Sleep Predicts Collegiate Academic Performance: Implications for Equity in Student Retention and Success

The Role of Sleep Effort as a Mediator Between Anxiety and Depression

Depression, anxiety, and insomnia are all conditions that share a complex bidirectional relationship. Sleep effort is a construct with cognitive and behavioral components that perpetuates insomnia. Although many studies have examined the associations between these three variables, no studies have yet examined sleep effort as a mediating variable between anxiety and depression and vice versa. Online versions of the Hospital Anxiety and Depression Scale and the Glasgow Sleep Effort Scale were administered to a sample of 1927 higher education students aged 18-40 years (75.9% women and 76% from 18 to 23 years old). As part of the survey, participants also completed a sociodemographic questionnaire. Mediation analysis indicated that sleep effort mediates the relationship between depression and anxiety, when the former was the predictor and the latter was the criterion. Moreover, sleep effort also mediated the relationship between anxiety and depression when the former was the predictor and the latter was the criterion, albeit in a lesser extent. Sleep effort appears to play a bidirectional mediational role between depression and anxiety, being a potential target for intervention.

Health-Related Behaviors and Academic Achievement Among College Students

PURPOSE

College students' academic achievement has crucial implications for their future success. Students' health may be a key determinant of academic performance, but more research is needed to understand this relationship.

DESIGN/SETTING/SUBJECTS

Secondary analysis of the American College Health Association-National College Health Assessment III pre-COVID-19 Spring 2020 dataset. N = 39 146 undergraduates at 75 higher education institutions (14% mean response rate, comparable with other large-scale national college health surveys).

MEASURES

Self-reported grade point average (GPA) and 33 health behaviors in the categories of dietary behavior, physical activity, sedentary behavior, substance use, sexual risk behavior, violence-related behavior, mental health, and sleep behavior.

ANALYSIS

Weighted cross-tabulations examining the association between GPA and health behaviors; multinomial logistic regressions assessing if behaviors predicted GPA, controlling for year, sex/gender, and race/ethnicity. Individual GPA categories were also compared to a D/F referent group.

RESULTS

There were gradient trends across GPA categories for A through D/F (18 behaviors) or A through C (12 behaviors) (P < .001). Each health behavior predicted GPA differences (P < .001), except heroin use (P = .052). The A GPA group was significantly different from the D/F GPA group for 27 behaviors (P < .001). In general, protective behaviors corresponded with higher GPAs and most risk behaviors were associated with lower GPAs.

CONCLUSIONS

There is a link between numerous health behaviors and academic performance. Stakeholders invested in college students' health and academics should engage in mutually beneficial strategies to safeguard students' current and future well-being and success.

Association between stressful life events and sleep quality in Chinese university students: Mediating and moderating roles of emotion regulation

This study investigated whether emotion regulation mediates or modulates the relationship of SLEs with sleep quality and potential sex differences. A total of 1447 Chinese university students completed the Adolescent Self-Rating Life Events Checklist, the Pittsburgh Sleep Quality Index, and the Emotion Regulation Questionnaire. The results indicated that both cognitive reappraisal and expressive suppression significantly mediated and moderated the negative association between SLEs and sleep quality. Additionally, sex differences were found for the mediating role of cognitive reappraisal and for the modulating roles of cognitive reappraisal and expressive suppression in the relationship between SLEs and sleep quality. Although the present cross-sectional data does not allow us to test any causal relationships, these results help clarify the underlying emotion-regulation process between SLEs and sleep in university students and highlight the importance of considering sex differences in emotion regulation.

An Artificial Intelligence Platform to Stratify the Risk of Experiencing Sleep Disturbance in University Students After Analyzing Psychological Health, Lifestyle, and Sports: A Multicenter Externally Validated Study

Background

Sleep problems are prevalent among university students, yet there is a lack of effective models to assess the risk of sleep disturbance. Artificial intelligence (AI) provides an opportunity to develop a platform for evaluating the risk. This study aims to develop and validate an AI platform to stratify the risk of experiencing sleep disturbance for university students.

