Family and cultural influences on sleep development

The association between trait mindfulness and sleep problems: A three-level meta-analysis

Trait mindfulness has shown potential in relieving the symptoms related to sleep problems, but the relationship between trait mindfulness and sleep problems varies across studies. To explore this association and obtain reliable estimates, a three-level meta-analysis was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) approach. A comprehensive literature search identified 86 studies involving 87 independent samples and 35,521 participants. A total of 441 effect sizes were analyzed. The study indicated a negative association between trait mindfulness and sleep problems. Furthermore, the meta-analysis revealed significant moderating effects of study design, mindfulness facets, and measurement for trait mindfulness on this relationship. This study suggests that trait mindfulness is closely related to the alleviation of sleep problems. Furthermore, trait mindfulness is vital important in strengthening prevention and intervention measures targeting individuals' sleep problems.

Construction of the Views oN Infant Sleep (VNIS) Questionnaire

Parents' beliefs about infant sleep behaviour vary over time and across cultures. No validated instrument exists to understand parents' pre- and postnatal views on infant sleep behaviours, which may influence their caregiving decisions. The Views oN Infant Sleep Questionnaire (VNIS) will be a tool to assess parents' beliefs in order to facilitate tailored perinatal care, increase the reliability of postnatal self-report measures, allow for cross-cultural comparisons, and provide a baseline for researchers to use in longitudinal studies. We recruited an online sample of 971 female participants who were resident in the United Kingdom, at least 28 weeks pregnant, and at least 18 years of age. The initial questionnaire consisted of 31 questions about infant independence, night-waking, infant feeding, touch, and safety, and items were rated on a 5-point Likert scale. The item pool was reduced to 12 using principal component analysis and a structure was found for the three components "Closeness", "Independence", and "Night-waking". Overall, these results suggest that the VNIS can provide a brief scale to measure different aspects of individuals' beliefs about infant sleep. In further research the VNIS needs to be validated with a confirmatory factor analysis in another sample, and to be tested as a cross-cultural instrument.

The Sleep Environment, Napping, and Sleep Outcomes among Urban Children With and Without Asthma

OBJECTIVES

Children with asthma living in U.S. urban neighborhoods experience increased risk for asthma morbidity and poor sleep outcomes. In addition to asthma, environmental factors (e.g. noise, uncomfortable temperature, light exposure) related to urban poverty may disturb children's sleep. This study examined the association between environmental factors and sleep outcomes among urban children with and without asthma, and whether napping underlies the environment-sleep link. Additionally, the study tested whether these associations differed by health status (i.e. asthma) or race/ethnicity.

METHOD

Participants included urban children aged 7-9 years with (N = 251) and without (N = 130) asthma from Latino, Black, or non-Latino White (NLW) background. Caregivers reported sleep environmental factors and naps. Sleep duration, efficiency, and nightly awakenings were assessed via actigraphy.

RESULTS

Regardless of health status, frequent exposure to noise and light was associated with poorer sleep outcomes only among Latino children. In the full sample with and without asthma, noise exposure during nighttime sleep was related to more frequent daytime naps, which were linked to shorter nighttime sleep duration.

CONCLUSIONS

Exposure to noise and light may play a particularly influential role in shaping urban children's sleep outcomes. Racial/ethnic differences and the potential mediating role of napping in this environment-sleep association may inform tailored interventions.

Association between media use and poor sleep quality among senior high school students: a cross-sectional study

Background : Poor sleep quality (PSQ) is an increasing health problem among adolescents. Mobile phones and portable media devices have become a part of children's lives and may affect their sleep duration and quality. This study aimed to explore the prevalence of PSQ and identify the association between media use and PSQ among adolescents studying in high school grades 10-12. Methods: This cross-sectional study was conducted in central Thailand. A multi-stage sampling technique was used to enroll 777 adolescents from eight schools from August to October 2016. The research instruments comprised factors of demographics and consumption behaviors and the Pittsburgh Sleep Quality Index questionnaire. Multivariable logistic regression was used to calculate adjusted odds ratios (OR adj) and 95% confidence intervals (CI). Results: Prevalence of PSQ was 56.24%. The study subjects were mostly 16-17 years old (67.82%) and female (70.39%). Multivariable logistic regression, after controlling for possible confounders, revealed an increased odds of PSQ among those who used a social media device (OR=1.34, 95%CI=0.97-1.87), and showed a higher proportion of social media use in the PSQ group. Conclusion: A surveillance system to detect media use and PSQ should be conducted accompanied by knowledge sharing on media use among parents, teachers and adolescents. To determine causal relationships, further longitudinal studies will be required to test the association between media users and PSQ. This study may also provide some implications for health promotion on sleep quality of senior high school students.

