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

背景：睡眠质量差，导致功能受损，在城市，种族/种族 部分原因是睡眠卫生差。尽管成功的睡眠卫生干预措施， 年龄较小的儿童，没有一个侧重于青少年，这是一个有独特发展需要的群体。城市青少年 面临独特的环境压力源，这可能导致睡眠卫生行为的无效使用。注意- 身体整合（MBIH）方法（如瑜伽，冥想）改善成人的睡眠质量，但很少 适用于青少年。MBIH已被证明可以减轻青少年的压力。总的来说，这 这表明，将MBIH与睡眠卫生策略相结合，有可能产生协同效应， 改善睡眠质量。然而，没有干预措施同时使用MBIH和睡眠卫生与青少年。 在制定干预措施的过程中往往缺乏过程评价。我们处理这些治疗， 方法上的差距。目的：这项先导研究将：（1）发展以学校为本的健康睡眠/健康生活 健康中心（SBHC）干预，结合MBIH和睡眠卫生策略，以改善睡眠质量， 评价干预的可行性和可接受性 （3）评价对城市青少年睡眠质量的初步干预效果。 假设：（1）高招募率证明干预措施是可行和可接受的， 遵守治疗方案，高干预满意度;（2）超过[ 三 ]个月， 与对照组相比，随机分配到干预组的青少年在两个主要睡眠方面都有改善， 质量结果，（a）睡眠持续时间和（B）睡眠片段（睡眠效率和中断），测量 客观（活动记录仪）和主观（使用经验证的仪器）。方法：本研究包括一个 开发阶段和试验性个体随机分组治疗（IRGT）阶段。在第一年，我们将 使用迭代参与式设计过程开发新的综合干预措施。我们将遵循 通过焦点小组和与SBHC医疗和心理健康提供者的访谈， 健康教育工作者和工作人员。在第二年，我们将进行一项IRGT试验， 60 [英语泛读材料青少年睡眠不足 从纽约市的两个SBHC招募的。青少年将以1：1的比例随机接受干预， 注意力控制在严格的忠诚框架指导下与青少年进行过程评估访谈 并与SBHC供应商和人员进行沟通，以获得有关干预的反馈 程序.意义：这项研究具有很高的公共卫生意义，因为它（1）将达到城市种族 和少数民族青少年，弱势群体[ 有特殊需要的 ]严重影响睡眠质量 质量，但在迄今为止的干预文献中大部分被忽视;（2）同时利用MBIH和睡眠 卫生，潜在地放大干预效果;以及（3）利用客观的睡眠质量测量， 严格的形成过程评估。这项研究的结果将指导未来全尺寸IRGT的设计。

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.