Methods

A total of 2243 university students were included, with 1882 students from five universities comprising the model derivation group and 361 students from two additional universities forming the external validation group. Six machine learning techniques, including extreme gradient boosting machine (eXGBM), decision tree (DT), k-nearest neighbor (KNN), random forest (RF), neural network (NN), and support vector machine (SVM), were employed to train models using the same set of features. The models' prediction performance was assessed based on discrimination and calibration, and feature importance was determined using Shapley Additive exPlanations (SHAP) analysis.

Results

The prevalence of sleep disturbance was 44.69% in the model derivation group and 49.58% in the external validation group. Among the developed models, eXGBM exhibited superior performance, surpassing other models in metrics such as area under the curve (0.779, 95% CI: 0.728-0.830), accuracy (0.710), precision (0.737), F1 score (0.692), Brier score (0.193), and log loss (0.569). Calibration and decision curve analyses demonstrated favorable calibration ability and clinical net benefits, respectively. SHAP analysis identified five key features: stress score, severity of depression, vegetable consumption, age, and sedentary time. The AI platform was made available online at https://sleepdisturbancestudents-xakgzwectsw85cagdgkax9.streamlit.app/, enabling users to calculate individualized risk of sleep disturbance.

Conclusion

Sleep disturbance is prevalent among university students. This study presents an AI model capable of identifying students at high risk for sleep disturbance. The AI platform offers a valuable resource to guide interventions and improve sleep outcomes for university students.

The Negative Effects of Travel on Student Athletes Through Sleep and Circadian Disruption

Collegiate athletes must satisfy the academic obligations common to all undergraduates, but they have the additional structural and social stressors of extensive practice time, competition schedules, and frequent travel away from their home campus. Clearly such stressors can have negative impacts on both their academic and athletic performances as well as on their health. These concerns are made more acute by recent proposals and decisions to reorganize major collegiate athletic conferences. These rearrangements will require more multi-day travel that interferes with the academic work and personal schedules of athletes. Of particular concern is additional east-west travel that results in circadian rhythm disruptions commonly called jet lag that contribute to the loss of amount as well as quality of sleep. Circadian misalignment and sleep deprivation and/or sleep disturbances have profound effects on physical and mental health and performance. We, as concerned scientists and physicians with relevant expertise, developed this white paper to raise awareness of these challenges to the wellbeing of our student-athletes and their co-travelers. We also offer practical steps to mitigate the negative consequences of collegiate travel schedules. We discuss the importance of bedtime protocols, the availability of early afternoon naps, and adherence to scheduled lighting exposure protocols before, during, and after travel, with support from wearables and apps. We call upon departments of athletics to engage with sleep and circadian experts to advise and help design tailored implementation of these mitigating practices that could contribute to the current and long-term health and wellbeing of their students and their staff members.

Neighborhood predictors of short sleep duration and bedtime irregularity among children in the United States: results from the 2019-2020 National Survey of Children's Health

BACKGROUND

Environmental factors may contribute to short sleep duration and irregular bedtime in children. Neighborhood factors and children's sleep duration and bedtime regularity remain a less investigated area. The aim of this study was to investigate the national and state-level proportions of children with short sleep duration and irregular bedtime and their neighborhood predictors.

METHODS

A total of 67,598 children whose parents completed the National Survey of Children's Health in 2019-2020 were included in the analysis. Survey-weighted Poisson regression was used to explore the neighborhood predictors of children's short sleep duration and irregular bedtime.

