in regular and/or heavy drinking show that sleep can be improved in those individuals, as well as potentially reducing alcohol craving and alcohol-related consequences, no studies in any age group have yet demonstrated that improving sleep reduces drinking behavior. Notable limitations include relatively few longitudinal studies and only two experimental studies, insufficient consideration of different assessment timescales (e.g., day-to-day vs. years), insufficient consideration of the multidimensional nature of sleep, a paucity of objective measures of sleep and circadian rhythms, and insufficient consideration of how demographic variables may influence sleep/circadian-alcohol associations. Examining such moderators, particularly those related to minoritized identities, as well as further investigation of putative mechanistic pathways linking sleep/circadian characteristics to alcohol outcomes, are important next steps.
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Affiliation(s)
- Brant P Hasler
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Christina T Schulz
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Sarah L Pedersen
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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Tuvel AL, Winiger EA, Ross JM. A Review of the Effects of Adolescent Cannabis Use on Physical Health. Psychiatr Clin North Am 2023; 46:719-739. [PMID: 37879834 DOI: 10.1016/j.psc.2023.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2023]
Abstract
The current review highlights the available research related to cannabis and indicators of physical health in a variety of domains. Various studies have found associations between cannabis use with pulmonary, cardiovascular, gastrointestinal, and endocrine function as well as body mass index and sleep. At this time, more research is needed to understand the influence of cannabis use on physical health, particularly among adolescent samples.
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Affiliation(s)
- Abigail L Tuvel
- Department of Psychology and Neuroscience, University of Colorado Boulder, 1777 Exposition Drive, Boulder, CO 80301
| | - Evan A Winiger
- Department of Psychiatry, School of Medicine, University of Colorado Anschutz Medical Campus, 1890 N Revere Court, Aurora, CO, 80045
| | - J Megan Ross
- Department of Psychiatry, Division of Addiction Sciences, Treatment and Prevention, University of Colorado Anschutz Medical Campus, 1890 N Revere Court, Aurora, CO, 80045.
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Parnes JE, Berey BL, Pielech M, Meisel SN, Padovano HT, Miranda R. Does sleep relate to next-day cannabis use during treatment? Findings from an adolescent and young adult motivational enhancement and cognitive behavioral therapy plus topiramate intervention. Drug Alcohol Depend 2023; 253:111006. [PMID: 37944198 PMCID: PMC10842099 DOI: 10.1016/j.drugalcdep.2023.111006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 10/12/2023] [Accepted: 10/13/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND Interventions for youth cannabis use have limited efficacy. Sleep is likely to affect treatment response, as sleep difficulties are cross-sectionally associated with use and common during treatment. This analysis examined how sleep duration and subjective trouble sleeping related to next-day cannabis use among youth during cannabis treatment. METHOD Participants (N=64) received a psychosocial intervention plus topiramate versus placebo while completing a 6-week ecological momentary assessment study. Time-varying effect modeling (TVEM) examined within- and between-person associations between sleep and cannabis use and how the strength of within-person associations varied over the course of treatment. RESULTS TVEM resvealed that, between-participants, youth with longer average sleep duration used cannabis less often controlling for baseline cannabis use, topiramate, and weekend status. Daily within-person fluctuations in sleep duration and trouble were not associated with use. CONCLUSIONS Findings suggest regularly shorter sleep may impede treatment outcomes. Adolescents who regularly have insufficient sleep durations likely need additional intervention to improve sleep difficulties in tandem with cannabis use reduction.
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Affiliation(s)
- Jamie E Parnes
- Center for Alcohol and Addiction Studies, School of Public Health, Brown University, Providence, RI, USA; E. P. Bradley Hospital, Riverside, RI, USA
| | - Benjamin L Berey
- Center for Alcohol and Addiction Studies, School of Public Health, Brown University, Providence, RI, USA
| | - Melissa Pielech
- Center for Alcohol and Addiction Studies, School of Public Health, Brown University, Providence, RI, USA; Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Samuel N Meisel
- Center for Alcohol and Addiction Studies, School of Public Health, Brown University, Providence, RI, USA; E. P. Bradley Hospital, Riverside, RI, USA
| | - Hayley Treloar Padovano
- Center for Alcohol and Addiction Studies, School of Public Health, Brown University, Providence, RI, USA; Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Robert Miranda
- Center for Alcohol and Addiction Studies, School of Public Health, Brown University, Providence, RI, USA; E. P. Bradley Hospital, Riverside, RI, USA; Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA.