A systematic review of acculturation and sleep health among adult immigrants in the United States

The United States (US) has more immigrants than any other country in the world, with an estimated 44 million non-US-born individuals residing in the country as of 2018. Previous studies have linked US acculturation to both positive and negative health outcomes, including sleep. However, the relationship between US acculturation and sleep health is not well understood. This systematic review aims to identify and synthesize scientific studies on acculturation and sleep health among adult immigrants in the US. A systematic search of the literature was performed in PubMed, Ovid MEDLINE, and Web of Science in 2021 and 2022 with no date limiters. Quantitative studies published anytime in a peer-reviewed journal in English among an adult immigrant population with an explicit measure of acculturation and a sleep health dimension, sleep disorder, or daytime sleepiness measure were considered for inclusion. The initial literature search yielded 804 articles for review; after removing duplicates, applying inclusion and exclusion criteria, and searching reference lists, 38 total articles were included. We found consistent evidence that acculturative stress was associated with worse sleep quality/continuity, daytime sleepiness, and sleep disorders. However, we discovered limited consensus on the association of acculturation scales and acculturation proxy measures with sleep. Our review demonstrated that compared to US-born adult populations, there is a high prevalence of adverse sleep health among immigrant populations, and acculturation likely plays an important role in shaping this disparity, particularly through acculturative stress.

Sleep Disorders during Adolescence

Sleep disorders during adolescence period increase each year and adversely affect the physical and mental health of adolescents. After-school social activities and various work outside the school may cause delays in bedtime. In addition, there can be shifts in the circadian rhythm due to a number of biological changes seen in the transition to adolescence, which can result in a wide range of sleep problems, such as not being able to fall asleep at night, difficulty waking up in the morning, daytime sleepiness, sleep deprivation and deterioration in sleep quality. It is important to know the causes of sleep disorders, possible effects on physical health and mental health, and protective and risk-forming factors seen in adolescent period; to intervene in these disorders and to develop preventive measures. Preventive measures, such as increasing awareness about sleep disorders in adolescents, informing families and adolescents about the issue, and organizing school start-up times for this age group, may contribute significantly to solving this important issue, which has increased year-to-year.

Relations between bedtime parenting behaviors and temperament across 14 cultures

Objectives

The present study examined parental sleep-supporting practices during toddlerhood in relation to temperament across 14 cultures. We hypothesized that passive sleep-supporting techniques (e.g., talking, cuddling), but not active techniques (e.g., walking, doing an activity together), would be associated with less challenging temperament profiles: higher Surgency (SUR) and Effortful Control (EC) and lower Negative Emotionality (NE), with fine-grained dimensions exhibiting relationships consistent with their overarching factors (e.g., parallel passive sleep-supporting approach effects for dimensions of NE).

Methods

Caregivers (N = 841) across 14 cultures (M = 61 families per site) reported toddler (between 17 and 40 months of age; 52% male) temperament and sleep-supporting activities. Utilizing linear multilevel regression models and group-mean centering procedures, we assessed the role of between- and within-cultural variance in sleep-supporting practices in relation to temperament.

Results

Both within-and between-culture differences in passive sleep-supporting techniques were associated with temperament attributes, (e.g., lower NE at the between-culture level; higher within-culture EC). For active techniques only within-culture effects were significant (e.g., demonstrating a positive association with NE). Adding sleep-supporting behaviors to the regression models accounted for significantly more between-culture temperament variance than child age and gender alone.

Conclusion

Hypotheses were largely supported. Findings suggest parental sleep practices could be potential targets for interventions to mitigate risk posed by challenging temperament profiles (e.g., reducing active techniques that are associated with greater distress proneness and NE).

Maternal Depression and Early Parenting: A Comparison Between Culturally and Linguistically Diverse and Australian born Mothers

OBJECTIVE

To examine the risk of perinatal depression, parenting stress and infant sleep practices in Australian culturally and linguistically diverse (CaLD) women.

METHOD

Within the Mercy Pregnancy and Emotional Wellbeing Study, we examined 487 pregnant women of whom 52 were CaLD and 435 non-CaLD. Depression was measured using the Structured Clinical Interview for DSM-IV and the Edinburgh Postnatal Depression Scale. In addition, Parenting Stress Index and infant sleep measures were collected.

RESULTS

Fewer CaLD women had a depression diagnosis but there were no differences between CaLD and non-CaLD women for perinatal mental health symptoms. More mothers in the CaLD group were bed sharing with their infant during the night at six months; however, bedsharing was only associated with higher parenting stress for non-CaLD mothers.

CONCLUSIONS

Findings suggest both differences in infant sleep parenting practices and in parenting stress but not general emotional wellbeing. Future research is required to replicate these findings.

Culturally-consistent diet among individuals of Mexican descent at the US-Mexico border is associated with sleep duration and snoring

BACKGROUND

Existing studies show that consuming food consistent with one's culture reduces cardiometabolic risk. However, few studies have assessed whether these dietary choices influence sleep health. Accordingly, this study assessed how Mexican food consumption by individuals of Mexican descent residing at the US-Mexico border, was associated with various measures of sleep, after accounting for acculturation.

METHODS

Data were provided by 100 adults between the ages of 18-60, in the city of Nogales, AZ. Questionnaires were provided in either Spanish or English. Acculturation was assessed with the Acculturation Scale for Mexican-Americans (ARSMA-II), with an additional question, asking how often "my family cooks Mexican foods." Frequency of cooking Mexican food was coded as either "yes" or "no." Sleep was assessed, using validated measures that include the Insomnia Severity Index (ISI), the Epworth Sleepiness Scale (ESS), the Pittsburgh Sleep Quality Index (PSQI), and sleep duration with the item "how many hours of actual sleep did you get at night?" Regression models estimated the associations between sleep health variables as outcomes and consumption of Mexican food as the independent variable. Covariates included age, sex, and acculturation scores. Parental education level was also included, as an indicator of childhood socioeconomic status and since food culture likely involves parents.

