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

Accepting PhD students

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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

Shift Workers Have Higher Blood Pressure Medicine Use, But Only When They Are Short Sleepers: A Longitudinal UK Biobank Study

Riegel, B., Daus, M., Lozano, A. J., Malone, S. K., Patterson, F., & Hanlon, A. L. (2019). Journal of the American Heart Association, 8(20), e013269. 10.1161/JAHA.119.013269
Abstract
Background Some, but not all, studies report associations between shift work and hypertension, suggesting that particular subgroups may be at risk. We examined moderating effects of sleep duration and circadian preference on the relationship between shift work and new blood pressure (BP) medicine use at follow-up. Methods and Results Baseline and 5-year follow-up data from the UK Biobank cohort (N=9200) were used to generate logistic regression models for shift workers and nonshift workers. The moderating effects of sleep duration (short ≤6 hours; adequate 7-8 hours; long ≥9 hours) and circadian preference (morning "larks;" intermediate; evening "owls") at baseline were examined with new BP medicine use at follow-up, adjusting for age, sex, race, education, employment, urban/rural, cardiovascular disease family history, depression, alcohol intake, physical activity, diet, smoking, and body mass index. The sample was predominately middle aged (55.3±7.4), female (57.3%), and white (97.9%). Most reported adequate sleep duration (7-8 hours, 73.7%) and were intermediate type (65.3%); 8.0% were shift workers at baseline. Only 6.5% reported new BP medicine use at follow-up. Short sleep duration was a significant moderator of new BP medicine use in shift workers. Among short sleepers, shift workers had a 2.1-fold increased odds of new BP medicine use compared with nonshift workers (odds ratio=2.08, 95% CI=1.21-3.58, P=0.008). In those reporting adequate (odds ratio=0.82, 95% CI=0.54-1.25, P=0.35) and long sleep (odds ratio=0.64, 95% CI=0.11-3.54, P=0.60), this relationship was protective but nonsignificant. Interaction between circadian preference and shift work on BP medicine use was nonsignificant. Conclusions Shift workers with short sleep duration may be at risk for hypertension.

Sleep and alertness in a duty-hour flexibility trial in internal medicine

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Abstract
BACKGROUND A purpose of duty-hour regulations is to reduce sleep deprivation in medical trainees, but their effects on sleep, sleepiness, and alertness are largely unknown. METHODS We randomly assigned 63 internal-medicine residency programs in the United States to follow either standard 2011 duty-hour policies or flexible policies that maintained an 80-hour workweek without limits on shift length or mandatory time off between shifts. Sleep duration and morning sleepiness and alertness were compared between the two groups by means of a noninferiority design, with outcome measures including sleep duration measured with actigraphy, the Karolinska Sleepiness Scale (with scores ranging from 1 [extremely alert] to 9 [extremely sleepy, fighting sleep]), and a brief computerized Psychomotor Vigilance Test (PVT-B), with long response times (lapses) indicating reduced alertness. RESULTS Data were obtained over a period of 14 days for 205 interns at six flexible programs and 193 interns at six standard programs. The average sleep time per 24 hours was 6.85 hours (95% confidence interval [CI], 6.61 to 7.10) among those in flexible programs and 7.03 hours (95% CI, 6.78 to 7.27) among those in standard programs. Sleep duration in flexible programs was noninferior to that in standard programs (between-group difference, −0.17 hours per 24 hours; one-sided lower limit of the 95% confidence interval, −0.45 hours; noninferiority margin, −0.5 hours; P=0.02 for noninferiority), as was the score on the Karolinska Sleepiness Scale (between-group difference, 0.12 points; one-sided upper limit of the 95% confidence interval, 0.31 points; noninferiority margin, 1 point; P<0.001). Noninferiority was not established for alertness according to the PVT-B (between-group difference, −0.3 lapses; one-sided upper limit of the 95% confidence interval, 1.6 lapses; noninferiority margin, 1 lapse; P=0.10). CONCLUSIONS This noninferiority trial showed no more chronic sleep loss or sleepiness across trial days among interns in flexible programs than among those in standard programs. Noninferiority of the flexible group for alertness was not established.

Sleep and Alertness Outcomes in a Duty-Hour Flexibility Trial in Internal Medicine

Malone, S. (2019). New England Journal of Medicine, 915-923.

Sleep as a Target for Optimized Response to Smoking Cessation Treatment

Patterson, F., Grandner, M. A., Malone, S., Rizzo, A., Davey, A., & Edwards, D. G. (2019). Nicotine & Tobacco Research : Official Journal of the Society for Research on Nicotine and Tobacco, 21(2), 139-148. 10.1093/ntr/ntx236
Abstract
Declining national rates of current tobacco use to an all-time low of 15.1% represents a public health victory. Undermining this progress, however, are smoking rates of up to 50% among high-risk, low-income populations. Current FDA-approved treatments for nicotine dependence are ineffective with between 70-95% of treatment-seekers relapsing within the first year of attempted abstinence. Thus, identification of novel intervention targets to optimize response to currently available treatments for nicotine dependence is a critical next step. One such target may be sleep insomnia. Insomnia is a clinically verified nicotine withdrawal symptom but, to date, addressing insomnia or other sleep disturbance symptoms as an adjunctive smoking cessation therapy has yet to be fully considered. To this end, this manuscript presents a narrative review of: (1) sleep continuity and architecture in smokers versus nonsmokers; (2) effects of nicotine abstinence on sleep; (3) possible mechanisms linking sleep with smoking cessation outcomes; (4) plausible adjunctive sleep therapies to promote smoking cessation; (5) possible treatments for unhealthy sleep in smokers; and (6) directions for future research. Taken together, this will provide conceptual support for sleep therapy as an adjunctive treatment for smoking cessation. Implications: This narrative literature review presents a comprehensive discussion of the relationship between habitual sleep and cigarette smoking. The extent to which unhealthy sleep in smokers may be a viable intervention target for promoting response to smoking cessation treatment is considered. Ultimately, this review provides conceptual support for sleep therapy as an adjunctive treatment for smoking cessation.

Social jetlag, circadian disruption, and cardiometabolic disease risk

Kohl Malone, S., Mendoza, M., & Patterson, F. (2019). Elsevier.

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.

A systematic review of biological mechanisms of fatigue in chronic illness

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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.