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Goodhines PA, Rathod K. Substance use and sleep health in young adults: Implications for integrated treatment and harm reduction. Sleep Med Rev 2023; 70:101811. [PMID: 37423096 DOI: 10.1016/j.smrv.2023.101811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 06/27/2023] [Indexed: 07/11/2023]
Abstract
In their systematic review and meta-analysis, Meneo and colleagues document distinct substance-sleep effects reported by young adults (ages 18-30) across multidimensional sleep health and different substances used in the naturalistic environment, including alarming rates of self-medication for sleep aid. Key innovations of Meneo et al.'s review include (a) a multidimensional approach to defining sleep health and (b) robust inclusion of various substances commonly used in young adults. Although future research will be essential to clarifying transdiagnostic risk mechanisms, interplay of co-used substances, and the role of expectancies in risk processes, the developing literature reviewed herein may inform much-needed clinical recommendations. This work by Meneo et al should prompt an emphasis on approaching young adult substance use and self-medication through a harm reduction lens, highlighting recommendations for integrated behavioral sleep treatment tailored to stage of change using motivational interviewing.
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Abstract
The current review highlights the available research related to cannabis and indicators of physical health in a variety of domains. Various studies have found associations between cannabis use with pulmonary, cardiovascular, gastrointestinal, and endocrine function as well as body mass index and sleep. At this time, more research is needed to understand the influence of cannabis use on physical health, particularly among adolescent samples.
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Affiliation(s)
- Abigail L Tuvel
- Department of Psychology and Neuroscience, University of Colorado Boulder, 1777 Exposition Drive, Boulder, CO 80301
| | - Evan A Winiger
- Department of Psychiatry, School of Medicine, University of Colorado Anschutz Medical Campus, 1890 N Revere Court, Aurora, CO, 80045
| | - J Megan Ross
- Department of Psychiatry, Division of Addiction Sciences, Treatment and Prevention, University of Colorado Anschutz Medical Campus, 1890 N Revere Court, Aurora, CO, 80045.
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Goodhines PA, Wedel AV, Dobani F, Zaso MJ, Gellis LA, Park A. Cannabis use for sleep aid among high school students: Concurrent and prospective associations with substance use and sleep problems. Addict Behav 2022; 134:107427. [PMID: 35872526 PMCID: PMC9999445 DOI: 10.1016/j.addbeh.2022.107427] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 07/03/2022] [Accepted: 07/05/2022] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Adolescents are at risk for both sleep problems and cannabis use. Despite emerging evidence for college students' self-medication with cannabis to help sleep, generalizability to earlier developmental stages remains unknown. This study remedied this literature gap by characterizing high school students' cannabis sleep aid use in terms of psychosocial correlates and prospective associations with substance use and sleep. METHODS Data were drawn froma longitudinal urban adolescent health behavior study, Project Teen, including 4079th-11thgraders(Year 1 Mage = 16.00 [SD = 1.08, range = 13-19]; 58% female; 41% Black, 22% White, 18% Asian, 17% multiracial,2% Native Hawaiian or other Pacific Islander, 1% American Indian or Alaska Native; 12% Hispanic/Latinx). Students completed two web-based surveys (Minterval = 388.89 days [SD = 27.34]) assessingsubstance use and sleep at Year 1 (Y1) and Year 2 (Y2). RESULTS Students reporting lifetime cannabis sleep aid use (8%) endorsed greater depression and anxiety symptoms at Y1, as well as greater cannabis, alcohol, and cigarette use (but not insomnia symptoms or sleep durations) at Y1 and Y2, compared to non-using peers. Over one year, cannabis sleep aid use was associated with increased cannabis dependence symptoms among students using cannabis, past-2-week binge drinking among students using alcohol, and lifetime cigarette use. However, cannabis sleep aid use was not prospectively associated with changes in insomnia symptoms or sleep durations. CONCLUSIONS Although replication is needed, cannabis sleep aid use among high school students may be associated with exacerbated cannabis dependence symptoms and increased binge drinking and cigarette use over time, without the intended sleep benefit.
