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Fischer AR, Doudell KR, Cundiff JM, Green SRM, Lavender CA, Gunn HE. Maternal Sleep Health, Social Support, and Distress: A Mixed-Methods Analysis of Mothers of Infants and Young Children in Rural US. Behav Sleep Med 2024:1-24. [PMID: 38600856 DOI: 10.1080/15402002.2024.2339818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/12/2024]
Abstract
OBJECTIVES The purpose of this study was to explore sleep health in rural maternal populations through a social-ecological framework and identify risk and protective factors for this population. METHODS 39 individuals who are mothers of infants or children under the age of 5 years completed an online survey, 35 of which completed a subsequent semi-structured interview. Recruitment was limited to one rural community and was in partnership with community healthcare providers. Results were integrated using a convergent, parallel mixed-methods design. RESULTS Poor sleep health and high prevalence of insomnia symptoms in rural mothers were evident and associated with social support and maternal distress. Qualitative content from interviews indicated that well-established precipitating and perpetuating factors for insomnia may contribute to poor maternal sleep health. Results also revealed a gap in knowledge and language surrounding sleep health among rural mothers. CONCLUSIONS Sleep health is challenged during the transition to motherhood and rural mothers have less access to specialized perinatal and behavioral health care than their urban counterparts. In this sample, poor sleep was attributable to distress in addition to nocturnal infant and child sleep patterns which has implications for psychoeducation and promotion of sleep health in mothers. Sleep is a modifiable health indicator that is associated with several other maternal health outcomes and should be considered an element of a comprehensive maternal health for prevention and intervention across individual, interpersonal, and societal domains of the social-ecological model of sleep health.
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Affiliation(s)
| | - Kelly R Doudell
- Department of Psychology, University of Alabama, Tuscaloosa, AL, USA
| | - Jenny M Cundiff
- Department of Psychology, University of Alabama, Tuscaloosa, AL, USA
| | | | - Catherine A Lavender
- College of Community Health Sciences, University of Alabama, Tuscaloosa, AL, USA
| | - Heather E Gunn
- Department of Psychology, University of Alabama, Tuscaloosa, AL, USA
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Novak JR, Miller K, Gunn HE, Troxel WM. Development of the Couples' Sleep Conflict Scale: A new tool to assess conflict around sleep in romantic relationships. Sleep Health 2024:S2352-7218(24)00011-1. [PMID: 38604936 DOI: 10.1016/j.sleh.2024.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 01/11/2024] [Accepted: 01/28/2024] [Indexed: 04/13/2024]
Abstract
OBJECTIVE The purpose of this study was to evaluate the psychometric properties of the Couples' Sleep Conflict Scale, a new measure designed to identify the extent of conflict around sleep in romantic relationships. METHODS Data from an individual sample (N = 158) and dyadic sample (N = 143 mixed-gender couples) in romantic relationships were used to examine the psychometric properties of the Couples' Sleep Conflict Scale, including internal consistency, convergent and divergent validity, and whether the factor structure differed between couples with concordant and discordant chronotypes. RESULTS Results revealed that the Couples' Sleep Conflict Scale fit a 1-factor solution of 5 items, a summed or mean score can be used, and that it is reliable for both men and women. In addition, more relational sleep conflict was associated with both their own and their partners' poorer sleep hygiene, worse sleep quality, and more daytime sleepiness as well as more general relationship conflict, lower relationship satisfaction, and higher anxious and avoidant attachment. Finally, we found partial measurement invariance for factor loadings, intercepts, and latent variable variances between couples with concordant vs. discordant chronotypes. CONCLUSION The Couples' Sleep Conflict Scale is a brief measure that can be used in both research and in health care settings to examine how sleep-related conflict can affect both sleep and relationship quality among couples.
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Affiliation(s)
- Josh R Novak
- Department of Human Development and Family Science, Auburn University, Auburn, Alabama, United States.
| | - Kaleigh Miller
- Department of Human Development and Family Science, Auburn University, Auburn, Alabama, United States
| | - Heather E Gunn
- Department of Psychology, University of Alabama, Tuscaloosa, Alabama, United States
| | - Wendy M Troxel
- Division of Behavior and Policy Sciences, RAND Corporation, Social and Behavioral Policy Program, Pittsburgh, Pennsylvania, United States
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Ewing EL, Xia M, Gunn HE. Affiliative Parent-Adolescent Bedtime and Waketime Interactions are Associated with Adolescent Sleep. Behav Sleep Med 2024; 22:168-178. [PMID: 37318033 PMCID: PMC10721726 DOI: 10.1080/15402002.2023.2217970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
OBJECTIVES The current study examined whether evening and morning affiliation (i.e., warmth) and autonomy (i.e., more or less in charge) around sleep routines predicted adolescent sleep on weekdays. METHOD Participants were 28 parent (Mage = 43.19; 85.17% mothers) and adolescent (Mage = 12.34 years) dyads who completed the same electronic diaries morning and evening for 10 days, with a total number of 221 nights observed across dyads. Sleep duration and sleep quality were assessed via the Pittsburgh Sleep Diary; degree of affiliation and autonomy around bedtime and waketime routines were assessed with single items on a visual analog scale. Multilevel modeling was utilized to evaluate the effects of more or less affiliation or autonomy on sleep outcomes (i.e., duration and quality) between and within dyads. RESULTS Across all participants, adolescents who reported more affiliative interactions with their parent around bedtime and waketime slept longer and had better sleep quality at night. Further, when adolescents experienced greater than average affiliative interactions with their parent than was typical for them, they had better sleep quality that night. Adolescent sleep quality and duration were not impacted by whether or not adolescents were in charge of their bedtime and waketime routines. CONCLUSIONS Findings support parents' role in social and emotional security and highlight the importance of affiliative parent interactions around the sleep period for optimal sleep for young adolescents.
