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

Impact of adverse childhood experiences and family resilience on sleep duration in autistic children

LAY ABSTRACT

Autistic children are more likely to have sleep difficulties and to experience adverse childhood experiences. Adverse childhood experiences can include parental divorce, bullying, or witnessing violence. We also know that children in families who are resilient (e.g. families who are connected, work together, and help each other) are less impacted by adverse childhood experiences. Our study examined whether there was a relationship between adverse childhood experiences and sleep duration in autistic children. We also wanted to find out whether family resilience protects from the negative impact of adverse childhood experiences on sleep duration. We used data from 3247 parent surveys about their children that we got from the National Survey of Children's Health. We found that children with adverse childhood experiences are more likely to get less sleep. We also found that children with resilient families were more likely to get more sleep. Our results show that family resilience helps weaken the relationship between adverse childhood experiences and sleep, so it is important to help families build resilience.

Physical activity, sedentary behaviour, and sleep knowledge and self-efficacy among parents of young children in Canada

Background

Engaging in healthy movement behaviours in early childhood is beneficial for children's development, and parents play a critical role in shaping movement habits during these formative years. This study aimed to explore parents' knowledge of the Canadian 24-Hour Movement Guidelines for the Early Years (The Guidelines) and their perceived knowledge and self-efficacy of movement behaviour concepts in early childhood. The influence of sociodemographic characteristics on these variables was also examined.

Methods

Via a cross-sectional online survey with parents/guardians (n = 576) of young children in Canada, participants' knowledge of The Guidelines (11 items), and perceived knowledge (11 items; 5-point scale) and self-efficacy (11 items; 11-point scale) of movement behaviour concepts in early childhood were examined. Descriptive statistics were calculated for independent variables and multivariate regression models were estimated to examine sociodemographic factors that were associated with participants' knowledge and self-efficacy.

Results

Few participants (11.9%) reported to be familiar with The Guidelines. Parents were most knowledgeable about the screen time guideline for children under 2 years (75.0% correctly identified the guideline) and least familiar with the recommendation for toddler/preschooler total physical activity (14.7% correctly identified the guideline). Parents/guardians perceived they were the most knowledgeable about safe sleep practices (65.9% very/extremely knowledgeable) and least knowledgeable about muscle- and bone-strengthening activities (71.8% not at all/somewhat knowledgeable). Overall, parents/guardians were moderately confident in promoting healthy movement behaviours (M = 6.01; SD = 1.73). Participants with higher levels of education reported significantly higher perceived knowledge compared to those who were less educated (p = .004), and parents/guardians identifying as White reported significantly higher levels of self-efficacy compared to parents/guardians from minority ethnic groups (p = .028). Finally, parents/guardians who were more physically active reported both higher perceived knowledge (p < .001) and self-efficacy (p < .001) than those who were less active.

Conclusion

These findings shed light on the need to raise awareness of The Guidelines among parents of young children and highlight specific movement behaviour concepts in need of focus in future training for this population. Targeted education for parents/guardians from lower socioeconomic groups is also needed to address equity concerns.

Supplementary Information

The online version contains supplementary material available at 10.1186/s44167-024-00051-x.

Enhancing sleep health in urban American Indian/Alaska Native adolescents: Implications for culturally tailored interventions

BACKGROUND

Urban American Indian/Alaska Native (AI/AN) adolescents are vulnerable to sleep and other health-related disparities due to numerous social drivers, including historical trauma and relocation to urban areas. This study aims to identify strategies to increase protective factors and culturally tailor sleep health interventions for this population.

METHODS

Using community-based participatory research, the NAYSHAW study conducted in-depth interviews with urban AI/AN adolescents aged 12-19 years to understand critical components needed for developing a culturally sensitive sleep health intervention. Data from two qualitative subsamples (N = 46) and parent surveys (N = 110) were analyzed, focusing on factors that affect sleep health behaviors, including parental involvement, technology, and traditional practices.

RESULTS

Key findings include the detrimental impact of electronics use at night and protective effects of traditional practices on sleep. Parental involvement in sleep routines varied by adolescent's age. Adolescents desired sleep health education in interactive formats, whereas parents preferred workshops and digital applications for sleep health strategies. Findings suggest that interventions need to address electronics use and should also be culturally tailored to address the unique experiences of urban AI/AN adolescents.

CONCLUSIONS

Results underscore the importance of utilizing community-based strategies to develop culturally tailored sleep interventions for underserved populations, specifically urban AI/AN adolescents. Integrating traditional practices with evidence-based sleep health strategies can provide a holistic approach to improving sleep and overall well-being. Parental education and involvement will be critical to the success of such interventions.

Sleep duration is associated with appetitive traits in school-age years - results from the Generation XXI birth cohort

Sleep may influence appetite regulation through physiological and neurocognitive pathways. However, the association between sleep and appetite in childhood has been scarcely reported, particularly using a prospective design. We aimed to test associations between sleep duration at 7 years of age (y) and appetitive traits at both 7 and 10 y. Participants are from the population-based birth cohort Generation XXI (Porto, Portugal), at 7 (n = 2437) and 10 y (n = 1938) follow-ups. Data on sleep was gathered at 7 y and, considering bedtime and get-up time, total mean sleep duration was calculated and further categorized according to the 10th and 90th percentiles. Appetitive traits were assessed at 7 and 10 y using the parent-reported Children's Eating Behaviour Questionnaire. Associations were tested through Generalized Linear Models (co-variates: child's sex; maternal age, education and pre-pregnancy body mass index at 7 y). At 10 y, associations were further adjusted for the respective appetitive trait at 7 y. Children slept a mean of 10.2 h/night, and 13% and 9% slept ≤9.5 and ≥ 11.0 h/night at 7 y, respectively. For each additional hour in sleep duration, children scored 0.078 (99%CI: -0.145; -0.011) lower on Food Responsiveness, 0.065 (99%CI: -0.129; -0.002) lower on Emotional Undereating and 0.096 (99%CI: -0.161; -0.032) lower on Food Fussiness. Lastly, children sleeping ≤9.5 h/night scored higher on Food Responsiveness (β = 0.145 99%CI: 0.020; 0.271); while those sleeping ≥11.0 h/night scored lower on Food Fussiness (β = -0.255 99%CI: -0.370; -0.079). No significant prospective associations were found. In conclusion, in 7 y children, sleep duration was cross-sectionally associated with lower scores on food approach (Food Responsiveness) and avoidant traits (Emotional Undereating and Food Fussiness). However, the magnitude of the associations was small and further studies are warranted.

