Sleep Practices Research Articles

Sleep Duration and Sleep Hygiene Among Rural and Urban Residents in District Etawah of Uttar Pradesh: A Community Based Comparative Cross-sectional Study

Background: Sleep deprivation include physical effects (sleepiness, fatigue) cognitive impairment (deterioration of performance, attention and motivation) and mental health issues. Objectives: To assess and compare sleep duration and sleep hygiene with their associated factors among rural and urban residents of a district of Uttar Pradesh. Material and Methods: This cross?sectional study was conducted in Etawah district, UP, from January 2022 to June 2022. All residents of rural and urban areas were included using multistage sampling. Study tool included a questionnaire which collected sociodemographic information, sleep duration, and sleep hygienic practices using sleep hygiene index. Results: In this study, 240 participants each from the rural and urban areas were included. The mean duration of sleep among the participants in rural and urban areas was 7.40±1.22 and 8.18±1.30 h during the workdays whereas, 7.30±1.30 and 8.11±1.35 h during the weekends respectively. About 40% were having unhygienic sleep practices. Most of the study participants had the history of sleep duration less than 8 hr. among the comparison groups. Graduated participants had the more sleep problems. Conclusions: Particularly among the elderly, inadequate sleep duration and differences in sleep rhythm between weekdays and weekends were seen.

Exploring the Relationship Between Sleep Quality and Musculoskeletal Pain in Internet-Addicted College Students

Background: The pervasive use of the internet among college students has raised concerns about internet addiction and its associated health implications. This addiction is characterized by excessive and obsessive internet usage that often leads to detrimental effects on physical, psychological, and social well-being. Among these effects, musculoskeletal discomfort and poor sleep quality are prevalent symptoms reported by this demographic. Objective: This study aims to explore the relationship between sleep quality and musculoskeletal pain in internet-addicted college students to identify potential interventions that can mitigate these adverse effects. Methods: A cross-sectional study was conducted with 171 students aged 16-20 years, who reported using screens for more than three hours daily and experienced idiopathic musculoskeletal pain. The study employed the Nordic Musculoskeletal Questionnaire (NMQ) and the Sleep Quality Scale (SQS) for data collection. Statistical analyses, including chi-square tests, were performed using SPSS Version 25 to explore associations between internet usage hours, sleep quality, and musculoskeletal pain. Results: The participants had a mean age of 17.99±1.37 years, with a balanced gender distribution (50.3% male, 49.7% female). Musculoskeletal pain was most frequently reported in the neck and shoulder regions (29.8% each), followed by the lower back (26.9%). Regarding sleep quality, 44.5% of students suffered from severe sleep disorders. Significant associations were found between the number of hours of internet usage and both the presence of musculoskeletal pain (p<0.001) and poor sleep quality (p=0.049). Conclusion: The findings indicate a significant correlation between excessive internet use and both increased musculoskeletal pain and deteriorated sleep quality among college students. These results underscore the need for targeted interventions to promote healthier internet use habits and improve the ergonomic and sleep hygiene practices among this population. Keywords: Internet addiction, musculoskeletal pain, sleep quality, college students, ergonomic health, cross-sectional study, SPSS analysis.

Children's nocturnal awakenings and sleep duration during the first two years of life in the NASCITA cohort study

PurposePrevious studies have analyzed the characteristics and prevalence of sleep disturbances among Italian children. Less attention has been paid, however, to the factors involved in sleep disturbances in the first two years of life. The goals of the present study were, therefore: 1) to provide a developmental trajectory of Italian infants' night awakenings and duration during the first two years of life and 2) to analyze which factors affect night awakenings the most over time. MethodsData for this study were collected in the NASCITA cohort. During the well-child visits conducted at 6, 12, and 24 months, pediatricians asked parents to report if the child had any sleep disturbances, especially frequent night awakenings. Univariate and multivariable analyses were performed to test the association between child and family variables and the likelihood of frequent awakenings. Results2973 toddlers, out of 5054 initially enrolled newborns, were included in this study; 875 (29.4 %) of whom presented frequent awakenings in at least one visit (peak of prevalence of 19.8 % at 12 months). Bed-sharing (adjusted OR 2.53; 95%CI:2.05–3.12) and living in the northern Italy (aOR 2.25; 95%CI:1.80–2.81) were the variables more strongly associated with an increased likelihood of frequent awakenings in the binomial logistic regression, while sleeping alone was associated with a decreased chance (aOR 0.62; 95%CI 0.45–0.89). A short sleep duration (<11 h/day) was reported for 801 (26.9 %) at 12 months, for 743 (25.0 %) at 24 months of age; in 383 cases, the short sleep duration was reported at both time points. An association was observed between frequent awakenings at 12 or 24 months and short sleep duration (OR 1.23; 95%CI 1.05–1.44 -ꭓ2 6.25, p = 0.012). ConclusionsThe current study identified some early predictors of frequent awakenings during the first two years of life. Since optimal sleep practices in children are essential for their development, effective, early interventions must be defined and integrated into pediatric care practices.

