Impact of delaying high school start times on weight and related behaviors - the START study.

In the US, few adolescents get adequate school night sleep, largely due to early school start times. In the START study we aimed to test the following hypothesis: That following the implementation of later high school start times students have lesser longitudinal increases in body mass index (BMI) and shift to more healthful weight-related behaviors relative to students attending schools that retain early start times. The study enrolled a cohort of students (n = 2426) in five high schools in the Twin Cities, MN metro. Heights and weights were measured objectively, and surveys were administered annually from 9th through 11th grades (2016-2018). All study schools started early (either 7:30 am or 7:45 am) at baseline (2016). At follow-up 1 (2017) and continuing through follow-up 2 (2018), two schools delayed their start times by 50-65 min, while three comparison schools started at 7:30 am throughout the observation period. Using a difference-in-differences natural experiment design, we estimated differences in changes in BMI and weight-related behaviors over time between policy change and comparison schools. Students' BMIs increased in parallel in both policy change and comparison schools over time. However relative to changes in comparison schools after the start time shift, students in policy change schools had a modestly more healthful profile of weight-related behaviors - for instance they had a relatively greater probability of eating breakfast, having supper with their family, getting more activity, eating fast food less frequently, and eating vegetables daily. Later start times could be a durable, population-wide strategy that promotes healthful weight behaviors.

Creation and Psychometric Validation of the Sexual Minorities and Prostate Cancer Scale (SMACS) in Sexual Minority Patients-The Restore-2 Study.

BACKGROUND: Existing measures of sexual functioning in prostate cancer survivors focus primarily on erectile function and do not adequately measure the experiences of sexual minority men. AIM: To develop and psychometrically evaluate a new scale to measure sexual functioning among sexual minority men with prostate cancer. METHODS: Sexual minority prostate cancer patients (n = 401) completed an online battery of urinary and sexual functioning tests in 2019, including a new 37-item instrument about their sexual functioning post-treatment for prostate cancer. OUTCOMES: We used confirmatory factor analysis to determine the construct validity of a new scale including five subscales: a four-factor model for all participants (n = 401) evaluated Sexual Satisfaction, Sexual Confidence, Frequency of Sexual Problems, and Urinary Incontinence in Sex. A single-factor model completed only by participants who had attempted or desired receptive anal sex (n = 255) was evaluated in the fifth subscale: Problematic Receptive Anal Sex. To evaluate criterion validity, we calculated the intercorrelations between each Sexual Minorities and Prostate Cancer Scale (SMACS) subscale and four related scales: the Expanded Prostate Cancer Index Composite-50 (EPIC), the Functional Assessment of Cancer Therapy-Prostate, the Brief Symptom Inventory-18, and the International Consultation on incontinence questionnaire. Cronbach's alphas were calculated to measure internal consistency (ie, reliability). RESULTS: Cronbach's alpha values ranged from 0.64 to 0.89. Loadings (0.479-0.926) and model fit indices were strong (Root Mean Square Error of Approximation: 0.085, Standardized root mean squared residual: 0.063, comparative fit index: 0.927, Tucker-Lewis Index: 0.907). For criterion validity, Sexual Satisfaction, Sexual Confidence, and Frequency of Sexual Problems were moderately correlated with EPIC function and bother scores (r = 0.50-0.72) and Urinary incontinence in sex correlated moderately with EPIC Urinary Function and International Consultation on incontinence questionnaire scores (0.45-0.56). CLINICAL IMPLICATIONS: The SMACS can be used by clinicians and researchers to comprehensively measure sexual functioning in sexual minority men, in conjunction with existing scales. STRENGTHS AND LIMITATIONS: This new scale is validated in a large, geographically diverse cohort of sexual minority cancer survivors and fills an important gap in existing measures of sexual functioning. Limitations include a lack of a validation sample. CONCLUSION: The SMACS is a valid and reliable new scale that measures sexual minority men's experience of urinary incontinence in sex, problematic receptive anal sex, and sexual distress. Polter EJ, Kohli N, Rosser BRS, et al. Creation and Psychometric Validation of the Sexual Minorities and Prostate Cancer Scale (SMACS) in Sexual Minority Patients-The Restore-2 Study. J Sex Med 2022;19:529-540.

Association of Delaying School Start Time With Sleep Duration, Timing, and Quality Among Adolescents.