RESULTS

The prevalence of short sleep duration and irregular bedtime among children in the United States (US) was 34.6% [95% confidence interval (CI) = 33.8%-35.4%] and 16.4% (95% CI = 15.6%-17.2%) in 2019-2020, respectively. Safe neighborhoods, supportive neighborhoods, and neighborhoods with amenities were found to be protective factors against children's short sleep duration, with risk ratios ranging between 0.92 and 0.94, P < 0.05. Neighborhoods with detracting elements were associated with an increased risk of short sleep duration [risk ratio (RR) = 1.06, 95% CI = 1.00-1.12] and irregular bedtime (RR = 1.15, 95% CI = 1.03-1.28). Child race/ethnicity moderated the relationship between neighborhood with amenities and short sleep duration.

CONCLUSIONS

Insufficient sleep duration and irregular bedtime were highly prevalent among US children. A favorable neighborhood environment can decrease children's risk of short sleep duration and irregular bedtime. Improving the neighborhood environment has implications for children's sleep health, especially for children from minority racial/ethnic groups.

Psychological Well-Being in Asian and Asian American University Students: Impacts of Discrimination During the COVID-19 Pandemic

PURPOSE

The aim of this study is to determine what modifiable behavioral and sociological factors were predictive of psychological distress and suicide risk in Asian and Asian American students, the ethnic group with the highest unmet mental health need in collegiate populations. We also compared these relationships in Fall 2019 to Fall 2020 to better understand how the impact of these factors changed during the COVID-19 pandemic and concurrent increase in Anti-Asian discrimination.

METHODS

We used factor analysis to extract a wide range of predictor variables from the Fall 2019 and Fall 2020 American College Health Association's National College Health Assessment III. Next, we used structural equation modeling to identify significant drivers of psychological distress (Kessler-6 scale) and suicidality (Suicide Behavior Questionnaire-Revised scale) in Asian and Asian American students (n = 4,681 in 2019 and 1,672 in 2020).

RESULTS

When compared to 2019, experiencing discrimination in 2020 had a substantially larger effect on both psychological distress and suicidality among Asian and Asian American university students. Loneliness and depression were also significant drivers of negative mental health outcomes both years, and their effect magnitudes remained largely unchanged. Being well rested had a protective effect against psychological distress both years.

DISCUSSION

During the COVID-19 pandemic, discrimination was an important driver of psychological distress and suicidality in Asian and Asian American students. These findings suggest that organizations should enhance culturally competent mental healthcare services, while also working at the systems level to reduce bias and discrimination.

Risk of impaired school performance in children hospitalized with concussion: a population-based matched cohort study

Aim

To examine the impact of concussion on objective measures of school performance.

Materials & methods

Population-based matched cohort study using linked health and education records of young people aged ≤18 years hospitalized with concussion in New South Wales, Australia, during 2005-2018, and matched comparisons not hospitalized with any injury.

Results

Young people with concussion had higher risk of not achieving the national minimum standards for literacy and numeracy assessments, ranging from 30% for numeracy to 43% for spelling, and not completing high school, ranging from 29% for year 10 to 77% for year 12, compared with matched peers.

Conclusion

Young people hospitalized with concussion have impaired school performance compared with uninjured matched peers.

Associations between COVID-19 sleep patterns, depressive symptoms, loneliness, and academic engagement: a latent profile analysis

Background: The COVID-19 pandemic has had important implications for college students' socioemotional and academic well-being. Sleep problems were common during this time, which may have further impacted well-being. Methods: Five hundred and fifty-two college students (Mage = 19.81; 58% female; 42% White) completed a survey in Fall 2021 reflecting on behaviors/emotions (sleep, depressive symptoms, loneliness, academic engagement) experienced during the first peak of COVID-19 and over the past month. Latent profile analysis was conducted to identify subgroups of sleepers during peak-COVID in relation to well-being during and after the initial peak. Results: Four sleep profiles were identified: Optimal (49%), High Latency/Medicated (23%), Average/Fair (16%), Low-Duration (12%). During peak-COVID, depression and loneliness were highest in High Latency/Medicated and Low-Duration subgroups; academic engagement was highest for Optimal sleepers. Following peak-COVID, academic engagement was highest for Average/Fair sleepers. Conclusions: Findings highlight heterogeneity in students' sleep patterns during the initial peak of COVID-19 and their relation to well-being during and post-peak-pandemic.

