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Objective: In response to the rise in mental health needs among youth, a school-based resilience intervention was implemented for sixth graders at an urban middle school. The goal of this analysis is to examine improvements in key mental health parameters among students who endorsed negative affectivity at baseline. Method: A total of 285 11-12-year-olds (72% white, 18% Hispanic, 55% female) participated in a single-arm, non-randomized 6-week 1:1 school-based coaching intervention, Healthy Kids. Youth completed validated surveys at baseline and 6-week follow-up assessing depression/anxiety symptoms, bullying, self-efficacy, academic pressure, grit, and resilience. Participants were determined to have elevated negative affectivity if they reported mild-to-severe symptoms for both depression and anxiety symptoms. General linear models examined differences between groups for each mental health parameter, as well as change in outcomes from baseline to follow-up. Results: A third of participants (38%) at baseline endorsed negative affectivity. Youth who endorsed negative affectivity were more often female (71% vs 29%; p < 0.001) and identified as victims of cyberbullying (25% vs 8%; p < 0.001). Youth with baseline negative affectivity scored lower for self-efficacy (total 70.5 vs 86.8; p < 0.0001). Baseline negative affectivity was a significant moderator for change in mental health parameters. Post-intervention, those who endorsed baseline negative affectivity, medium effect sizes were observed for self-efficacy (g = 0.6; 95%CI 0.3, 0.9; p < 0.001) and anxiety symptoms (g = - 0.70; 95%CI - 1.0, - 0.4; p < 0.001). Among all youth, there were significant medium intervention effects in resilience (g = 0.5; 95%CI 0.3, 0.7; p < 0.001) and self-efficacy (g = 0.7; 95%CI 0.4, 0.9; p < 0.001). Conclusions: A universal resiliency program may improve self-efficacy and symptoms of anxiety among youth experiencing negative affectivity, while improving resilience and self-efficacy among all youth. Our findings suggest a universal school-based coaching program benefits all youth, while also specifically targeting the needs of youth with negative affectivity who are most at risk for mental health concerns.

Recent reports have shown that the majority of school-aged children and adolescents experience insufficient sleep duration making sleep health a significant public health concern. School-based sleep interventions that have the ability to reach large numbers of children simultaneously may be a viable strategy to combat this epidemic. The goal of this topical review is to examine published school-based interventions to identify lessons learned and provide suggestions for future research. Our findings show that school-based sleep interventions to date have been designed as both universal interventions for all students as well as targeted interventions delivered only to those identified as having sleep problems. Unfortunately, most interventions resulted in minimal change in sleep, with only 3 interventions improving sleep by more than 30 min per night. Education-based strategies alone are typically insufficient to produce substantial behavior change. The strategy of screening the most at-risk students and then providing individual and specifically targeted intervention may be an efficient use of resources that schools could utilize. Further work is needed to examine the feasibility and efficacy of school-based interventions in achieving clinically significant improvements in sleep duration at a larger scale to curb the epidemic of insufficient sleep in school-aged children and adolescents., Author(s): Jill L. Kaar [sup.1] , Anne E. Bowen [sup.2] , Emma Clark [sup.3] , Meredith Ware [sup.1] , Jessica L. Chandrasekhar [sup.1] , Lauren Gulley [sup.2] [sup.3] , Christina [...]

Objective: The study objective was to inform patient-centered care for adolescent insomnia by describing adolescents' perspectives on insomnia. Specific constructs of interest included: 1) factors that contributed to insomnia development or maintenance, 2) impact of insomnia on day-to-day life, 3) recommended research priorities, and 4) overall experience living with insomnia. Method: A convenience sample of adolescents (ages 13–18 years) self-identifying with insomnia symptoms was recruited through social media. Respondents (n = 3,014) completed an online survey. Responses to an open-ended item assessing patient experience were coded using thematic analysis. Results: Participants identified as 70.8% White non-Hispanic, 77.0% female, and lived in one of five English-speaking countries (United States, United Kingdom, Canada, Australia, or New Zealand). Most (87.5%) met DSM-V diagnostic criteria for insomnia. The most common contributory factors to insomnia endorsed were stress (72.1%) and depressed mood (63.6%), while common impact areas were mood (72.2%), focus (61.0%), and pain (49.7%). Patient-centered research priorities were identifying insomnia causes (66.4%) and early detection (66.1%). Common adolescent experiences included high distress levels, feelings of invalidation, and helplessness about their insomnia. Conclusions: Adolescents with insomnia offer a unique perspective that should inform patient-centered research and care. There is a need for heightened screening and awareness about insomnia as a condition that causes significant distress and impairment for adolescents. To provide validating care, providers should recognize the multifaceted causes of insomnia. [ABSTRACT FROM AUTHOR]