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Affiliation(s)
- Emily L. Ewing
- University of Alabama, Tuscaloosa, Department of Psychology
| | - Mengya Xia
- University of Alabama, Tuscaloosa, Department of Psychology
- Arizona State University, Tempe, T. Denny Sanford School of Social and Family Dynamics
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Novak JR, Miller KC, Gunn HE, Troxel WM. Yours, mine, or ours? Dyadic sleep hygiene and associations with sleep quality, emotional distress, and conflict frequency in mixed-gender, bed-sharing couples. J Sleep Res 2023:e14047. [PMID: 37749792 DOI: 10.1111/jsr.14047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 07/28/2023] [Accepted: 09/11/2023] [Indexed: 09/27/2023]
Abstract
Although prior research demonstrates the interdependence of sleep quality within couples (i.e., the sleep of one partner affects the sleep of the other), little is known about the degree to which couples' sleep hygiene behaviours are concordant or discordant, and if one's own sleep hygiene or their report of their partners' sleep hygiene is related to worse relational, psychological, and sleep outcomes. In a sample of 143 mixed-gender, bed-sharing couples, each partner completed an online questionnaire consisting of the Sleep Hygiene Index (for themselves and their partner), PROMIS sleep disturbance scale, conflict frequency, PHQ-4 for anxiety and depressive symptoms, and the Perceived Stress Scale. Paired samples t-tests between partners were conducted using total and individual-item Sleep Hygiene Index scores to examine similarities and differences. Intraclass correlation coefficient (ICC) scores of dyadic reports were conducted to examine the level of agreement between each partner's sleep hygiene. Finally, we examined associations between one's own sleep hygiene and their report of their partner's sleep hygiene with both partner's sleep quality, emotional distress, and conflict frequency in a dyadic structural equation model with important covariates and alternative model tests. The results revealed a significant difference between men's (M = 14.45, SD = 7.41) and women's total score self-report sleep hygiene ([M = 17.67, SD = 8.27]; t(142) = -5.06, p < 0.001) and partners only had similar sleep hygiene for 5 out of the 13 items. Examining dyadic reports of sleep hygiene revealed that partners had moderate agreement on their partners' sleep hygiene (0.69-0.856). The results from the dyadic structural equation model revealed that poorer sleep hygiene was associated with one's own poor sleep quality, higher emotional distress, and more frequent relational conflict. For both men and women a poorer report of a partner's sleep hygiene was associated with one's own report of higher relationship conflict. Finally, men's poorer report of a partner's sleep hygiene was related better to their own sleep quality but was related to poorer sleep quality for their partners. These results have implications for sleep promotion and intervention efforts as well as for couple relationship functioning.
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Affiliation(s)
- Josh R Novak
- Department of Human Development and Family Science, Auburn University, Auburn, Alabama, USA
| | - Kaleigh C Miller
- Department of Human Development and Family Science, Auburn University, Auburn, Alabama, USA
| | - Heather E Gunn
- Department of Psychology, University of Alabama, Tuscaloosa, Alabama, USA
| | - Wendy M Troxel
- Department of Behavior and Policy Sciences, RAND Corporation, Pittsburgh, Pennsylvania, USA
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Wallace ML, Kissel N, Hall MH, Germain A, Matthews KA, Troxel WM, Franzen PL, Buysse DJ, Reynolds C, Monk T, Roecklein KA, Gunn HE, Hasler BP, Goldstein TR, McMakin DL, Szigethy E, Soehner AM. Age Trends in Actigraphy and Self-Report Sleep Across the Life Span: Findings From the Pittsburgh Lifespan Sleep Databank. Psychosom Med 2022; 84:410-420. [PMID: 35100181 PMCID: PMC9064898 DOI: 10.1097/psy.0000000000001060] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Sleep changes over the human life span, and it does so across multiple dimensions. We used individual-level cross-sectional data to characterize age trends and sex differences in actigraphy and self-report sleep dimensions across the healthy human life span. METHODS The Pittsburgh Lifespan Sleep Databank consists of harmonized participant-level data from sleep-related studies conducted at the University of Pittsburgh (2003-2019). We included data from 1065 (n = 577 female; 21 studies) Pittsburgh Lifespan Sleep Databank participants aged 10 to 87 years without a major psychiatric, sleep, or medical condition. All participants completed wrist actigraphy and the self-rated Pittsburgh Sleep Quality Index. Main outcomes included actigraphy and self-report sleep duration, efficiency, and onset/offset timing, and actigraphy variability in midsleep timing. RESULTS We used generalized additive models to examine potentially nonlinear relationships between age and sleep characteristics and to examine sex differences. Actigraphy and self-report sleep onset time shifted later between ages 10 and 18 years (23:03-24:10 [actigraphy]; 21:58-23:53 [self-report]) and then earlier during the 20s (00:08-23:40 [actigraphy]; 23:50-23:34 [self-report]). Actigraphy and self-report wake-up time also shifted earlier during the mid-20s through late 30s (07:48-06:52 [actigraphy]; 07:40-06:41 [self-report]). Self-report, but not actigraphy, sleep duration declined between ages 10 and 20 years (09:09-07:35). Self-report sleep efficiency decreased over the entire life span (96.12-93.28), as did actigraphy variability (01:54-01:31). CONCLUSIONS Awareness of age trends in multiple sleep dimensions in healthy individuals-and explicating the timing and nature of sex differences in age-related change-can suggest periods of sleep-related risk or resilience and guide intervention efforts.