Chronotype in college science students is associated with behavioral choices and can fluctuate across a semester

Many students self-report that they are "night owls," which can result from neurodevelopmental delays in the circadian timing system. However, whether an individual considers themselves to be an evening-type versus a morning-type (self-reported chronotype) may also be influenced by academic demands (e.g. class start times, course load) and behavioral habits (e.g. bedtime social media use, late caffeine consumption, daytime napping). If so, then chronotype should be malleable. We surveyed 858 undergraduate students enrolled in demanding science courses at up to three time points. The survey assessed morning/evening chronotype, global sleep quality, academics, and behavioral habits. Evening and morning-type students showed similar demographics, stress levels, and academic demands. At baseline measurements, relative to morning-types, evening-types showed significantly worse sleep quality and duration as well as 22% greater bedtime social media usage, 27% greater daytime napping duration, and 46% greater likelihood of consuming caffeine after 5pm. These behavioral habits partially mediated the effects of self-reported chronotype on sleep quality/duration, even after controlling for demographic factors. Interestingly, 54 students reported switching from being at least moderate evening-types at baseline to being at least moderate morning-types later in the semester and 56 students showed the reverse pattern (6.3% of students switched from "definitely" one chronotype to the other chronotype). Evening-to-morning "chrono-switchers" consumed less caffeine after 5pm and showed significantly better sleep quantity/quality at the later timepoint. Thus, some students may consider themselves to be night owls in part because they consume caffeine later, take more daytime naps, or use more social media at bedtime. Experimental work is needed to determine whether nudging night owls to behave like morning larks results in better sleep health or academic achievement.

Changes in the sleeping habits of Japanese university students during the COVID-19 pandemic: a 3-year follow-up study

BACKGROUND

The coronavirus disease 2019 (COVID-19) pandemic has greatly changed our daily life. Owing to the imposed restrictions, many educational facilities have introduced remote teaching. This study aims to clarify the association between remote teaching and Japanese university students' sleeping habits.

METHODS

The participants were medical students at Aichi Medical University. We used data from an ongoing longitudinal sleeping habits survey. For the participants who enrolled in the university during 2018-2020, multilevel analyses of sleep duration during weekdays and weekends across 3 years were conducted, adjusting for sex, grade, place of stay, sleep problems and lifestyle habits.

RESULTS

Among the students enrolled in the university, the data of 677 in 2018, 657 in 2019, and 398 in 2020 was available for analysis. The mean sleep duration during weekdays (in minutes) was 407.6 ± 60.3 in 2018, 406.9 ± 63.0 in 2019, and 417.3 ± 80.9 in 2020. The mean sleep duration during weekends (in minutes) was 494.5 ± 82.5 in 2018, 488.3 ± 87.9 in 2019, and 462.3 ± 96.4 in 2020. Multilevel analysis conducted for the 684 participants who enrolled during 2018-2020 showed that sleep duration during weekdays was associated with the place of stay and survey year. Moreover, students reported significantly longer sleep duration during weekdays in 2020 than in 2019, but no significant difference in sleep duration was found between 2018 and 2019. The other multilevel analysis found sleep duration during weekends to be associated with the survey year, sex and always doing something before going to bed. Sleep duration during weekends was shorter in 2020 than in 2019 and longer for male students and students who always do something before going to bed. Ten students were reported to have a delayed sleep phase in 2020.

CONCLUSIONS

Students' sleep duration increased during weekdays and decreased during weekends in 2020. This difference could be explained by the COVID-19 pandemic and the introduction of remote teaching.

Assessing the impact of sleep restriction on the attention and executive functions of medical students: a prospective cohort study

OBJECTIVE

To compare the performance of medical students regarding attention and executive functions during a period of sleep restriction (insufficient sleep; period of classes) and a period of free sleep (sufficient sleep; vacation period).