Aim: Type 1 diabetes (T1D) increases the risk of morbidity and mortality from cardiovascular disease, and insufficient sleep is prevalent. Emerging evidence suggests a link between sleep and cardiometabolic health, but this has not been examined across the lifespan in individuals with T1D. We aimed to examine associations between sleep and cardiometabolic health in adolescents and adults with T1D in a secondary analysis of data from a 4‐week double‐blind, random‐order, placebo‐controlled crossover trial of bromocriptine quick release (BCQR) therapy with a 4‐week washout in between conditions. Materials and Methods: Forty‐two adults (19‐60 years) and 42 adolescents (12‐18 years) with T1D >9 months completed 1 week of home monitoring with wrist‐worn actigraphy to estimate sleep duration and continuous glucose monitoring, anthropometrics, arterial stiffness, magnetic resonance imaging (adolescents only), and fasting laboratory testing at each treatment phase. Results: Sixty‐two per cent of adolescents and 74% of adults obtained <7 h of sleep per night at baseline. After adjustment for age, sex and diabetes duration, baseline sleep <7 h per night was associated with a higher body mass index, a higher waist circumference, a higher systolic blood pressure, worse arterial stiffness and a lower estimated insulin sensitivity (all p <.05). When examined by age group, associations between sleep duration and cardiometabolic health outcomes remained significant, predominantly for adolescents. In adolescents only, wake time was significantly later (p =.027) and time in bed was significantly longer with BCQR versus placebo (p =.049). Conclusions: Objectively measured sleep <7 h per night was prevalent in adolescents and adults with T1D and associated with poorer cardiometabolic health markers. Small changes in sleep were seen following BCQR treatment in adolescents only. Sleep may be an important and novel target for improving cardiometabolic health in individuals with T1D. [ABSTRACT FROM AUTHOR]

Background: Both sleep duration and physical activity following concussion may influence subsequent recovery. Objective measurement of sleep and physical activity behavior via wearable technology may provide insights into their association with concussion recovery. Objective: To determine whether sleep behavior (eg, duration, timing) and/or physical activity (steps/day, or exercise frequency, duration, intensity) in the first month after adolescent sports‐related concussion are associated with developing persisting postconcussion symptoms (PPCS). Design: Case–control. Setting: Outpatient sports medicine clinic. Participants: The study prospectively enrolled adolescent athletes who sustained a concussion (N = 49, age = 14.8 ± 1.8 years; 51% female) who were evaluated within 14 days of concussion (mean = 6.7 ± 2.7 days) and followed uvia sleep/physical activity monitoring for the subsequent 2 weeks. Main Outcome Measures: Participants wore a monitor to track sleep (sleep time, wake time, and time spent awake in bed at night) and physical activity (average steps/day, exercise frequency, exercise duration) behavior for 2 weeks after initial assessment. Participants were followed until symptom resolution, and the main outcome of interest was development of PPCS (symptom duration >28 days). A multivariable logistic regression model was used to examine associations between physical activity and sleep behavior with PPCS. Results: Of the 49 participants, 47% (n = 23, mean symptom resolution = 57 ± 23 days post injury) developed PPCS and 53% (n = 26, mean symptom resolution = 15 ± 7 days post injury) did not. Univariable analysis showed that the PPCS group took fewer steps/day (7526 ± 2975 vs. 9803 ± 3786 steps/day; p =.02), exercised less frequently (2.5 ± 2.2 vs. 4.4 ± 2.1 days/week; p =.005), and spent more time in bed awake (1.2 ± 0.3 vs. 0.8 ± 0.3 h/night; p =.03) than the no PPCS group. Multivariable results indicated the odds of developing PPCS significantly increased with fewer exercise session/week (adjusted odds ratio = 1.96, 95% confidence interval = 1.09, 3.51, p =.024). Conclusions: More exercise sessions that were longer than 15 minutes during concussion recovery was associated with a lower risk of developing PPCS, whereas sleep and other physical activity measures were not. Further studies regarding exercise duration and intensity are needed. Clinicians may consider advising patients to optimize sleep and physical activity during concussion recovery. [ABSTRACT FROM AUTHOR]