Parent-child associations of sleep quality: is physical activity a confounder? The EPI-FAMILY health study

INTRODUCTION

The incidence of sleep deprivation has increased in pediatric populations, however, the relationship with physical activity (PA) remains uncertain and lacks evidence. Although some studies have shown that parents' lifestyle habits can influence this process, one point that requires further clarification in the literature is whether parents' sleep quality is linked to that of their children and whether parents' physical activity could play an important role in these possible relationships.

OBJECTIVES

To investigate the relationship of sleep quality between parents and children and verify the role of physical activity in this association.

METHODS

This is a cross-sectional study. Sleep quality was assessed using the Mini Sleep Questionnaire. The amount of sleep was estimated by the number of hours slept. PA domains (occupational activities, leisure, and active commuting) were assessed using the Baecke questionnaire, while moderate to vigorous PA (MVPA) was assessed with an accelerometer. Socioeconomic status was obtained through a questionnaire. The relationship of sleep quality between parents and children was carried out using hierarchical models with Binary Logistic Regression, where the factors were inserted one by one (1. unadjusted model; 2. sociodemographic variables; 3. children's PA; 4. parents' PA).

RESULTS

The study sample consisted of 102 children and adolescents (6-17 years), 92 mothers, and 69 fathers. Poor sleep quality of mothers was associated with their children's sleep quality (OR = 3.95; 95%CI = 1.33-11.38; P = 0.013). After inserting mothers' PA intensity into the final model, the associations remained significant (OR = 8.05; 1.33-48.59; P = 0.023). No relationship was observed between poor sleep quality of fathers and their children's sleep quality.

CONCLUSION

The relationship between poor sleep quality of mothers and that of their children remained significant, regardless of confounding variables.

Sleep Health among Children Adopted from Foster Care: The Moderating Effect of Parent-Child Sleep Interactions

OBJECTIVES

Sleep disruption is prevalent among children placed in foster care, elevating risk for a range of deleterious outcomes. Theoretically, achieving permanency via adoption may have a positive influence on children's sleep via the presence of various factors, but little is known about the sleep health of children adopted from foster care, including predictors and moderators of sleep health.

METHOD

The current study included 226 parents who adopted a child from foster care in the U.S. (aged 4-11 years) within the past two years and a propensity score matched sample of 379 caregivers of children currently in foster care. Both samples completed online questionnaires about their child's sleep, physical, and mental health.

RESULTS

Comparatively, children in foster care experienced more nightmares, night terrors, moving to someone else's' bed during the night, and worse overall sleep quality, whereas adopted children were reported to experience significantly more nighttime awakenings. In the adopted sample, a greater number of prior foster placements unexpectedly predicted lower total sleep disturbance scores, but this relationship was moderated by parent-child interactions around sleep. In general, greater parental involvement in children's sleep was associated with lower levels of child sleep disturbance.

CONCLUSIONS

Findings suggest that while specific sleep problems might remit after children in foster care achieve permanence, nighttime sleep fragmentation often persists. Parent-child interactions surrounding sleep may be pivotal in improving sleep health in this population.

The Impact of Delayed School Start Times During COVID-19 on Academic Performance: A Longitudinal Naturalistic Study in Italian High Schools

Background

Delaying school start times has been proposed as a potential solution to address chronic sleep curtailment among adolescents and its negative consequences on their physical and mental well-being. This study investigates the impact of delayed school start times due to the COVID-19 pandemic on academic achievement.

Subjects and Methods

Two separate observational studies were conducted involving high school students from the first/second year (n=232) (Study 1) and from the final year (n=39) (Study 2). Multivariate Analyses of Covariance were performed to assess for statistical differences in academic performance (ie, global, humanistic, and scientific performance) and absenteeism (ie, number of school absences). Two main factors were considered: "school start time" (ie, standard-8:00 AM vs late-9:40 AM) and "time interval" (ie, first academic semester vs second academic semester), controlling for the school year (Study 1) and circadian preference (Study 2).

Results

Delaying school start times was positively associated with better academic performance in scientific subjects among first/second-year students (F1,229=6.083, p=0.026) and global academic performance among last-year students (F1,35=4.522, p=0.041). Furthermore, first/second-year students significantly increased their school achievement (F1,229>29.423, p<0.001) and school absences (F1,229=66.160, p<0.001) during the second semester of the academic year. No significant effect of "school start time" on school attendance was observed. Additionally, circadian preference was found to be a significant covariate among last-year students, with early chronotypes exhibiting better academic performance (r>0.369, p<0.025).

Conclusion

These findings confirm past evidence about the beneficial effects of delayed school start times on academic outcomes, with the additional advantage of observing them within a natural context that emerged during the pandemic. Further research is needed to explore the phenomenon more systematically and take into account the broader implications of implementing this change.

Neighborhood and Household Environment as Contributors to Racial Disparities in Sleep Duration among U.S. Adolescents

Objective

Racial disparities in adolescent sleep duration have been documented, but pathways driving these disparities are not well understood. This study examined whether neighborhood and household environments explained racial disparities in adolescent sleep duration.

Methods

Participants came from Waves I and II of Add Health (n=13,019). Self-reported short sleep duration was defined as less than the recommended amount for age (<9 hours for 6-12 years, <8 hours for 13-18 years, and <7 hours for 18-64 years). Neighborhood factors included neighborhood socioeconomic disadvantage, perceived safety and social cohesion. Household factors included living in a single parent household and household socioeconomic status (HSES). Structural equation modeling was used to assess mediation of the neighborhood and household environment in the association between race/ethnicity and short sleep duration.

Results

Only HSES mediated racial disparities, explaining non-Hispanic (NH) African American-NH White (11.6%), NH American Indian-NH White (9.9%), and Latinx-NH White (42.4%) differences. Unexpectedly, higher HSES was positively associated with short sleep duration.