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Affiliation(s)
- Meredith L. Wallace
- Department of Psychiatry, University of Pittsburgh School of Medicine
- Departments of Statistics and Biostatistics, University of Pittsburgh
| | | | - Martica H. Hall
- Department of Psychiatry, University of Pittsburgh School of Medicine
- Departments of Psychology, University of Pittsburgh
| | - Anne Germain
- Department of Psychiatry, University of Pittsburgh School of Medicine
| | - Karen A. Matthews
- Department of Psychiatry, University of Pittsburgh School of Medicine
- Departments of Psychology, University of Pittsburgh
| | | | - Peter L. Franzen
- Department of Psychiatry, University of Pittsburgh School of Medicine
| | - Daniel J. Buysse
- Department of Psychiatry, University of Pittsburgh School of Medicine
- Department Clinical & Translational Science, University of Pittsburgh
| | - Charles Reynolds
- Department of Psychiatry, University of Pittsburgh School of Medicine
| | - Timothy Monk
- Department of Psychiatry, University of Pittsburgh School of Medicine
| | | | | | - Brant P. Hasler
- Department of Psychiatry, University of Pittsburgh School of Medicine
- Departments of Psychology, University of Pittsburgh
- Department Clinical & Translational Science, University of Pittsburgh
| | - Tina R. Goldstein
- Department of Psychiatry, University of Pittsburgh School of Medicine
| | | | - Eva Szigethy
- Department of Medicine, University of Pittsburgh
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Decker AN, Fischer AR, Gunn HE. Socio-Ecological Context of Sleep: Gender Differences and Couples' Relationships as Exemplars. Curr Psychiatry Rep 2022; 24:831-840. [PMID: 36401678 PMCID: PMC9676909 DOI: 10.1007/s11920-022-01393-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/28/2022] [Indexed: 11/21/2022]
Abstract
PURPOSE OF REVIEW We summarized recent findings on insufficient sleep and insomnia, two prominent sleep issues that impact public health. We demonstrate the socio-ecologial impact of sleep health with findings on gender and couples' relationships as exemplars. RECENT FINDINGS Robust gender differences in sleep duration and insomnia are due to biological and socio-ecological factors. Gender differences in insufficient sleep vary by country of origin and age whereas gender differences in insomnia reflect minoritized identities (e.g., sexual, gender). Co-sleeping with a partner is associated with longer sleep and more awakenings. Gender differences and couples' sleep were affected by intersecting social and societal influences, which supports a socio-ecological approach to sleep. Recent and seminal contributions to sleep health highlight the importance of observing individual sleep outcomes in a socio-ecological context. Novel methodology, such as global measures of sleep health, can inform efforts to improve sleep and, ultimately, public health.
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Affiliation(s)
- Andrea N. Decker
- Department of Psychology, The University of Alabama, 505 Hackberry Lane, Tuscaloosa, AL 35401 USA
| | - Alexandra R. Fischer
- Department of Psychology, The University of Alabama, 505 Hackberry Lane, Tuscaloosa, AL 35401 USA
| | - Heather E. Gunn
- Department of Psychology, The University of Alabama, 505 Hackberry Lane, Tuscaloosa, AL 35401 USA
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Abstract
Using a social-ecological framework, we identify social determinants that interact to influence sleep health, identify gaps in the literature, and make recommendations for targeting sleep health in rural mothers. Rural mothers experience unique challenges and protective factors in maintaining adequate sleep health during the postpartum and early maternal years. Geographic isolation, barriers to comprehensive behavioral medicine services, and intra-rural ethno-racial disparities are discussed at the societal (e.g., public policy), social (e.g., community) and individual levels (e.g., stress) of the social-ecological model. Research on sleep health would benefit from attention to methodological considerations of factors affecting rural mothers such as including parity in population-level analyses or applying community-based participatory research principles. Future sleep health programs would benefit from using existing social support networks to disseminate sleep health information, integrating behavioral health services into clinical care frameworks, and tailoring culturally-appropriate Telehealth/mHealth programs to enhance the sleep health of rural mothers.