RESULT

We found that among individuals who identified as Mexican-Americans who consumed culturally-consistent foods, was associated with, on average, 1.41 more hours of sleep (95% CI 0.19, 2.62; p = 0.024) and were less likely to report snoring (OR: 0.25; 95% CI 0.07, 0.93; p = 0.039). Consuming Mexican food was not associated with sleep quality, insomnia severity or sleepiness.

CONCLUSION

Individuals of Mexican descent residing at the US-Mexico border who regularly consumed Mexican food, reported more sleep and less snoring. Mexican acculturation has been shown previously to improve sleep health. This is likely due to consumption of a culturally- consistent diet. Future studies should examine the role of acculturation in sleep health, dietary choices, and subsequent cardiometabolic risk.

Infant Sleep Difficulties at the 6th Week and the 12th Month Postpartum: What Is their Relationship with Maternal Mental Health and Other Perinatal Factors?

INTRODUCTION

Infant sleep difficulties are often a challenge for new parents and may be related to maternal mood.

AIM

The aim of this study was to investigate whether the presence of reported infant sleep difficulties at the 6th week and at the 12th month postpartum is associated with maternal psychological well-being and the presence of a mental health disorder in the perinatal period or with other perinatal factors.

METHODS

It is a retrospective longitudinal study, examining a sample of 622 women who attended a 12-month innovative psychosocial intervention. Data were obtained through the EPDS and PHQ-9 psychometric tools, and the completion of a health history. Statistical analyses included Spearman rank correlation coefficients and Chi-square tests.

RESULTS

Reported infant sleep difficulties at the 6th week postpartum were associated with a) increased maternal scores on psychometric tools (EPDS and PHQ-9) during pregnancy and at the 6th week postpartum, b) the presence of pathological maternal mental health symptoms in the perinatal period (p =.034), c) high maternal educational level (p <.001), and d) reported maternal breastfeeding difficulties at the 6th week postpartum (p =.031). Reported infant sleep difficulties at the 12th month postpartum were associated with a) increased maternal scores on the EPDS at the 6th week after birth (p =.030), and at the 6th (p =.031) and the 12th month (p =.006) postpartum, b) reported infant sleep difficulties (p <.001) and frequent infant awakenings in the puperperium (p <.001), d) maternal fatigue at the 6th week postpartum (p <.001), e) infant gastro-esophageal reflux problems (p <.001), and f) high maternal educational level (p =.001).

CONCLUSIONS

This study demonstrates a positive relationship between infant sleep difficulties at the 6th week and at the 12th months postpartum, with poor maternal mental health in the perinatal period.

A systematic review of prevention and treatment of infant behavioural sleep problems

AIM

The aim of this review was to evaluate the evidence for interventions for behavioural sleep problem in infants.

METHODS

Systematic review based on a search in MEDLINE, Web of Science and PsychINFO in December 2017 for articles published in English during 2007-2017 about preventive and treatment interventions for sleep problems in infants. The review included controlled trials and meta-analyses with at least 20 infants in study groups assessed according to the Grading of Recommendations Assessment, Development and Evaluation criteria.

RESULTS

Out of 476 original articles assessed for eligibility, 12 studies were included in the synthesis. Interventions with behavioural, educational and massage strategies were evaluated. No intervention was evaluated in more than one trial. Five interventions with behavioural methods for establishing consistent routines or controlled crying showed modest short-term effects, while the evidence for elements of education was inconsistent. Studies of massage were of poor quality. Knowledge gaps were identified regarding interventions in cross-cultural context, involving fathers, in children below six months of age, in high-risk populations and consequences of interventions that include extinction.

CONCLUSION

Some support for short-term effects of behavioural treatment strategies was found, but more studies are needed to establish evidence.

Measuring sleep duration in adolescence: Comparing subjective and objective daily methods

OBJECTIVES

This study provides the first investigation into the correspondence between self-reported and actigraph-measured nighttime sleep duration in adolescents that disambiguates between- versus within-person associations. Moderators were evaluated to determine if between- and within-person correspondence vary by participant characteristics.

METHODS

One hundred fifty adolescents (14-21 years) reported sleep time for 1 week, while wearing an actigraph, and reported on moderators, including demographics (i.e., sex, age, ethnicity, and socioeconomic status), depressive symptoms, and perceived stress. Mixed effects models evaluated within- and between-person associations between self-reported and actigraph-measured sleep, and examined whether these associations differed by possible moderators.

RESULTS

Results indicated significant between- (b = 0.77, SE = 0.08, P < .001) and within-person (b = 0.51, SE = 0.04, P < .001) associations between self-reported and actigraph-measured sleep duration, with no significant moderation effects.

CONCLUSIONS

Our results support the use of either self-reports or actigraphs to examine within-person nighttime sleep duration in adolescent community samples.