BACKGROUND

Sleep deprivation is associated with poor academic outcomes. Few studies have assessed the cognitive changes associated with sleep deprivation due to insufficient sleep syndrome in students and how they occur in real-life situations.

METHODS

This was a prospective cohort study. Medical students were assessed at two moments (class and vacation). The interval between assessments was 30 days. The Pittsburgh Sleep Quality Index, the Consensus Sleep Diary, the Montreal Cognitive Assessment, the Psychomotor Vigilance Test (PVT) and the Wisconsin Sorting Cards Test were used.

RESULTS

Forty-one students were assessed, 49% were female, with a median age of 21 (20; 23) years. There was a lower number of hours slept (5.75 (5.4; 7.0) vs 7.33 (6.0; 8.0) hours; p = 0.037), and a significantly poorer performance in the PVT (mean reaction time, p = 0.005; Minor lapses, p = 0.009) during the period of classes when compared to the vacation period. There was a correlation between the variation in hours of sleep of the two assessments and a variation in minor lapses in the two assessments (Ro: -0.395; p = 0.011; Spearman's correlation).

CONCLUSIONS

Students had fewer hours of sleep and more reduced attention during the period of classes than during the vacation period. This decrease in sleeping hours was correlated with more impaired attention.

Comparison Between High School Youth and College Freshmen Toward Their Psychological Disorders Under the Influence of Sleep Hygiene During COVID-19 Pandemic

OBJECTIVE

Adolescents experience the critical period for physical and psychological growth. Few studies focus on the influence of sleep hygiene on the psychological health of adolescence aging from high school to freshmen year. Also, the influence from the COVID-19 pandemic has a public health significance.

METHODS

A total of 698 students from high schools and colleges were included in the manuscript, and a cross-sectional procedure was conducted, objective to make an epidemiological comparison of the social phobia/depression prevalence, and discuss the effects of potential determinants.

RESULTS

Psychological problems including social phobia and depression were prevalent especially among the high school students, with the female gender showing higher possibilities. Current results also indicated that the association between sleep status and the occurrence of social phobia is most obvious among high school students, while relatively higher MMR risks was found both for high school students showing symptoms of social phobia and college freshmen with depressive symptoms. Moreover, the interaction between social phobia and depression was obvious for both populations.

CONCLUSIONS

Psychological problems including social phobia symptoms and depression are more prevalent among the high school females when compared with their male and freshemen peers. Sgnificant influencial factors for the risk of psychological problems among 2 populations are different, but media multitasking status should be paid attention to for both.

The association between race- and ethnicity-related stressors and sleep: the role of rumination and anxiety sensitivity

STUDY OBJECTIVES

This study was designed to investigate the association between psychosocial factors and self-reported sleep duration and two indices of sleep quality in a racially and ethnically diverse sample of adults. We investigated the relations between both rumination and anxiety sensitivity with these self-reported sleep outcomes. We also examined rumination and anxiety sensitivity as moderators of three race- and ethnicity-related stressors: discrimination, acculturative stress, and socioeconomic status.

METHODS

In a cross-sectional design, we assessed 1326 adults (ages 18-48 years) selected for self-reported racial and ethnic minority status. Regression analyses were used to examine the associations between demographic, social/environmental stressors, depression severity, rumination, and anxiety sensitivity and three sleep outcomes: sleep duration, sleep quality subscale, and global sleep quality.

RESULTS

Our findings supported the hypothesized role of rumination as an amplification factor for the influence of race- and ethnicity-related stressors on sleep duration and quality. Rumination was associated with all three sleep outcomes (sleep duration, sleep quality subscale, and global sleep quality) and was a moderator of the associations between discrimination and all 3 sleep outcomes. Anxiety sensitivity was not consistently associated with these sleep outcomes. Depression symptoms did not account for these findings.

