Faculty

Susan Malone headshot

Susan Malone

MSN PhD

Senior Research Scientist

1 212 992 7047

433 First Avenue
Room 412
New York, NY 10010
United States

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Professional overview

The overarching goal of Dr. Malone’s career is to promote health and prevent cardio-metabolic disease across the lifespan. This goal has been motivated by Dr. Malone’s diverse clinical experiences, including school nursing and outpatient diabetes education. Dr. Malone’s research focuses on bridging research in behavioral, biological, and environmental rhythms to chronotherapeutic interventions that mitigate type 2 diabetes risk and improve overall health. She has studied the relationship between several dimensions of sleep (duration, timing, chronotype, regularity), health behaviors, and body mass index in adolescents. She has also conducted several population based studies examining relationships between these dimensions of sleep and chronic disease in adults, as well as sleep disparities across ethno-racial groups. She is interested in understanding what factors make some people vulnerable and others resilient to sleep loss and disrupted circadian rhythms.

Education

Postdoctoral Fellow, University of Pennsylvania
PhD, University of Pennsylvania
MSN, University of Pennsylvania
BSN, Georgetown University

Honors and awards

Marion R. Gregory Award for distinguished completed doctoral dissertation, University of Pennsylvania School of Nursing (2015)
Heilbrunn Nurse Scholar Award, The Rockefeller University (2014)
National Association of School Nurses Annual Conference research poster winner: Intraabdominal adipose tissue and cardio-metabolic disease risk in children and adolescents (2013)
Leadership Identification Scholarship, University of Pennsylvania School of Nursing (1985)
“Susan Kohl Award”. This award is given annually to a member of the Georgetown University Women’s Swim Team who demonstrates hard work, leadership, and dedication to team efforts.

Specialties

Community/population health

Professional membership

Society for Research in Biological Rhythms
American Academy of Nursing
Eastern Nursing Research Society
Sleep Research Society
National Association of School Nurses
Sigma Theta Tau Nursing Honor Society

Publications

Publications

Addressing the Social Determinants of Health: A Call to Action for School Nurses

Schroeder, K., Malone, S., McCabe, E., & Lipman, T. (2018). Journal of School Nursing, 34(3), 182-191. 10.1177/1059840517750733
Abstract
Social determinants of health (SDOH), the conditions in which children are born, grow, live, work or attend school, and age, impact child health and contribute to health disparities. School nurses must consider these factors as part of their clinical practice because they significantly and directly influence child well-being. We provide clinical guidance for addressing the SDOH when caring for children with three common health problems (obesity, insufficient sleep, and asthma). Given their unique role as school-based clinical experts, care coordinators, and student advocates, school nurses are well suited to serve as leaders in addressing SDOH.

Dose-Dependent Associations between Sleep Duration and Unsafe Behaviors among US High School Students

Weaver, M. D., Barger, L. K., Malone, S., Anderson, L. S., & Klerman, E. B. (2018). JAMA Pediatrics. 10.1001/jamapediatrics.2018.2777

Interactive effects of sleep duration and morning/evening preference on cardiovascular risk factors

Patterson, F., Malone, S., Grandner, M. A., Lozano, A., Perkett, M., & Hanlon, A. (2018). European Journal of Public Health, 28(1), 155-161. 10.1093/eurpub/ckx029
Abstract
Background Sleep duration and morningness/eveningness (circadian preference) have separately been associated with cardiovascular risk factors (i.e. tobacco use, physical inactivity). Interactive effects are plausible, resulting from combinations of sleep homeostatic and circadian influences. These have not been examined in a population sample. Methods Multivariable regression models were used to test the associations between combinations of sleep duration (short [≤6 h], adequate [7-8 h], long [≥9 h]) and morning/evening preference (morning, somewhat morning, somewhat evening, evening) with the cardiovascular risk factors of tobacco use, physical inactivity, high sedentary behaviour, obesity/overweight and eating fewer than 5 daily servings of fruit and vegetables, in a cross-sectional sample of 439 933 adults enrolled in the United Kingdom Biobank project. Results Participants were 56% female, 95% white and mean age was 56.5 (SD = 8.1) years. Compared with adequate sleep with morning preference (referent group), long sleep with evening preference had a relative odds of 3.23 for tobacco use, a 2.02-fold relative odds of not meeting physical activity recommendations, a 2.19-fold relative odds of high screen-based sedentary behaviour, a 1.47-fold relative odds of being obese/overweight and a 1.62-fold relative odds of <5 fruit and vegetable daily servings. Adequate sleep with either morning or somewhat morning preference was associated with a lower prevalence and odds for all cardiovascular risk behaviours except fruit and vegetable intake. Conclusions Long sleepers with evening preference may be a sleep phenotype at high cardiovascular risk. Further work is needed to examine these relationships longitudinally and to assess the effects of chronotherapeutic interventions on cardiovascular risk behaviours.