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Affiliation(s)
- Alexandra R Fischer
- Department of Psychology, University of Alabama, Box 87034, Tuscaloosa, AL, 35487, USA
| | | | - Heather E Gunn
- Department of Psychology, University of Alabama, Box 87034, Tuscaloosa, AL, 35487, USA.
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8
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Abstract
Objective: To assess whether worry and rumination differ in predicting nighttime sleep disturbance versus daytime sleep-related impairment, as assessed using short forms from the Patient Reported Outcomes Measurement Information System (PROMIS). Participants: Adults recruited from the United States population (N = 459) via an online crowdsourcing service. Methods: Factor analysis explored whether items comprising validated measures of worry and rumination loaded onto separate factors. Hierarchical multiple regression models entered worry and rumination in a stepwise fashion to assess their relative strength in predicting PROMIS sleep disturbance and sleep-related impairment, after controlling for 17 covariates. All analyses were run twice using sleep-specific and general measures of worry and rumination. Results: Worry and rumination items loaded onto separate factors. In the regression analysis of sleep-specific cognition, only worry entered the model predicting sleep disturbance, whereas rumination entered after worry in the model predicting sleep-related impairment. In the analysis of general cognition, both cognitive process variables significantly predicted the PROMIS outcomes. Worry was the stronger predictor of sleep disturbance, whereas rumination was the stronger predictor of sleep-related impairment. Conclusions: Worry and rumination were observed to be distinct constructs that separately contributed to predicting daytime sleep-related impairment. Future studies should more closely examine how cognitive processes relate to insomnia symptomology during the day.
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Affiliation(s)
- Joshua Tutek
- Department of Psychology, The University of Alabama , Tuscaloosa, Alabama
| | - Heather E Gunn
- Department of Psychology, The University of Alabama , Tuscaloosa, Alabama
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Gunn HE, Lee S, Eberhardt KR, Buxton OM, Troxel WM. Nightly sleep-wake concordance and daily marital interactions. Sleep Health 2021; 7:266-272. [PMID: 33446469 DOI: 10.1016/j.sleh.2020.11.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 10/23/2020] [Accepted: 11/09/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE We and others have found that couples' sleep is a shared and dyadic process. Couples' sleep-wake concordance (whether couples are awake or asleep at the same time) is associated with couples' relationship factors; however, we know little of the temporal associations between concordance and daily relationship characteristics. The purpose of this study was to examine daily positive and negative interpersonal interactions to determine how they predict, and are predicted by, nightly sleep-wake concordance. METHOD Participants were 48 heterosexual couples between 18 and 45 years of age who shared a bed with their spouse. Couples completed questionnaires and daily assessments of positive and negative interactions. Each member of the dyad wore wrist actigraphs for 10 days. Sleep-wake concordance was calculated as the percentage of time couples were awake or asleep throughout the night at one-minute intervals. Multilevel modeling with lagged effects determined bidirectional and lagged associations between concordance and couples' daily interactions. RESULTS Couples had more negative interactions than their usual following nights with higher concordance than their usual (but not vice versa) and this was more pronounced for well-adjusted couples. In contrast, across all couples, more positive interactions and perceived warmth and support from partners were associated with higher concordance. CONCLUSIONS Our findings demonstrate that the valence of sleep-wake concordance depends on relationship quality characteristics (eg, marital adjustment). Future research on relationships, sleep, and health should consider couples' shared sleep behaviors as one mechanism by which relationships are associated with long-term health outcomes.
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Affiliation(s)
- Heather E Gunn
- Department of Psychology, University of Alabama, Tuscaloosa, AL, USA.
| | - Soomi Lee
- School of Aging Studies, University of South Florida, Tampa, FL, USA
| | - Kenda R Eberhardt
- Department of Psychology, University of Alabama, Tuscaloosa, AL, USA
| | - Orfeu M Buxton
- Department of Biobehavioral Health, The Pennsylvania State University, University Park, PA, USA
| | - Wendy M Troxel
- RAND Corporation, Behavior and Policy Sciences, Pittsburgh, PA, USA
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Gunn HE, Eberhardt KR. 0996 School Start Times Are Associated With Youth And Parent Sleep Duration. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Early school start times contribute to insufficient sleep in adolescents; however, we know little about the impact of school start times at a family level. Moreover, even among similar school start times, sleep opportunity varies depending on mode of transportation and travel time. Thus, the purpose of this study was to determine whether AM school departure time is associated with sleep duration in parents and young adolescents.
