Susan Malone

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.

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.

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.

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.

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.

Abstract

Cognition, memory, safety, mental health, and weight are all affected by inadequate sleep. Biological studies indicate significant changes in sleep architecture during adolescence, such as changes in melatonin secretion, and a need for greater total sleep time. Yet, social contexts and cultural values impinge on these changing biological sleep needs making adolescents vulnerable to the dangers of insufficient sleep. Sleep hygiene practices are purported as potential mediating factors between biological sleep needs and the sociocultural context of sleep. The purpose of this literature review is to highlight biological and social factors contributing to insufficient sleep in adolescents, to explore the evidence of several recommended sleep hygiene practices, and to stimulate further research about how adolescents negotiate their shifting biological sleep needs amid increasing social demands.

Abstract

Vigilance has been central to nursing practice since Florence Nightingale. Often, the nurse's work of surveillance goes unnoticed and the public never recognizes the value of the nurse's work. The 1999 Institute of Medicine report on hospital deaths due to preventable errors has lifted the veil shrouding professional vigilance. But how to measure vigilance remained elusive, until the concept, failure to rescue (FTR), was proposed. FTR has taken a prominent role in health care since its adoption as a patient safety indicator by the Agency for Healthcare Research and Quality (AHRQ) and as a measure for nursing performance in acute care by the National Quality Forum (NQF). However, its applicability to school nursing has been unexplored. This article provides an initial review of the literature and an analysis of anecdotal stories and media accounts that illustrate professional vigilance in school nursing practice.

Abstract

The dramatic increase in our understanding of the brain's development throughout childhood has increased our knowledge of the significance of micronutrients, such as iron and vitamin B-12, for this development. Deficiencies of these micronutrients have been shown to have an impact on students' cognitive development. Regardless of this knowledge, students continue to make unhealthy food choices and develop poor dietary habits. School environments are places where there is an opportunity to practice healthy eating habits. Yet many school policies fail to address the sale of foods of minimal nutritional value in the school setting. School nurses can play a vital role in planning policies at the local and national level that support and encourage healthy food environments, performing assessments of the nutritional status of students, and spearheading the implementation of evidence-based health promotion programs. It is time for school nurses to take the lead in efforts aimed at improving the quality of students' dietary intake in the school setting.