Sleep and Organizational Behavior: Implications for Workplace Productivity and Safety

The interaction between sleep and work-related behaviors influence many aspects of employee performance, safety, and health as well as organizational-level success. Although it is well established that quantity and quality of sleep can affect different types of task performance and personal health, the interactions between sleep habits and organizational behaviors have received much less attention. It is important to examine how sleep habits and workplace behaviors relate and the role of the underlying circadian rhythm on the potential impact of sleep and sleepiness in the workplace. Developing a deeper understanding of how sleep habits and sleepiness impact workers and the organization can help provide the necessary background for human resource management to develop more progressive support networks for employees that benefit both the worker and the organization. Human resources and employees should emphasize the impact of good sleep and sleep habits on organizational and individual productivity and safety.

Parent Perspectives on Sleep and Sleep Habits Among Young Children Living With Economic Adversity

OBJECTIVE

To examine the perspectives of ethnically diverse, low-income parents of young children regarding sleep, sleep habits, and preferences for sleep promotion for themselves and their children.

METHOD

We recruited a sample of mothers who had a 15- to 60-month-old child enrolled in the Special Supplemental Nutritional Program for Women, Infants and Children in a Northeastern U.S. city. We used a convergent mixed-methods design to conduct semistructured interviews and questionnaires to measure parent sleep quality (Pittsburgh Sleep Quality Index), sleep apnea (Berlin Apnea Questionnaire), mood (Centers for Epidemiological Studies of Depression), children's sleep (Children's Sleep Habits Questionnaire), and behavior (Child Behavior Checklist).

RESULTS

Thirty-two mothers (M age = 30.97 [SD 6.34] years; n = 21 [65%] African American) and children (N = 14 [44% female]; M age =38 [SD 12.63] months) participated. Children's average sleep duration was 10 hr, which is below the recommendation for this age group; overall sleep difficulty was high despite most mothers reporting that their children had normal sleep. Five children had abnormal Child Behavior Checklist scores, suggesting internalizing and externalizing behaviors. More than half of the mothers had poor sleep quality and 24 (75%) were at high risk for sleep apnea. Mothers viewed sleep as important for themselves and their children and identified both effective and ineffective practices to promote sleep, including practices learned from their own families.

CONCLUSIONS

Ethnically diverse mothers who are living with economic adversity value sleep for themselves and their children. The high value placed on sleep, despite misconceptions about normal sleep, suggest opportunities to promote sleep interventions. The content and delivery methods should be tailored to their knowledge, preferences, and cultural practices.

Factor structure of the Sleep Disturbance Scale for Children (SDSC) in those with Attention Deficit and Hyperactivity Disorder (ADHD)

Objective

Method

Results

Conclusion

•

The original SDSC factor structure could not be replicated in an ADHD sample.

•

The fit of competing factor structures was evaluated.

•

An optimal structure including six-specific and a general factor was identified.

•

The alternative structure reported adequate psychometric properties.

•

The SDSC may be used to yield a total sleep difficulties score in ADHD samples.

Parental support of the Canadian 24-hour movement guidelines for children and youth: prevalence and correlates

BACKGROUND

To explore the prevalence of parental support for meeting the Canadian 24-Hour Movement Guidelines for Children and Youth, identify key interactive support profiles among the four movement behaviors, and investigate subsequent sociodemographic and social cognitive correlates of these profiles.

METHODS

A sample of Canadian parents (N = 1208) with children aged 5 to 17 years completed measures of the theory of planned behavior (TPB), and support of the four child movement behaviors via questionnaire. Differences in the proportion of parents supporting these four health behaviors were explored and demographic and social cognitive (attitude and perceived control) correlates of combinations of parental support for the four health behaviors were evaluated.

RESULTS

Child and youth sleep behavior had the highest parental support (73%) and moderate to vigorous physical activity support had the lowest prevalence (23%). Interactive profiles of the four movement behaviors yielded six primary clusters and comprised wide variation from parents who supported none of these behaviors (19%), to parents who supported all four behaviors (14%). These profiles could be distinguished by the age of the child (younger children had higher support) and the gender of the parent (mothers provided more support), as well as constructs of the TPB, but TPB cognitions were more specific predictors of each health behavior rather than general predictors of aggregate health behavior clusters.

CONCLUSIONS

Teenagers and fathers may represent key targets for parental support intervention of the 24-Hour Movement Guidelines. Intervention content may need to comprise the underlying foundations of attitude and perceived behavioral control to change parental support while considering the unique features of each health behavior to maximize related intervention effectiveness.

Parent-reported sleep disorders in children with motor disabilities: a comparison with the Sleep Disturbance Scale for Children's new norms

OBJECTIVE

Children with motor disabilities such as cerebral palsy or neuromuscular diseases present more sleep disorders than their typically developing (TD) peers. However, research on these populations has always been performed using historical normative datasets or controls such as siblings. Therefore, we assessed the sleep quality of children with motor disabilities in comparison with a large, contemporary, general population sample.