Routine del sonno e risvegli notturni nei bambini durante i primi due anni di vita

Background - Previous studies analyzed the characteristics and prevalence of sleep problems in Italian children. However, less attention is shed on the factors involved in sleep disturbances in the first two years of life. Aims - To provide a developmental trajectory of Italian infants’ sleep patterns during the first two years of life and to analyze what factors affect it most over time. Materials and Methods - Data for this study were collected within the NASCITA cohort. During the well-child visits conducted at 6, 12, and 24 months, paediatricians asked parents to report if their children had any sleep disturbances, particularly frequent night awakenings. Univariate and multivariable analyses were performed to test the association between child and family variables and the likelihood of frequent awakenings. Results - 2,973 toddlers were included in this study; 875 (29.4%) toddlers presented frequent awakenings in at least one visit (peak of prevalence of 19.8% at 12 months). Bed-sharing (adjusted OR 2.53; 95% CI: 2.05-3.12) and living in the North of Italy (aOR 2.25; 95% CI:1.80-2.81) were the variables more strongly associated with an increased likelihood of frequent awakenings in the binomial logistic regression, while sleeping alone was associated with a decreased chance (aOR 0.62; 95% CI 0.45-0.89). Conclusion - The current study identifies some early predictors of frequent awakenings during the first two years of life. Since optimal sleep practices in children are essential for their development, paediatric care practices must define and integrate early effective interventions.

Validation of the Korean version of the Sleep Hygiene Practice Scale in a Non-Clinical Population

ABSTRACT Objectives This study aimed to validate the Korean version of the sleep hygiene practice scale (SHPS-K) and determine its effectiveness in screening poor sleepers with insomnia. Methods Online survey was conducted using translated SHPS in Korean, the Korean versions of the Pittsburgh Sleep Quality Index (PSQI-K), Insomnia Severity Index (ISI-K), and Epworth Sleepiness Scale (KESS) in a non-clinical population. The internal consistency and test-retest reliability of the SHPS-K were assessed using Cronbach’s alpha and intraclass correlation coefficients (ICC), respectively. Construct validity was evaluated using correlation analyses with other questionnaires and confirmatory factor analysis. We determined the cutoff values that could identify poor sleepers with insomnia symptoms (PSQI-K > 5 and ISI-K ≥ 15) using receiver operating characteristic analysis. Results A total of 484 participants (242 women, mean age of 43.8 years) were enrolled. The average SHPS-K score was 71.2, with no significant sex differences. Women had poorer sleep scheduling and timing behaviors, and men had poorer eating and drinking behaviors. Good internal consistency (Cronbach’s alpha = 0.88) and test-retest reliability (ICC = 0.80) were observed. The SHPS-K was positively correlated with the PSQI-K (r = 0.55), ISI-K (r = 0.54), and KESS (r = 0.42). A cutoff value of 73 identified poor sleepers with insomnia (area under the curve = 0.828). Conclusions The SHPS-K is a reliable instrument for evaluating sleep hygiene in non-clinical Korean populations.

