Non-school Days Research Articles

Are Cooked Nutritious School Lunches Associated with Improved Attendance? Findings from the 2022-2023 Tasmanian School Lunch Project.

Background/Objectives: During 2022-2023, the School Lunch Project (SLP) provided free nutritious cooked lunches 1-4 days per week to Kinder to Grade 10 students attending 30 schools in areas of high disadvantage in Tasmania, Australia. This analysis examined if the SLP was associated with student attendance. Methods: Staff (teachers, support staff, and principals) from 12 schools completed an online survey and/or participated in focus groups/interviews. Government-held, objectively measured, grade-level attendance data were provided for 17 SLP and 11 matched comparison schools for 2018-2023. Linear mixed models compared attendance on school lunch and non-school lunch days in SLP schools. Difference-in-difference regression compared attendance between SLP and comparison schools. Qualitative data were analysed thematically. Results: Sixty-five staff completed surveys, where 22% reported that increased attendance was a benefit of the SLP. Similar findings were observed in the staff focus groups/interviews (N = 51). Mean attendance was similar on school lunch and non-school lunch days among the SLP schools during 2022 (difference: 0.04, 95% CI: -0.5, 0.6) and 2023 (difference 0.1, 95% CI: -0.2, 0.4) and similar between SLP and comparison schools (average treatment effect in the treated: 1.2, 95% CI: -0.7, 3.0). Conclusions: The SLP was perceived by some staff to improve attendance but was not associated with objectively measured attendance examined at the grade level.

Social media use and sleep health among adolescents in Canada.

Public health concerns over the impact of social media use (SMU) on adolescent health are growing. We investigated the relationship between SMU and sleep health in adolescents in Canada aged 11 to 17 years. Data from the 2017-2018 Health Behaviour in School-aged Children study were available for 12 557 participants (55.2% female). SMU was categorized by frequency of use (non-active, active and intense) and the presence of addiction-like symptoms (problematic). Mixed effects logistic regression models identified associations between SMU and seven sleep health indicators (insomnia symptoms, daytime wakefulness problems, screen time before bed, meeting sleep duration recommendations, sleep variability and late bedtime on school and non-school days). Compared to active SMU, non-active SMU was associated with better sleep indicators, except for insomnia symptoms. Intense SMU was associated with greater odds of having poor sleep health indicators (adjusted odds ratio [aORs] from 1.09 to 2.24) and problematic SMU with the highest odds (aORs from 1.67 to 3.24). Associations with problematic SMU were greater among girls than boys, including having a later bedtime on school days (aOR = 3.74 vs. 1.84) and on non-school days (aOR = 4.13 vs. 2.18). Associations between SMU and sleep outcomes did not differ by age group. Intense and problematic SMU were associated with greater odds of poor sleep health among adolescents in Canada, with stronger associations among girls than boys. Further research is needed to understand the mechanisms underlying associations between SMU and sleep to inform public health recommendations.

Indoor temperature and CO[formula omitted] in South African primary school classrooms: Inspecting brick, container, and prefab structures

In the resource-constrained education sector in South Africa, infrastructure deemed temporary or backup elsewhere is used as permanent classrooms, mainly in areas of low income. Temperature and CO2 levels, substantial determinants of air quality, have not been studied across different classroom types, despite their direct impact on children’s cognitive performance and comfort. We measure CO2 and temperature every 11 min in 24 classrooms at two schools in Stellenbosch, South Africa. Container classrooms with and without insulation, mobile (prefabricated) classrooms, and brick classrooms of different configurations are included. Measurements were concurrently sampled over twelve months, across multiple seasons with relevant metadata, including ambient weather conditions. We analyse temperature and CO2 concentrations for classroom types and classroom categories and compare school days with non-school days. The results show that temporary classrooms (container and mobile) have substantially worse thermal environments, even when air conditioning is available. The CO2 concentrations in container classrooms are substantially worse, whereas mobile classrooms have better conditions comparable to brick classrooms. We conclude that container classrooms have the worst temperatures and ventilation, prefabricated classrooms have acceptable ventilation but poor thermal qualities, and brick classrooms have the best thermal environment and ventilation.