CONCLUSIONS

If confirmed in longitudinal study, our findings introduce a potentially important treatment target-rumination-for addressing sleep disparities in prevention or intervention models. Rumination appears to amplify the negative sleep consequences of race- and ethnicity-related stressors and is a modifiable treatment target.

Academic Achievements, Satisfaction with Studies and Risky Behaviours among First-Year Students of Kaunas (Lithuania) Universities, 2000-2017

Risky behaviours are prevalent among university students and may affect academic achievements. This study aimed to evaluate the associations between academic achievements, satisfaction with studies and risky behaviours among first-year students of Kaunas (Lithuania) universities. Three cross-sectional surveys were conducted in 2000, 2010, and 2017. The self-administered questionnaires were filled in during lectures and assessed frequency and amount of alcohol consumption, drinking problems (CAGE test), smoking and drug use frequency, and academic achievements. The associations between risky behaviours and academic achievements were analysed using multivariable logistic regression analysis. Altogether 3325 students (1341 men and 1984 women) aged 20.0 (1.5) years participated in the survey. The proportion of students who consumed alcohol at least once a week and drank 11 or more standard alcoholic units (SAU) a week decreased. Every fifth student reported a drinking problem. Daily smoking prevalence declined, and drug use increased among male students. Multivariable logistic regression analysis revealed that frequent alcohol consumption and problem drinking were associated with low importance of good grades. Students who rated their academic performance below average and were dissatisfied with studies were more likely to consume ≥11 SAU a week. Daily smoking was more common among students who reported low importance of good grades and academic performance below average. A higher prevalence of drug use was found only in male students who declared low importance of good grades. Health promoting interventions at the individual and student community level are required to reduce the prevalence of substance use and improve the academic achievements of students.

Insomnia Symptoms, Sleep Hygiene, Mental Health, and Academic Performance in Spanish University Students: A Cross-Sectional Study

BACKGROUND

Insomnia has been associated with decreased academic performance and unhealthy behaviors in university students. Although many studies have analyzed sleep phenomenology among this population, only few have focused on insomnia and its related variables. In addition, such studies do not always include a clinical interview or a specific and validated instrument for measuring insomnia. This study aimed to explore the prevalence of insomnia symptoms and the relationship between insomnia and health habits, mental health, and academic performance in a large university student sample.

METHODS

Five hundred and eighty-two students were recruited from the University of Granada, Spain. Data were collected through an online survey with questions on sociodemographic and academic data and health habits as well as the Pittsburgh Sleep Quality Index, Insomnia Severity Index, Sleep Hygiene Index, and Sleepiness, Depression, Anxiety, and Stress Scales. A multiple regression analysis explored the relationship between academic performance, health habits, mood state, and insomnia symptoms.

RESULTS

The prevalence of students with symptoms of insomnia was high (39.7%). A multiple logistic regression analysis revealed that depression, sleep hygiene, stress and anxiety were significant predictors of insomnia symptoms. Multivariate analyses revealed that subjective insomnia symptoms, sleep efficiency, and depression were significantly correlated with academic performance in a dependent way.

CONCLUSIONS

In university students, anxiety, stress, and poor sleep hygiene are risk factors for insomnia, which plays an important role in academic performance. Promoting sleep and mental health could be a potentially effective way to improve their academic performance.

Nighttime Sleep Awakening Frequency and Its Consistency Predict Future Academic Performance in College Students

Although the relationship between sleep and academic performance has been extensively examined, how sleep predicts future academic performance (e.g., 2-3 years) remains to be further investigated. Using wearable smartwatches and a self-report questionnaire, we tracked sleep activities of 45 college students over a period of approximately half a month to see whether their sleep activities predicted their academic performance, which was estimated by grade point average (GPA). Results showed that both nighttime sleep awakening frequency and its consistency in the tracking period were not significantly correlated with the GPA for the courses taken in the sleep tracking semester (current GPA). However, both nighttime sleep awakening frequency and its consistency inversely predicted the GPA for the rest of the courses taken after that semester (future GPA). Moreover, students with more difficulty staying awake throughout the day obtained lower current and future GPAs, and students with higher inconsistency of sleep quality obtained lower future GPA. Together, these findings highlight the importance of nighttime sleep awakening frequency and consistency in predicting future academic performance, and emphasize the necessity of assessing the consistency of sleep measures in future studies.

