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、民族/种族中普遍存在。 少数族裔青少年的部分原因是糟糕的睡眠卫生。尽管成功地进行了睡眠卫生干预 年龄较小的儿童，没有一个专注于青少年，这是一个具有独特发展需求的群体。城市青少年 面对独特的背景压力，这可能会导致睡眠卫生行为的无效使用。注意- 身体综合(MBIH)方法(例如瑜伽、冥想)改善成年人的睡眠质量，但很少见 适用于青少年。MBIH已被证明可以减轻青少年的压力。总而言之，这是 提示将MBIH与睡眠卫生策略相结合具有潜在的协同作用 提高睡眠质量。然而，没有干预措施同时使用MBIH和青少年的睡眠卫生。 在干预措施的制定过程中，常常缺乏过程评估。我们致力于这些治疗和 方法上的差距。目标：这项初步研究将：(1)开发以学校为基础的睡眠健康/生活健康 健康中心(SBHC)结合MBIH和睡眠卫生策略的干预措施，以改善 城市青少年睡眠质量差；(2)评估干预的可行性和可接受性 评估对城市青少年睡眠质量的初步干预效果。 假设：(1)高招聘率证明，干预措施是可行和可接受的， 遵守治疗方案和较高的干预满意度；以及(2)超过[ 三 ]个月， 与对照组相比，随机接受干预的青少年将在两个主要睡眠方面有所改善 质量结果，(A)睡眠持续时间和(B)睡眠碎片(睡眠效率和中断)，测量 客观的(活动图)和主观的(使用经过验证的工具)。方法：本研究包括一项 开发阶段和试点个人随机组治疗(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。我们将在以下指导下 青少年通过焦点小组以及与SBHC医疗和精神卫生提供者的面谈提供的意见， 健康教育工作者和工作人员。在第二年，我们会与[ 60 睡眠不足的青少年 从纽约市的两家SBHC招募的。青少年将以1：1的随机比例接受干预或 一种注意力控制。在严格的青少年忠诚度框架指导下进行过程评估面试 并将与SBHC的提供者和人员一起进行，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)将涉及城市种族 和少数民族青少年，这是一个脆弱的群体[ 有特定需求的 ]受到睡眠不佳的严重影响 质量，但到目前为止在干预文献中基本上被忽视；(2)同时利用MBIH和睡眠 卫生，潜在地放大干预效果；和(3)利用客观的睡眠质量措施和 严格的成型过程评估。这项研究的发现将指导未来全尺寸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.