Māori perspectives on sleep and aging

IntroductionSleep is vital for health in older adulthood. Ethnic disparities have been noted with regards to sleep health. However, culturally appropriate approaches to sleep as a broader social experience are lacking.MethodsHere, sleep-related group interviews were conducted in the form of hui (group meetings and discussions) with eleven participants of a health service intervention for older Māori (the Indigenous people of New Zealand) and their whānau (extended family). Notes were collated and analyzed thematically.ResultsFour key themes were constructed that represent the key conversations and ideas. These concerned the conceptualizing of sleep—including appreciation for its somatic role but also the spiritual properties of sleep states; the changing obligations around sleep and wake—including individual and communal time use and changing cultural and familial obligations with advancing age; and the barriers and facilitators for supporting sleep—including the social and spiritual nature of communal sleeping, the schedules and sleep of others, as well as holistic and environmental methods for relaxation. Findings demonstrate the multifaceted nature of sleep and aging among Māori. Culturally relevant interpretations of sleep practices and disturbances were offered and are beyond typical Western models which are predominantly medicalized.DiscussionThis work aids the understanding and representation of sleep as a social and cultural perspective within the New Zealand context. This provides foundations for future participatory research to design culturally appropriate approaches to assessing and supporting sleep health in forms that are meaningful for aging well across cultures.

Promoting Safe Sleep: The Role of Doulas in Black Communities

BackgroundAccidental suffocation and strangulation in bed continues to be a critical issue in Black communities, despite the widespread initiatives to promote safe sleep. Doulas are in an ideal position to promote safe sleep, particularly in hard-to-reach communities that are more distrusting of conventional medical providers. Little is known about their practices and perspectives for putting infants down to rest. This study informs this gap in the literature.PurposeThe purpose of this study was to explore doulas’ perspectives and practices in the field of putting infants down to sleep. The researchers aimed to determine whether Black caregivers that work with doulas are likely to encounter safe sleep education.MethodsThe researchers used a descriptive approach to inquiry. They conducted three focus groups with a total of 17 Black doulas. The researchers independently and critically reviewed the transcriptions and observation notes from each group to identify codes. They then triangulated the results using Artificial Intelligence-driven tools.FindingsThe study found four themes: (1) Individualized Services, (2) Cultural Sensitivity, (3) Negotiating Safety, and (4) Safe Sleep Education.ConclusionsThe study concluded doulas have a commitment to promoting safe sleep. The researchers found that doulas engage in practices that help caregivers to integrate safe sleep practices into their lifestyle and to adapt them to meet their needs. The researchers also documented a desire for more information and instruction on safe sleep among practicing doulas.

Exploring the Role of Circadian Rhythms in Sleep and Recovery: A Review Article.

Sleep is essential for every living organism. Humans spend about one-third of their lives sleeping. Sleep has been studied extensively, and the role of sleep in psychological, mental, and physical well-being is established to be the best. The rhythm of the brain between wakefulness and sleep is called the circadian rhythm, which ismainly controlled by melatonin and the pineal gland. The imbalance of this rhythm can lead to devastating effects on health. Vigorous workouts close to bedtime can interfere with falling asleep. Meal timing and composition can significantly affect sleep quality. It is advised to avoid large meals, caffeine, and alcohol before bedtime. Heavy meals close to bedtime can lead to poor sleep and hormone disruption. By following these guidelines enumerated in the article, individuals can improve sleep quality and overall health. Sleep cycles, especially rapid eye movement sleep, have a profound influence on mental and physical health. Adhering to recommended sleep practices enhances bodily restoration, fortifies the immune system, and upholds metabolic equilibrium. Sleep hygiene aligned with circadian rhythms is crucial for disease prevention and well-being. Healthcare professionals should prioritize sleep optimization strategies for patient care and public health.

The Effect of Sleep Duration on Hypertension Risk in an Adult Asian Population: A Systematic Review and Meta-Analysis.