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Affiliation(s)
| | - Amelia V Wedel
- Department of Psychology, Syracuse University, Syracuse, NY 13244, USA
| | - Fatima Dobani
- Department of Psychology, Syracuse University, Syracuse, NY 13244, USA
| | - Michelle J Zaso
- Clinical and Research Institute on Addictions, University at Buffalo - The State University of New York, Buffalo, NY, USA
| | - Les A Gellis
- Department of Psychology, Syracuse University, Syracuse, NY 13244, USA
| | - Aesoon Park
- Department of Psychology, Syracuse University, Syracuse, NY 13244, USA.
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Goodhines PA, Desalu JM, Zaso MJ, Gellis LA, Park A. Sleep Problems and Drinking Frequency among Urban Multiracial and Monoracial Adolescents: Role of Discrimination Experiences and Negative Mood. J Youth Adolesc 2020; 49:2109-2123. [PMID: 32860577 PMCID: PMC7487034 DOI: 10.1007/s10964-020-01310-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 08/20/2020] [Indexed: 12/13/2022]
Abstract
Mounting evidence suggests that multiracial adolescents may be at greater risk than their monoracial peers for both sleep problems and alcohol use. However, mechanisms underlying these uniquely-heightened risky health behaviors among multiracial adolescents remain a gap in the literature. This cross-sectional study examined a risk pathway involving discrimination experiences and negative mood underlying racial disparities in concurrent sleep problems and drinking frequency. Students at an urban, socioeconomically-disadvantaged high school (N=414; grades 9–11, Mage=16.00 [SD=1.08]; 57% female; 17% multiracial, 41% Black, 22% White, 18% Asian, 2% Other; 12% Hispanic/Latinx) completed a survey. Path analysis demonstrated that associations of multiracial status with sleep problems (insomnia symptom severity and insufficient weekday sleep duration), but not drinking frequencies (past-year drinking or past-2-week binge-drinking frequencies), were explained by discrimination experiences and, in turn, negative mood. In ancillary analysis excluding White students, the serial indirect risk pathway was significant for both insomnia symptom severity and past-year drinking frequency outcomes. Discrimination experiences and negative mood may function as intermediate factors contributing to racial disparities in adolescent sleep problems, although longitudinal replication is needed.
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Affiliation(s)
| | - Jessica M Desalu
- Department of Psychology, Syracuse University, Syracuse, NY, 13244, USA
| | - Michelle J Zaso
- Department of Psychology, Syracuse University, Syracuse, NY, 13244, USA
- Clinical and Research Institute on Addictions, University at Buffalo, Buffalo, NY, 14203, USA
| | - Les A Gellis
- Department of Psychology, Syracuse University, Syracuse, NY, 13244, USA
| | - Aesoon Park
- Department of Psychology, Syracuse University, Syracuse, NY, 13244, USA.
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Peiper NC, Ridenour TA, Fishbein DH. Characterizing psychiatric symptoms and neurocognitive functioning among substance-naïve early adolescents: Associations with sleep problems. Early Interv Psychiatry 2020; 14:439-449. [PMID: 31468719 PMCID: PMC10576860 DOI: 10.1111/eip.12869] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 07/09/2019] [Accepted: 08/06/2019] [Indexed: 11/30/2022]
Abstract
AIM Evidence consistently links psychiatric symptoms, reduced neurocognitive functioning (NCF) and sleep problems to the initiation of a wide range of risk behaviours. Less is known, however, about the associations between sleep problems with psychiatric symptoms and NCF among early adolescents yet to engage in substance use. METHODS The present study examined baseline data from an ongoing prospective study of 529 youth aged 10-12 years who completed a battery of instruments measuring symptom counts for four psychiatric disorders, performance on six tests of NCF and five types of sleep behaviour on week days. We used latent class analysis to classify the 473 substance-naïve youth into subtypes characterized by probabilistic patterns of psychiatric symptoms and poorer NCF. RESULTS Four subtypes emerged: normative (24% of the sample); nonspecific mental health symptoms (27%); lower neurocognitive function (24%) and comorbid psychiatric symptoms and lower neurocognitive function (25%). In a multivariable latent regression model, three or more sleep arousals per night, sleep phase of two or more hours and sleep latency of 20 minutes or more were significantly associated with the two classes having higher symptom counts. Lack of family support was significantly associated with the two classes having lower neurocognitive function and comorbid psychiatric symptoms. CONCLUSIONS The youth subtypes in this study provide an important baseline characterization to subsequently understand how these neuropsychiatric relationships may change when substance use and other risk behaviours develop during adolescence. Implications for preventing and treating sleep problems associated with psychiatric comorbidity and neurocognitive dysfunctions are discussed.