METHODS

Demographic, medical, and the Sleep Disturbance Scale for Children (SDSC) questionnaires were sent to parents of children aged 4-18 years and followed by our tertiary pediatric neurorehabilitation clinic, and to those of school-aged children in regional primary and secondary schools. TD participant data allowed us to set pathological sleep score thresholds (T score ≥70).

RESULTS

We collected 245 responses for children with motor disabilities and 2891 for those from the general population (37% and 26% response rates, respectively). Cerebral palsy was the most frequent diagnosis (N = 109, 44.5%). Children with motor disabilities had significantly more frequent pathological sleep reported in their total SDSC score (7% vs 1.9%, odds ratio (OR) 3.98, 95% confidence interval (CI) 2.17-7.27, p < 0.001) and in five subscores. Single-parent households and drug-resistant epilepsy showed significant positive associations with pathological sleep among children with motor disabilities. For TD peers, parental unemployment and parental nationality were positively associated with pathological sleep.

CONCLUSION

This population-based study robustly estimated the prevalence of sleep disorders in children with motor disabilities. Sleep disorders were significantly more frequent in children with motor disabilities, but at a lower frequency than previously reported.

Guelph Family Health Study: pilot study of a home-based obesity prevention intervention

OBJECTIVE

To examine the feasibility and preliminary impact of a home-based obesity prevention intervention among Canadian families.

METHODS

Families with children 1.5-5 years of age were randomized to one of three groups: (1) four home visits (HV) with a health educator, emails, and mailed incentives (4HV; n = 17); (2) two HV, emails, and mailed incentives (2HV; n = 14); or (3) general health advice through emails (control; n = 13). Parents randomized to the 2HV and 4HV groups completed post-intervention satisfaction surveys. At baseline and post-intervention, parents reported frequency of family meals and their children's fruit, vegetable, and sugar-sweetened beverage (SSB) intake. We assessed the children's physical activity, sedentary behaviour, and sleep using accelerometers and their % fat mass using bioelectrical impedance analysis. Differences in outcomes at post-intervention, controlling for baseline, were examined using generalized estimating equations.

RESULTS

Of the 44 families enrolled, 42 (96%) had 6-month outcome data. Satisfaction with the intervention was high; 80% were "very satisfied" and 20% were "satisfied." At post-intervention, children randomized to the 4HV and 2HV groups had significantly higher fruit intake and children randomized to the 2HV group had significantly lower percentage of fat mass, as compared to the control. No significant intervention effect was found for frequency of family meals, the children's vegetable or SSB intake, physical activity, sedentary behaviour, or sleep.

CONCLUSIONS

Our results suggest that the delivery of a home-based intervention is feasible among Canadian families and may lead to improved diet and weight outcomes among children. A full-scale trial is needed to test the effectiveness of this home-based intervention.

CLINICAL TRIALS REGISTRATION NUMBER

NCT02223234.

Do parents' support behaviours predict whether or not their children get sufficient sleep? A cross-sectional study

BACKGROUND

Sleep is an essential component of healthy cognitive and physical development. Lack of sleep may put children at risk for a variety of mental and physical health outcomes, including overweight, obesity and related chronic diseases. Given that children's sleep duration has decreased in recent decades, there is a need to understand the determinants of child sleep, including the role of parental support behaviours. This study aims to determine the relative contribution of different types of parental support behaviours for predicting the likelihood that children meet recently established Canadian sleep guidelines.

METHODS

Data were collected using Computer Assisted Telephone Interviews (CATI) of parents or guardians with at least one child under the age of 18 living in Ontario, Canada. To align with sleep guidelines, parents included in this analysis had at least one child between 5 and 17 years of age (n = 1622). Two multivariable logistic regression models were built to predict whether or not parents reported their child was meeting sleep guidelines - one for weekday sleep and another for sleep on weekends. Independent variables included parent and child age and gender, motivational and regulatory parental support behaviours, and socio-demographic characteristics.

RESULTS

On weekdays, enforcing rules about child bedtime was a significant positive predictor of children meeting sleep guidelines (OR: 1.59; 95% CI: 1.03-2.44); while encouraging the child to go to bed at a specific time was a significant negative predictor of child meeting sleep guidelines (OR: 0.29; 95% CI: 0.13-0.65). On weekends, none of the parental support behaviours contributed significantly to the predictions of child sleep. For both weekdays and weekends, the child's age group was an important predictor of children meeting sleep guidelines.

CONCLUSIONS

The contribution of parental support behaviours to predictions of children meeting sleep guidelines varied with the type of support provided, and weekend versus weekday sleep. While only enforcing bedtime rules on weekdays contributed to children meeting sleep guidelines, the importance of children getting a good night's sleep, and the capacity of parents to help them do so, should be emphasized in public health efforts promoting healthy child development.

Exploring parent-reported barriers to supporting their child's health behaviors: a cross-sectional study

Background

Parents can influence the health behaviors of their children by engaging in supportive behaviors (e.g., playing outside with their child, limiting recreational screen time). How, and the extent to which parents engage in supportive behaviors may be influenced by perceived barriers. The purpose of this study is to explore whether the frequency, and types, of barriers to providing parental support are dependent on the type of child health behavior being supported (i.e., physical activity, recreational screen time reduction, healthy eating, and sleep).