Sleep duration has been proposed as a potential and important modifiable risk factor, yet its precise relationship with hypertension among Asian adults remains unclear. This meta-analysis aims to elucidate the impact of short sleep duration on hypertension risk within the adult Asian population. A systematic search of databases, including PubMed, Scopus, and ScienceDirect, was conducted to identify relevant studies published up to January 4, 2024. Eligible studies comprised observational cohort studies and cross-sectional studies that compared short sleep duration to normal sleep duration in relation to hypertension risk among Asian adults. The definitions for short and normal sleep durations were derived from the respective studies. The random effects model was utilized to pool effect estimates, and all statistical analyses were conducted usingReview Manager 5.4 software (RevMan) (Cochrane Collaboration, Oxford, UK). Results from a systematic search obtained seven studies assessing sleep duration and hypertension risk in Asian populations. Based on a meta-analysis of six studies, short sleep duration is associated with a higher hypertension risk when compared to normal sleep duration (OR: 1.36; 95% CI: 1.13-1.64; p: 0.0010; I2: 75%). Subgroup analysis based on sex showed that the association is evident across males (OR: 1.12; 95% CI: 1.01-1.25; p: 0.03; I2: 64%) and females (OR: 1.22; 95% CI: 1.10-1.35; p: 0.0003; I2: 82%). In conclusion, based on the analyzed studies, short sleep duration is associated with a higher mild risk of hypertension, irrespective of sex. Thus, short sleep duration can be a modifiable risk factor that can be prevented to reduce the risk of hypertension. By incorporating sleep hygiene practices and promoting healthy sleep habits,significantimprovement in cardiovascular health can be made, especially in hypertension riskat a population level. Further studies on the effect of sleep duration in different age populations should be conducted to confirm the impact of short sleep duration.

SleepSync: Early Testing of a Personalised Sleep-Wake Management Smartphone Application for Improving Sleep and Cognitive Fitness in Defence Shift Workers.

Shift work, long work hours, and operational tasks contribute to sleep and circadian disruption in defence personnel, with profound impacts on cognition. To address this, a digital technology, the SleepSync app, was designed for use in defence. A pre-post design study was undertaken to examine whether four weeks app use improved sleep and cognitive fitness (high performance neurocognition) in a cohort of shift workers from the Royal Australian Air Force. In total, 13 of approximately 20 shift-working personnel from one base volunteered for the study. Sleep outcomes were assessed using the Insomnia Severity Index (ISI), the Patient-Reported Outcomes Measurement Information System (PROMIS), Sleep Disturbance and Sleep-Related Impairment Scales, the Glasgow Sleep Effort Scale, the Sleep Hygiene Index, and mental health was assessed using the Depression, Anxiety, and Stress Scale-21. Sustained attention was measured using the 3-min Psychomotor Vigilance Task (PVT) and controlled response using the NBack. Results showed significant improvements in insomnia (ISI scores 10.31 at baseline and 7.50 after app use), sleep-related impairments (SRI T-scores 53.03 at baseline to 46.75 post-app use), and healthy sleep practices (SHI scores 21.61 at baseline to 18.83 post-app use; all p < 0.001). Trends for improvement were recorded for depression. NBack incorrect responses reduced significantly (9.36 at baseline; reduced by -3.87 at last week of app use, p < 0.001), but no other objective measures improved. These findings suggest that SleepSync may improve sleep and positively enhance cognitive fitness but warrants further investigation in large samples. Randomised control trials with other cohorts of defence personnel are needed to confirm the utility of this intervention in defence settings.

Do try this at home: Age prediction from sleep and meditation with large-scale low-cost mobile EEG

Abstract EEG is an established method for quantifying large-scale neuronal dynamics which enables diverse real-world biomedical applications including brain-computer interfaces, epilepsy monitoring and sleep staging. Advances in sensor technology have freed EEG from traditional laboratory settings, making low-cost ambulatory or at-home assessments of brain function possible. While ecologically valid brain assessments are becoming more practical, the impact of their reduced spatial resolution and susceptibility to noise remain to be investigated. This study set out to explore the potential of at-home EEG assessments for biomarker discovery using the brain age framework and four-channel consumer EEG data. We analyzed recordings from more than 5200 human subjects (18-81 years) during meditation and sleep, to predict age at the time of recording. With cross-validated R2 scores between 0.3 - 0.5, prediction performance was within the range of results obtained by recent benchmarks focused on laboratory-grade EEG. While age prediction was successful from both meditation and sleep recordings, the latter led to higher performance. Analysis by sleep stage uncovered that N2-N3 stages contained most of the signal. When combined, EEG features extracted from all sleep stages gave the best performance, suggesting that the entire night of sleep contains valuable age-related information. Furthermore, model comparisons suggested that information was spread out across electrodes and frequencies, supporting the use of multivariate modeling approaches. Thanks to our unique dataset of longitudinal repeat sessions spanning 153 to 529 days from eight subjects, we finally evaluated the variability of EEG-based age predictions, showing that they reflect both trait- and state-like information. Overall, our results demonstrate that state-of-the-art machine learning approaches based on age prediction can be readily applied to real-world EEG recordings obtained during at-home sleep and meditation practice.