Light exposure profiles differ between myopes and non-myopes outside school hours

PurposeConsidering the putative role of light in myopia, and variations in socioeconomic, lifestyle, educational and environmental factors across ethnicities, we objectively investigated light exposure patterns in Indian school children.MethodsThe light...

Frequency and duration measurements of children’s outdoor free play: A Scoping review

Outdoor free play encompasses unstructured, self-directed play in the outdoors and has been shown to support children’s health and development. Accurate and reliable measures are required to conduct research on children’s outdoor free play and examine cross-sectional and longitudinal variation. This study systematically reviews and evaluates measurement approaches for children’s outdoor free play used in existing literature. A scoping review was conducted to identify English-language peer-reviewed and grey literature that included measurements of the occurrence, frequency or duration of outdoor free play with children aged 2 to 17 years old. Studies were excluded if the outdoor free play measure included structured settings or activities, or focused on a specific location or play activity. Quantitative and qualitative content analysis was used to consider outdoor free play terminology, definition, and operationalization; positioning in relation to other variables and the topic of interest; and data collection context. A total of 4,860 unique studies were identified. After screening and full-text review, 184 papers were taken forward for analysis. Parent-recall questionnaires were used in 70.1% of included studies to measure outdoor free play, often using a single question to capture the variable. A lack of differentiation between outdoor play emanating from structured and unstructured settings was common, as was limited consideration of contextual factors such as season, school or non-school days, and time of day. The implications of existing approaches to measuring children’s outdoor free play and the need for valid and reliable measures to further research examining children’s outdoor free play are discussed.

Poor self-reported health in association with sleep duration and health complaints among adolescents in Latvia

Insufficient sleep and recurrent health complaints may increase the risk of poorer self-reported health in adolescence, yet the relationships between these factors are not well understood. This study aims to explore the association between poor self-reported health and insufficient sleep duration among 11, 13, and 15 years old adolescents in Latvia by assessing the moderation effects of age and gender and by considering the mediating effect of health complaints. Methods: Data from the Health Behaviour in School-aged Children Study on 2017/2018 of Latvia (n = 4412) were used for statistical analysis. Results: On average, 19.3% reported insufficient sleep duration on schooldays and 4.4% on non-school days. Of those with insufficient sleep duration, 5.8% reported poor self-reported health while this proportion was 2% among those with sufficient sleep. Poor self- reported health was associated insufficient sleep duration on school days (OR = 3.02; 95%CI 2.02-4.49), but not on non-schooldays. The association between insufficient sleep and poor self-reported health changed considerably after adjustment with health complaints (OR = 1.58;95%CI 1.03-2.43), however, it still remained significant. Conclusions: There is significant association between insufficient sleep and poor self-reported health regardless of total burden of health complaints.

The ongoing impact of the COVID-19 pandemic on physical activity and screen time among Canadian youth.

The COVID-19 pandemic has caused changes in health behaviours, including participation in physical activity and screen time. The purpose of this paper is to examine trends in physical activity and screen time among Canadian youth from January 2018 to February 2022. The Canadian Community Health Survey asks Canadian youth (aged 12 to 17 years) to report the time they spend active by domain: recreation, transportation, school and household. Survey respondents are also asked to report their screen time on school days and non-school days. The present analysis compares the physical activity from four cross-sectional samples collected during 2018 (January to December; n=3,952), January to March 2020 (n=911), September to December 2020 (n=1,573), and January 2021 to February 2022 (n=3,501). Screen time is compared between 2018 and 2021/2022. Sub-annual descriptive analyses examine how physical activity and screen time varied within and between these years. Before the COVID-19 pandemic, half of Canadian youth met the physical activity recommendation (2018: 49.6%; January to March 2020: 53.7%). The percentage meeting the recommendation dropped in the first year of the pandemic (September to December 2020: 37.3%) and recovered slightly in 2021 (43.8%). From 2018 to 2021, total physical activity dropped by 8.3 minutes per day (58.1 minutes per week) among girls and by 2.1 minutes per day (14.7 minutes per week) among boys. The percentage of youth meeting the screen time recommendation on school days dropped from 40.7% in 2018 to 29.1% in 2021 and from 21.4% in 2018 to 13.2% in 2021 on non-school days. The COVID-19 pandemic had a detrimental impact on the physical activity and screen time of youth, in particular among girls. This analysis provides an update on how the pandemic has continued to affect the physical activity and screen habits of youth in 2020, 2021, and early 2022.