Methods
Parent-adolescent dyads (n=31) completed 10 days of actigraphy and sleep diaries. Adolescents were 10-14 year olds (58% male). Parents were predominately mothers (87%) and their mean age was 44 yrs (SD = 5.9). Dyads were 77% White, 11% Black, and 12% Biracial or Other. Youth leave for school time was assessed with the School Sleep Habits Survey. Actigraphy- and diary-assessed total sleep time (TST) was averaged across 10 days and on weekdays. Separate regressions models for parents and adolescents determined associations between school leave time (predictor) and two outcomes: 10-day TST and weekday TST.
Results
For adolescents, later leave for school time was associated with longer 10-day actigraphy-assessed TST (β = .504, p = .012) and diary-assessed TST (β =.683, p <.001). Later leave for school time was also associated with more weekday actigraphy and diary-assessed TST (β = .661 and .426, respectively, p’s < .05). For parents, later leave for school time predicted more diary-assessed sleep across 10 days (β = .481, p = .013) and on weekdays, but this finding did not reach significance (β = .373, p = .061). Leave for school time was not associated with parents’ actigraphy-assessed TST across the 10-day period or on weekdays (p’s > .10).
Conclusion
The time that youth need to leave for school may more closely approximate sleep opportunity regardless of actual school start time. This is particularly relevant for urban and rural youth with long commutes. Findings add to the strong support that delayed school start times or flexible scheduling will benefit adolescent sleep and also suggest positive impacts at the family level.
Support
This material is based upon work supported by the Sleep Research Society Foundation.
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Affiliation(s)
- H E Gunn
- University of Alabama, Tuscaloosa, AL
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Affiliation(s)
- Kenda Eberhardt
- Psychology Department, University of Alabama, Tuscaloosa, AL, USA
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12
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Abstract
PURPOSE OF REVIEW Present a conceptual model and review the recent literature on family dynamics, sleep, and hypertension. RECENT FINDINGS Family dynamics predict hypertension and hypertension risk, in part, due to shared health behaviors. Sleep health behaviors (sleep duration, quality, and efficiency) predict hypertension risk in children and youth and are emerging as a family-level health behavior. Importantly, both family dynamics and sleep are modifiable. Family members influence one another's sleep through their physical presence and through psychological and emotional mechanisms. Family members' sleep patterns may also be coregulated. Negative family dynamics are associated with poor sleep health and predict greater cardiovascular risk. Sleep health behaviors in the family context may also interact with family dynamics to dampen or exacerbate hypertension risk factors in children and youth. This review proposes that promoting sleep health in a family context could be one way to reduce long-term hypertension risk.
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Affiliation(s)
- Heather E Gunn
- Department of Psychology, University of Alabama, Box 870348, Tuscaloosa, AL, 35487-0348, USA.
| | - Kenda R Eberhardt
- Department of Psychology, University of Alabama, Box 870348, Tuscaloosa, AL, 35487-0348, USA
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Abstract
Cognitive behavioral treatment for insomnia (CBTI) is an effective treatment of insomnia; however, there are insufficient CBTI providers for the 10% to 25% of the population who have insomnia. Brief behavioral treatment for insomnia (BBTI) is a 4-session manualized treatment paradigm administrable in medical settings by nonpsychologist health professionals. BBTI is effective in reducing symptoms of insomnia, such as sleep onset latency, wake after sleep onset, and sleep efficiency. In some cases, BBTI resulted in full remission from insomnia. Ongoing clinical trials are further testing the efficacy of BBTI using alternative treatment deliveries and in primary medical care settings.
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Affiliation(s)
- Heather E Gunn
- Department of Psychology, University of Alabama, 505 Hackberry Lane, Box 870348, Tuscaloosa, AL 35487-0348, USA.
| | - Joshua Tutek
- Department of Psychology, University of Alabama, 505 Hackberry Lane, Box 870348, Tuscaloosa, AL 35487-0348, USA
| | - Daniel J Buysse
- Sleep & Chronobiology Center, Department of Psychiatry, University of Pittsburgh, 3811 O'Hara Street, Pittsburgh, PA 15213, USA
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Gunn HE, Eberhardt K, Hall M, Buysse DJ. 0251 Sleep Duration And Blood Pressure Reactivity In Young Adolescents. Sleep 2018. [DOI: 10.1093/sleep/zsy061.250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- H E Gunn
- University of Alabama, Tuscaloosa, AL
| | | | - M Hall
- University of Pittsburgh, Pittsburgh, PA
| | - D J Buysse
- University of Pittsburgh, Pittsburgh, PA
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Gunn HE, Buysse DJ, Matthews KA, Kline CE, Cribbet MR, Troxel WM. Sleep-Wake Concordance in Couples Is Inversely Associated With Cardiovascular Disease Risk Markers. Sleep 2017; 40:2661822. [PMID: 28364457 DOI: 10.1093/sleep/zsw028] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/02/2016] [Indexed: 11/13/2022] Open
Abstract
Aim To determine whether interdependence in couples' sleep (sleep-wake concordance i.e., whether couples are awake or asleep at the same time throughout the night) is associated with two markers of cardiovascular disease (CVD) risk, ambulatory blood pressure (BP) and systemic inflammation. Methods This community-based study is a cross-sectional analysis of 46 adult couples, aged 18-45 years, without known sleep disorders. Percent sleep-wake concordance, the independent variable, was calculated for each individual using actigraphy. Ambulatory BP monitors measured BP across 48 h. Dependent variables included mean sleep systolic BP (SBP) and diastolic BP (DBP), mean wake SBP and DBP, sleep-wake SBP and DBP ratios, and C-reactive protein (CRP). Mixed models were used and were adjusted for age, sex, education, race, and body mass index. Results Higher sleep-wake concordance was associated with lower sleep SBP (b = -.35, SE = .01) and DBP (b = -.22, SE = .10) and lower wake SBP (b = -.26, SE = .12; all p values < .05). Results were moderated by sex; for women, high concordance was associated with lower BP. Men and women with higher sleep-wake concordance also had lower CRP values (b = -.15, SE = .03, p < .05). Sleep-wake concordance was not associated with wake DBP or sleep/wake BP ratios. Significant findings remained after controlling for individual sleep quality, duration, and wake after sleep onset. Conclusions Sleep-wake concordance was associated with sleep BP, and this association was stronger for women. Higher sleep-wake concordance was associated with lower systemic inflammation for men and women. Sleep-wake concordance may be a novel mechanism by which marital relationships are associated with long-term CVD outcomes.