Methods

Study participants were 1140 Ontario parents with at least one child under the age of 18 who completed a Computer Assisted Telephone Interview (CATI) survey about parental support behaviors. Open-ended responses about perceived barriers to parental support were coded, and aggregated to meta-categories adopted from the social-ecological model (i.e., individual child, individual parent, interpersonal, environmental). Freidman rank sum tests were used to assess differences across child behaviors. Wilcoxon rank sum tests with Bonferroni adjustments were used as a post hoc test for significant Freidman results.

Results

There were more barriers reported for supporting physical activity than for any other child behavior (ps < .01, As ≥ .53). Parents reported more parent level and environmental level barriers to supporting child physical activity versus other behaviors (ps < .001, As ≥ .55), child level barriers were more frequently reported for supporting healthy eating and sleep (ps < .001, As ≥ .57), and interpersonal barriers were more frequently reported for supporting recreational screen time reduction (ps < .001, As ≥ .52). Overall, parents reported more child and parent level barriers versus interpersonal and environmental barriers to supporting child health.

Conclusions

Parents experience a variety of barriers to supporting their children’s health behaviors. Differences in types of barriers across child health behaviors emerged; however, some frequently reported barriers (e.g., child preferences) were common across behaviors. Interventions promoting parental support should consider strategies that can accommodate parents’ busy schedules, and relate to activities that children find enjoyable. Creating supportive environments that help facilitate support behaviors, while minimizing parent level barriers, may be of particular benefit. Future research should explore the impact of barriers on parental support behaviors, and effective strategies for overcoming common barriers.

East Meets West: Adopted Chinese Girls' Nighttime Sleep Problems and Adoptive Parents' Self-Judgment About Parenting

We investigated the association between adopted Chinese girls' nighttime sleep problems and adoptive parents' self-judgment about their parenting. The girls were 1.7-6.9 years old (M = 4.6 years, SD = 1.0) and were adopted at 7-56 months (M = 13.9 months, SD = 6.6) by families in North America. At Wave 2 of a longitudinal study on adopted Chinese children's development, the adoptive parents provided survey data on bedtime resistance or anxiety and parasomnias in their daughters and their own parental sense of entitlement and parenting competence. Results showed that controlling for child and family demographics, parasomnias, but not bedtime resistance or anxiety, negatively predicted parental sense of entitlement (B = -.13, p < .01) and parenting competence (B = -.14, p < .01).

Adopted youth and sleep difficulties

Sleep is a critical component of healthy development for youth, with cascading effects on youth’s biological growth, psychological well-being, and overall functioning. Increased sleep difficulties are one of many disruptions that adopted youth may face throughout the adoption process. Sleep difficulties have been frequently cited as a major concern by adoptive parents and hypothesized in the literature as a problem that may affect multiple areas of development and functioning in adopted youth. However, there is limited research exploring this relationship. Using a biopsychosocial framework, this paper reviews the extant literature to explore the development, maintenance, and impact of sleep difficulties in adopted youth. Finally, implications for future research and clinical interventions are outlined.

Racial/Ethnic and Socio-Contextual Correlates of Chronic Sleep Curtailment in Childhood

STUDY OBJECTIVES

To examine the association between race/ethnicity and sleep curtailment from infancy to mid-childhood, and to determine the extent to which socioeconomic and contextual factors both explain racial/ethnic differences and are independently associated with sleep curtailment.

METHODS

We studied 1,288 children longitudinally in Project Viva, a pre-birth cohort study, from 6 months to 7 years of age. The main exposure was the child's race/ethnicity. The main outcome was a sleep curtailment score from 6 months to 7 years. The score ranged from 0-13, where 0 indicated maximal sleep curtailment and 13 indicated never having curtailed sleep.

RESULTS

The mean (standard deviation) sleep curtailment score was 10.2 (2.7) points. In adjusted models (β [95% CI]), black (-1.92, [-2.39, -1.45] points), Hispanic (-1.58, [-2.43, -0.72] points), and Asian (-1.71, [-2.55, -0.86] points) children had lower sleep scores than white children. Adjustment for sociodemographic covariates attenuated racial/ethnic differences in sleep scores for black (by 24%) and Hispanic children (by 32%) but strengthened the differences for Asian children by 14%. Further adjustment for environmental and behavioral variables did not substantially change these differences. Independently, low maternal education, living in households with incomes < $70,000, viewing more TV, and having a TV in the child's bedroom were associated with lower sleep scores.

CONCLUSIONS

Chronic sleep curtailment from infancy to mid-childhood was more prevalent among black, Hispanic, and Asian children. These differences were partially but not entirely explained by socio-contextual variables. Independently, children from lower socioeconomic status and those with greater exposures to TV also had greater sleep curtailment.

