Sleep knowledge, attitudes and behaviours in rugby league: influences of age, body composition and ancestry

Rugby league is a physically demanding sport that necessitates considerable nutritional intake, focusing on quality and type, in order to optimize training and competition demands. However, rugby league athletes are reported to have inadequate nutrition intake to match these demands. Some factors that may determine an athlete's nutrition intake have been reported in other sports, including (but not limited to, knowledge, time, cooking skills, food costs, income, belief in the importance of nutrition, body composition goals, and family/cultural support). However, these potential factors are relatively unexplored in rugby league, where a range of personal (age, body composition) or social (ancestry) influences could affect nutritional intake. Further exploration of these factors is warranted to understand the knowledge, attitudes and behavior underlying rugby league athletes' nutritional intake that can provide practitioners with a more detailed understanding of how to approach nutrition behaviors and attitudes in rugby league athletes. The primary aim was to describe the nutrition behaviors and knowledge of rugby league athletes. A secondary aim was to compare nutrition knowledge and behavior based on age, body composition and self-identified ancestry. Fifty professional rugby league athletes anonymously completed a seventy-six-question online survey. The survey consisted of three sections : 1) sports nutrition knowledge, 2) attitudes toward nutrition on performance , and 3) nutrition behaviors. All participants completed the online survey without assistance using their own personal device, with data entered via REDCap during pre-season. Nutrition knowledge was compared based on age (years), body composition (body fat percentage (%)) and ancestral groups (Pasifika, Aboriginal and/or Torres Strait Islander (ATSI) and Anglo- European).Pearson correlation was used for the relationship between nutrition knowledge, age and body composition. An Analysis of Covariance (ANCOVA) was used to determine nutrition knowledge differences between ancestral groups with age and body composition as covariates. Attitudes and behaviors were compared based on age groups (<20, 20-24 and >25 y), ancestry and body composition. Attitudes and behaviors were analyzed by Pearson correlation for body composition, one-way ANOVA for age groups and ANCOVA for ancestry with covariates age and body composition. Overall athletes' nutrition knowledge score was reported as 40 ± 12% (overall rating "poor"). Nutritional behaviors were significant for body composition, as those with lower body fat percentage had higher intakes of vegetables and dairy products (p = 0.046, p = 0.009), and ate more in the afternoon (lunch p = 0.048, afternoon snack p = 0.036). For ancestry, after adjustment for both age and body composition, Pasifika athletes were more inclined to miss breakfast and lunch compared to their Anglo-European (p = 0.037, p = 0.012) and ATSI (p = 0.022, p = 0.006) counterparts and ate more fruit than Anglo-Europeans (p = 0.006, p = 0.016). After adjustment for body composition, ATSI athletes also viewed the impact of nutrition on mental health and well-being significantly lower than Pasifika (p = 0.044). These findings suggest differences exist within rugby league athletes based on ancestral backgrounds and body composition for nutrition attitudes, behaviors and knowledge. Such outcomes could be used when designing nutrition education interventions, with consideration given to these factors to optimize long-term positive behavior change.

IntroductionSleep is essential for optimising health and academic performance, yet university students consistently report poor sleep quality. We conducted a before-and-after study to determine if an interactive, online sleep course improved sleep (1) knowledge, (2) attitudes, and (3) behaviours among university students.MethodsUndergraduate students completed the course from August-November 2020. The course involved activities that encouraged students to reflect on their own sleep behaviours and goals. Baseline data was collected through course surveys and students were invited to complete a 6-month follow-up survey via email.ResultsN=212 students completed the baseline questionnaires and n=75 (35%) completed the follow-up survey. Students retained at follow-up possessed higher baseline sleep knowledge and received higher grades. At 6-months follow-up, sleep knowledge increased from baseline (mean quiz score: 60 vs 84%, p<0.001). 85% of students aimed to increase their sleep knowledge at baseline and 91% reported that they were more knowledgeable at follow-up. 83% of students aimed to improve their sleep at baseline and 37% reported improvement at follow-up. 53% of students’ attitudes towards their sleep behaviours had changed from baseline. There was reduction in sleep latency (mean 33.3 vs 25.6min, p=0.015), but no change in total Pittsburgh Sleep Quality Index score at follow-up.DiscussionCompletion of an interactive sleep education course led to increased sleep knowledge and changes in sleep attitudes, with no meaningful change in sleep behaviours. Future interventions require careful design and evaluation, and should consider components of behavioural change (e.g. motivation, triggers) that go beyond the knowledge-attitudes-behaviour continuum.