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Affiliation(s)
- Heather E Gunn
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Daniel J Buysse
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Karen A Matthews
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Christopher E Kline
- Department of Health and Physical Activity, University of Pittsburgh, Pittsburgh, PA
| | - Matthew R Cribbet
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, PA
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Gunn HE, Critchfield KL, Mackaronis JE, Rau HK, Cribbet MR, Troxel WM, Williams PG. Affiliative interpersonal behaviors during stress are associated with sleep quality and presleep arousal in young, healthy adults. Sleep Health 2017; 3:98-101. [PMID: 28346164 DOI: 10.1016/j.sleh.2016.12.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Revised: 10/26/2016] [Accepted: 12/05/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVES This study examined the association between stress-related interpersonal behaviors, presleep arousal (PSA), and sleep quality. METHODS Sixty-four participants (53% female) described a recent stressful interpersonal event that was coded for overall degree of affiliation (warmth vs hostility) and autonomy (independence vs interdependence). Cognitive and somatic PSA and sleep quality were examined using regression with affiliation and autonomy scores as predictors. Specific interpersonal behaviors that comprise overall affiliation were also examined. RESULTS More affiliation (warmth) was associated with lower cognitive PSA (β=-.32) and better sleep quality (β=-.28). Autonomy was not associated with sleep quality or PSA. The specific behavior trust in others was associated with better sleep quality (rs=-.25). CONCLUSIONS Behaviors during stress reflect underlying dimensions of interpersonal security. Findings underscore importance of interpersonal frameworks for understanding associations between stress and sleep, and provide support for the anthropological theory that interpersonal security is necessary for healthy sleep.
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Affiliation(s)
- Heather E Gunn
- Department of Psychology, University of Utah, Salt Lake City, UT, USA; Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
| | - Kenneth L Critchfield
- Department of Psychology, University of Utah, Salt Lake City, UT, USA; Department of Psychology at James Madison University, Harrisonburg, VA, USA
| | | | - Holly K Rau
- Department of Psychology, University of Utah, Salt Lake City, UT, USA
| | - Matthew R Cribbet
- Department of Psychology, University of Utah, Salt Lake City, UT, USA; Department of Psychology, Texas Tech University, Lubbock, TX, USA
| | - Wendy M Troxel
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA and RAND Corporation, Pittsburgh, PA, USA
| | - Paula G Williams
- Department of Psychology, University of Utah, Salt Lake City, UT, USA
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Gunn HE, Buysse DJ, Hasler BP, Begley A, Troxel WM. Sleep Concordance in Couples is Associated with Relationship Characteristics. Sleep 2015; 38:933-9. [PMID: 25581920 DOI: 10.5665/sleep.4744] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Accepted: 10/18/2014] [Indexed: 11/03/2022] Open
Abstract
STUDY OBJECTIVES Coregulation of biological systems is a defining feature of normative attachment in close adult relationships. Sleep is a shared, intimate biological process between couples; however, sleep is usually examined at the individual level. We examined minute-by-minute concordance in couples' actigraphy-defined sleep-wake patterns, and how attachment style and marital satisfaction relate to concordance. DESIGN Couples completed measures of avoidant and anxious attachment styles and relationship functioning and wore wrist actigraphs for 10 days. Minute-by-minute concordance of sleep and wake (i.e., the percentage of epochs in which both partners were asleep, or both were awake) was calculated for each sleep period. Mixed modeling was used to account for measurement occasions across time. RESULTS Percent concordance ranged from 53-88% and was not associated with couples' sleep quality or circadian preference. For wives, neither anxious nor avoidant attachment was associated with sleep-wake concordance. For husbands, anxious attachment style was associated with higher concordance, but was moderated by wives' marital satisfaction. High marital satisfaction in wives was associated with higher concordance, regardless of husbands' attachment style. In couples in which wives reported low satisfaction, concordance was higher when husbands had an anxious attachment style. Avoidant attachment style in husbands was not related to concordance. CONCLUSIONS Sleep concordance provides a unique measure of couples' cosleep and varies depending on attachment style and relationship satisfaction.
