Danice K. Eaton

Relationships between hours of sleep and health-risk behaviors in US adolescent students

OBJECTIVEnTo examine associations between insufficient sleep (<8h on average school nights) and health-risk behaviors.nnnMETHODSn2007 national Youth Risk Behavior Survey data of U.S. high school students (n=12,154) were analyzed. Associations were examined on weighted data using multivariate logistic regression.nnnRESULTSnInsufficient sleep on an average school night was reported by 68.9% of students. Insufficient sleep was associated with higher odds of current use of cigarettes (age-adjusted odds ratio [AOR], 1.67; 95% confidence interval [CI], 1.45-1.93), marijuana (AOR, 1.52; 95% CI, 1.31-1.76), and alcohol (AOR, 1.64; 95% CI, 1.46-1.84); current sexual activity (AOR, 1.41; 95% CI, 1.25-1.59); seriously considered attempting suicide (AOR, 1.86; 95% CI, 1.60-2.16); feeling sad or hopeless (AOR, 1.62; 95% CI, 1.43-1.84); physical fighting (AOR, 1.40; 95% CI, 1.24-1.60), not being physically active at least 60min ≥ 5days in the past 7days (AOR, 1.16; 95% CI, 1.04-1.29), using the computer ≥3h/day (AOR, 1.58; 95% CI, 1.38-1.80), and drinking soda/pop > 1time/day (AOR, 1.14; 95% CI, 1.03-1.28).nnnCONCLUSIONnTwo-thirds of adolescent students reported insufficient sleep, which was associated with many health-risk behaviors. Greater awareness of the impact of sleep insufficiency is vital.

Associations of Dating Violence Victimization With Lifetime Participation, Co-Occurrence, and Early Initiation of Risk Behaviors Among U.S. High School Students

This study examined the association of victimization in a physically violent dating relationship with risk behaviors, age of risk behavior initiation, and co-occurrence of risk behaviors among students in grades 9 through 12 in the United States. Data were from the 2003 national Youth Risk Behavior Survey (YRBS). Nearly 9% of students reported experiencing dating violence victimization. Dating violence victimization was associated with alcohol use, marijuana use, and having ever had sexual intercourse among female students and having ever had sexual intercourse among male students. Dating violence victimization also was associated with early initiation of alcohol use among female students. The odds of dating violence victimization increased as the number of risk behaviors increased and as the number of lifetime sexual partners increased. These risk behavior patterns should serve as warning signs of elevated risk for dating violence victimization and may be helpful in identifying adolescents who could benefit from targeted, preventive interventions.

Prevalence of insufficient, borderline, and optimal hours of sleep among high school students - United States, 2007.

We describe the prevalence of insufficient, borderline, and optimal sleep hours among U.S. high school students on an average school night. Most students (68.9%) reported insufficient sleep, whereas few (7.6%) reported optimal sleep. The prevalence of insufficient sleep was highest among female and black students, and students in grades 11 and 12.

Sufficient sleep, physical activity, and sedentary behaviors.

BACKGROUNDnInsufficient sleep among adolescents is common and has adverse health and behavior consequences. Understanding associations of physical activity and sedentary behaviors with sleep duration could shed light on ways to promote sufficient sleep.nnnPURPOSEnThe purpose of this study is to determine whether physical activity and sedentary behaviors are associated with sufficient sleep (8 or more hours of sleep on an average school night) among U.S. high school students.nnnMETHODSnData were from the 2009 national Youth Risk Behavior Survey and are representative of 9th-12th-grade students nationally (n=14,782). Associations of physical activity and sedentary behaviors with sufficient sleep were determined using logistic regression models controlling for confounders. Data were analyzed in October 2010.nnnRESULTSnStudents who engaged in ≥60 minutes of physical activity daily during the 7 days before the survey had higher odds of sufficient sleep than those who did not engage in ≥60 minutes on any day. There was no association between the number of days students were vigorously active ≥20 minutes and sufficient sleep. Compared to their respective referent groups of 0 hours on an average school day, students who watched TV ≥4 hours/day had higher odds of sufficient sleep and students who played video or computer games or used a computer for something that was not school work ≥2 hours/day had lower odds of sufficient sleep.nnnCONCLUSIONSnDaily physical activity for ≥60 minutes and limited computer use are associated with sufficient sleep among adolescents.

Texting while driving and other risky motor vehicle behaviors among US high school students

OBJECTIVE: To assess the prevalence of texting/e-mailing while driving (TWD) and association of TWD with other risky motor vehicle (MV) behaviors among US high school students. METHODS: Data were used from the Centers for Disease Control and Prevention’s 2011 national Youth Risk Behavior Survey, which assessed TWD during the 30 days before the survey among 8505 students aged ≥16 years from a nationally representative sample of US high school students. TWD frequency was coded into dichotomous and polychotomous variables. Logistic regression assessed the relationship between TWD and other risky driving behaviors, controlling for age, race/ethnicity, and sex. RESULTS: The prevalence of TWD on ≥1 days during the 30 days before the survey was 44.5% (95% confidence interval: 40.8%–48.2%). Students who engaged in TWD were more likely than their non-TWD counterparts to not always wear their seatbelt (prevalence ratio; 95% confidence interval: 1.16; 1.07–1.26), ride with a driver who had been drinking alcohol (1.74; 1.57–1.93), and drink alcohol and drive (5.33; 4.32–6.59). These other risky MV behaviors were most likely to occur among students who frequently engaged in TWD. CONCLUSIONS: Nearly half of US high school students aged ≥16 years report TWD during the past 30 days; these students are more likely to engage in additional risky MV behaviors. This suggests there is a subgroup of students who may place themselves, their passengers, and others on the road at elevated risk for a crash-related injury or fatality by engaging in multiple risky MV behaviors.