Educational Boost Slashes SIDS Risk Awareness Gap Among Nurses in Iraq

This study evaluates the impact of an educational program on nurses' knowledge of Sudden Infant Death Syndrome (SIDS) risk factors at pediatric teaching hospitals in Baghdad City. Using a quasi-experimental design with fifty nurses divided into a control and a research group, we assessed knowledge levels through pre-tests and two post-tests. Results indicated that the educational intervention significantly improved nurses' knowledge from 60% to 76%, although this effect diminished slightly over time. The study underscores the importance of continuous education in enhancing nurse awareness and the implementation of safe sleep practices to reduce SIDS occurrences. Highlights: Educational Impact: The study demonstrates a significant increase in nurses' knowledge about SIDS risk factors following an educational intervention. Sustained Learning: Knowledge gains were observed to diminish slightly over time, highlighting the need for ongoing educational programs. Practical Implications: Enhanced nurse training supports safer sleep practices, potentially reducing the incidence of SIDS. Keywords: Nurse Education, Knowledge, Risk Factors, Sudden Infant Death Syndrome, Safe Sleep Practices

Daytime Sleepiness and Affect in Middle-aged Adults Who Engage in Daytime Sleep Practice

This study examines how daytime sleepiness and negative emotions relate in middle-aged adults who nap during the day. Surprisingly, we found a slight negative link between daytime sleepiness and feeling down, suggesting daytime naps might help regulate emotions. However, more research is needed to fully grasp this connection. Our findings highlight the complexity of mood regulation and stress the importance of looking at the bigger picture when it comes to emotional well-being. We suggest future studies use longer-term observations and broader assessments to uncover the full story. Ultimately, understanding these links could lead to targeted strategies for improving sleep quality and emotional health in our modern lives.

Sleep initiation patterns and sleep quality among toddlers in the southeast of China: initial study results

BackgroundA large number of psychological consequences including sleep health emerged during the 2019 Coronavirus disease (COVID-19) pandemic. Sleep patterns in toddlers are vulnerable to negative environmental exposures, however, very few studies on this topic have been published so far.ObjectivesIn this paper, we aimed to investigate the sleep patterns and associated factors in toddlers from China confined at home in the context of COVID-19 pandemic.MethodsFrom April to November 2021, a convenience sample of 493 parents of young children aged (12–35 months) were surveyed from Fuzhou, Sanming, Quanzhou, Nanping, and Longyan cities in the Fujian Province, China. A cross-sectional survey was conducted via Electronic questionnaires to collect parent and child social-demographic characteristics. The Brief Infant Sleep Questionnaire (BISQ) was used to collect data on sleep practices, sleep duration and patterns, as well as the number of nocturnal awaking .ResultsThe mean age of toddlers was 2.11 years old, and 52.54% (259/493) were males. Among the 493 toddlers’ sleep patterns, 331(67.1%) initiated sleep accompanied by parents, 67(13.6%) slept independently, 59 (12.0%) were breast fed/bottle fed to initiate sleep, 27 (5.5%) were held and 9 (1.8%) rocked. The clear longitudinal association between the duration of night-time sleep, the frequency of nighttime awakenings, and various sleep patterns remains clear (p < 0.05). Multiple linear regression analysis indicated that sleep initiation with bottle-feeding/breast-feeding and rocked significantly increased the frequency of nighttime awakenings and reduced the duration of nighttime sleep (p < 0.05), as held was dramatically only for increasing the number of nighttime awakenings (p < 0.05). Multi-variate logistic regression analysis demonstrated that toddlers with severe sleep difficulties had a higher probability of being rocked to initiate sleep (p < 0.05). Conversely, young children with minor sleep problems were more apt to be in bed alone to initiate sleep (p < 0.05).ConclusionsDuring the COVID-19 pandemic, most infants and toddlers initiated sleep accompanied by parents and tend to have electronic media exposure before bedtime. Increased waking at night may be associated with sleep initiation with breast-feeding/bottle-feeding. Therefore, pediatric practitioners in primary community hospitals should pay attention to the education and promotion of sleep hygiene and parenting knowledge of young children to avoid the formation of poor sleep hygiene habits.