Conclusion

Household SES may be an important pathway explaining racial disparities in adolescent sleep duration. Future studies should examine mechanisms linking household SES to sleep and identify buffers for racial/ethnic minority adolescents against the detrimental impacts that living in a higher household SES may have on sleep.

Short Sleep Duration in School-Age Children: Differential Factors on Weekdays and Weekends

OBJECTIVES

To quantify school-age children's sleep and parent-associated factors on weekdays and weekends in Singapore, and investigate school-related and parent-related factors associated with short sleep.

METHODS

In an online survey, 251 parents with a child aged 7-12 y in Singapore reported their child's sleep duration and school start time. Parent-related factors including sleep hygiene (e.g., parent-set bedtime), sleep priority (the amount of sleep respondents allowed their children to trade for other activities), and both parents' sleep durations, were also reported.

RESULTS

The prevalence of short sleep among the children was 64.5% on weekdays and 19.5% on weekends. Children's sleep duration increased from 8.42 h on weekdays to 9.45 h on weekends (p < .001). Relative to weekdays, on weekends, parents showed similar increases in sleep durations (p < .001), imposed poorer sleep hygiene on their children (reduced likelihood of setting bedtimes and increased pre-bedtime electronic device use; p < .001), and allowed their children to trade more sleep for interacting with family and friends, social media, gaming, and TV / videos (p < .001). Shorter sleep duration in children was significantly associated with earlier school start time (B = 0.80, p = .02) and poorer sleep hygiene on weekdays (B = 0.16, p < .001), but lower sleep priority (B = 0.05, p = .002) and shorter parental sleep duration on weekends (maternal: B = 0.18, p < .001, paternal: B = 0.17, p = .002).

CONCLUSIONS

Delaying school start times may be effective in increasing school-age children's sleep duration on weekdays, while family-based interventions designed to enhance sleep hygiene, priority of sleep over other activities, and parents' sleep durations can benefit children's sleep duration on both weekdays and weekends.

Examination of parent-reported differences in children's daily screen use, sleep, and sleep hygiene behaviors during the school year and summer and their association with BMI

OBJECTIVE

The current study examined school-summer differences in children's sleep patterns and sleep hygiene. Cross-sectional relationships with children's sleep, sleep hygiene, and weight status were explored during the school year and summer.

METHODS

Children (5-8 years) and their parents (n = 197 dyads) were recruited from 4 schools in southeastern Texas and via Facebook. Parents reported children's school year and summer sleep, sleep hygiene, and screen media use. Children's body mass index (BMI) was objectively assessed at the beginning and end of the summer. Associations between children's sleep hygiene and screen media use, sleep duration, and weight status were explored.

RESULTS

Children's sleep midpoint was earlier during the school year (1:54 AM ± 0.03) than in the summer (2:06 AM ± 0.03; t = 4.07, p < .0001). During summer, children increased their screen media use by 38 minutes (t = 2.32, p = .023) and decreased their caffeine intake from 7.43 to 7.0 (with scores ranging from 3 to 15; t = 2.83, p = .006). Greater sleep-inhibiting (β = 0.40, p = .011) and fewer sleep-promoting (β = -0.28, p = .049) behaviors during the school year were associated with having a higher BMI. There were no associations among sleep patterns, sleep hygiene and BMI during summer.

CONCLUSIONS

More positive school year sleep hygiene behaviors were supportive of having a healthier weight status. Changes in these behaviors during the summer did not portend worse weight outcomes. Supporting families in the establishment of sleep-promoting behaviors, particularly during the school year may help address the child obesity epidemic.

[Sleepiness among adolescents: etiology and multiple consequences]

Over the past century a dramatic decline in sleep duration among adolescents, such as more than one hour of sleep loss per night, has been reported. A debt in sleep duration could lead to sleep deprivation, a major risk factor associated with daytime sleepiness. Sleepiness refers to the inability to maintain an adequate level of alertness during the day which may result in more or less being able to control falling asleep at inappropriate times. This literature review updates on sleepiness regarding its characteristics, etiology and consequences on adolescents. Studies revealed that from 25 % to 78 % of adolescents had reported sleepiness. Its manifestations may include heavy lids, yawns, difficulties to concentrate and emotional irritability. In addition, while it is recommended that adolescents under 18 years-old should sleep from eight to ten hours a night, only 63 % of them actually do so. The etiology of sleep deprivation and sleepiness in this population can be explained by various biological and societal factors. First, the sleep-wake cycle of adolescents shows a biological shift from the beginning of pubertal maturation, described as a perfect storm. It refers to a social jetlag by going to sleep and waking up later and accumulating a sleep debt during weekdays which they try to reimburse during weekends. This phenomenon can be explained by physiological changes such as a slower accumulation of sleep pressure. In addition to this perfect storm, environmental and societal factors contribute to the social jetlag and reduce sleep duration in adolescents. Screen exposure before bedtime can delay sleep and wake onset, which is a risk factor for sleeping debt. Substance use such as caffeine, cigarettes or electronic vaporizer, ADHD or freely available medication, alcohol, cannabis use or drug consumption could further disrupt sleep-wake cycle by stimulating, depressing or otherwise disrupting the central nervous system. Early, before 8:30 am, class start times have been associated with chronic sleep deprivation, higher level of sleepiness and delayed melatonin peak secretion. Adolescents working or doing extracurricular occupations for more than 20hours a week are more at risk for reduced sleep duration and sleepiness. Parental supervision about sleep during the weekdays were associated with more appropriate bedtime. Adolescents from low socio-demographic characteristics and from minority ethnic groups have reported displaying a shorter sleep duration. Finally, sleep disorders of a physiological origin such as narcolepsy, sleep apnea or restless legs syndrome, may explain the sleep deprivation and sleepiness. Sleep deprivation and sleepiness in adolescents have consequences on their health. Cognitive functioning, such as problem solving, attention or memory, as well as school performance, can be compromised by sleep deprivation and sleepiness. At the psychological level, adolescents reporting sleepiness are more prone to display mental health problems: associations were found between sleepiness and subjective perception of depression, anxiety, somatic complaints as well as with antisocial behaviors. Finally, 68 % of 16 year-old adolescents reported they drove a car, and the reported sleepiness could lead to road accidents due to reduced attentional functioning, reaction time and decision-making abilities. In the United-States, from 7 % to 16.5 % of deadly accidents were related to driving while drowsy. Highlighting etiology and problems associated with sleep deprivation and sleepiness in adolescents could guide researchers and clinicians towards the development of possible interventions. Public health measures and knowledge transfer programs regarding modifiable psychosocial and societal factors associated with sleep-wake bioregulation could increase awareness in parents as well as in political and societal decision makers.