Associations of Health Risk Behaviors With School Absenteeism. Does Having Permission for the Absence Make a Difference

BACKGROUNDnNearly 10% of students enrolled in US public schools are absent daily. Although previous research has shown associations of school absenteeism with participation in risk behaviors, it is unclear if these associations vary by whether the absence was excused. The purpose of this study was to examine the associations of health risk behaviors with being absent from school with and without permission among high school students.nnnMETHODSnDuring spring 2004, questionnaires similar to the Youth Risk Behavior Survey questionnaire were completed by 4517 ninth- and eleventh-grade students. Responses to items assessing frequency of school absences during the past 30 days for any reason and without permission were combined to create a variable coded as absent on: 0 days; > or =1 day, all with permission (WP); and > or =1 day, at least 1 day without permission (WOP). Logistic regression analyses controlling for gender, grade, and race/ethnicity examined the association of risk behaviors with absenteeism.nnnRESULTSnControlling for demographic variables, compared to students who were absent 0 days, students who were absent WP had significantly higher odds of engaging in 25 of 55 risk behaviors examined and students who were absent WOP had significantly higher odds of engaging in 43 of the 55 behaviors. Students who were absent WOP also had approximately twice the odds of engaging in risk behaviors compared to students who were absent WP.nnnCONCLUSIONSnSchool absenteeism, with and without permission, is associated with risk behaviors. Schools should recognize absenteeism for any reason as a warning sign for a variety of risk behaviors.

Passive versus active parental permission in school-based survey research: does the type of permission affect prevalence estimates of risk behaviors?

This study investigates whether the type of parental permission affects prevalence estimates for risk behaviors from the national 2001 Youth Risk Behavior Survey. Participants were 13,195 students from 143 schools, of which 65% used passive permission and 35% active permission. Student participation rates were 86.7% in passive permission schools and 77.3% in active permission schools. For 24 of 26 behaviors tested, no significant differences were seen in the prevalence of risk behavior by type of parental permission. As long as high response rates are obtained, type of parental permission does not affect prevalence estimates for risk behaviors that are based on self-report.

Comparison of paper-and-pencil versus Web administration of the Youth Risk Behavior Survey (YRBS): risk behavior prevalence estimates.

The authors examined whether paper-and-pencil and Web surveys administered in the school setting yield equivalent risk behavior prevalence estimates. Data were from a methods study conducted by the Centers for Disease Control and Prevention (CDC) in spring 2008. Intact classes of 9th- or 10th-grade students were assigned randomly to complete a survey via paper-and-pencil or Web. Data from 5,227 students were analyzed using logistic regression to identify associations of mode with reporting of 74 risk behaviors. Mode was associated with reporting of only 7 of the 74 risk behaviors. Results indicate prevalence estimates from paper-and-pencil and Web school-based surveys are generally equivalent.

Association of Sleep Duration with Obesity among US High School Students

Increasing attention is being focused on sleep duration as a potential modifiable risk factor associated with obesity in children and adolescents. We analyzed data from the national Youth Risk Behavior Survey to describe the association of obesity (self-report BMI ≥95th percentile) with self-reported sleep duration on an average school night, among a representative sample of US high school students. Using logistic regression to control for demographic and behavioral confounders, among female students, compared to 7 hours of sleep, both shortened (≤4 hours of sleep; adjusted odds ratio (95% confidence interval), AOR = 1.50 (1.05–2.15)) and prolonged (≥9 hours of sleep; AOR = 1.54 (1.13–2.10)) sleep durations were associated with increased likelihood of obesity. Among male students, there was no significant association between obesity and sleep duration. Better understanding of factors underlying the association between sleep duration and obesity is needed before recommending alteration of sleep time as a means of addressing the obesity epidemic among adolescents.

Comparison of paper-and-pencil versus Web administration of the Youth Risk Behavior Survey (YRBS): Participation, data quality, and perceived privacy and anonymity

The Youth Risk Behavior Surveillance System (YRBSS) monitors priority health-risk behaviors among US high school students. To better understand the ramifications of changing the YRBSS from paper-and-pencil to Web administration, in 2008 the Centers for Disease Control and Prevention conducted a study comparing these two modes of administration. Eighty-five schools in 15 states agreed to participate in the study. Within each participating school, four classrooms of students in grades 9 or 10 were randomly assigned to complete the Youth Risk Behavior Survey questionnaire in one of four conditions (in-class paper-and-pencil, in-class Web without programmed skip patterns, in-class Web with programmed skip patterns, and on your own Web without programmed skip patterns). Findings included less missing data for the paper-and-pencil condition (1.5% vs. 5.3%, 4.4%, 6.4%; p<.001), less perceived privacy and anonymity among respondents for the in-class Web conditions, and a lower response rate for the on your own Web condition than for in-class administration by either mode (28.0% vs. 91.2%, 90.1%, 91.4%; p<.001). Although Web administration might be useful for some surveys, these findings do not favor the use of a Web survey for the YRBSS.