Maintaining behavior change: A 6-year follow-up of adolescent 'night-owls' and an evaluation of a habit-based sleep health intervention

项目总结/摘要 表现出夜间昼夜节律的年轻人（“夜猫子”）遵循延迟的睡眠时间表， 与早晨型相比， （“云雀”）。夜晚感是心理社会、行为和生物因素共同作用的结果，是一种 是加剧青年脆弱性和风险恶性循环的重要因素。虽然基本 朝向均匀性的生物学转变-最初在青春期开始时触发-可能难以改变， 心理和行为因素是可以改变的。在R 01 HD 071065的支持下，我们进行了 一个“治疗实验”，我们在其中提供了青少年的跨诊断睡眠和昼夜节律干预， （Trans-C）以减少10-18奥尔兹的夜间活动。我们随机给年轻人分配了一个晚上 时间型，以及在五个健康相关领域（情感，认知， 行为、社会、身体），（a）TransS-C（n = 89）或（B）心理教育（n = 87）。虽然结果 虽然前景看好，但观察到治疗收益有所下降。这与之前的研究一致 记录表明，在治疗后的几年中，经常观察到下降。事实上， 一直呼吁研究是否以及如何维持行为干预（NOT-OD-19-040）。因此，在这 修订后的续期申请，我们建议进行为期6年的研究， R 01 HD 071065招募的独特青年队列的随访。年轻人将在16至26岁之间。他们 将评估睡眠和昼夜节律功能以及五个健康相关领域（情绪， 认知、行为、社会、身体）（SA 1）和他们对睡眠健康行为的利用（SA 2）。作为下一个 在这项研究计划的第一步，我们建议评估是否基于睡眠的睡眠健康干预 （“HABITS”）--一种利用习惯形成科学的新的低成本方法--提高了 利用睡眠健康行为，改善睡眠和昼夜节律的结果和功能，在五个 短期和长期的健康相关领域结果（SA 3）。一个独立的青年样本， 表现出高水平的夜间活动，并在五个健康相关领域中至少有一个领域处于“危险”状态， 随机分配到单独的HABIT或HABIT加文本消息（“HABIT+文本”）（n = 160）。文本 信息传递部分来自学习理论、行为改变轮和焦点小组。我们还将 检查已成为习惯的睡眠健康行为是否介导治疗对改善的影响 在睡眠、昼夜节律和健康结果方面。适度分析将检查干预的有效性是否 与年龄/发育阶段、性别、SES、种族/少数民族群体和参与季节相关。这 研究将促进对长期结果的了解， 导致青年人的结果较差，以及利用学习理论和习惯科学的价值 在健康促进方面。

Project Summary/Abstract Youth who exhibit an evening circadian chronotype (“night-owls”) follow a delayed sleep schedule, increasing activity later in the day and both going to sleep and getting up later, compared to morning types (“larks”). Eveningness arises from a confluence of psychosocial, behavioral and biological factors and is an important contributor to vicious cycles that escalate vulnerability and risk among youth. While the basic biological shift toward eveningness—initially triggered around the onset of puberty—may be difficult to modify, the psychosocial and behavioral contributors are modifiable. Supported by R01HD071065, we have conducted a “treatment experiment” in which we delivered the Transdiagnostic Sleep and Circadian Intervention for Youth (TranS-C) to reduce eveningness among 10-18 year olds. We randomly allocated youth with an evening chronotype, and who were “at risk” in at least one of five health-relevant domains (emotional, cognitive, behavioral, social, physical), to either: (a) TranS-C (n = 89) or (b) Psychoeducation (n = 87). While the results were promising, some drop off in treatment gains were observed. This is consistent with prior research documenting that a drop-off in the years following treatment is too commonly observed. Indeed, there have been calls to study if and how behavioral interventions are maintained (NOT-OD-19-040). Hence, in this revised renewal application, we propose to study the maintenance of behavior change by conducting a 6-year follow-up of the unique cohort of youth recruited for R01HD071065. The youth will be 16 to 26 years old. They will be assessed for sleep and circadian functioning and functioning in five health-relevant domains (emotional, cognitive, behavioral, social, physical) (SA1) and for their utilization of sleep health behavior (SA2). As a next step in this research program, we propose to evaluate if a Habit-based Sleep Health Intervention (“HABITs”)—a novel low-cost approach derived by leveraging the science of habit formation—improves the utilization of sleep health behavior and improves sleep and circadian outcomes and functioning in the five health-relevant domain outcomes in the short and longer term (SA3). An independent sample of youth who exhibit a high level of eveningness and are “at risk” in at least one of the five health-relevant domains will be randomly allocated to HABITs alone or HABITs plus Text Messaging (“HABITs+Texts”) (n = 160). The text messaging portion is derived from learning theory, the Behavior Change Wheel and focus groups. We will also examine if sleep health behavior that has become habitual mediates the effects of treatment on improvement in sleep, circadian and health outcomes. Moderation analyses will examine if intervention effectiveness is related to age/developmental stage, sex, SES, racial/ethnic minority group and season of participation. This research will advance knowledge on longer-term outcomes, the role of eveningness as a mechanism contributing to poorer youth outcome and the value of leveraging of learning theory and the science of habit formation in health promotion.