Are smartphones detrimental to adolescent sleep? An electronic diary study of evening smartphone use and sleep

Previous research associated smartphone use with worsened sleep among adolescents. However, the prior findings were mainly based on cross-sectional, self-reported data, and a between-person level of analysis. This study examined between- and within-person associations for adolescents' smartphone use and multiple sleep outcomes: sleep onset time, sleep onset latency, sleep duration, subjective sleep quality, and subjective daily sleepiness. The participants were 201 Czech adolescents (aged 13–17) who daily reported their sleep outcomes, daily stressors, and other media use for 14 consecutive days via a custom-made research app on their smartphones. The app also collected logs of the participants' smartphone use. We found that interindividual differences within the average volume of smartphone use before sleep were not associated with differences in sleep outcomes. At the within-person level, we found that, when adolescents used smartphones before sleep for longer than usual, they went to sleep earlier (β = −.12) and slept longer (β = .11). However, these two associations were weak. No other sleep outcomes were affected by the increased use of a smartphone before sleep on a given day. We found no interaction effects for age, gender, insomnia symptoms, media use, or daily stressors. However, the association between smartphone use and earlier sleep onset time was stronger on nights before a non-school day. Our findings suggest that the link between smartphone use and adolescent sleep is more complex, and not as detrimental, as claimed in some earlier studies.

The relationship between parental knowledge, attitudes, and behaviour: Australian primary school -aged children and nature experiences

ABSTRACT Children are spending significantly less time outdoors in free play than previous generations, which has implications for children’s development. This study explores parental knowledge, attitudes and the time children spend in outdoor free play. Parents or caregivers of children aged between five and nine years old (N = 82) completed an online mixed methods survey. Data collected included knowledge of the benefits of outdoor play, attitudes towards outdoor play and time children spend outdoors. Participant’s knowledge varied between 1 and 19 benefits of outdoor free play (mean = 7.54). Participants had a positive attitude towards outdoor recreation, demonstrating a statistically significant positive correlation with time their child spends in outdoor free play on a non-school and school day. Findings contribute to research within the Australian context regarding the influence that parental attitude has on children’s engagement with nature, allowing for potential programmes around parental attitudes, to support greater time outdoors.

0221 Time to wake up! Adolescents woken up by an alarm or family member get short sleep on schooldays and weekends/holidays

Abstract Introduction Many adolescents get insufficient sleep on schooldays because they need to wake up early. It is often assumed that students can sleep in longer on non-schooldays (weekends and holiday periods) to recover their sleep debt. However, few studies have explored the degree to which adolescents are given the freedom to extend their nocturnal sleep. Here, (1) we investigated how often adolescents are awoken by an alarm or family member on schooldays and non-schooldays, and (2) we tested whether this results in shorter sleep even on non-school days. Methods Adolescents aged 13-18 years (n=66; 10 schools in Singapore) wore an actigraphy watch (Actigraph wGT3X-BT) and completed daily diaries for 7 days during their school and holiday periods. Each morning, students indicated their reason for having woken. Actigraphy-derived sleep parameters included sleep onset, sleep offset, and the nocturnal sleep period. Simple effect sizes (e.g., mean difference in sleep period) were calculated for schooldays versus non-schooldays, and for days waking up to an alarm or family member versus other reasons. Results Adolescents’ nocturnal sleep was about 1.7 hours shorter on schooldays (mean=6.50h, 95% CI=6.24h-6.75h) compared with non-schooldays (mean=8.17h, 95% CI=7.89h to 8.45h) because they woke up much earlier. Students were awoken by an alarm or family member on 78% of schooldays, and this was associated with shorter nocturnal sleep compared with waking up for other reasons (mean difference in sleep period=-1.16h, 95% CI=-1.59h to -0.80h). By comparison, adolescents were awoken by an alarm or family member on 41% of non-schooldays. In such instances, students also obtained shorter sleep by about an hour (mean difference in sleep period=-1.21h, 95% CI=-1.46h to -0.94h) and slept less than the recommended amount for their age group (mean sleep period=7.38h, 95% CI=7.18h to 7.59h). Conclusion Adolescents’ nocturnal sleep was frequently interrupted by an alarm or family member on both schooldays and non-schooldays. Chronic sleep restriction extends beyond schooldays if adolescents are not allowed to wake up naturally on their ‘free days’. This may have deleterious effects on students’ performance and wellbeing. Support (if any) The research was funded by the National Institute of Education, Singapore (OER 14/21 JJG).