Parental psychological control and depression, anxiety among adolescents: The mediating role of bedtime procrastination and moderating role of neuroticism

Studies have shown that maladaptive parenting styles, particularly parental psychological control may be an important risk factor for emotional problems in adolescence. However, the potential mechanisms behind this association are still not fully understood. To fill the research gap, this study investigated the relationship between parental psychological control and depression and anxiety among adolescents. It also explored the mediating effect of bedtime procrastination and the moderating effect of neuroticism through a moderated mediation analysis. A sample of 665 adolescents (331 girls) were recruited from two secondary schools in southern China. All participants completed standardized self-report questionnaires measuring the severity of parental psychological control, bedtime procrastination, depression, anxiety, and neuroticism. Data were analyzed using SPSS 25.0 and PROCESS macros. The results indicated that parental psychological control had a positive predictive effect on depression and anxiety among adolescents. Bedtime procrastination partially mediated the relationship between parental psychological control and depression, as well as parental psychological control and anxiety. Neuroticism was found to play a moderating role in the path from bedtime procrastination to depression and from bedtime procrastination to anxiety, with these effects being stronger for adolescents with higher levels of neuroticism. This study advances a deeper understanding of how and when or for whom parental psychological control is related to adolescents' severe depression and anxiety. Our findings suggest that intervention programs or strategies aimed at reducing parental psychological control and assisting adolescents in establishing healthy sleep hygiene practices should be developed to decrease the risk of depression and anxiety in adolescents.

Adapting the athlete sleep behavior questionnaire (ASBQ) for Arabic-speaking populations: Translation, reliability testing, and validation using classical theory and item response theory

Sleep is essential for athletes' physical performance as well as their general health, well-being, and quality of life. To assess athletes' sleep behaviors, the Athlete Sleep Behavior Questionnaire (ASBQ) was developed in the English language. However, a validated Arabic-version of the ASBQ is lacking. This study aimed to translate the ASBQ into Arabic (ASBQ-AR) and evaluate its reliability and validity among Arabic-speaking athletes.A total of 458 participants (254 athletes, 202 non-athletes) from four Arabic countries completed the ASBQ-AR and the Insomnia Severity Index (ISI) questionnaires. The psychometric properties of the ASBQ-AR were examined using unidimensional reliability analysis, confirmatory factor analysis (CFA), Item Response Theory (IRT), and convergent validity.The ASBQ-AR had acceptable internal consistency (Cronbach's α = 0.723, McDonald's ω = 0.725) and a factorial structure, confirming its construct validity. CFA demonstrated improved model fit indices after the removal of two potentially misfitting items (items 4 and 13); however, the model's fit to the data remains suboptimal. IRT results indicated that the majority of items demonstrated a good model fit, suggesting effective measurement of the intended construct without significant interference, except for ASBQ-AR 4. Additionally, ASBQ-AR 4 appears to present the highest level of difficulty for respondents. In terms of convergent validity, the mean ASBQ-AR global score was correlated with the mean ISI global score (r = 0.5, p < 0.0001).The ASBQ-AR is a reliable and valid tool for assessing maladaptive sleep practices among Arabic-speaking athletes. Additional refinements to the ASBQ-AR are warranted to optimize its psychometric properties.

Impact of sleep and mental health in adolescence: an overview.

