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

项目摘要/摘要 表现出夜间昼夜节律类型的年轻人(“夜猫子”)遵循延迟的睡眠时间表，增加 与清晨类型的人相比，一天中活动时间较晚，睡觉和起床都较晚 (“云雀”)。夜晚是心理社会、行为和生物因素共同作用的结果，是一种 这是加剧青年脆弱性和风险的恶性循环的重要推动者。而基本的 生物向夜间的转变--最初是在青春期开始时触发的--可能很难改变， 心理社会和行为的贡献者是可以改变的。在R01HD071065的支持下，我们进行了 为青少年提供跨诊断性睡眠与昼夜节律干预的“治疗实验” (反式-C)以减少10-18岁青少年的夜间活动。我们随机给年轻人分配了一个晚上 时间类型，以及在五个与健康相关的领域中至少一个领域(情绪、认知、 行为、社会、身体)，以：(A)反式-C(n=89)或(B)心理教育(n=87)。虽然结果是 都是有希望的，但观察到治疗收益有所下降。这与先前的研究一致。 记录在治疗后的几年中出现下降的情况太常见了。事实上，已经有 被要求研究是否以及如何维持行为干预(非-OD-19-040)。因此，在这个 修订后的续期申请，我们建议通过进行为期6年的研究来研究维持行为的改变 为R01HD071065招募的独特青年队列的后续行动。年轻人的年龄在16岁到26岁之间。他们 将评估睡眠和昼夜节律功能以及与健康相关的五个领域的功能(情绪， 认知、行为、社会、身体)(SA1)和对睡眠健康行为的利用(SA2)。作为下一个 在这项研究计划中，我们建议评估基于习惯的睡眠健康干预 (“习惯”)--一种利用习惯形成科学衍生的新的低成本方法--改进了 睡眠健康行为的利用，并改善五个人的睡眠和昼夜节律结果和功能 健康相关领域的短期和长期成果(SA3)。一个独立的年轻人样本 表现出高度的夜间行为，并且在五个与健康相关的领域中至少有一个领域处于风险之中 随机分配给单独的习惯组或习惯加短信组(“习惯+短信”)(n=160)。正文 消息传递部分来源于学习理论、行为改变轮和焦点小组。我们还将 检查已经养成习惯的睡眠健康行为是否会调节治疗对改善的效果 在睡眠、昼夜节律和健康结果方面。适度分析将检查干预有效性是否 与年龄/发育阶段、性别、社会经济地位、种族/少数族裔群体和参与季节有关。这 研究将促进对更长期结果的了解，即夜间作为一种机制的作用 导致较差的青年结果以及利用学习理论和习惯科学的价值 在健康促进中形成。

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.