University students' diurnal learning-directed behavior is strongly influenced by school start times with implications for grades.

School start times impose constraints on sleep-wake timing that may influence academic achievement. We used large university archived datasets to test the hypothesis that larger differences in timing of students' diurnal learning behavior on school days relative to non-school days would be associated with lower grades. Diurnal learning-directed behavior was examined in 33 645 university students by analyzing their learning management system (LMS) login rhythm. We tested the associations between the phase-difference in students' behavioral rhythm on school days versus non-school days with grade point average, LMS-login phase on non-school days (LMS-login chronotype), and school start time. We also tested the chronotype-dependent effects of school start times on diurnal behavior to determine whether students obtained better course grades when their first class of the day was in synch with their LMS-login chronotype. Students whose LMS-login rhythm was more than 2 hours earlier on school days had significantly lower grades than their peers. The change in LMS-login phase was larger in students with a later LMS-login chronotype and for earlier school start times. Minimal changes in LMS-login phase and higher course grades were observed when students' first class of the day was aligned with their LMS-login chronotype. Our findings demonstrate that school start times have a profound impact on students' diurnal learning behavior with implications for grades. Universities can potentially improve learning by starting school later to minimize differences in diurnal learning behavior between school days and non-school days.

Delayed bedtime on non-school days associates with higher weight and waist circumference in children: Cross-sectional and longitudinal analyses with Mendelian randomisation.

Sleep duration has been linked with obesity in population-based studies. Less is known about bedtimes and, especially, if discrepancy between bedtimes on school and non-school days associate with adiposity in children. The associations of self-reported bedtimes with the body mass index z-score (BMIz) and waist-to-height ratio (WtHr) were examined among children with a mean (SD) age of 11.2 (0.85) years in cross-sectional (n=10,245) and longitudinal (n=5085) study settings. The causal relationship of whether BMIz contributes to bedtimes, was further examined in a subset of 1064 participants by exploiting Mendelian randomisation (MR). After adjusting for sleep duration and other confounders, every 0.5 h later bedtime on non-school nights and a delay in bedtime in non-school nights compared with school nights associated with 0.048 (95% CI 0.027; 0.069) and 0.08 (95% CI 0.056; 0.105) higher BMIz as well as 0.001 (95% CI 0; 0.002) and 0.004 (95% CI 0.003; 0.005) with higher WtHr, respectively. Moreover, every 0.5-h delay in bedtime in non-school nights compared with school nights associated with 0.001 (95% CI 0; 0.002) greater increase in WtHr in the 2.5 years follow-up. Thus, a 2-h delay in bedtime at the age of 11 years corresponds with a 0.6 cm increase in waist circumference. The MR analysis did not indicate an opposite causal relationship: higher BMIz was not causing delayed bedtimes. Later bedtime on non-school days and discrepancy in bedtimes associated with increased BMIz and WtHr, while longitudinally these predicted higher WtHr, independently of sleep duration. Promoting early bedtimes, especially on weekends, should be considered in obesity prevention among school-aged children.