The multiplicative effect of stress and sleep on academic cognitions in Latino college students

Latino students are increasingly represented in higher education within the United States, but remain one of the groups least likely to graduate from a four-year institution. Stress and sleep are factors that have been implicated in students' academic success. This study examined concurrent and longitudinal interactive effects of stress and sleep on academic cognitions in a sample of 196 Latino students (M_age = 18.95; 64.4% female) in their second and third semester of college. Stress and actigraphy-measured sleep (duration, efficiency, midpoint, midpoint-variability) were measured in the second semester and academic cognitions (engagement, motivation, self-efficacy) were measured in the second and third semesters. Structural equation modeling revealed that higher stress was concurrently related to lower academic cognitions for students with consistently delayed sleep timings (e.g., later average midpoints) and longitudinally related to reduced academic functioning for students with lower sleep efficiency. These findings can inform programs that target stress-reduction and sleep hygiene among incoming college students.

Prevalence and factors associated with excessive and severe daytime sleepiness among healthcare university students in the Brazilian Midwest

The present study aimed to determine the prevalence of, and factors associated with excessive and severe daytime sleepiness in healthcare university students. A cross-sectional university-based study was conducted with 1,779 students from a university located in the Brazilian Midwest State of Goiás, Brazil, in 2018. Daytime sleepiness was assessed using the Epworth Sleepiness Scale (ESS) and classified as excessive daytime sleepiness (EDS; cut-off ESS score ≥10) and severe EDS (S-EDS; cut-off ESS score ≥16). Associated factors included sociodemographic, behavioural, academic, nutritional status, and sleep-related and perceived health characteristics. Poisson regression was used for the data analysis. The mean (SD) age of the sample was 22.5 (3.84) years. The prevalence of EDS was 54.4% (95% confidence interval [CI] 51.9-56.1) and S-EDS was 10.0% (95% CI 9.2-11.7). After adjustment, a higher probability of occurrence of EDS was found among women (prevalence ratio [PR] 1.37, 95% CI 1.24-1.53), younger students (PR 1.23, 95% CI 1.07-1.42), those who were studying medicine (PR 1.14, 95% CI 1.02-1.28), with poor sleep quality (PR 1.29, 95% CI 1.17-1.43), and among those who reported constant loss of sleep due to internet use (PR 1.14, 95% CI 1.02-1.27). After adjustment, the highest probability of occurrence of S-EDS was found among women (PR 1.72, 95% CI 1.22-2.43), among those with poor sleep quality (PR 2.17, 95% CI 1.54-3.08), and medical students (PR 1.39, 95% CI 1.01-1.90). In conclusion, there was a high prevalence of daytime sleepiness among healthcare university students, especially among medical students and women.

Health literacy, health status and health behaviors of German students- study protocol for the "Healthy Habits" cohort study

BACKGROUND

The emerging adulthood is traditionally viewed as a time of optimal health, but also as a critical life span, characterized by changing life circumstances and the establishment of an individual lifestyle. Especially university life seems to hold several challenges impeding the manifestation of a health supporting manner, as many students tend to show a poorer health behavior and a higher amount of health-related problems than comparable age groups. This, along with a steady growth of the higher education sector, brings increased attention to the university setting in the context of prevention. To date, there are few empirical longitudinal and coherent cross-sectional data on the status of students' health literacy, health status, and health behaviors, and on the impact of the study format on students' health. The aim of this prospective cohort study is to reduce this research gap.

