180 Are Sleep Education Programs Equitable? A Meta-Analysis on Sleep Knowledge and Behaviors Across Gender and Racial/Ethnic Groups

Abstract

Abstract Introduction Female and under-represented minority students (URMs) disproportionately experience sleep disturbances. Such sleep disparities may contribute to health disparities and academic achievement gaps. A potential solution is to improve sleep quality via education-based sleep interventions, but it remains unclear whether such interventions produce equitable sleep outcomes across gender and racial/ethnic groups. Methods We conducted a meta-analysis on sleep education interventions in high school and college students. We requested that authors provide demographic-separated data on how the intervention changed sleep knowledge, sleep quality, and sleep duration. Data were shared from 12 of the studies that met inclusion criteria (N=964; 64.8% female; 27.6% URM). We used random-effects models and computed Hedges’ g for each demographic group for each variable/study separately. We also systematically reviewed the content of each intervention to evaluate diversity, inclusion, and cultural sensitivity metrics. Results Sleep education significantly improved sleep knowledge (g=.82, p<.001) and sleep quality (g=.14, p=.01), but not sleep duration (g=.12, p=.28). Pre-to-post change scores indicated that the sleep education intervention was similarly effective for sleep knowledge across males (g=.80, p=.01) and females (g=.76, p=.002); sleep knowledge also similarly improved in White/Caucasian students (g=.94, p=.002), Asian students (g=.85, p=.08), and URM students (g=1.24, p=.01). Furthermore, sleep quality improved in Asian students (g=.28, p=.03), White/Caucasian students (g=.12, p=.09), and female students (g=.22, p=.008; but not males; g=.11, p=.22). Whereas URM students showed the largest improvement in sleep knowledge (g=1.24), they showed the least improvement in sleep quality (g=.07, p=.58). Systematic review of intervention content showed that 75% of interventions were individually-focused (e.g., interviews, participants selected their own goals), but only one sleep intervention was explicitly designed to be culturally sensitive and no interventions addressed financial, social, or neighborhood-level barriers to poor sleep. Conclusion Sleep education programs increase sleep knowledge in all student groups, but may not equitably improve sleep quality. Future sleep interventions will need to utilize theories of behavioral change, incorporate cultural tailoring, and address system-level financial, social, and other barriers to sleep quality in URM students. Support (if any) National Science Foundation (1920730 and 1943323)