Development and Pilot Testing of Sleeping Healthy/Living Healthy a Comprehensive Sleep Intervention for Adolescents in Urban SBHCs

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Background: Poor sleep quality, which contributes to impaired functioning, is elevated in urban, ethnic/racial minority adolescents due, in part, to poor sleep hygiene. Despite successful sleep hygiene interventions in younger children, none focus on adolescents, a group with unique developmental needs. Urban adolescents face unique contextual stressors, which may contribute to ineffective use of sleep hygiene behaviors. Mind- body integrative (MBIH) approaches (e.g. yoga, meditation) improve sleep quality in adults, but are rarely applied to adolescents. MBIH has been shown to reduce stress among adolescents. Taken together, this suggests that integrating MBIH with sleep hygiene strategies has the potential for a synergistic effect on improving sleep quality. Yet no interventions concurrently use MBIH and sleep hygiene with adolescents. Process evaluations are often lacking during intervention development. We address these treatment and methodological gaps. Aims: This pilot study will: (1) develop Sleeping Healthy/Living Healthy, a school-based health center (SBHC) intervention that combines MBIH and sleep hygiene strategies to improve sleep quality in urban adolescents with poor sleep quality; (2) evaluate the feasibility and acceptability of intervention procedures; and (3) assess the preliminary intervention effects on sleep quality in urban adolescents. Hypotheses: (1) The intervention will be feasible and acceptable as evidenced by high rates of recruitment, adherence to treatment protocols, and high intervention satisfaction ratings; and (2) over [ three ] months, compared to controls, adolescents randomized to the intervention will have improvement on two primary sleep quality outcomes, (a) sleep duration and (b) sleep fragmentation (sleep efficiency and disruptions), measured objectively (actigraphs) and subjectively (using validated instruments). Methods: This study includes a development phase and a pilot individually-randomized group treatment (IRGT) phase. In Year 1 we will develop the novel integrated intervention using an iterative participatory design process. We will be guided by input from adolescents via focus groups and by interviews with SBHC medical and mental health providers, health educators, and staff. In Year 2, we will conduct an IRGT trial with [ 60 ] adolescents with insufficient sleep recruited from two SBHCs in New York City. Adolescents will be randomized 1:1 to receive the intervention or an attention control. Process evaluation interviews guided by a rigorous fidelity framework with adolescents and with SBHC providers and personnel will be conducted to obtain feedback regarding intervention procedures. Significance: This study has high public health significance because it (1) will reach urban racial and ethnic minority adolescents, a vulnerable population [ with specific needs ] greatly impacted by poor sleep quality but largely ignored in the intervention literature to date; (2) simultaneously leverages MBIH and sleep hygiene, potentially amplifying intervention effects; and (3) utilizes objective sleep quality measures and rigorous formative process evaluation. Findings from this study will guide the design of a future full-scale IRGT.