University students consistently report poor sleep. We conducted a before-and-after study to evaluate the impact of an online 10-week course on undergraduate students’ sleep knowledge, attitudes, and behaviours at 6-month follow-up. Data were collected via baseline course surveys (August–September 2020) and follow-up surveys distributed via email (February–March 2021). n = 212 students completed baseline surveys and n = 75 (35%) completed follow-up. Students retained to follow-up possessed higher baseline sleep knowledge and received higher course grades. At the 6-month follow-up, sleep knowledge had increased (mean score out of 5: 3.0 vs. 4.2, p < 0.001). At baseline, 85% of students aimed to increase their sleep knowledge and 83% aimed to improve their sleep. At follow-up, 91% reported being more knowledgeable and 37% reported improved sleep. A novel Stages of Change item revealed that 53% of students’ attitudes towards their sleep behaviours had changed from baseline. There was a reduction in sleep latency at follow-up (mean 33.3 vs. 25.6 min, p = 0.015), but no change in the total Pittsburgh Sleep Quality Index score. In summary, completion of an online course led to increased sleep and circadian knowledge and changed sleep attitudes, with no meaningful change in sleep behaviours. Future interventions should consider components of behavioural change that go beyond the knowledge–attitudes–behaviour continuum.

Poor sleep quality, often resulting from poor sleep hygiene, is common among medical students. Educational interventions aimed at improving sleep knowledge are beneficial for sleep quality in healthy populations. However, sleep education is often given minimal attention in medical school curriculums. The aim of the study was to explore whether a short educational intervention could improve sleep knowledge, and consequently sleep quality, among medical students. We recruited preclinical- and clinical-stage medical students during the 2017-2018 academic year. Students completed a demographic survey, the Pittsburgh Sleep Quality Index (PSQI), the Epworth Sleepiness Scale (ESS), and the Assessment of Sleep Knowledge in Medical Education (ASKME) questionnaire. Students then attended a lecture on the physiology and importance of sleep. To assess the efficacy of the intervention, questionnaires were repeated 4 months thereafter. A total of 87 students (31 preclinical) with a mean age of 25.86 years (standard deviation [SD], 3.33), 51 of whom were women, participated in the study. At baseline, students had poor sleep quality with a PSQI mean score of 5.9 (SD, 2.37), without significant sleepiness, and a mean ESS score of 8.86 (SD, 4.32). The mean ASKME scores were consistent with poor sleep knowledge at 11.87 (SD, 4.32). After the intervention, the mean ASKME results improved to 14.15 (SD, 4.5; P < .001), whereas sleep quality did not. The effect was similar in preclinical and clinical medical students. Sleep knowledge was inadequate among medical students, who also experienced poor sleep quality. A short educational intervention improved sleep knowledge but was insufficient at improving sleep quality. Further studies are needed to determine which interventions may provide benefit in both sleep knowledge and sleep quality.

The effectiveness of sleep education programs in improving sleep hygiene knowledge, sleep behavior practices and/or sleep quality of college students: a systematic review protocol

P-1360 - Self-reported sleep quality and knowledge of healthy sleep behaviours

There is little known about the demands of medical school on students' sleep behavior. The study's main goal was to examine the interplay between medical students' sleep knowledge, personal attitudes towards sleep, and their sleep habits. An anonymous online survey was created and emailed to all students enrolled at a large metropolitan medical school. Data on demographics, sleep perception, and habits in addition to self-reported measures of students' sleep knowledge, beliefs, and sleepiness were collected. There were 261, out of a possible 720, responses to the survey. While 71.5% of respondents believed that they needed >7h of sleep, only 24.9% of respondents stated they average >7h of sleep. During the week of an examination, only 15.3% of students stated they averaged >7h of sleep. A comparison of pre-clinical and clinical students revealed that reported median sleep during a school or rotation night was significantly lower in clinical students as compared to pre-clinical students while mean sleep during examination weeks between the two groups was not statistically different. In regard to sleep knowledge, clinical students were more knowledgeable (65.53% correct) than pre-clinical students (39.83% correct) (t(1) = -8.9, p = .00). However, there was no difference in the assessment of dysfunctional beliefs between the two groups (66.0 for preclinical students, 64.7 for clinical students (t(1) = 0.37, p = .71)) while clinical students had a higher score of sleepiness compared to pre-clinical students (9.12 to 7.83, t(1) = -2.3, p = .023). A majority of medical students are sleeping an inadequate amount of time during their 4years, and as they progress from the pre-clinical to the clinical years, the amount of time they sleep decreases even though their knowledge about sleep increases. Increased awareness around sleep health is required beyond sleep education, as medical students appear to need help translating knowledge into strategies to improve their own sleep and well-being.