Promoting Sleep Duration in the Pediatric Setting Using a Mobile Health Platform: A Randomized Optimization Trial

Objective

Determine the optimal combination of digital health intervention component settings that increase average sleep duration by ≥30 minutes per weeknight.

Methods

Optimization trial using a 25 factorial design. The trial included 2 week run-in, 7 week intervention, and 2 week follow-up periods. Typically developing children aged 9-12y, with weeknight sleep duration <8.5 hours were enrolled (N=97). All received sleep monitoring and performance feedback. The five candidate intervention components (with their settings to which participants were randomized) were: 1) sleep goal (guideline-based or personalized); 2) screen time reduction messaging (inactive or active); 3) daily routine establishing messaging (inactive or active); 4) child-directed loss-framed financial incentive (inactive or active); and 5) caregiver-directed loss-framed financial incentive (inactive or active). The primary outcome was weeknight sleep duration (hours per night). The optimization criterion was: ≥30 minutes average increase in sleep duration on weeknights.

Results

Average baseline sleep duration was 7.7 hours per night. The highest ranked combination included the core intervention plus the following intervention components: sleep goal (either setting was effective), caregiver-directed loss-framed incentive, messaging to reduce screen time, and messaging to establish daily routines. This combination increased weeknight sleep duration by an average of 39.6 (95% CI: 36.0, 43.1) minutes during the intervention period and by 33.2 (95% CI: 28.9, 37.4) minutes during the follow-up period.

Conclusions

Optimal combinations of digital health intervention component settings were identified that effectively increased weeknight sleep duration. This could be a valuable remote patient monitoring approach to treat insufficient sleep in the pediatric setting.

Lifestyle Patterns of Children Experiencing Homelessness: Family Socio-Ecological Correlates and Links with Physical and Mental Health

Diet, screen time, physical activity, and sleep combine into lifestyle patterns with synergistic effects on health. This study aimed to identify lifestyle patterns in children without housing and assess their associations with physical and mental health and family socio-ecological factors. In the 2013 ENFAMS cross-sectional survey (children aged 6-12 experiencing homelessness, Greater Paris area, n = 235), parents reported socio-ecological factors, children's behaviours, and mental health (the latter was also child-reported). Nurses measured children's haemoglobin concentrations and body mass index. Principal component analysis was used to derive sex-specific lifestyle patterns. Hierarchical linear regressions and "outcome-wide" analyses assessed, respectively, these patterns' relations to health and family socio-ecological factors. A rather healthy lifestyle pattern-similarly characterized by diverse diet and high sleep time-was identified, with slight differences by sex. Scores for this pattern were higher for children in food-secure or higher-income households, whose parents were proficient in French, who slept longer, or who received more social support compared to their counterparts, with some nuances by sex. Higher scores for this pattern were associated with higher prosocial behaviour scores (girls) and lower anxiety and hyperactivity-inattention symptoms scores (boys), but not with physical health. For this underserved and understudied population, the results highlight the importance of family socio-ecological factors in shaping the lifestyles and mental health of children.

Go to bed! A systematic review and meta-analysis of bedtime procrastination correlates and sleep outcomes

Bedtime procrastination is defined as the volitional delay of going to bed, without any external circumstances causing the delay, and is associated with inadequate sleep. Alleviating bedtime procrastination is an important target for interventions promoting adequate sleep, yet the correlates of bedtime procrastination are poorly understood. This study examined (1) correlates of bedtime procrastination, and (2) strength and direction of the association between bedtime procrastination and sleep outcomes. Six databases (CINAHL, EMBASE, PsychINFO, PubMed, Scopus, Web of Science) were searched from inception to September 2021 against pre-determined eligibility criteria. Forty-three studies were included (GRADE = low). Meta-analysis revealed that bedtime procrastination had a moderate negative association with self-control (z = -0.39; CI: -0.45, -0.29) and a moderate positive association with evening chronotype (z = 0.43; CI: 0.32, 0.48). Furthermore, bedtime procrastination was moderately negatively associated with sleep duration (z = -0.31; CI: -0.37, -0.24), sleep quality (z = -0.35; CI: -0.42, -0.27) and moderately positively associated with daytime fatigue (z = 0.32; CI: 0.25, 0.38). Further high-quality studies are needed to identify causal relationships between bedtime procrastination and correlates, as well as bedtime procrastination and sleep. Future work will guide the development of interventions targeting bedtime procrastination for improved sleep outcomes. STUDY REGISTRATION: PROSPERO registration number CRD42021248891.

Sleep health among U.S. Hispanic/Latinx children: An examination of correlates of meeting sleep duration recommendations

OBJECTIVES

The objective of this study was to examine the association between sociodemographic, behavioral, and environmental factors and adherence to sleep duration recommendations among 1165 U.S. Hispanic/Latinx children.

METHODS

In this cross-sectional study, the following parent-reported variables were examined as correlates of whether children met age-appropriate nightly sleep duration recommendations: caretaker and child demographics (eg, gender, age, poverty level), presence of TV in child's bedroom, child's daily screen time and bedtime.

RESULTS

Most (61.4%) children (mean age: 6.39 years, SD = 2.66) met sleep duration guidelines. Multivariable regression results revealed the odds of meeting recommendations were significantly higher among children 6-12 years old living above the poverty threshold (odds ratio [OR] = 1.57; 95% confidence interval [95%CI]: 1.08, 2.31) and those with a regular bedtime ("Some of the time:" OR = 2.05; 95%CI: 1.07, 3.92; "Most of the time:" OR = 3.19; 95%CI: 1.77, 5.74; "Always:" OR = 4.46; 95%CI: 2.43, 8.13).