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Affiliation(s)
- Heather E Gunn
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Daniel J Buysse
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Brant P Hasler
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Amy Begley
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, PA
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Gunn HE, Troxel WM, Hall MH, Buysse DJ. Interpersonal distress is associated with sleep and arousal in insomnia and good sleepers. J Psychosom Res 2014; 76:242-8. [PMID: 24529045 PMCID: PMC4018775 DOI: 10.1016/j.jpsychores.2013.11.010] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2013] [Revised: 11/18/2013] [Accepted: 11/19/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE The interpersonal environment is strongly linked to sleep. However, little is known about interpersonal distress and its association with sleep. We examined the associations among interpersonal distress, objective and subjective sleep in people with and without insomnia. METHODS Participants in this cross-sectional observational study included men and women with insomnia (n = 28) and good sleeper controls (n = 38). Interpersonal distress was measured with the Inventory of Interpersonal Problems. Sleep parameters included insomnia severity, self-reported presleep arousal, and sleep quality; and polysomnographically-assessed sleep latency (SL), total sleep time (TST), wake after sleep onset (WASO), percent delta (stage 3 + 4 NREM), percent REM, and EEG beta power. Hierarchical linear regression was used to assess the relationship between distress from interpersonal problems and sleep and the extent to which relationships differed among insomnia patients and controls. RESULTS More interpersonal distress was associated with more self-reported arousal and higher percentage of REM. More interpersonal distress was associated with greater insomnia severity and more cognitive presleep arousal for individuals with insomnia, but not for controls. Contrary to expectations, interpersonal distress was associated with shorter sleep latency in the insomnia group. Results were attenuated, but still significant, after adjusting for depression symptoms. CONCLUSION Distress from interpersonal problems is associated with greater self-reported arousal and higher percent REM. Individuals with insomnia who report more distress from interpersonal problems have greater insomnia severity and cognitive presleep arousal, perhaps due to rumination. These findings extend our knowledge of the association between interpersonal stressors and sleep. Assessment and consideration of interpersonal distress could provide a novel target for insomnia treatment.
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Affiliation(s)
- Heather E Gunn
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Wendy M Troxel
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA; RAND Corporation, Pittsburgh, PA, USA
| | - Martica H Hall
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Daniel J Buysse
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
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Cribbet MR, Carlisle M, Cawthon RM, Uchino BN, Williams PG, Smith TW, Gunn HE, Light KC. Cellular aging and restorative processes: subjective sleep quality and duration moderate the association between age and telomere length in a sample of middle-aged and older adults. Sleep 2014; 37:65-70. [PMID: 24470696 DOI: 10.5665/sleep.3308] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
STUDY OBJECTIVES To examine whether subjective sleep quality and sleep duration moderate the association between age and telomere length (TL). DESIGN Participants completed a demographic and sleep quality questionnaire, followed by a blood draw. SETTING Social Neuroscience Laboratory. PARTICIPANTS One hundred fifty-four middle-aged to older adults (age 45-77 y) participated. Participants were excluded if they were on immunosuppressive treatment and/or had a disease with a clear immunologic (e.g., cancer) component. INTERVENTIONS N/A. MEASUREMENTS AND RESULTS Subjective sleep quality and sleep duration were assessed using the Pittsburgh Sleep Quality Index (PSQI) and TL was determined using peripheral blood mononuclear cells (PBMCs). There was a significant first-order negative association between age and TL. Age was also negatively associated with the self-reported sleep quality item and sleep duration component of the PSQI. A significant age × self-reported sleep quality interaction revealed that age was more strongly related to TL among poor sleepers, and that good sleep quality attenuated the association between age and TL. Moreover, adequate subjective sleep duration among older adults (i.e. greater than 7 h per night) was associated with TL comparable to that in middle-aged adults, whereas sleep duration was unrelated to TL for the middle-aged adults in our study. CONCLUSIONS The current study provides evidence for an association between sleep quality, sleep duration, and cellular aging. Among older adults, better subjective sleep quality was associated with the extent of cellular aging, suggesting that sleep duration and sleep quality may be added to a growing list of modifiable behaviors associated with the adverse effects of aging.