IntroductionTrainee psychologists receive limited sleep and insomnia education during postgraduate study. This study examined the delivery of a sleep psychology training workshop for postgraduate psychology students and examined changes in sleep knowledge from pre- to post-workshop.MethodsA 6-hour Sleep Psychology Workshop was delivered to postgraduate psychology students around Victoria. Online pre- and post-workshop questionnaires were used to evaluate changes in sleep psychology knowledge and collect feedback on the workshop.ResultsThe participants were 187 students (82% female, M age = 32), most of whom were in their 5th year of psychology training (69%) and had not received any sleep education during their postgraduate studies at the date of the intervention (77%). Students’ sleep knowledge significantly improved after workshop completion (pre: 56% vs. post: 80% correct), t(107)= -21.41, p < .001. Students provided positive feedback about the workshop, with 96% rating the workshop as excellent/very good and 86% reporting that they would recommend the workshop to other postgraduate students. Overall, 94% of students agreed/strongly agreed that the sleep psychology workshop improved their confidence to manage sleep disturbances in their future psychology practice.DiscussionPostgraduate psychology students require sleep and insomnia education. This study demonstrates that students’ sleep psychology knowledge can improve after a 6-hour sleep education and training workshop and provides initial positive feedback about the benefits of sleep and insomnia education for postgraduate students.

To determine the feasibility and pilot a sleep education program in New Zealand high school students. A parallel, two-arm randomized controlled pilot trial was conducted. High school students (13 to 16 years) were randomly allocated to either a classroom-based sleep education program intervention (n = 15) or to a usual curriculum control group (n = 14). The sleep education program involved four 50-minute classroom-based education sessions with interactive groups. Students completed a 7-day sleep diary, a sleep questionnaire (including sleep hygiene, knowledge and problems) at baseline, post-intervention (4 weeks) and 10 weeks follow-up. An overall treatment effect was observed for weekend sleep duration (F 1,24 = 5.21, p = 0.03). Participants in the intervention group slept longer during weekend nights at 5 weeks (1:37 h:min, p = 0.01) and 10 weeks: (1:32 h:min, p = 0.03) compared to those in the control group. No differences were found between groups for sleep duration on weekday nights. No significant differences were observed between groups for any of the secondary outcomes (sleep hygiene, sleep problems, or sleep knowledge). A sleep education program appears to increase weekend sleep duration in the short term. Although this program was feasible, most schools are under time and resource pressure, thus alternative methods of delivery should be assessed for feasibility and efficacy. Larger trials of longer duration are needed to confirm these findings and determine the sustained effect of sleep education on sleep behavior and its impact on health and psychosocial outcomes. A commentary on this article appears in this issue on page 793.

IntroductionSleep problems, particularly insomnia and sleep deprivation, are common among adolescents, and may increase their risk for poor psychosocial and metabolic health. Traditional classroom-based education programmes showed inconsistent results in promoting sleep behavioural changes. In contrast, enhancing training programme with experiential activities alongside classroom learning may be considered as a more sustainable means to promote healthy sleep in adolescents.ObjectivesThe present study evaluated the impact of a four-week enhanced sleep education programme on adolescents’ sleep quality, knowledge and behaviour, and their experience of participation.MethodsAdolescent participants took part in the Youth Sleep Ambassadors Programme, which was designed to equip them with evidence-based information on sleep and circadian health through active learning and community outreach activities. A mixed-methods design was adopted to evaluate the programme. Participants completed self-administered questionnaires, including a sleep knowledge quiz, the Pittsburgh Sleep Quality Index (PSQI) to assess subjective sleep quality, and the Sleep Hygiene Index (SHI) to evaluate healthy sleep behaviour, before and after the programme. Additionally, two focus groups were conducted to understand participants’ experiences with the programme.ResultsThirteen participants, aged 15 to 17, participated in the progamme and rated the programme’s effectiveness at 4.38 out of 5. At post-programme, there were significant increases in total sleep time (baseline: 6.12hr, post: 7.31hr, p=.006) and time in bed (baseline: 6.83hr, post: 7.98hr, p=.046), in addition to a reduction in PSQI score (baseline: 5.92±1.98, post: 3.92±1.50, p=.031). There was a noticeable trend of improved sleep knowledge with a 13.5% increase in correct rate and healthy sleep behaviour (SHI: baseline: 24.4±6.76, post: 20.6±5.33). Focus groups revealed increased awareness and confidence to advocate for better sleep and mental health among peers. Participants praised the programme as professional and well-organised but expressed a preference for more experiential and research activity over classroom learning, underscoring the limitations of classroom-based sleep education.ConclusionsThe findings provided preliminary support for this enhanced sleep education programme as a viable strategy to engage adolescents in understanding and awareness of sleep and circadian health. Beyond traditional classroom education, self-discovery and knowledge application with experiential tasks can better develop their perspectives and advocate in their community.Disclosure of InterestNone Declared

