Sleep behavioral outcomes of school-based interventions for promoting sleep health in children and adolescents aged 5 to 18 years: a systematic review.

Study Objectives: Insufficient sleep is common among children and adolescents, and can contribute to poor health. School-based interventions potentially could improve sleep behavior due to their broad reach, but their effectiveness is unclear. This systematic review focused on the effects of school-based interventions on sleep behavior among children and adolescents aged 5 to 18 years. Methods: Five electronic databases were searched for randomized controlled trials of sleep health interventions initiated or conducted in school settings and in which behavioral sleep outcomes were measured. Cochrane risk of bias tools were used to assess study quality. Results: From the 5303 database records and two papers from other sources, 21 studies (22 papers) met the inclusion criteria for this review. These studies involved 10 867 children and adolescents at baseline from 13 countries. Most studies (n = 15) were conducted in secondary schools. Sleep education was the most common intervention, either alone (n = 13 studies) or combined with other initiatives (stress management training, n = 2; bright light therapy, n = 1; health education, n = 1). Interventions were typically brief in terms of both the intervention period (median = 4 weeks) and exposure (median = 200 minutes). Behavioral outcomes included actigraphy-measured and self-reported sleep patterns, and sleep hygiene. All outcomes had high risk of bias or some concerns with bias. Sleep education interventions were typically ineffective. Later school start times promoted longer sleep duration over 1 week (1 study, high risk of bias). Conclusions: Current evidence does not provide school-based solutions for improving sleep health, perhaps highlighting a need for complex, multi-component interventions (e.g. whole-of-school approaches) to be trialed.

Healthy together Victoria and childhood obesity study: effects of a large scale, community-based cluster randomised trial of a systems thinking approach for the prevention of childhood obesity among secondary school students 2014-2016.

BACKGROUND: Healthy Together Victoria (HTV) was a Victorian Government initiative that sought to reduce the prevalence of overweight and obesity through targeting chronic disease risk factors including physical activity, poor diet quality, smoking, and harmful alcohol use. The intervention involved a boosted workforce of > 170 local-level staff in 12 communities; employed to deliver system activation around health and wellbeing for individuals, families and communities. A cluster randomised trial (CRT) of a systems thinking approach to obesity prevention was embedded within HTV. We present the two-year changes in overweight and obesity and associated behaviours among secondary school students across Victoria, Australia. METHODS: Twenty-three geographically bounded areas were randomised to intervention (12 communities) or comparison (11 communities). Randomly selected secondary schools within each community were invited to participate in the trial in 2014 and 2016. Students in Grade 8 (aged approximately 13-15 years) and Grade 10 (aged approximately 15-16 years) at participating schools were recruited using an opt-out approach across July-September 2014 and 2016. Primary outcomes were body mass index (BMI) and waist circumference. Secondary outcomes were physical activity, sedentary behaviour, diet quality, health-related quality of life, and depressive symptoms. Linear mixed models were fit to estimate the intervention effect adjusting for child/school characteristics. RESULTS: There were 4242 intervention children and 2999 control children in the final analysis. For boys, the two-year change showed improvement in intervention versus control for waist circumference (difference in change: - 2.5 cm; 95% confidence interval [CI]: - 4.6, - 0.5) and consumption of sugar-sweetened beverages per day (< 1 serve: 8.5 percentage points; 95% CI: 0.6, 16.5). For girls, there were no statistically significant differences between conditions. CONCLUSIONS: HTV seemed to produce favourable changes in waist circumference and sugar-sweetened beverage consumption for boys, however, no effect on BMI was observed. Although the HTV intervention was cut short, and the period between data collection points was relatively short, the changes observed in HTV contribute to the growing evidence of whole-of-community interventions targeting childhood obesity. TRIAL REGISTRATION: This trial is unregistered. The intervention itself was a policy setting delivered by government and our role was the collection of data to evaluate the effect of this natural experiment. That is, this study was not a trial from the classical point of view and we were not responsible for the intervention.

The Sleep-Obesity Nexus: Assessment of Multiple Sleep Dimensions and Weight Status Among Victorian Primary School Children.

Purpose: To examine the association between sleep and weight status across multiple dimensions of sleep (duration, efficiency, quality and timing) and assess the cumulative influence of these dimensions on the overall sleep-obesity association. Participants and Methods: Cross-sectional data from 2253 students aged 8.8 to 13.5 years participating in two monitoring studies across regional Victoria was analyzed. Students were invited to have measures of height and weight taken and to complete a self-report electronic questionnaire on demographic characteristics and health behaviors. Logistic regression models were used to assess association between sleep dimensions and BMI z-scores. Results: Beyond sleep duration, poor perceived sleep quality, delayed sleep initiation, later bed times and sleep-wake timing, all significantly increased the odds of overweight/obesity (OR 1.47, 95% CI: 1.07-2.01; OR 1.25, 95% CI: 1.02-1.55; and OR 1.70. 95% CI: 1.28-2.28, respectively). Additionally, a cumulative effect of having multiple poorly scored sleep dimensions was found, where four or more poorly scored sleep dimensions more than doubled the odds of overweight/obesity among children (OR 2.25, 95% CI: 1.41-3.58). Conclusion: This study highlights the importance of measuring and considering multiple dimensions of sleep, along with the individual and additive influence of the sleep dimension on the sleep-obesity nexus.