Applying behavioral insights to delay school start times

Malone, S., Ziporyn, T., & Buttenheim, A. M. (2017). Sleep Health, 3(6), 483-485. 10.1016/j.sleh.2017.07.012
Abstract
Healthy People 2020 established a national objective to increase the proportion of 9th-to-12th-grade students reporting sufficient sleep. A salient approach for achieving this objective is to delay middle and high school start times. Despite decades of research supporting the benefits of delayed school start times on adolescent sleep, health, and well-being, progress has been slow. Accelerating progress will require new approaches incorporating strategies that influence how school policy decisions are made. In this commentary, we introduce four strategies that influence decision-making processes and demonstrate how they can be applied to efforts aimed at changing school start time policies.

Differences in morning–evening type and sleep duration between Black and White adults: Results from a propensity-matched UK Biobank sample

Malone, S., Patterson, F., Lozano, A., & Hanlon, A. (2017). Chronobiology International, 34(6), 740-752. 10.1080/07420528.2017.1317639
Abstract
Biological evidence suggests that ethno-racial differences in morning–evening type are possible, whereby Blacks may be more likely to be morning type compared to Whites. However, population-level evidence of ethno-racial difference in morning–evening type is limited. In an earlier study, we reported that morning type was more prevalent in Blacks compared to Whites in the United Kingdom (UK) Biobank cohort (N = 439 933). This study aimed to determine if these ethno-racial differences persisted after accounting for an even broader range of social, environmental and individual characteristics and employing an analytic approach that simulates randomization in observational data, propensity score modeling. Data from UK Biobank participants whose self-identified race/ethnicity was Black/Black British or White; who did not report daytime napping, shift work or night shift work; who provided full mental health information; and who were identified using propensity score matching were used (N = 2044). Each sample was strongly matched across all social, environmental and individual characteristics as indicated by absolute standardized mean differences <0.09 for all variables. The prevalence of reporting nocturnal short, adequate and long sleep as well as morning, intermediate and evening type among Blacks (n = 1022) was compared with a matched sample of Whites (n = 1022) using multinomial logistic regression models. Blacks had a 62% greater odds of being morning type [odds ratio (OR) = 1.620, 95% confidence interval (CI): 1.336–1.964, p <.0001] and a more than threefold greater odds of reporting nocturnal short sleep (OR = 3.453, 95% CI: 2.846–4.190, p <.0001) than Whites. These data indicate that the greater prevalence of morning type and short nocturnal sleep in Blacks compared to Whites is not fully explained by a wide range of social and environmental factors. If sleep is an upstream determinant of health, these data suggest that ethno-racially targeted public health sleep intervention strategies are needed.

Characteristics Associated With Sleep Duration, Chronotype, and Social Jet Lag in Adolescents

Malone, S., Zemel, B., Compher, C., Souders, M., Chittams, J., Thompson, A. L., & Lipman, T. H. (2016). Journal of School Nursing, 32(2), 120-131. 10.1177/1059840515603454
Abstract
Sleep is a complex behavior with numerous health implications. Identifying sociodemographic and behavioral characteristics of sleep is important for determining those at greatest risk for sleep-related health disparities. In this cross-sectional study, general linear models were used to examine sociodemographic and behavioral characteristics associated with sleep duration, chronotype, and social jet lag in adolescents. One hundred and fifteen participants completed Phase I (self-reported sleep measures), and 69 of these participants completed Phase II (actigraphy-estimated sleep measures). Black adolescents had shorter free night sleep than Hispanics. Youth with later chronotypes ate fewer fruits and vegetables, drank more soda, were less physically active, and took more daytime naps. Based on these findings, recommendations for individual support and school policies are provided.

Ethnic differences in sleep duration and morning-evening type in a population sample

Malone, S., Patterson, F., Lu, Y., Lozano, A., & Hanlon, A. (2016). Chronobiology International, 33(1), 10-21. 10.3109/07420528.2015.1107729
Abstract
This cross-sectional population study examined associations of sleep duration and morning-evening type with sociodemographic and cardiometabolic disease in adults participating in the UK Biobank study (N = 439 933). Multivariable Poisson regression models of sleep duration and morning-evening type with a robust error variance were generated to estimate adjusted prevalence ratios and their 95% confidence intervals. All models were adjusted for sex, race, college attendance, employment status and age. Twenty five percent of the sample reported short sleep; 27% were morning, 64% intermediate and 9% evening type. Black ethnicity emerged as most strongly associated with sleep behavior. Short sleep was twice as prevalent, and morning versus intermediate type was 1.4 times more prevalent in Black than White participants. The greater prevalence of short sleep and morning type among Blacks suggests that sleep-based approaches to improving cardiometabolic outcomes may require a more multidimensional approach that encompasses adequate sleep and circadian alignment in this population.