PARENTAL REGULATION OF INFANT SLEEP: ROUND-THE-CLOCK EFFORTS FOR SOCIAL SYNCHRONIZATION

The sleep-cycle development of infants is influenced by familial and sociocultural conditions, but there is a lack of knowledge on how parental regulation of infant sleep is related to the specific life situation of a family. This article describes a context-sensitive study of parental regulation of infant sleep that includes the whole 24-hr day, parents' intentions, and familial and sociocultural conditions. The results are based on a longitudinal qualitative study in Norway of 51 families. Parents were interviewed in the infants' first year of life and approximately 18 months later. An interpretive analysis in four steps was conducted, informed by cultural psychological perspectives on development. The parents were found to perform five types of regulatory actions: facilitating sleep, letting sleep, letting be awake, keeping awake, and waking. These actions were performed continuously throughout the 24-hr day, each to different extents and at different hours in individual families, forming a regulation cycle. We describe patterns and variations in regulation cycles, changes over time as increased social synchronization, and how the regulation cycle is embedded in familial and sociocultural conditions. Finally, implications for clinical practice are discussed.

Parent-child bed-sharing: The good, the bad, and the burden of evidence

The practice of parent and child sharing a sleeping surface, or 'bed-sharing', is one of the most controversial topics in parenting research. The lay literature has popularized and polarized this debate, offering on one hand claims of dangers, and on the other, of benefits - both physical and psychological - associated with bed-sharing. To address the scientific evidence behind such claims, we systematically reviewed 659 published papers (peer-reviewed, editorial pieces, and commentaries) on the topic of parent-child bed-sharing. Our review offers a narrative walkthrough of the many subdomains of bed-sharing research, including its many correlates (e.g., socioeconomic and cultural factors) and purported risks or outcomes (e.g., sudden infant death syndrome, sleep problems). We found general design limitations and a lack of convincing evidence in the literature, which preclude making strong generalizations. A heat-map based on 98 eligible studies aids the reader to visualize world-wide prevalence in bed-sharing and highlights the need for further research in societies where bed-sharing is the norm. We urge for multiple subfields - anthropology, psychology/psychiatry, and pediatrics - to come together with the aim of understanding infant sleep and how nightly proximity to the parents influences children's social, emotional, and physical development.

Reasons for mother-infant bed-sharing: a systematic narrative synthesis of the literature and implications for future research

Mother-infant bed-sharing has been a common practice for centuries. Understanding the reasons parents choose to bed-share can help tailor safe sleep education. The purpose of this article was to systematically review the international literature on: (1) reasons parents bed-share, (2) the cultural context of bed-sharing, and (3) implications for interventions and future research. The search occurred August-September 2013 via PubMed, CINAHL, and Psyc INFO using the terms: "infant," "sleep," "bed shar*," "co sleep*," "sleep location," "sleep practices," and "sleep arrangements," alone or in combination. Google Scholar was searched using: "bed share," "bed sharing," "co sleep," and "co sleeping." Inclusion criteria were: (1) referenced bed-sharing with infants 12 months or younger; (2) provided reasons for bed-sharing; and (3) published between 1990 and 2013. Studies were excluded if they focused on disorders such as epilepsy, breathing disorders, or among multi-gestational infants. Narrative synthesis was used to summarize findings. Thirty-four studies met inclusion criteria. The main themes around bed-sharing based on this synthesis included: (1) breastfeeding, (2) comforting, (3) better/more sleep, (4) monitoring, (5) bonding/attachment, (6) environmental, (7) crying, (8) tradition, (9) disagree with danger, and (10) maternal instinct. Findings suggest that future research should examine parents' decision-making process on infant sleep location, including how they weigh personal reasons and sources of advice. Public health interventions should incorporate the particular reasons of the population they are targeting. Clinicians should discuss infant sleep environment with each family, along with their motivations for choosing this environment, and work within that framework to address the safety of the sleep environment.

Eat, play, view, sleep: Exploring Mexican American mothers' perceptions of decision making for four behaviors associated with childhood obesity risk

OBJECTIVE

This mixed methods study sought to understand who makes decisions about whether preschool-aged Mexican American children engage in eating, outdoor play, sleep, and screen time behaviors.

METHODS

Forty Mexican American mothers of children ages 3-4 participated in two interviews, during which both closed- and open-ended questions elicited perceptions of who made decisions for the four behaviors, as well as who was present, mealtime rules, and food choice values. Interviews were transcribed, coded for emergent themes, and compared across participants.

RESULTS

Participants generally perceived themselves to be primary decision makers for all four behaviors; however, food decisions often seemed to be made collaboratively with the child. Fathers were most likely to participate in evening television decisions. Other family members were rarely mentioned. Selecting foods that children liked was a strong food choice value, while cost was rarely mentioned. Participants appeared to have low perceived control over their child's behaviors relative to their perceived roles in decision making.

CONCLUSIONS

Mothers may be the primary audience for obesity prevention messages for preschool-aged, Mexican American children; however, health promotion programs may need to increase mothers' awareness of their control over children's behaviors. Understanding how children's behaviors are regulated is an important aspect of obesity prevention for low-income, Mexican American children.

Prediction of insomnia severity based on cognitive, metacognitive, and emotional variables in college students

OBJECTIVE

Insomnia is the most common sleep disorder whose origin is attributed to various variables. The current study aims to predict the symptoms of insomnia by investigating some of its predictors.