Sleep and obesity among children: A systematic review of multiple sleep dimensions.

The objectives were to systematically investigate the multiple dimensions of sleep and their association with overweight or obesity among primary school-aged children. CINHAL, PsycINFO, SPORTDiscus, Medline, Cochrane, Embase, and PubMed databases were searched for papers reporting on an association between children's sleep and weight status. Studies on clinical populations, published in languages other than English, without objectively measured weight status, or where weight status was reported outside the outlined age bracket (5-13 years) were excluded. A total of 34 248 citations were extracted from our systematic search protocol, of which 112 were included for detailed review. Compared with sleep duration, of which 86/103 articles found a significant inverse association between sleep duration and measured weight status, few studies examined other dimensions of sleep, such as quality, efficiency and bed/wake times, and relationship with weight status. Where studies existed, variation in defining and measurement of these dimensions restricted comparison and potentially influenced discrepancies across results. Overall, the findings of this review warrant the need for further research of the outlined dimensions of sleep. Future research would benefit from clarity on definitions across the different dimensions, along with the use of valid and reliable tools.

Dietary and Activity Factors Influence Poor Sleep and the Sleep-Obesity Nexus among Children.

Background: Behavioral factors such as physical activity, sedentary behavior and diet have previously been found to be key modifiable determinants of childhood overweight and obesity, yet require further investigation to provide an understanding of their potential influence on sleep outcomes along with the sleep-obesity nexus. Methods: The study included 2253 students (ages 8.8-13.5) from two monitoring studies across regional Victoria. Students completed a self-report electronic questionnaire on demographic characteristics, health behaviors (including sleep, physical activity, screen time and diet) and well-being, and were invited to have anthropometric measurements (height and weight) taken. Regression models were used to assess the associations between sleep, behavioral factors and BMI z-scores. Results: Screen time (particularly in bed) and sugar-sweetened beverage (SSB) consumption were shown to increase the likelihood of having more than three sleep problems, while physical activity and other dietary factors were not. After controlling for these behaviors, significance remained for having two or more than three sleep problems and an increased odds of overweight/obesity. Conclusions: This study highlights how the usage of screen devices and SSB consumption behaviors might influence children's weight status via the sleep-obesity nexus.

Sleep duration and risk of obesity among a sample of Victorian school children.

BACKGROUND: Insufficient sleep is potentially an important modifiable risk factor for obesity and poor physical activity and sedentary behaviours among children. However, inconsistencies across studies highlight the need for more objective measures. This paper examines the relationship between sleep duration and objectively measured physical activity, sedentary time and weight status, among a sample of Victorian Primary School children. METHODS: A sub-sample of 298 grades four (n = 157) and six (n = 132) Victorian primary school children (aged 9.2-13.2 years) with complete accelerometry and anthropometry data, from 39 schools, were taken from a pilot study of a larger state based cluster randomized control trial in 2013. Data comprised: researcher measured height and weight; accelerometry derived physical activity and sedentary time; and self-reported sleep duration and hypothesised confounding factors (e.g. age, gender and environmental factors). RESULTS: Compared with sufficient sleepers (67 %), those with insufficient sleep (<10 hrs/day) were significantly more likely to be overweight (OR 1.97, 95 % CI:1.11-3.48) or obese (OR 2.43, 95 % CI:1.26-4.71). No association between sleep and objectively measured physical activity levels or sedentary time was found. CONCLUSION: The strong positive relationship between weight status and sleep deprivation merits further research though PA and sedentary time do not seem to be involved in the relationship. Strategies to improve sleep duration may help obesity prevention initiatives in the future.

An assessment of change in risk perception and optimistic bias for hurricanes among Gulf Coast residents.

This study focuses on levels of concern for hurricanes among individuals living along the Gulf Coast during the quiescent two-year period following the exceptionally destructive 2005 hurricane season. A small study of risk perception and optimistic bias was conducted immediately following Hurricanes Katrina and Rita. Two years later, a follow-up was done in which respondents were recontacted. This provided an opportunity to examine changes, and potential causal ordering, in risk perception and optimistic bias. The analysis uses 201 panel respondents who were matched across the two mail surveys. Measures included hurricane risk perception, optimistic bias for hurricane evacuation, past hurricane experience, and a small set of demographic variables (age, sex, income, and education). Paired t-tests were used to compare scores across time. Hurricane risk perception declined and optimistic bias increased. Cross-lagged correlations were used to test the potential causal ordering between risk perception and optimistic bias, with a weak effect suggesting the former affects the latter. Additional cross-lagged analysis using structural equation modeling was used to look more closely at the components of optimistic bias (risk to self vs. risk to others). A significant and stronger potentially causal effect from risk perception to optimistic bias was found. Analysis of the experience and demographic variables' effects on risk perception and optimistic bias, and their change, provided mixed results. The lessening of risk perception and increase in optimistic bias over the period of quiescence suggest that risk communicators and emergency managers should direct attention toward reversing these trends to increase disaster preparedness.