CONCLUSIONS

Sleep health disparities must be addressed through culturally and contextually appropriate interventions that combine individual-level strategies with those that address social and environmental factors.

Promoting children's sleep health: Intervention Mapping meets Health in All Policies

Background

To design a comprehensive approach to promote children's sleep health in Amsterdam, the Netherlands, we combined Intervention Mapping (IM) with the Health in All Policies (HiAP) perspective. We aimed to create an approach that fits local infrastructures and policy domains across sectors.

Methods

First, a needs assessment was conducted, including a systematic review, two concept mapping studies, and one cross-sectional sleep diary study (IM step 1). Subsequently, semi-structured interviews with stakeholders from policy, practice and science provided information on potential assets from all relevant social policy sectors to take into account in the program design (HiAP and IM step 1). Next, program outcomes and objectives were specified (IM step 2), with specific objectives for policy stakeholders (HiAP). This was followed by the program design (IM step 3), where potential program actions were adapted to local policy sectors and stakeholders (HiAP). Lastly, program production (IM step 4) focused on creating a multi-sector program (HiAP). An advisory panel guided the research team by providing tailored advice during all steps throughout the project.

Results

A blueprint was created for program development to promote children's sleep health, including a logic model of the problem, a logic model of change, an overview of the existing organizational structure of local policy and practice assets, and an overview of policy sectors, and related objectives and opportunities for promoting children's sleep health across these policy sectors. Furthermore, the program production resulted in a policy brief for the local government.

Conclusions

Combining IM and HiAP proved valuable for designing a blueprint for the development of an integrated multi-sector program to promote children's sleep health. Health promotion professionals focusing on other (health) behaviors can use the blueprint to develop health promotion programs that fit the local public service infrastructures, culture, and incorporate relevant policy sectors outside the public health domain.

Investigating the association between sleep and aspects of mental health in children: findings from the Canadian Health Survey on Children and Youth

INTRODUCTION

Sufficient sleep and good quality sleep are crucial aspects of children's healthy development. While previous research has suggested associations between sleep and positive mental health, few studies have been conducted in Canadian children.

METHODS

This study used data from the 2019 Canadian Health Survey on Children and Youth. Parents of children aged 5 to 11 years (N = 16 170) reported on their children's sleep habits and mental health. Descriptive statistics were used to calculate means and percentages for sleep and mental health indicators. Logistic regression was used to compare mental health outcomes by meeting sleep duration recommendations (9-11 hours of sleep vs. < 9 or > 11 hours of sleep), sleep quality (difficulties getting to sleep) and having enforced rules for bedtime.

RESULTS

Overall, 86.2% of children aged 5 to 11 years met sleep duration recommendations (9-11 hours of sleep), 90.0% had high sleep quality and 83.1% had enforced rules for bedtime. While 83.0% of children had high general mental health, mental health diagnoses were reported for 9.5% of children, and 15.8% of children required or received mental health care. High sleep quality was consistently associated with better mental health, enforced rules for bedtime were associated with some negative mental health outcomes and meeting sleep duration recommendations tended not to be associated with mental health outcomes.

CONCLUSION

Sleep quality was strongly associated with mental health among children in this study. Future research should explore longitudinal associations between sleep and mental health in Canadian children.

Maternal-child overweight relationship, assessment of maternal perception of child weight status and feeding behaviours

BACKGROUND

Parents play a key role in constructing children' behaviours. We studies maternal-child overweight relationship and compared maternal perception of child weight status and feeding behaviours between groups of normal-weight and overweight children.

METHODS

The cross-sectional study was conducted on 192 girls aged 10-13 years and their mothers. They were divided to two groups of overweight (n = 94) and normal-weight (n = 98) children. Anthropometric characteristics were measured for children and mothers. Logistic regression analysis was used to examine the association between child overweight and tertiles of maternal body mass index (BMI). Maternal perception of child's weight status and her engagement in promoting child's healthy behaviours was assessed.

RESULTS

BMI and waist circumference was significantly higher in children (P < 0.001) and mothers (P < 0.01) of overweight compared to normal-weight group. There was a significant relationship between children's overweight and tertiles of maternal BMI, which remained significant after adjusting for potential confounders. Mothers of overweight children were more concerned for their child's overeating and overweight, and for compelling the child to diet to maintain a desirable weight (P < 0.001). In contrast, mothers of normal-weight children restricted sugar-sweetened drinks (P = 0.008), offered fruit and vegetables (P = 0.035), and helped their children to get enough physical activity (P = 0.022) and night sleep (P = 0.001) more than mothers in other group.

CONCLUSIONS

This study showed a strong relationship between children and mothers' overweight. Despite being more concerned about their child weight status, mothers of overweight children reported behaviours which were less encouraging the children for healthy eating and lifestyle than mothers of normal-weight children.

An Exploratory Analysis of the Effect of Demographic Features on Sleeping Patterns and Academic Stress in Adolescents in China

Adolescents typically engage in unhealthy lifestyle habits including short sleep and high academic stress. These in turn may have serious impacts on their development. The present study examines the effect of demographic characteristics on sleep patterns and academic stress in adolescents. A sample of 244 (119 females) junior high school adolescents aged between 11 and 16 were recruited from China. The Student Life Stress Questionnaire and the School Sleep Habits Survey were used to assess participants' sleep habits and academic stress. Multipair and corrected pairwise Kruskal-Wallis tests were conducted to assess the effect of school grade, gender, academic performance level, living situation, single child status, and parental education on adolescents' sleeping patterns and academic stress. Significant changes in facets of sleeping patterns emerged when examining groups of students in terms of school grade, living situation, and single-child status. Furthermore, caffeine consumption was found to be significantly higher in males, in students with poorer academic performances, and in single-child adolescents. Ultimately, academic stress was modulated by adolescents' school grade, academic performances, living situation, and single-child status. Developmental trajectories in sleep patterns together with differential exposure to stressors and adopted coping mechanisms are discussed in the manuscript.