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Affiliation(s)
- Nicholas C. Peiper
- Louisville Center, Pacific Institute for Research and Evaluation, Louisville, Kentucky
- Department of Epidemiology and Population, Health, University of Louisville, Louisville, Kentucky
| | - Ty A. Ridenour
- Substance Use Prevention, Evaluation, and Research Program, RTI International, Research Triangle Park, North Carolina
- Center for Education and Drug Abuse Research, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Diana H. Fishbein
- Department of Human Development and Family Studies, The Pennsylvania State University, University Park, Pennsylvania
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Widome R, Berger AT, Iber C, Wahlstrom K, Laska MN, Kilian G, Redline S, Erickson DJ. Association of Delaying School Start Time With Sleep Duration, Timing, and Quality Among Adolescents. JAMA Pediatr 2020; 174:697-704. [PMID: 32338727 PMCID: PMC7186915 DOI: 10.1001/jamapediatrics.2020.0344] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
IMPORTANCE Sleep is a resource that has been associated with health and well-being; however, sleep insufficiency is common among adolescents. OBJECTIVE To examine how delaying school start time is associated with objectively assessed sleep duration, timing, and quality in a cohort of adolescents. DESIGN, SETTING, AND PARTICIPANTS This observational cohort study took advantage of district-initiated modifications in the starting times of 5 public high schools in the metropolitan area of Minneapolis and St Paul, Minnesota. A total of 455 students were followed up from grade 9 (May 3 to June 3, 2016) through grade 11 (March 15 to May 21, 2018). Data were analyzed from February 1 to July 24, 2019. EXPOSURES All 5 participating schools started early (7:30 am or 7:45 am) at baseline (2016). At follow-up 1 (2017) and continuing through follow-up 2 (2018), 2 schools delayed their start times by 50 and 65 minutes, whereas 3 comparison schools started at 7:30 am throughout the observation period. MAIN OUTCOMES AND MEASURES Wrist actigraphy was used to derive indices of sleep duration, timing, and quality. With a difference-in-difference design, linear mixed-effects models were used to estimate differences in changes in sleep time between delayed-start and comparison schools. RESULTS A total of 455 students were included in the analysis (among those identifying sex, 225 girls [49.5%] and 219 boys [48.1%]; mean [SD] age at baseline, 15.2 [0.3] years). Relative to the change observed in the comparison schools, students who attended delayed-start schools had an additional mean 41 (95% CI, 25-57) objectively measured minutes of night sleep at follow-up 1 and 43 (95% CI, 25-61) at follow-up 2. Delayed start times were not associated with falling asleep later on school nights at follow-ups, and students attending these schools had a mean difference-in-differences change in weekend night sleep of -24 (95% CI, -51 to 2) minutes from baseline to follow-up 1 and -34 (95% CI, -65 to -3) minutes from baseline to follow-up 2, relative to comparison school participants. Differences in differences for school night sleep onset, weekend sleep onset latency, sleep midpoints, sleep efficiency, and the sleep fragmentation index between the 2 conditions were minimal. CONCLUSIONS AND RELEVANCE This study found that delaying high school start times could extend adolescent school night sleep duration and lessen their need for catch-up sleep on weekends. These findings suggest that later start times could be a durable strategy for addressing population-wide adolescent sleep deficits.