METHODS

Starting during winter semester 2020/21, the prospective cohort study collects data on health literacy, health status and health behavior on a semester-by-semester basis. All enrolled students of the IST University of Applied Sciences, regardless of study format and discipline, can participate in the study at the beginning of their first semester. The data are collected digitally via a specifically programmed app. A total of 103 items assess the subjectively perceived health status, life and study satisfaction, sleep quality, perceived stress, physical activity, diet, smoking, alcohol consumption, drug addiction and health literacy. Statistical analysis uses (1) multivariate methods to look at changes within the three health dimensions over time and (2) the association between the three health dimensions using multiple regression methods and correlations.

DISCUSSION

This cohort study collects comprehensive health data from students on the course of study. It is assumed that gathered data will provide information on how the state of health develops over the study period. Also, different degrees of correlations of health behavior and health literacy will reveal different impacts on the state of students' health. Furthermore, this study will contribute to empirically justified development of target group-specific interventions.

TRIAL REGISTRATION

German Clinical Trials Register: DRKS00023397 (registered on October 26, 2020).

Is food insecurity a barrier to dental student success?

PURPOSE

The prevalence of food insecurity among undergraduate students is higher than the national average and associated with adverse academic outcomes. Our objective was to describe the prevalence of food insecurity, food access behaviors, and associations between food security status and well-being in a dental student population.

METHODS

All dental students (N = 328) enrolled in the College of Dentistry at the University of Iowa in the fall 2019 semester were invited to participate. The survey was designed to query demographic variables, food security status (i.e., the United States Department of Agriculture's 10-item Adult Food Security Module), and food- or hunger-related well-being (i.e., sleep, academic performance, and stress). The survey was administered using the Qualtrics survey platform. Following the initial invitation, students were sent two reminders and allowed 3 weeks for completion.

RESULTS

The survey response rate was 24.7%. Forty-seven percent of respondents were food insecure. Food insecure students were more likely to attend collegiate programming (e.g., lunch and learns) for the primary purpose of obtaining free food than their food secure peers (p <0.001). In addition, food insecure students were more likely to report experiencing food- or hunger-related sleep (p = 0.001), study or academic performance (p <0.001), or stress difficulties than their food secure peers (p <0.001).

CONCLUSION

The prevalence of food insecurity in dental students was relatively high and associated with adverse food- and/or hunger-related well-being outcomes. Food insecurity might be a barrier to dental student success, compromising their immediate health and ability to learn.

Should I study or should I go (to sleep)? The influence of test schedule on the sleep behavior of undergraduates and its association with performance

Sleep is crucial for college students' well-being. Although recommended sleep duration is between 7-9 hours per day, many students do not sleep that much. Scholar demands are among the causes of observed sleep deprivation in youth. We explored the influence of having a school test on previous night sleep in first-year students and the association of sleep duration and test performance. We ran two surveys in freshman students of the Universidad de la República, Montevideo, Uruguay: 1) 97 students of the School of Sciences who took the test at the same time; and 2) 252 School of Psychology students who took the test in four successive shifts. More than 1/2 of the participants (survey #1) and almost 1/3 (survey #2) reported short regular sleep duration (< 7h). In both samples, the sleep duration of the night before the test was reduced with respect to regular nights (survey #1: 2.1 ± 0.2 h, p < 0.001; survey #2: between 1.7 ± 0.4 h and 3.6 ± 0.3 h, all p < 0.001), with more than 10% of the students who did not sleep at all. In survey 2, sleep duration increased in later shifts (F (3,248) = 4.6, p = 0.004). Using logit regressions, we confirmed that sleep duration was positively related to test scores in both samples (survey #1: exp B = 1.15, p < 0.001; pseudo-R2 = 0.38; survey #2: exp B = 1.03, p < 0.001; pseudo-R2 = 0.25). Delaying test start time may prevent the reduction in sleep duration, which may also improve school performance. In addition, educational policies should include information for students about the impact of sleep on learning and of the consequences of reduced sleep duration.