Weekday and Weekend Physical Activity of Preschool Children in Relation to Selected Socioeconomic Indicators

Physical activity (PA) is as vital for improving the health of young children as it is positively associated with a broad range of psychological, cognitive, and cardio-metabolic outcomes. The aims of this study were to: (1) to assess the level of PA and meeting the WHO recommendations: moderate-to-vigorous physical activity (MVPA) and the number of steps in Polish preschool boys and girls on weekdays and on weekends; (2) to investigate the relationship between selected socioeconomic indicators (self-reported by parents) and PA, including meeting the WHO recommendation for daily MVPA and the number of steps on weekdays and on weekends among Polish preschoolers. Data were collected in the 2017/2018 school year. The study included a total of 522 boys and girls both aged between 5 and 6 years. The ActiGraph GT3X-BT tri-axial accelerometer was used to measure PA. Selected socioeconomic indicators as well as parental body weight and body height were self-reported by parents/caregivers using a questionnaire. In most of the PA indicators analyzed for girls (moderate, vigorous, total MVPA, and steps/day), the averages were higher during the week than during the weekend. Moreover, significantly more boys met the criteria of MVPA, both on weekdays and over the weekend (32.3% boys and 19.2% girls on weekdays and 31.1% boys and 18.1% girls on weekends). Additionally, more boys met the step recommendations, but only on weekends (15.5% boys and 6.6% girls). It was found that if there were two people in a household, there was an almost a three-fold greater chance (adj. OR = 2.94, p = 0.032) of meeting the MVPA criterion with an even stronger association (over fivefold greater chance) in meeting the step recommendation (adj. OR = 5.56, p = 0.033). The differences in the day schedule may potentially contribute with the level of PA in girls. Among the analyzed selected socioeconomic indicators, only the number of people in a household had a significant association on PA.

Gaming Behaviors and the Association with Sleep Duration, Social Jetlag, and Difficulties Falling Asleep among Norwegian Adolescents

The relationship between gaming and sleep is mostly informed by studies of addictive gaming behavior, thus limiting our understanding of sleep in the context of nonproblematic engaged gaming. The present study investigated whether addicted, problem, and engaged gaming behavior was associated with sleep duration, social jetlag, and difficulties falling asleep. The sample consisted of 13- and 16-year-old Norwegian adolescents (n = 3228) participating in the Health Behavior in School-Aged Children (HBSC) survey in 2018. Participants were categorized into addicted, problem, engaged, and normal/non-gaming behavior groups according to which GAS-7 criteria they fulfilled. Robust generalized linear mixed models with a random intercept for class ID were used to examine the association between the sleep variables and gaming behavior. Addicted gaming behavior was unfavorably associated with all sleep parameters. The findings for engaged gaming and problem gaming behavior were somewhat mixed. Engaged gamers slept less on weekends, less on weekdays for those aged 16, and experienced greater social jetlag compared to the normal/non-gaming group. Problem gamers experienced greater social jetlag and had higher odds of experiencing difficulties falling asleep. Overall, the results suggest that all types of gaming behaviors might harm sleep health, but to a greater extent for the addicted gamers.

The Influence of Family Sports Attitude on Children's Sports Participation, Screen Time, and Body Mass Index

Background: Children’s physical health is an important resource for a country’s future construction. However, researchers found that the physical fitness of young children around the world has declined during the two decades, from 1992 to 2012. The decline in the physique of young children has caused widespread concern around the world. Children’s main living places are families and kindergartens, so this research explores the impact of family factors on children’s body mass index (BMI) from the perspective of family attitudes, children’s sports participation, and screen time.

Methods: A cross-sectional study was used to conduct a questionnaire survey of children in China. A total of 600 children were investigated, and 589 valid questionnaires were obtained. SPSS21.0 statistical analysis software was used for descriptive analysis, mean comparison, and correlation analysis of the data. AMOS 21.0 was used to construct a structural equation model and carry out path analysis.

Results: (1) There are significant differences in children’s family sports attitude, sports participation, screen time, and BMI with different family structures, and parents’ education levels. (2) Family sports attitude is significantly positively correlated with parents’ education levels and children’s sports participation, and negatively correlated with children’s screen time and BMI. (3) Children’s sports participation and screen time play a chain-mediating role between family sports attitude and children’s BMI, and the role is a complete mediating role. Therefore, family sports attitudes can affect children’s physical health by affecting children’s sports participation and screen time. To promote children’s physical health, we should pay attention to the intervention of family sports attitude. (4) The mediating effects of exercise participation and screen time are similar in different family structures, so the structure of this study can be applied to different family structures.

Conclusions: Children’s family sports attitude, sports participation, and screen time can affect children’s BMI. Children’s screen time and sports participation play a chain-mediating role in the influence of family sports attitudes on the path of children’s BMI. The results of this study will provide a useful reference for teachers and parents to control children’s physical health.

Associations Between Social Media, Bedtime Technology Use Rules, and Daytime Sleepiness Among Adolescents: Cross-sectional Findings From a Nationally Representative Sample

BACKGROUND

Social media use is associated with poor sleep among adolescents, including daytime sleepiness, which affects adolescents' mental health. Few studies have examined the associations among specific aspects of social media, such as frequency of checking and posting, perceived importance of social media for social belonging, and daytime sleepiness. Identifying whether certain adolescents are more at risk or protected from the effects of social media on sleepiness may inform future interventions for social media, sleep, and mental health.

OBJECTIVE

This study aims to examine the association between social media use frequency and importance, daytime sleepiness, and whether the perceived importance of social media for social interactions and parental rules around bedtime technology moderated these relationships.

METHODS

This cross-sectional survey study was conducted with a sample of 4153 adolescents from across the United States. Qualtrics was used to collect data via panel recruitment from a national sample representing the US demographics of teens aged 12 to 17 years. Participants completed measures of daytime sleepiness, frequency of social media checking and posting, and the importance of social media for social interactions. Parents reported whether they had a household rule around bedtime media and screen use. Hierarchical regressions and moderation analyses were conducted, covarying for age, gender, and age at first smartphone use.

RESULTS

Participants had a mean age of 14.64 (SD 1.66) years in grades 6 to 12, 46.45% (1929/4153) identified as female, and 67.93% (2821/4153) identified as White. The results indicated that adolescents who posted (B=0.70, SE 0.04; P<.001) or checked (B=0.76, SE 0.04; P<.001) social media more frequently or who perceived social media to be more important for social belonging (B=0.36, SE 0.02; P<.001) had higher levels of daytime sleepiness. Moderation analyses indicated that the relationship between social media use frequency and daytime sleepiness was exacerbated by higher levels of perceived social media importance (B=0.04, SE 0.01; P<.001). Adolescents without household rules around bedtime technology use were more likely to be affected by social media checking (B=-0.34, SE 0.09; P<.001) and importance (B=-0.16, SE 0.04; P<.001) on daytime sleepiness.