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Affiliation(s)
- Rachel Widome
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis
| | - Aaron T. Berger
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis
| | - Conrad Iber
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, University of Minnesota Medical School, Minneapolis
| | - Kyla Wahlstrom
- Department of Organizational Leadership, Policy and Development, College of Education and Human Development, University of Minnesota, Minneapolis
| | - Melissa N. Laska
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis
| | - Gudrun Kilian
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis
| | - Susan Redline
- Department of Medicine, Brigham and Women’s Hospital and Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Darin J. Erickson
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis
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Berger AT, Wahlstrom KL, Widome R. Relationships between sleep duration and adolescent depression: a conceptual replication. Sleep Health 2019; 5:175-179. [PMID: 30928118 PMCID: PMC7040962 DOI: 10.1016/j.sleh.2018.12.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2018] [Revised: 11/05/2018] [Accepted: 12/04/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVE Given the growing concern about research reproducibility, we conceptually replicated a previous analysis of the relationships between adolescent sleep and mental well-being using a new dataset. METHODS We conceptually reproduced an earlier analysis (Sleep Health, June 2017) using baseline data from the START Study. START is a longitudinal research study designed to evaluate a natural experiment in delaying high school start times, examining the impact of sleep duration on weight change in adolescents. In both START and the previous study, school day bedtime, wake-up time, and answers to a 6-item depression subscale were self-reported using a survey administered during the school day. Logistic regression models were used to compute the association and 95% confidence intervals between the sleep variables (sleep duration, wake-up time, and bedtime) and a range of outcomes. RESULTS In both analyses, greater sleep duration was associated with lower odds (P < .0001) of all 6 indicators of depressive mood. Five of the 6 sleep duration point estimates from the START Study and 4 of the 6 wake-up time point estimates fell within the 95% confidence intervals from the previous analysis. However, the associations between wake-up time and outcomes differed between the 2 studies' analyses. CONCLUSION Our findings add strength to the evidence supporting an association between short sleep duration and depression. This issue deserves attention from school districts given the current epidemic of short sleep duration among youth and the potential impact school scheduling can have on teen sleep.
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Affiliation(s)
- A T Berger
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, 1300 S 2nd St, Suite #300, Minneapolis, MN 55454
| | - K L Wahlstrom
- Department of Organizational Leadership, Policy and Development, 210D Burton Hall, College of Education and Human Development, University of Minnesota, Minneapolis, MN 55455
| | - R Widome
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, 1300 S 2nd St, Suite #300, Minneapolis, MN 55454.
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Millar BM, Parsons JT, Redline S, Duncan DT. What's Sleep Got to Do with It?: Sleep Health and Sexual Risk-Taking Among Men Who have Sex with Men. AIDS Behav 2019; 23:572-579. [PMID: 30267366 DOI: 10.1007/s10461-018-2288-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Emerging evidence links poor sleep health with a range of adverse health behaviors, including condomless anal intercourse (CAI) among men who have sex with men (MSM). We tested associations between a range of sleep health indicators and sex outcomes in an online sample of 559 MSM in Paris France, recruited from a geosocial-networking phone application. Participants reported on sleep quality, sleep duration, problems falling asleep, and problems staying awake during wake-time activities, and four sex outcomes: numbers of receptive, insertive, and total CAI partners in the past three months, and use of substances before or during sex. In bivariate analyses, all four sleep variables were associated with the three CAI outcomes, whereas poor sleep quality and problems falling asleep were positively associated with using substances before or during sex. Most of these associations remained significant when adjusting for various socio-demographic and behavioral covariates. These findings highlight the importance of addressing sleep health to prevent HIV risk among MSM.