This systematic review and meta-analysis aimed to determine differences in body compositionn between playing standard and age in male rugby union and rugby league athletes. The MOOSE (Meta-analysis of Observational Studies in Epidemiology) guidelines for design, implementation, and reporting were followed. Studies were required to be in male rugby union or league and have body composition as the primary or secondary outcome. Data was required to be presented separately for positional groups and body composition presented as whole-body. A systematic search was performed in PubMed, Cochrane Library, MEDLINE, SPORTDiscus, and CINHAHL via EBSCOhost. 57 studies were included for meta-analysis. Results highlighted significantly higher fat-free mass in senior elite than senior sub-elite or junior elite athletes for all RU and RL forwards. Small and non-significant differences were found in fat mass between rugby union playing standards and age categories. Rugby league senior elite forwards had less fat mass than junior elite forwards. Practitioners should prioritise training and nutritional strategies that maximise fat-free mass development, especially in junior elite cohorts.

Although a few studies have examined sleep knowledge and attitudes as predictors of sleep behavior, the question of which better predicts actual sleep behavior is still open. Furthermore, the construct of sleep attitudes has been inconsistently defined and measured. We examined both sleep knowledge and attitudes to determine their unique associations with sleep hygiene behaviors, and direct and indirect associations with objective and subjective sleep outcomes. College students (N = 218) completed a series of questionnaires before and after wearing a FitBit Flex accelerometer for 7days. We collected objective sleep duration and quality using this apparatus, while participants reported subjective sleep outcomes, hygiene behaviors, knowledge, and attitudes. Analyses controlled for self-reported depression, diagnosed sleep disorder, and sleep-related medications. For both objective and subjective measures, more positive sleep attitudes but not greater sleep knowledge was directly associated with longer sleep duration, and indirectly (through sleep hygiene) with better sleep quality. The role of sleep attitudes in sleep-related behaviors and outcomes deserves further investigation as a potentially modifiable factor in sleep intervention efforts.

Despite increasing recognition of its importance, sleep medicine education remains limited during medical training. We sought to assess the baseline knowledge of a group of health professions trainees and to determine whether an educational sleep medicine "boot camp" led to improvement in sleep medicine knowledge. Participants attended a 2-day introduction to sleep medicine course designed for new sleep medicine fellows in July 2017 and 2018. Participants completed 2 validated sleep knowledge questionnaires (The Assessment of Sleep Knowledge in Medical Education and The Dartmouth Sleep Knowledge and Attitude Survey) prior to and at the conclusion of the course. A total of 21 health professions trainees including 14 sleep medicine fellows completed both presurveys and postsurveys. Baseline Assessment of Sleep Knowledge in Medical Education Survey score was 21.4 ± 3.4 out of 30 (71.4% ± 11.4%) and baseline Dartmouth Sleep Knowledge and Attitude Survey score was 16.1 ± 2.4 out of 24 (67.3% ± 9.9%). There was no difference in baseline scores between sleep medicine fellows and other health professions trainees. There was a statistically significant improvement in the Assessment of Sleep Knowledge in Medical Education Survey (2.9 ± 2.1 points, P = .004) and Dartmouth Sleep Knowledge and Attitude Survey (2.5 ± 3.0 points, P = .001) scores among all participants after the course, without a difference in degree of improvement among sleep medicine fellows compared to other health professions trainees. Our findings suggest that baseline sleep medicine knowledge is higher than previously reported among health professions trainees. An educational sleep medicine boot camp improved knowledge even in a group of learners with high baseline knowledge and interest in sleep medicine, including new sleep medicine fellows. Wappel SR, Scharf SM, Cohen L, etal. Improving sleep medicine education among health profession trainees. J Clin Sleep Med. 2021;17(12):2461-2466.

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&amp;lt;.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)

Can a school-based sleep education programme improve sleep knowledge, hygiene and behaviours using a randomised controlled trial