CONCLUSIONS

The findings suggest that social media use frequency and perceived importance of social interactions are associated with daytime sleepiness among adolescents. It is important to consider youth's perceptions of social media when assessing the potential effects of social media use frequency on youth well-being. Furthermore, youth who did not have parental rules around bedtime technology use were most likely to be affected by social media use and perceived importance. The findings may extend to other mental health outcomes and may guide future prevention and intervention programs designed to improve social media use, sleep, and mental health.

Engineering a mobile platform to promote sleep in the pediatric primary care setting

Study Objectives

Pediatricians lack tools to support families at home for the promotion of childhood sleep. We are using the Multiphase Optimization Strategy (MOST) framework to guide the development of a mobile health platform for childhood sleep promotion. The objective of this study is to demonstrate feasibility of a mobile health platform towards treating children with insufficient sleep.

Methods

Children aged 10–12 years were enrolled (Study #1: N = 30; Study #2: N = 43). Participants wore a sleep tracker to measure sleep duration. Data were retrieved by a mobile health platform, programmed to send introductory messages during run-in (2 weeks) and goal achievement messages during intervention (7 weeks) periods. In study #1, participants were randomized to control, gain-framed incentive or loss-framed incentive arms. In study #2, participants were randomized to control, loss-framed incentive, normative feedback or loss-framed incentive plus normative feedback arms.

Results

In study #1, 1514 nights of data were captured (69%) and sleep duration during the intervention was higher by an average of 21 (95% CI: −8, 51) and 34 (95% CI: 7, 61) minutes per night for the gain-framed and loss-framed arms, respectively, compared to controls. In study #2, 2,689 nights of data were captured (81%), with no major differences in average sleep duration between the control and the loss-framed or normative feedback arms.

Conclusions

We have developed and deployed a mobile health platform that can capture sleep data and remotely communicate with families. Promising candidate intervention components will be further investigated under the optimization phase of the MOST framework.

Clinical Trials

Both studies included in this manuscript were registered at clinicaltrials.gov:

-Study #1: NCT03263338

-Study #2: NCT03426644

Sleep among Youth with Severely Disabling Chronic Pain: Before, during, and after Inpatient Intensive Interdisciplinary Pain Treatment

Poor sleep is commonly reported in pediatric chronic pain. There are signals that intensive interdisciplinary pain treatments (IIPT) may inadvertently improve objective sleep, but this claim cannot be substantiated without baseline sleep data prior to IIPT. This study followed the objective sleep/wake patterns (e.g., duration, quality, timing, consistency) of pediatric patients with severely functionally disabling chronic pain before, during, and after inpatient IIPT (the Functional Independence Restoration Program-"FIRST Program"), alongside a similarly-disabled chronic pain Comparison Group. The final sample included N = 10 FIRST Patients and N = 9 Comparison Group patients. At baseline, the whole sample showed healthy sleep duration (~9 h), average sleep efficiency <90%, late sleep onset and offset (mean = 11:56 p.m.-8:50 a.m.), and highly inconsistent sleep schedules night to night. During IIPT, FIRST Patients maintained healthy sleep durations, moved sleep schedules 2 h earlier, and decreased timing and duration variability by >60 min while the Comparison Group maintained similar sleep to baseline. At follow up (1-2 months later), FIRST Patients' sleep schedules shifted later but were still less variable than at baseline. Results point to the malleability of sleep/wake patterns within treatment contexts with strict environmental control but suggest that these gains may be difficult for youth with chronic pain to maintain in the home environment.

Development of a consensus statement on the role of the family in the physical activity, sedentary, and sleep behaviours of children and youth

BACKGROUND

Children and youth who meet the physical activity, sedentary, and sleep behaviour recommendations in the Canadian 24-Hour Movement Guidelines are more likely to have desirable physical and psychosocial health outcomes. Yet, few children and youth actually meet the recommendations. The family is a key source of influence that can affect lifestyle behaviours. The purpose of this paper is to describe the process used to develop the Consensus Statement on the Role of the Family in the Physical Activity, Sedentary, and Sleep Behaviours of Children and Youth (0-17 years) and present, explain, substantiate, and discuss the final Consensus Statement.

METHODS

The development of the Consensus Statement included the establishment of a multidisciplinary Expert Panel, completion of six reviews (three literature, two scoping, one systematic review of reviews), custom data analyses of Statistics Canada's Canadian Health Measures Survey, integration of related research identified by Expert Panel members, a stakeholder consultation, establishment of consensus, and the development of a media, public relations, communications and launch plan.

RESULTS

Evidence from the literature reviews provided substantial support for the importance of family on children's movement behaviours and highlighted the importance of inclusion of the entire family system as a source of influence and promotion of healthy child and youth movement behaviours. The Expert Panel incorporated the collective evidence from all reviews, the custom analyses, other related research identified, and stakeholder survey feedback, to develop a conceptual model and arrive at the Consensus Statement: Families can support children and youth in achieving healthy physical activity, sedentary and sleep behaviours by encouraging, facilitating, modelling, setting expectations and engaging in healthy movement behaviours with them. Other sources of influence are important (e.g., child care, school, health care, community, governments) and can support families in this pursuit.

CONCLUSION

Family is important for the support and promotion of healthy movement behaviours of children and youth. This Consensus Statement serves as a comprehensive, credible, and current synopsis of related evidence, recommendations, and resources for multiple stakeholders.

How Are Adolescents Sleeping? Adolescent Sleep Patterns and Sociodemographic Differences in 24 European and North American Countries

PURPOSE

Insufficient and poor sleep patterns are common among adolescents worldwide. Up to now, the evidence on adolescent sleep has been mostly informed by country-specific studies that used different measures and age groups, making direct comparisons difficult. Cross-national data on adolescent sleep that could inform nations and international discussions are lacking. We examined the sleep patterns of adolescents across 24 countries and by gender, age, and affluence groups.