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Affiliation(s)
- Brett M Millar
- Center for HIV Educational Studies & Training (CHEST), Hunter College, City University of New York (CUNY), 142 West 36th St, 9th Floor, New York, NY, 10018, USA.
| | - Jeffrey T Parsons
- Center for HIV Educational Studies & Training (CHEST), Hunter College, City University of New York (CUNY), 142 West 36th St, 9th Floor, New York, NY, 10018, USA
- Department of Psychology, Hunter College, CUNY, New York, NY, USA
- Health Psychology and Clinical Science Training Area, Graduate Center, CUNY, New York, NY, USA
| | - Susan Redline
- Department of Medicine, Harvard Medical School, Brigham and Women's Hospital and Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Dustin T Duncan
- Spatial Epidemiology Lab, Department of Population Health, New York University School of Medicine, New York, NY, USA
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School start time effects on adolescent learning and academic performance, emotional health and behaviour. Curr Opin Psychiatry 2017; 30:485-490. [PMID: 28858008 DOI: 10.1097/yco.0000000000000368] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
PURPOSE OF REVIEW The investigation of the relationship between the time of day that school begins and the effects it could have on students began in the mid-1990s. Since that time, many articles have been written either for the medical literature or the educational literature. This review is intended to bridge that gap by examining together the findings for both academic and health outcomes, exploring what we know and what is needed in further investigation. RECENT FINDINGS Teens who are sleep deficient (defined as obtaining less than 8 h per night) because of early starting time for their school are much more likely to engage in risky behaviours, such as drug, cigarette and alcohol use, have significant feelings of depression, get lower grades and are at greater risk for car crashes. Many studies of academic performance and later school start time indicate benefits, although further research is needed to understand the related mechanisms that contribute to improvements in achievement. Recent research in adolescent sleep and outcomes is being shaped by not only measuring sleep duration, but also examining the timing in which sleep occurs. SUMMARY Early school starting time for middle and high students has a clear, deleterious effect on their health and well being. Most recently, sleep deficit in teens is being viewed as a public health issue that needs a wider discussion about its impact and it necessitates improved public education about the sleep phase shift that occurs during adolescence.
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Wahlstrom KL, Berger AT, Widome R. Relationships between school start time, sleep duration, and adolescent behaviors. Sleep Health 2017; 3:216-221. [PMID: 28526260 PMCID: PMC7178613 DOI: 10.1016/j.sleh.2017.03.002] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Accepted: 03/06/2017] [Indexed: 12/27/2022]
Abstract
OBJECTIVES The objectives were 2-fold: (1) to examine how high school start times relate to adolescent sleep duration, and (2) to test associations between sleep duration and mental health- and substance use-related issues and behaviors in teens. DESIGN This study examines selected questions from survey data collected between 2010 and 2013 high school students. SETTING Respondents included more than 9000 students in grades 9 to 12 in 8 high schools in 5 school districts across the United States. MEASUREMENTS The survey instrument is the 97-item Teen Sleep Habits Survey. Logistic regression models were used to calculate adjusted odds ratios and 95% confidence intervals. Because of clustering within schools and the use of repeated measures, generalized estimating equations were used to account for variance inflation. RESULTS Greater sleep duration was associated with fewer reports of various mental health- and substance use-related issues and behaviors (all P values <.01). For instance, for each additional hour of sleep reported, there was a 28% reduction in the adjusted odds of a participant reporting that he or she felt "unhappy, sad, or depressed." Later wake-up times were associated with a reduction in risk for some, but not all factors. Later start times were significantly associated with greater sleep duration. CONCLUSIONS Given that later start times allow for greater sleep duration and that adequate sleep duration is associated with more favorable mental health- and substance use-related issues and behaviors, it is important that school districts prioritize exploring and implementing policies, such as delayed start times, that may increase the amount of sleep of adolescent students, which is needed for their optimal development.
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Affiliation(s)
- Kyla L Wahlstrom
- Department of Organizational Leadership, Policy and Development, 210D Burton Hall, College of Education and Human Development, University of Minnesota, Minneapolis, MN 55455
| | - Aaron T Berger
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, 1300 South 2nd St, Suite #300, Minneapolis, MN 55454
| | - Rachel Widome
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, 1300 South 2nd St, Suite #300, Minneapolis, MN 55454.
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Affiliation(s)
- Brett M. Millar
- Health Psychology & Clinical Science Doctoral Program, The Graduate Center, City University of New York (CUNY), New York, NY, USA
- Center for HIV/AIDS Educational Studies & Training (CHEST), Hunter College, CUNY, New York, NY, USA
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