Physical activity and sedentary behaviour of male adolescents in Indonesia during the COVID-19 pandemic: a mixed-method case study using accelerometers, automated wearable cameras, diaries, and interviews

BackgroundPrevious physical activity and sedentary behaviour studies during the pandemic have largely utilized online surveys, with known limitations including recall bias. Employing both device-based and self-reported measurements may provide a more comprehensive picture of both behaviours. Physical activity and sedentary behaviour research in adolescents is still limited in low- and middle-income countries (LMICs), including Indonesia. Male adolescents had been identified as more active than females but have had a greater decrease in physical activity during the pandemic. The present study aimed to investigate the quantity, temporal patterns, contexts, and biopsychosocial factors of physical activity and sedentary behaviour during the COVID-19 pandemic in a small group of male Indonesian adolescents.MethodsMale adolescents (n = 5; 14–15 years old) from Yogyakarta wore accelerometers and automated wearable cameras for four days, and completed diaries and interviews in November 2020.ResultsParticipants’ activity was dominated by light intensity (67% of all physical activity). Sedentary behaviour was high; accelerometer, school days: 456 ± 145 min (78 ± 10% of wear time), non-school days: 344 ± 160 min (79 ± 17% of wear time); camera, school days: 176 ± 101 min (81 ± 46% of wear time), non-school days: 210 ± 165 min (86 ± 67% of wear time). Sedentary behaviour was mainly done during school hours on school days and from late afternoon to evening on non-school days. Screen time was largely for leisure purposes and action games were most favoured. Smartphones were the most used device, mainly used in a solitary context in the bedroom. Non-screen-based sedentary behaviour was consistently low. Interviews suggested that during the pandemic, supporting factors for physical activity are: self-determination, enjoyment, parental support, and physical education; meanwhile, factors influencing screen time are: educational demands, device and internet availability, screen time opportunities, parental control, social facilitators, phone notifications, and emotional state.ConclusionsMost participants were not able to stay active during the pandemic. Using digital platforms may be beneficial to shift some screen-based sedentary behaviour to ‘screen-based’ or ‘screen-prompted’ physical activity.

When public health crises collide: 5 years of pediatric firearm injury prevention opportunities

ObjectivesPrior publications on pediatric firearm-related injuries have emphasized significant social disparities. The pandemic has heightened a variety of these societal stresses. We sought to evaluate how we must now adapt...

Adolescent use of social media and associations with sleep patterns across 18 European and North American countries

ObjectiveOver the past decade, concurrent with increasing social media use (SMU), there has been a shift toward poorer sleep among adolescents in many countries. The purpose of this study was to examine the cross-national associations between adolescent SMU and sleep patterns, by comparing 4 different categories of SMU (nonactive, active, intense, and problematic use). Design, setting, and participantsData were from 86,542 adolescents in 18 European and North American countries that participated in the 2017/18 Health Behaviour in School-aged study. MeasurementsMixed-effects linear regression models were used to examine cross-national associations between 4 SMU categories and adolescent sleep duration, bedtime and social jetlag derived from self-reported data. ResultsFor all countries combined, nonactive SMU was associated with longer sleep, earlier bedtimes, and less social jetlag, compared to active SMU, although the differences were minor. By comparison, intense and problematic SMU were associated with less sleep and later bedtimes on both school and nonschool days, and greater social jetlag, compared to active SMU. While findings were relatively consistent between countries, some differences were observed, suggesting that the national and cultural context may be important in interpreting results. ConclusionsThese findings suggest that both intense and problematic SMU are associated with poorer sleep patterns in adolescents across most countries. Further research is needed to identify effective policies, programs, and messaging to promote the healthy use of social media and prevent potential negative impacts on adolescent sleep.

A comparison of sleep-wake patterns among school-age children and adolescents in Hong Kong before and during the COVID-19 pandemic.