METHODS

We obtained sleep data on 165,793 adolescents (mean age 13.5 years; 50.5% girls) in 24 European and North American countries from the recent cross-sectional Health Behaviour in School-aged Children surveys (2013-2014 and 2017-2018). For each country, we calculated the age-standardized mean in sleep duration, timing, and consistency and the proportions meeting sleep recommendations on school and nonschool days from self-reported bedtimes and wake times. We conducted stratified analyses by gender, age, and family affluence group.

RESULTS

Adolescent sleep patterns varied cross-nationally. The average sleep duration ranged between 7:47 and 9:07 hours on school days and between 9:31 and 10:22 hours on nonschool days, and the proportion of adolescents meeting sleep recommendations ranged between 32% and 86% on school days and between 79% and 92% on nonschool days. Sleep patterns by gender and affluence groups were largely similar, but older adolescents slept less and went to bed later on school days than younger adolescents in all countries.

CONCLUSIONS

The sleep patterns of adolescents vary across countries and sociodemographic groups. Insufficient sleep on school days is common in many countries. Public health and policy efforts to promote healthy adolescent sleep are encouraged.

Parents still matter: the influence of parental enforcement of bedtime on adolescents’ depressive symptoms

Study Objectives

The aim of the current study was to test a multilevel mediation model that examined how adolescent sleep duration might be linked to depressive symptoms via their daytime energy levels. Furthermore, the study examined how parents’ enforcement of various types of bedtime rules predicted the duration of adolescent sleep.

Methods

A total of 193 adolescent (ages 14–17; Mage = 15.7 years old, SD = .94; 54.4% female; 71% Caucasian) and parent dyads completed baseline, online surveys, and adolescents also completed online 7-day, twice-daily (i.e. morning and evening) reports of their sleep duration (morning diary) and their energy levels and depressive symptoms throughout the day (evening diary). Parents (Mage = 47.6 years old, SD = 5.4; 80% female) completed assessments of enforcement of bedtime-related rules (i.e. bedtime, cessation of electronic media usage, prohibiting afternoon/evening caffeine consumption). Multilevel modeling enabled the testing of the mediation model both at the between-person level and within individuals.

Results

Results suggested that adolescents’ energy levels mediated the association between adolescents’ sleep duration and depressive symptoms. Furthermore, both greater enforcement of bedtimes and later school start times predicted longer sleep durations for adolescents, and were indirectly associated with adolescents’ depressive symptoms.

Conclusions

These findings underscore the importance of adolescents obtaining sufficient sleep to support their mental health and suggest a critical point of intervention for preventing or decreasing insufficient sleep. Given the diverse threats to adolescents’ sleep as well as adolescents’ desire for greater independence, collaborative, autonomy-promoting bedtime limit-setting is recommended to support adolescents’ well-being.

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.

Healthy or Unhealthy? The Cocktail of Health-Related Behavior Profiles in Spanish Adolescents

The aim of this study was to identify the prevalence and clustering of health-related behaviors in Spanish adolescents and to examine their association with sex, body mass index (BMI), different types of sedentary screen time, and adherence to 24-hour movement guidelines. A final sample of 173 students (M = 12.99 ± 0.51) participated in this study. Cluster analysis was conducted based on five health-related behaviors: PA and sedentary time derived from accelerometers, as well as healthy diet, sedentary screen time, and sleep duration derived from self-reported scales. Recommendations for 24-hour movement guidelines (i.e., physical activity (PA), screen time, and sleep duration) were analyzed both independently and combined. A total of 8.9% of the sample did not meet any of the guidelines, whereas 72.3%, 17.3%, and 1.7% of the sample met 1, 2, or all 3 guidelines, respectively. Six distinct profiles were identified, most of them showing the co-occurrence of healthy- and unhealthy-related behaviors. Given that most of the adolescents failed to meet the combination of PA, screen time, and sleep duration guidelines, these findings suggest the necessity to implement school-based interventions that target multiple health behaviors, especially because (un)healthy behaviors do not always cluster in the same direction.

Exploring Brazilian Immigrant Mothers' Beliefs, Attitudes, and Practices Related to Their Preschool-Age Children's Sleep and Bedtime Routines: A Qualitative Study Conducted in the United States

In the United States (US), racial/ethnic minority children, low-income children, and children of immigrant families are at increased risk of childhood obesity. Mounting evidence documents that sleep duration and sleep quality are important modifiable factors associated with increased risk of obesity among preschool-aged children. The number of Brazilian immigrants in the US is increasing, yet no existing research, to our knowledge, has examined factors affecting sleep and bedtime routines of children of Brazilian immigrant families. Therefore, the purpose of this qualitative study was to explore Brazilian immigrant mothers' beliefs, attitudes, and practices related to sleep and bedtime routines among preschool-aged children. Seven focus group discussions (FGDs) were conducted with 37 Brazilian immigrant mothers of preschool-age children living in the US. The audio-recordings of the FGDs were transcribed verbatim in Portuguese without identifiers and analyzed using thematic analyses. Mothers also completed a brief questionnaire assessing socio-demographic and acculturation. Analyses revealed that most mothers were aware of the importance of sleep and sleep duration for their children's healthy growth and development. Mothers also spoke of children needing consistent bedtime routines. Nevertheless, many mothers reported inconsistent and suboptimal bedtime routines (e.g., lack of predictable and orderly bedtime activities such as bath, reading, etc. and use of electronics in bed). These suboptimal routines appeared to be influenced by day-to-day social contextual and environmental factors that are part of Brazilian immigrant families' lives such as parents' work schedule, living with extended family, living in multi-family housing, neighborhood noise, etc. Analyses identified several modifiable parenting practices related to young children's sleep and bedtime routines (e.g., irregular bedtime, late bedtime, inconsistent bedtime routines, use of electronics in bed, etc.) that can be addressed in parenting- and family-based obesity prevention interventions. Interventions should consider the social context of the home/family (e.g., parents' work schedules) and the environment (e.g., multi-family housing; neighborhood noise, etc.) faced by Brazilian immigrant families when developing health promotion messages and parenting interventions tailored to this ethnic group.