METHODS

Numerous variables such as depression and anxiety symptoms, worry, pre-sleep arousal (cognitive arousal and somatic arousal), dysfunctional cognitions, and metacognitive beliefs about sleep were assessed as insomnia predictors. A total of 400 students of Tehran University of Medical Sciences completed the Depression Anxiety Stress Scale (DASS), the Penn State Worry Questionnaire (PSWQ), the Pre-Sleep Arousal Scale (PSAS), the Dysfunctional Beliefs and Attitudes about Sleep Scale (DBAS-10), the Metacognitions Questionnaire-Insomnia (MCQ-I), and the Insomnia Severity Index (ISI).

RESULTS

All variables were significantly correlated with insomnia symptoms (P < .001). Stepwise multiple regression analysis suggested a predictive model for insomnia including cognitive arousal, dysfunctional beliefs about sleep, metacognitive beliefs about sleep, and depressive symptoms.

CONCLUSIONS

The findings underline the significant role of cognitive and metacognitive variables for predicting insomnia symptoms. Moreover, the results suggest that metacognitive beliefs about sleep may need to be considered as a significant component in the context of insomnia.

Clinical Implications of Impaired Sleep

Despite its pervasiveness in primary care, deficient sleep often is underappreciated as a cue to other health risks. Accordingly, this review discusses contemporary evidence-based perspectives on impaired sleep and its associations with other lifestyle medicine concerns, including obesity, cardiovascular conditions, psychological problems, and health-compromising habits. The potential clinical benefits of promoting sleep health also will be considered.

Behavioral Sleep Problems and their Potential Impact on Developing Executive Function in Children

Bedtime resistance and night waking are common sleep problems throughout childhood, especially in the early years. These sleep problems may lead to difficulties in neurobehavioral functioning, but most research into childhood sleep problems has not emphasized the importance of the developmental context in which disruptions in neurobehavioral and daytime functioning occur. We review the development of sleep as well as executive functioning (EF) in childhood and suggest that EF may be particularly vulnerable to the effects of these common childhood sleep problems because of its prolonged course of maturation. Behavioral problems associated with common sleep problems suggest poor self-regulation in the context of sleep loss, and developing EF skills play important roles in self-regulation. A research agenda that considers a developmental approach to sleep and sleep problems in the context of childhood EF performance is outlined to promote future research in this area.

CITATION

Turnbull K; Reid GJ; Morton JB. Behavioral sleep problems and their potential impact on developing executive function in children. SLEEP 2013;36(7):1077-1084.

School nurses can address existing gaps in school-age sleep research

Sleep has been linked to a host of physical, behavioral, and emotional outcomes, and research has documented that youth across the globe are experiencing inadequate sleep. Despite this knowledge, however, very little research has been conducted on school-age children; much of the extant research has focused on infants, toddlers, preschoolers, adolescents, and adults. School-age children exhibit increasing independence around health-related behaviors, which provide health professionals the opportunity to educate and promote healthy sleep behaviors. This commentary extends previous research reviews by identifying the current gaps in sleep research, highlighting future directions needed in sleep research, and explaining why school nurses are best suited to address this growing public health issue.

Eye of the beholder? Maternal mental health and the quality of infant sleep

Transactional models of parenting and infant sleep call attention to bidirectional associations among parenting, the biosocial environment, and infant sleep behaviors. Although night waking and bedtime fussing are normative during infancy and early childhood, they can be challenging for parents. The current study, conducted in the United States between 2003 and 2009, examined concurrent and longitudinal associations between maternal mental health and infant sleep during the first year. Concurrent associations at 6 and 12 months and longitudinal associations from 6 to 12 months were studied in a non-clinic referred sample of 171 economically and culturally diverse families. Mothers with poorer mental health reported that their infants had more night waking and bedtime distress and were more bothered by these sleep issues. Associations between infant sleep and maternal mental health were moderated by culture (Hispanic/Asian vs. other) and by stressors that included high parenting stress, more stressful life events, and low family income. Individual differences in maternal well-being may color mothers' interpretations of infants' sleep behaviors. It may be prudent to intervene to support maternal mental health when infants are referred for sleep problems.

Cultural issues in children's sleep: a model for clinical practice

Sleep is a human behavior that is driven by biological mechanisms, but also shaped and interpreted by cultural values and beliefs. The large diversity among societies and cultures may indicate that one "optimal cultural standard" for children's sleep behavior does not exist. In pediatric care, the interplay between children's biological as well as socioemotional needs and the cultural norms should be carefully considered and evaluated in the context of sleep complaints and behavioral functioning. Recognizing the culture in which children and their families live may eventually lead to better compliance and higher success rates of treatment interventions.

Treat the source not the symptoms: why thinking about sleep informs the social determinants of health

Based on theoretical and empirical work, we argue that autonomy is likely an important underlying source of healthy sleep. The implication is that 'treatment' for sleep problems cannot be understood as an individual-level behavioral problem but must instead be addressed in concert with larger scale social factors that may be inhibiting high-quality sufficient sleep in large segments of the population. When sleep is understood as a proxy for health, the implications extend even further. Policies and interventions that facilitate the autonomy of individuals therefore may not only help reduce individual sleep problems but also have broader consequences for ameliorating social disparities in health.