Sleep deprivation is known to affect multiple aspects of mental health, physical health, and daily functioning. With increasing reports of sleep disturbances and increasing mental health needs in adolescents, it is imperative that healthcare providers have a strong understanding of the relationship between sleep and mental health, the impact of poor sleep on the school experience, and an understanding of behavioral interventions targeting sleep practices. Recent studies have shown that the relationship between sleep and mental health is complex and multifaceted. While mental health diagnoses and symptoms can negatively influence sleep quality and quantity, so too does poor sleep increase the risk of mental health diagnoses, symptom severity, and suicide risk. Sleep likewise affects the school experience, both positively and negatively. Targeted interventions and prevention programs may be effective in treatment of sleep disturbances for adolescents. Clinicians must be aware of the above associations and their clinical implications. Patients with either mental health or sleep concerns should be screened for potential co-morbid conditions. Improving sleep hygiene practices can improve the sleep experience in adolescents, however, there remains a gap in understanding the best method to improve sleep hygiene practices in this population.

Sleep Norms

This study documents sleep norms and studies the effect of norm information on anticipated behavioral change. Participants were shown either a small or large gap between others' ideal sleep duration (injunctive norm) and actual sleep patterns (descriptive norm). While we find limited effects of injunctive norm information alone, alignment between perceived behavior and societal expectations led to greater intention for longer sleep and earlier bedtimes. Conversely, a large gap between norms and actual behavior heightened interest in advice for improving sleep. These results suggest that understanding and communicating social norms can be crucial in promoting healthy sleep practices.

Factors Associated with Breastfeeding Initiation and Continuation at Two Months Postpartum in American Indian Women: An Exploratory Analysis.

This study aimed to determine the prevalence of breastfeeding initiation and continuation at two months postpartum in American Indian (AI) mothers in South Dakota and to identify factors associated with breastfeeding. Using logistic regression, data from the South Dakota Pregnancy Risk Assessment Monitoring System were used to investigate the relationship between binary breastfeeding initiation and continuation outcomes and maternal behaviors and experiences including access to health care, safe sleep practices, ability to handle life events, depression, and sources of breastfeeding information. Higher odds of initiation were seen for factors including access to health care services, ability to handle life events, and sources of breastfeeding information, while lower odds were seen for factors including safe sleep. Higher odds of continuation were seen among mothers who reported not taking long to get over setbacks and among mothers who reported no postpartum depression, while lower odds of continuation were seen among mothers practicing safe sleep. Several modifiable factors were identified as reasons for stopping breastfeeding. This information about factors associated with higher odds of breastfeeding initiation and continuation at two months postpartum can be used to inform interventions, programs, and policies designed to support breastfeeding among AI women and to guide future research in this area.

Photos Shared on Facebook in the Context of Safe Sleep Recommendations: Content Analysis of Images.

Sudden unexpected infant death (SUID) remains a leading cause of infant mortality; therefore, understanding parental practices of infant sleep at home is essential. Since social media analyses yield invaluable patient perspectives, understanding sleep practices in the context of safe sleep recommendations via a Facebook mothers' group is instrumental for policy makers, health care providers, and researchers. This study aimed to identify photos shared by mothers discussing SUID and safe sleep online and assess their consistency with infant sleep guidelines per the American Academy of Pediatrics (AAP). We hypothesized the photos would not be consistent with guidelines based on prior research and increasing rates of accidental suffocation and strangulation in bed. Data were extracted from a Facebook mothers' group in May 2019. After trialing various search terms, searching for the term "SIDS" on the selected Facebook group resulted in the most relevant discussions on SUID and safe sleep. The resulting data, including 20 posts and 912 comments among 512 mothers, were extracted and underwent qualitative descriptive content analysis. In completing the extraction and subsequent analysis, 24 shared personal photos were identified among the discussions. Of the photos, 14 pertained to the infant sleep environment. Photos of the infant sleep environment were then assessed for consistency with safe sleep guidelines per the AAP standards by 2 separate reviewers. Of the shared photos relating to the infant sleep environment, 86% (12/14) were not consistent with AAP safe sleep guidelines. Specific inconsistencies included prone sleeping, foreign objects in the sleeping environment, and use of infant sleeping devices. Use of infant monitoring devices was also identified. This study is unique because the photos originated from the home setting, were in the context of SUID and safe sleep, and were obtained without researcher interference. Despite study limitations, the commonality of prone sleeping, foreign objects, and the use of both infant sleep and monitoring devices (ie, overall inconsistency regarding AAP safe sleep guidelines) sets the stage for future investigation regarding parental barriers to practicing safe infant sleep and has implications for policy makers, clinicians, and researchers.