Actiwatch devices are often used to estimate time in bed (TIB) but recently became commercially unavailable. Thigh-worn activPAL devices could be a viable alternative. We tested convergent validity between activPAL (CREA algorithm) and Actiwatch devices. Data were from free-living samples comprising 47 youth (3–16 valid nights/participant) and 42 adults (6–26 valid nights/participant) who wore both devices concurrently. On average, activPAL predicted earlier bedtimes and later risetimes compared with Actiwatch, resulting in longer overnight intervals (by 1.49 hr/night for youth and 0.67 hr/night for adults; both p <.001). TIB interruptions were predicted less commonly by activPAL (mean <2 interruptions/night for both youth and adults) than Actiwatch (mean of 24–26 interruptions/night in both groups; both p <.001). Overnight intervals for both devices tended to overlap for lengthy periods (mean of 7.38 hr/night for youth and 7.69 hr/night for adults). Within these overlapping periods, the devices gave matching epoch-level TIB predictions an average of 87.9% of the time for youth and 84.3% of the time for adults. Most remaining epochs (11.8% and 15.1%, respectively) were classified as TIB by activPAL, but not Actiwatch. Overall, the devices had fair agreement during the overlapping periods but limited agreement when predicting interruptions, bedtime, or risetime. Future work should assess the criterion validity of activPAL devices to understand implications for health research. The present findings demonstrate that activPAL is not interchangeable with Actiwatch, which is consistent with their differing foundations (thigh inclination for activPAL vs. wrist movement for Actiwatch). [ABSTRACT FROM AUTHOR]

To assess changes in duration, timing, and social jetlag in adolescent sleep during the COVID-19 pandemic and evaluate the impact of mood, physical activity, and social interactions on sleep. An online survey queried adolescents' sleep before (through retrospective report) and during the initial phase of COVID-19 in May 2020. Adolescents (N = 3,494), 13–19 years old, in the United States (U.S.) answered questions about their current and retrospective (prior to COVID-19) sleep, chronotype, mood, and physical and social activities. Linear regression models were fit for time in bed, reported bed and wake times, and social jetlag during COVID-19, accounting for pre-COVID-19 values. Total reported time in bed (a proxy for sleep duration) increased on weekdays by an average of 1.3 ± 1.8 hours (p <.001) during COVID-19, compared to retrospective report of time in bed prior to COVID-19. During COVID-19, 81.3% of adolescents reported spending 8 hours or more in bed on weekdays compared to only 53.5% prior to COVID-19. On weekdays, bedtimes were delayed on average by 2.5 hours and wake times by 3.8 hours during COVID-19 compared to prior to COVID-19. On weekends, bedtimes were delayed on average by 1.6 hours and waketimes by 1.5 hours (all p's < 0.001). Social jetlag of >2 hours decreased to 6.3% during COVID-19 compared to 52.1% prior to COVID-19. Anxiety and depression symptoms and a decline in physical activity during COVID-19 were associated with delayed bed and wake times during COVID-19. During COVID-19, adolescents reported spending more time in bed, with most adolescents reporting 8 hours of sleep opportunity and more consistent sleep schedules. As schools return to in-person learning, additional research should examine how sleep schedules may change due to school start times and what lessons can be learned from changes that occurred during COVID-19 that promote favorable adolescent sleep. [ABSTRACT FROM AUTHOR]