The lifestyles change of children and adolescents during the COVID-19 pandemic due to antipandemic measures can affect their sleep health. Existing studies have used convenient samples and focused on the initial months of the pandemic, leaving a knowledge gap on changes in young people's sleep patterns under the "new normal" under COVID-19. As part of a territory-wide epidemiological study in Hong Kong, this cross-sectional study recruited primary and secondary school students by stratified random sampling. Sleep parameters were collected using the structured diagnostic interview for sleep patterns and disorders. We investigated the pandemic's effects on sleep parameters by comparing data of participants recruited pre-COVID and those recruited during COVID using multivariate regression, adjusting for age, sex, household income, seasonality, and presence of mental disorders, and the moderators and mediators of the effects. Between September 1, 2019 and June 2, 2021, 791 primary and 442 secondary school students were recruited and analyzed. Primary school and secondary school participants assessed before COVID had a longer sleep latency on school days (95% confidence interval [CI] = 1.0-5.2 minutes, adjusted P-value = .010; and 95% CI= 3.9-13.0 minutes, adjusted P-value = .004, respectively) and nonschool days (95% CI = 1.7-7.2 minutes, adjusted P-value = .005; 95% CI = 3.4-13.7 minutes, adjusted P-value = .014, respectively). Low household income was a moderator for later bedtime (adjusted P-value = .032) and later sleep onset (adjusted P-value = .043) during nonschool days among secondary school students. Changes associated with COVID have a widespread and enduring effect on the sleep health of school-aged students in Hong Kong. Household income plays a role in adolescent sleep health resilience, and the impact of antiepidemic measures on the health gaps of the youth should be considered. Chau SWH, Hussain S, Chan SSM, etal. A comparison of sleep-wake patterns among school-age children and adolescents in Hong Kong before and during the COVID-19 pandemic. J Clin Sleep Med. 2023;19(4):749-757.

Clinical Research Updates.

Clinical Research Updates.

Non-School Day Catch-Up Sleep among Pupils in Japan

Non-School Day Catch-Up Sleep among Pupils in Japan

Wearable Artificial Intelligence for Assessing Physical Activity in High School Children

Eighty one percent of adolescents aged 11–17 years are inadequately physically active worldwide. Physical activity (PA) recommendations for high school children have not been studied previously in schools in the Qatar region. The objectives of the study were: (i) to assess the level of compliance of the recommended PA and to assess if there are any gender differences; and (ii) to analyze the recommended step count compliance during school and non-school days. An observational cross-sectional study was conducted. Twenty-nine children (12 boys and 17 girls) aged 13–17 years (15.24 ± 1.46) took part in this study. Participants wore Fitbit Charge 5 wrist bands for three weeks to collect various digital biomarkers including moderate-to-vigorous physical activity (MVPA) and step counts (tracking during out-of-school time and school time). Based on this study, high school children in the two Qatar region schools did not meet the MVPA and steps/day recommendation by the established agencies: 38% of the total study group met the recommended 60 min/day of activity (50% boys, 29% girls). Gender differences were also observed in PA levels and steps per day: for non-school days, 17% met the recommended 10,000 steps/day (25% boys, 12% girls). There was a pattern of greater PA performance and steps during the weekdays as opposed to the weekend, but these values showed no robust evidence in favor of H1 or statistical significance for step counts. However, the evidence was robust in favor of H1 (difference between weekend and weekday) due to a statistically significant difference for meeting the 60 min/day activity. While further studies are required to establish if this is a general trend in Qatari schools, this pilot study does highlight the need to design more effective programs and messaging strategies to improve PA levels in the high school population.

Sex differences in the sustained attention of elementary school children

BackgroundThe study investigates sex differences in sustained attention among children.MethodsForty-five children (23 girls) from Grades 2–5 (mean age of 7.47 ± 0.73 years) wore an actigraph for a continuous five to seven days including school and non-school days. Sustained attention using the psychomotor vigilance test (PVT) was measured twice a day on two school days and on one non-school day.ResultsNo sex differences were found for sleep patterns. However, sex differences in PVT performance were documented. While boys were faster (shorter reaction time) and showed fewer lapses than girls, they showed higher number of false starts than girls, on both weekdays and weekends.ConclusionsThe findings suggest that sex differences should been taken into account in studies investigating neurobehavioral functioning, particularly, sustained attention across various age groups.