Lisa J. Meltzer’s research while affiliated with National Jewish Health and other places

Sleep problems in young children are highly prevalent and represent a risk factor for numerous detrimental child and family outcomes. This pilot study aimed to test the preliminary efficacy and transdiagnostic impact of an online, parent-focused sleep intervention, the Lights Out Online program, in terms of its ability to a) reduce child sleep, anxiety, and behaviour problems, and b) to reduce parent sleep, depression, anxiety and stress problems, and improve parental self-efficacy. The study was an open (uncontrolled) trial with a within-group repeated measures (pre-treatment, post-treatment) design. Participants were 24 parents (Mage = 36.2, SD = 4.1) of children aged 3-6 years (Mage = 4.1 years, SD = 1.1) with sleep problems. Measures of child sleep, anxiety, and behaviour problems, as well as parental self-efficacy, and parent sleep, anxiety, depression and stress, were taken. A series of mixed-effects linear regression models demonstrated significant improvements in child sleep, child anxiety, child behaviour problems, parent sleep, parent anxiety and parental self-efficacy, from pre- to post-intervention. However, significant improvements were not demonstrated for parent depression and parent stress. Post-program feedback from parents suggested that they were satisfied with the program content and presentation. This study provides preliminary support for the efficacy and acceptability of an online, parent-focused program targeting child sleep problems.

Introduction Sleep is essential for development, yet best practices in pediatric sleep are based on studies of primarily non-Latino White families, where rates of room-sharing, bed-sharing, and feeding to sleep are relatively low in toddlers. This ongoing study characterizes room-sharing and bed-sharing reasons, beliefs, practices, and sleep among mothers and toddlers in Mexican American families. Methods 51 Mexican American mothers (19-43 years; mean education 12.3 + 3.2 years) of toddlers (77% boys; 12-15 months) completed surveys in Spanish (67%) or English. Mothers and toddlers wore an actigraph for 7 nights. Surveys included Bed-sharing and Room-sharing Beliefs (poor parent sleep, poor child sleep, child dependent on parent for sleep, parent preference to have child nearby) and the Brief Infant Sleep Questionnaire (sleep ecology, room-sharing reasons, sleep-related practices). Results Room-sharing was common (88%), with room-sharing reasons including parental preference to have child nearby (PREF, 53%), space/logistics (SPACE, 33%), and child needing parent to sleep (NEED, 13%). All NEED mothers reported bed-sharing with their toddler, with 50% of PREF and 47% of SPACE mothers reporting bed-sharing. SPACE mothers agreed that bed-sharing contributed to poor parent and child sleep more than PREF or NEED mothers (medium effect size). PREF mothers disagreed that bed-sharing made a child depend on parent for sleep more than the other groups (large effect size). Toddlers falling asleep at bedtime while feeding was common among all room-sharing mothers (SPACE=67%, PREF=88%, NEED=100%), although higher in bed-sharing families (96% vs. 65% own bed). Parent sleep timing (midpoint) was delayed 48 minutes for SPACE mothers vs. NEED mothers, while child sleep timing was 30 minutes delayed in bed-sharing toddlers and 54 minutes delayed in toddlers who fell asleep feeding. Toddlers who fell asleep feeding had a 35 minute longer sleep opportunity, but a 33 minute shorter sleep duration than non-feeding toddlers. Conclusion Early findings from our ongoing study of sleep in mothers and toddlers from Mexican American families suggest sleep ecology beliefs and practices differ from findings in U.S. non-Latino White families. Findings highlight the importance of cultural and ecological sensitivity when designing interventions to reduce sleep disparities and improve overall toddler health. Support (if any) R01HL163859

Introduction Room-sharing, but not bed-sharing is recommended for safe sleep, and pediatric behavioral sleep interventions commonly recommend a separate child sleep space, even when room-sharing. However, bed-sharing is more common globally and across cultural groups than in U.S.-based non-Latino White families. Further, most research has focused on maternal beliefs about bed-sharing, with little consideration of paternal beliefs. This exploratory study describes similarities and differences in maternal and paternal beliefs about bed-sharing in Mexican American couples with toddlers. Methods Fourteen Mexican American couples (mothers [27-41 years, mean education 12.8 + 3.7 years] and fathers [27-45 years, mean education 11.1 + 3.4 years]) with toddlers (78.6% boys; 12-15 months) completed the 17-item Bed-sharing Beliefs measure in Spanish (50%) or English. Half of families reported bed-sharing with their toddler. Although data collection is ongoing, we describe dyadic concordance (dyads both agree or disagree) or discordance (one person agrees, the other disagrees) in the current sample. Results The most dyadic concordant responses were parent sleep/privacy items: “bed-sharing interferes with the parents privacy” (100% concordance: 93% agree), “bed-sharing makes the parents sleep poorly” (86% concordance: 64% agree), and “bed-sharing helps the parent sleep well” (79% concordance, 36% agree). Teaching the child to sleep independently items also had strong dyadic concordant responses: “bed-sharing makes the transition to their own bed harder” (79% concordance, 64% agree), “bed-sharing makes it harder for the child to sleep on their own” (79% concordance, 64% agree), and “bed-sharing makes the child dependent on the parent to sleep” (77% concordance, 62% agree). The greatest dyadic discordant responses were related to the child’s sleep quality: 62% discordance for both “bed-sharing keeps the child from sleeping comfortably” and “bed-sharing interferes with the child’s sleep.” No differences between bed-sharing and non-bedsharing dyads were found. Conclusion Early findings from our ongoing study of sleep beliefs in Mexican American families with toddlers suggest greater parental concordance about the impact of bed-sharing on parental privacy/sleep and toddlers learning to sleep independently, with discordant beliefs about the impact of bed-sharing on child sleep quality. Further exploration of dyadic parental beliefs about bed-sharing and the relationship with sleep location is needed in a larger sample. Support (if any) R01HL163859