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Affiliation(s)
- Matthew R Cribbet
- Department of Psychology and Health Psychology Program, University of Utah, Salt Lake City, UT
| | - McKenzie Carlisle
- Department of Psychology and Health Psychology Program, University of Utah, Salt Lake City, UT
| | - Richard M Cawthon
- Department of Human Genetics, University of Utah, Salt Lake City, UT
| | - Bert N Uchino
- Department of Psychology and Health Psychology Program, University of Utah, Salt Lake City, UT
| | - Paula G Williams
- Department of Psychology and Health Psychology Program, University of Utah, Salt Lake City, UT
| | - Timothy W Smith
- Department of Psychology and Health Psychology Program, University of Utah, Salt Lake City, UT
| | - Heather E Gunn
- Department of Psychology and Health Psychology Program, University of Utah, Salt Lake City, UT
| | - Kathleen C Light
- Department of Anesthesiology, University of Utah, Salt Lake City, UT
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Abstract
STUDY OBJECTIVES Continuous positive airway pressure (CPAP) improves sleep and quality of life for both patients with obstructive sleep apnea (OSA) and their spouses. However, few studies have investigated spousal involvement in treatment adherence. Aims of this observational study were to assess perceptions of spousal involvement and evaluate associations between involvement and adherence. METHODS Spousal involvement in CPAP adherence was assessed in 23 married male OSA patients after the first week of treatment. At 3 months, 16 participants completed a second assessment of spousal involvement. Types of involvement assessed included positive (e.g., encouraging), negative (e.g., blaming), collaboration (e.g., working together), and one-sided (e.g., asking). An interpersonal measure of supportive behaviors was also administered at 3 months to evaluate the interpersonal qualities of spousal involvement types. Objective CPAP adherence data were available for 14 participants. RESULTS Average frequency of spousal involvement ratings were low for each involvement type and only negative spousal involvement frequency decreased at 3 month follow-up (p = 0.003). Perceptions of collaborative spousal involvement were associated with higher CPAP adherence at 3 months (r = 0.75, p = 0.002). Positive, negative and one-sided involvement were not associated with adherence. Collaborative spousal involvement was associated with moderately warm and controlling interpersonal behaviors (affiliation, r = 0.55, p = 0.03, dominance r = 0.47, p = 0.07). CONCLUSIONS Patients reported low frequency but consistent and diverse perceptions of spousal involvement in CPAP over the first 3 months of treatment. Perceptions of collaborative spousal involvement were the only type associated with adherence and represent moderately warm and controlling interpersonal behavior. Interventions to increase spousal collaboration in CPAP may improve adherence.
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Affiliation(s)
- Kelly Glazer Baron
- Department of Neurology, Feinberg School of Medicine, Northwestern University, Abbott Hall, Rm 523, 710 N. Lake Shore Dr., Chicago, IL 60611, USA
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Cribbet MR, Williams PG, Gunn HE, Rau HK. Effects of tonic and phasic respiratory sinus arrhythmia on affective stress responses. Emotion 2011; 11:188-93. [DOI: 10.1037/a0021789] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Baron KG, Berg CA, Czajkowski LA, Smith TW, Gunn HE, Jones CR. Self-efficacy contributes to individual differences in subjective improvements using CPAP. Sleep Breath 2010; 15:599-606. [DOI: 10.1007/s11325-010-0409-5] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2010] [Revised: 07/26/2010] [Accepted: 08/23/2010] [Indexed: 10/19/2022]
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Abstract
The prospective influence of relationship support and conflict on adherence to continuous positive airway pressure (CPAP) was examined over the first 3 months of CPAP treatment in 42 married, male patients with obstructive sleep apnea (OSA). CPAP adherence reports were available for 23 patients. Patient ratings of marital conflict predicted average nightly adherence (beta = -0.357, p < .05), but ratings of marital support did not predict adherence. Three-month follow-up ratings of marital support and conflict, subjective sleepiness, depression, and functional impairment were available for 16 patients from the first sample. Six additional patients without adherence reports provided baseline and 3-month follow-up questionnaire data, which resulted in a total of 22 patients with follow-up questionnaire data. Following 3 months of CPAP, patients reported decreased marital conflict (d = 0.43, p < .05), sleepiness (d = 1.13, p < .001), depression (d = 0.73, p < .001), and functional impairment (d = 1.48, p < .001). These findings highlight the importance of evaluating marital conflict for OSA patients and suggest marital conflict may be a target for interventions to improve CPAP adherence.
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Tartaro J, Luecken LJ, Gunn HE. Exploring heart and soul: effects of religiosity/spirituality and gender on blood pressure and cortisol stress responses. J Health Psychol 2006; 10:753-66. [PMID: 16176954 DOI: 10.1177/1359105305057311] [Citation(s) in RCA: 86] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The current study investigated gender effects on the influence of self-reported religiosity and spirituality on cardiovascular and cortisol responses to a laboratory stressor among young adults. Participants with higher composite religiosity/spirituality scores, religiosity, levels of forgiveness and frequency of prayer showed lower cortisol responses. Greater composite religiosity/spirituality, religiosity, frequency of prayer and attendance at services were associated with lower blood pressure in males and elevated blood pressure in females. Findings suggest that spiritual and/or religious individuals may experience a protective effect against the neuroendocrine consequences of stress, though cardiovascular benefits may vary by gender. This work represents an important step in the convergence of multiple realms of research by linking physiological measures with indicators of individual belief systems.
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Affiliation(s)
- Jessica Tartaro
- Department of Psychology, Arizona State University, Tempe 85287, USA
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