Importance: Sleep is a resource that has been associated with health and well-being; however, sleep insufficiency is common among adolescents. Objective: To examine how delaying school start time is associated with objectively assessed sleep duration, timing, and quality in a cohort of adolescents. Design, Setting, and Participants: This observational cohort study took advantage of district-initiated modifications in the starting times of 5 public high schools in the metropolitan area of Minneapolis and St Paul, Minnesota. A total of 455 students were followed up from grade 9 (May 3 to June 3, 2016) through grade 11 (March 15 to May 21, 2018). Data were analyzed from February 1 to July 24, 2019. Exposures: All 5 participating schools started early (7:30 am or 7:45 am) at baseline (2016). At follow-up 1 (2017) and continuing through follow-up 2 (2018), 2 schools delayed their start times by 50 and 65 minutes, whereas 3 comparison schools started at 7:30 am throughout the observation period. Main Outcomes and Measures: Wrist actigraphy was used to derive indices of sleep duration, timing, and quality. With a difference-in-difference design, linear mixed-effects models were used to estimate differences in changes in sleep time between delayed-start and comparison schools. Results: A total of 455 students were included in the analysis (among those identifying sex, 225 girls [49.5%] and 219 boys [48.1%]; mean [SD] age at baseline, 15.2 [0.3] years). Relative to the change observed in the comparison schools, students who attended delayed-start schools had an additional mean 41 (95% CI, 25-57) objectively measured minutes of night sleep at follow-up 1 and 43 (95% CI, 25-61) at follow-up 2. Delayed start times were not associated with falling asleep later on school nights at follow-ups, and students attending these schools had a mean difference-in-differences change in weekend night sleep of -24 (95% CI, -51 to 2) minutes from baseline to follow-up 1 and -34 (95% CI, -65 to -3) minutes from baseline to follow-up 2, relative to comparison school participants. Differences in differences for school night sleep onset, weekend sleep onset latency, sleep midpoints, sleep efficiency, and the sleep fragmentation index between the 2 conditions were minimal. Conclusions and Relevance: This study found that delaying high school start times could extend adolescent school night sleep duration and lessen their need for catch-up sleep on weekends. These findings suggest that later start times could be a durable strategy for addressing population-wide adolescent sleep deficits.

The START study: An evaluation to study the impact of a natural experiment in high school start times on adolescent weight and related behaviors.

BACKGROUND: Research has shown that early high school start times, which are asynchronous with adolescent biology, are one of the most significant obstacles to youth being able to net sufficient sleep. Given that adolescence is a critical period that sets the stage for long-term obesity risk behavior patterns, there is an need to understand the obesity-related implications of increased sleep as a result of intervention and policy changes. METHODS: We evaluated a community-based natural experiment in school start time policy modification when several Minneapolis-St. Paul, MN metro area school districts shifted to later school start times in Fall 2016. We collected data on student weight and related risks (via paper survey, objective weight and height measurement, dietary recall, and sleep actigraphy) before and after two districts (two high schools) shifted their start times later and in a comparison district (three high schools) which kept their start times early (7:30am) through the course of the study. Our specific aims were: 1) Determine how a shift to a later high school start time relates to objectively measured weight change over time. 2) Identify the relationship between school start times and obesity-related behaviors over time.At baseline we had 2,133 returned surveys (93% participation) and 2,037 (86% participation) objective height/weight measurements from 9th grade students (class of 2019) in the five schools. The sample was 87.7% white, 12.8% reported qualifying for free/reduced price lunch (a measure of lower socio-economic status), and the mean age was 15.2 (SD=0.35) years. DISCUSSION: The products of this research will clarify causal connections between sleep and obesity among adolescents as well as provide evidence for whether a school start time policy can minimize unhealthy weight gain.

Correlates of short sleep duration among adolescents.

INTRODUCTION: Short sleep duration is exceedingly common among adolescents and has implications for healthy youth development. We sought to document associations between adolescents' sleep duration and characteristics of their schedules, behaviors, and wellbeing. METHODS: We used data from the baseline wave (9th grade year) of the START study, a cohort of 2134 students in five Minnesota high schools to assess how self-reported sleep duration was associated with the prevalence of time-use characteristics (i.e. activity schedules, screen use), sleep-wake problems (i.e. trouble waking in the morning, falling asleep in class, etc.), and risk of depression. RESULTS: Shorter sleep duration was associated with various behaviors including greater computer/screen time and screen use after bed, a lower probability of doing homework, participation in sports doing chores on school nights, and reporting that it takes at least 20 min to fall asleep on school days (p < 0.05). Suboptimal sleep duration was also associated with a higher probability of all reported sleep-wake problems as well as higher risk of depressive symptoms (p < 0.05). CONCLUSIONS: Given that getting an optimal amount of sleep can protect youth from risk and promote healthy youth development, it is critical that we gain a greater understanding of correlates and consequences of short sleep duration in order to develop a sleep-friendly culture for youth.

Sleep Duration and Weight-Related Behaviors among Adolescents.

Background: Insufficient sleep is widespread among adolescents and has consequences that extend far beyond hampering day-to-day functioning. It may influence eating and physical activity patterns and be an important determinant of adolescent overweight/obesity status. Methods: We assessed how self-reported sleep duration on school nights was associated with weight-related behaviors (eating, diet, and physical activity) and overweight/obesity at the baseline wave (ninth grade year) of the START study (n = 2134). Results: Fifteen percent of our sample reported optimal sleep duration (8.5-10.0 hours); nonwhites, participants of lower socioeconomic status, and girls were at greater risk for insufficient sleep. Suboptimal sleep was associated with various poor weight-related behaviors such as increased sugar-sweetened beverage consumption, decreased vegetable consumption, and decreased breakfast eating (p < 0.001). Fewer hours of sleep were also associated with less physical activity and an increased likelihood of obesity (p = 0.02 for both associations). Conclusions: The influence of adolescent sleep insufficiency on diet and activity could impact childhood obesity and following chronic disease risk especially if lack of sleep sets the stage for enduring, lifelong, poor, weight-related behavior patterns.