Introduction Good sleep hygiene includes restricting screen use in the hour before bedtime. Despite this, bedtime screen use starts for many in early childhood. To inform the design of interventions aiming to promote quality sleep, a better understanding of parental conceptualizations about their children’s bedtime screen use is needed. We evaluated whether maternal beliefs about bedtime screen use and self-efficacy to limit bedtime screen use are related to toddler screen use before bedtime in Mexican American families. Methods This study used data from a larger study enrolling Mexican American families with toddlers (15-26 months old) recruited from a federally qualified health system. Participants were asked how much they agreed that using a screen device before bed helps little children sleep better (belief) and how confident they were about limiting their toddler’s bedtime screen use (self-efficacy). Screen use before bedtime was measured via a 7-day diary completed by mothers, resulting in a count of nights the child used a screen device in the hour before bedtime. We used multiple regression to evaluate whether maternal beliefs and self-efficacy were associated with toddlers’ bedtime screen use, adjusting for child age, and maternal education and employment status. Results Participants (n=286) were on average 31.4 years old (SD=5.9) and 73% reported ≤ high school degree. Mean child age was 21.7 (SD=3.1) months. Over one-third (36%, n=103) of children used a screen device in the hour before bedtime at least 4 nights per week. Mothers’ stronger beliefs that screen use before bed helps with sleep (Incidence rate ratio (IRR)=1.22, 95% CI 1.06-1.41) and mothers’ lower self-efficacy to limit bedtime use (IRR=0.79, 95% CI 0.70-0.89) were associated with greater toddler bedtime screen use. Conclusion Maternal beliefs and self-efficacy regarding limiting screen use at bedtime should be considered in interventions addressing toddler sleep hygiene in this population. Support (if any) Research reported in this publication was supported by NIH/NINR (R01NR017605, PI: Thompson) and NIH/NCATS Colorado CTSA Grant Number UM1 TR004399. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.

Objective: The study objective was to inform patient-centered care for adolescent insomnia by describing adolescents' perspectives on insomnia. Specific constructs of interest included: 1) factors that contributed to insomnia development or maintenance, 2) impact of insomnia on day-to-day life, 3) recommended research priorities, and 4) overall experience living with insomnia. Method: A convenience sample of adolescents (ages 13-18 years) self-identifying with insomnia symptoms was recruited through social media. Respondents (n = 3,014) completed an online survey. Responses to an open-ended item assessing patient experience were coded using thematic analysis. Results: Participants identified as 70.8% White non-Hispanic, 77.0% female, and lived in one of five English-speaking countries (United States, United Kingdom, Canada, Australia, or New Zealand). Most (87.5%) met DSM-V diagnostic criteria for insomnia. The most common contributory factors to insomnia endorsed were stress (72.1%) and depressed mood (63.6%), while common impact areas were mood (72.2%), focus (61.0%), and pain (49.7%). Patient-centered research priorities were identifying insomnia causes (66.4%) and early detection (66.1%). Common adolescent experiences included high distress levels, feelings of invalidation, and helplessness about their insomnia. Conclusions: Adolescents with insomnia offer a unique perspective that should inform patient-centered research and care. There is a need for heightened screening and awareness about insomnia as a condition that causes significant distress and impairment for adolescents. To provide validating care, providers should recognize the multifaceted causes of insomnia.

Cultural differences in the experience of sleep warrant consideration in the measurement of sleep across populations. This requires careful attention to both language and culture when translating survey measures. While forward and back translation is the most commonly used approach, it has numerous limitations if used as an isolated method. Best practice guidelines recommend a multi-step team-based approach for translating questionnaires. We present our recent experience applying best practices in a study with both Spanish and English-speaking Mexican American mothers of toddlers. This work is part of a larger project that will measure parental sleep-related beliefs and parenting practices in Mexican American parents of toddlers. We utilized a team-based approach to translation and cultural adaptation, assembling a diverse, bilingual, and bicultural team. The translation process started with items and measures that we had selected, revised as needed, or created. New items were based on constructs identified in semi-structured interviews and focus groups used to explore parental sleep-related beliefs and parenting practices in the target population. Following this, our translation process included forward and back translation, harmonization and decentering, cognitive interviewing, debriefing, adjudication, and proofreading. We outline details of our process and the rationale for each step. We also highlight how each step contributes to ensuring culturally appropriate items with conceptual equivalence across languages. To ensure inclusivity and scientific rigor within the field of sleep research, investigators must utilize best practices for translations and cultural adaptations, building on the foundation of cultural constructs often identified in qualitative work.