Smoking, Screen-Based Sedentary Behavior, and Diet Associated with Habitual Sleep Duration and Chronotype: Data from the UK Biobank

Patterson, F., Malone, S., Lozano, A., Grandner, M. A., & Hanlon, A. L. (2016). Annals of Behavioral Medicine, 50(5), 715-726. 10.1007/s12160-016-9797-5
Abstract
Background: Sleep duration has been implicated in the etiology of obesity but less is known about the association between sleep and other behavioral risk factors for cardiovascular disease. Purpose: The aim of this study was to examine the associations among sleep duration, chronotype, and physical activity, screen-based sedentary behavior, tobacco use, and dietary intake. Methods: Regression models were used to examine sleep duration and chronotype as the predictors and cardiovascular risk factors as outcomes of interest in a cross-sectional sample of 439,933 adults enrolled in the UK Biobank project. Results: Short sleepers were 45 % more likely to smoke tobacco than adequate sleepers (9.8 vs. 6.9 %, respectively). Late chronotypes were more than twice as likely to smoke tobacco than intermediate types (14.9 vs. 7.4 %, respectively). Long sleepers reported 0.61 more hours of television per day than adequate sleepers. Early chronotypes reported 0.20 fewer daily hours of computer use per day than intermediate chronotypes. Early chronotypes had 0.25 more servings of fruit and 0.13 more servings of vegetables per day than late chronotypes. Conclusions: Short and long sleep duration and late chronotype are associated with greater likelihood of cardiovascular risk behaviors. Further work is needed to determine whether these findings are maintained in the context of objective sleep and circadian estimates, and in more diverse samples. The extent to which promoting adequate sleep duration and earlier sleep timing improves heart health should also be examined prospectively.

Social jet lag, chronotype and body mass index in 14–17-year-old adolescents

Malone, S., Zemel, B., Compher, C., Souders, M., Chittams, J., Thompson, A. L., Pack, A., & Lipman, T. H. (2016). Chronobiology International, 33(9), 1255-1266. 10.1080/07420528.2016.1196697
Abstract
The relationship between sleep duration and obesity in adolescents is inconclusive. This may stem from a more complex relationship between sleep and obesity than previously considered. Shifts toward evening preferences, later sleep–wake times and irregular sleep–wake patterns are typical during adolescence but their relationship to body mass index (BMI) has been relatively unexplored. This cross-sectional study examined associations between sleep duration, midpoint of sleep and social jet lag (estimated from 7 days of continuous actigraphy monitoring), and morningness/eveningness with BMIs (BMI z-scores) and waist-to-height ratios in 14–17-year-old adolescents. Seventy participants were recruited from ninth and tenth grades at a public high school. Participants’ characteristics were as follows: 74% female, 75% post-pubertal, 36% Hispanic, 38% White, 22% Black, 4% Asian and 64% free/reduced lunch participants with a mean age of 15.5 (SD, 0.7). Forty-one percent of the participants were obese (BMI ≥ 95th percentile); 54% were abdominally obese (waist-to-height ratio ≥ 0.5). Multivariable general linear models were used to estimate the association between the independent variables (school night sleep duration, free night sleep duration, midpoint of sleep (corrected), social jet lag and morningness/eveningness) and the dependent variables (BMI z-scores and waist-to-height ratios). Social jet lag is positively associated with BMI z-scores (p < 0.01) and waist-to-height ratios (p = 0.01). Midpoint of sleep (corrected) is positively associated with waist-to-height ratios (p = 0.01). After adjusting for social jet lag, school night sleep duration was not associated with waist-to-height ratios or BMI z-scores. Morningness/eveningness did not moderate the association between sleep duration and BMI z-scores. Findings from this study suggest that chronobiological approaches to preventing and treating obesity may be important for accelerating progress in reducing obesity rates in adolescents.

Measurement and Interpretation of Body Mass Index During Childhood and Adolescence

Malone, S., & Zemel, B. S. (2015). Journal of School Nursing, 31(4), 261-271. 10.1177/1059840514548801
Abstract
The landscape of childhood health and disease has changed over the past century, and school nurses are now in a unique position to address the conditions that lead to chronic disease, such as obesity. Measuring body mass index (BMI) during childhood and adolescence is the recommended method for screening and/or monitoring obesity in school communities. Yet changes in the size, proportion, and distribution of fat mass and fat-free mass during growth and development introduce challenges to interpreting BMI measurements. Understanding these challenges and ensuring accurate measurement techniques are the foundation for implementing school-based BMI measurement programs. This article will provide an overview of body composition during childhood and adolescence, introduce strategies to improve the accuracy of BMI measurements, and explore the school nurse’s role in BMI surveillance and/or screening activities.