|Year : 2018 | Volume
| Issue : 1 | Page : 31-36
Association between sleeping duration and health-related behaviors in college student
Pin-Hsuan Lin1, Chung-Ying Lin2, Po-Yu Wang3, Shang-Yu Yang4
1 Department of Health and Beauty, Shu Zen Junior College of Medicine and Management, Kaohsiung, Taiwan
2 Department of Rehabilitation Sciences, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Hong Kong, China
3 Department of Pediatric Emergency, Changhua Christian Children's Hospital, Changhua, Taiwan
4 Institute of Allied Health Science, College of Medicine, National Cheng Kung University, Tainan, Taiwan
|Date of Web Publication||24-Jul-2018|
Dr. Shang-Yu Yang
Institute of Allied Health Science, College of Medicine, National Cheng Kung University, No. 1, University Road, Tainan 701
Source of Support: None, Conflict of Interest: None
Introduction: Although the past studies have presented differences between sleep duration and health-related behavior, to the best of our knowledge, no studies have considered the different dimensions of adolescent health-related behavior according to gender. The current study aims to investigate the association between sleep duration and health-related behavior in both genders. Method: A cross-sectional study was conducted in a college in southern Taiwan. We used convenience sampling and invited all undergraduate full-time students in their 3rd year to participate in this study in 2014. There were three parts in our questionnaire, including participant's characteristics, the Adolescent Health Promotion (AHP) scale, and medication consumption habits. The participants were classified into two groups according to their sleep duration (<7 h vs. ≥7 h). We examined the predictors of sleep duration through the use of logistic regression analysis with the six AHP dimensions and unsafe medicine consumption habits as independent variables, respectively. Results: Using our whole sample, sufficient sleep duration was associated with higher AHP scores on nutrition and stress management and less unsafe medicine consumption habits (P < 0.05). For both males and females, sleeping more than 7 h was associated with better stress management (P < 0.01). Conclusions: Students whose sleeping duration was ≥7 h had a greater tendency to have good nutritional behavior and stress management behavior than those whose sleeping duration was <7 h. Moreover, students with insufficient sleep may have a significantly greater tendency to have unsafe medicine consumption habits.
Keywords: College student, health-related behavior, sleeping duration
|How to cite this article:|
Lin PH, Lin CY, Wang PY, Yang SY. Association between sleeping duration and health-related behaviors in college student. Soc Health Behav 2018;1:31-6
|How to cite this URL:|
Lin PH, Lin CY, Wang PY, Yang SY. Association between sleeping duration and health-related behaviors in college student. Soc Health Behav [serial online] 2018 [cited 2019 Nov 13];1:31-6. Available from: http://www.shbonweb.com/text.asp?2018/1/1/31/237419
| Introduction|| |
Sleep is a basic human physiological need and an important physiological basis for human beings to maintain health. Due to a multitude of intrinsic and environmental factors, college students are particularly vulnerable to sleep problems. Intrinsic factors including gender and being female may result in shorter sleep durations than males due to individual health status, for example, headaches. External factors such as unhealthy behavior including the use of electronic devices late at night further delay sleep onset. In Taiwan, >40% of college students have sleep problems; these problems delay their bedtime and reduced sleep hours results in increased daytime burnout., Furthermore, insufficient sleep duration may affect academic performance, physical and mental health, social function, and quality of life and may even lead to suicidal ideation.,,,, A study  indicated that students who reported sleeping <7 h engage in higher risk behaviors, such as driving after drinking or driving without seatbelt use, as compared to those sleeping >7 h. Furthermore, insufficient sleep duration is associated with an increased risk for motor vehicle crashes among college students. Thus, sleep duration for college students is an important issue because the habits and health conditions of students may continue and affect them as they mature.
Appropriate sleep duration is important in terms of good general health and quality of life and has been related to some health promotion behaviors. For example, adolescent students who had poor stress coping skills were shown to exhibit shorter sleep duration, delayed sleep, fragmented sleep, and increased daytime sleepiness. Lower quality diet, lower consumption of fruit, and higher consumption of empty calories have been shown to be related to longer sleep duration. Sleep duration has been positively associated with social interaction, social skills, and peer acceptance. A systematic review reported that engaging in exercise promotes sleep efficiency and duration regardless of the mode and intensity of activity, and the report also indicated that exercise improved sleep duration or quality. Furthermore, short sleep duration has been linked to drug use problems. Clinical studies have shown that sleep problems may increase the frequency of illicit drug use. However, little work has been done to comprehensively investigate adolescent health-related behavior and sleep duration.
Although the past studies have presented differences between sleep duration and health-related behavior, to the best of our knowledge, no studies have considered the different dimensions of adolescent health-related behavior according to gender. It is necessary to investigate gender differences in relationship between sleep duration and health-related behavior for health-care providers designing gender-specific strategies to improve sleep health. The current study is aimed toward an investigation of the association between sleeping duration and health-related behavior in both genders.
| Methods|| |
A cross-sectional study was conducted in a college in Southern Taiwan. We used convenience sampling and invited all undergraduate full-time students in their 3rd year to participate in this study in 2014. A total of 195 students agreed to participate and provided informed consent after verbal consent. They then completed the questionnaire. After excluding students with missing information, the final analyzed participants comprised 184 students. Ethical approval for the study was obtained from the National Cheng Kung University Human Research Ethics Committee (No. 102-093, Tainan, Taiwan).
There were three parts in the questionnaire: The first part comprised participant characteristics, including demographic information, legal substance abuse such as smoking every week, alcohol use every week, betel nut chewing every week, and sleep duration. We used the InBody720 (body composition analyzer) to measure height, weight, and body mass index. Referring to Wheaton's study, sufficient sleep duration was defined as >7 h (including 7 h) of sleep per night, while insufficient sleep duration was defined as <7 h of sleep per night.
The second part of the questionnaire measured health-related behavior through the Adolescent Health Promotion (AHP) scale. The AHP is a self-administered, self-reporting instrument that measures adolescent health-related behavior. The AHP comprises 40 items to evaluate and gauge six dimensions of behavior. These six dimensions of behavior include (1) nutrition, which includes 6 items; (2) social support, which includes 7 items; (3) health responsibility, which includes 8 items; (4) life appreciation, which includes 8 items; (5) exercise behavior, which includes 4 items; and (6) stress management, which includes 7 items. All items are rated on a 5-point scale including “never, rarely, sometimes, usually, and always,” with the rating score ranging from 1 to 5. Higher scores indicate better health-promoting behavior. The Cronbach's alpha of the AHP was 0.93 for the total scale and 0.75–0.88 for the subscales. The AHP has been used in more than 15 countries in five language versions and has been deemed both reliable and valid.
The third part of the questionnaire measured medication-taking habits, which included four items. These four items included: (1) taking diet pills without seeing a doctor, (2) taking cold medicine without seeing a doctor, (3) taking sleeping pills without seeing a doctor, and (4) taking painkillers without seeing a doctor, with “yes” or “no” (including never taking) as answer options. The above four items were accumulated as one item for each participant (coding: Yes = 1; No = 0), called “unsafe medicine consumption habits.” Thus, “unsafe medicine consumption habits” in this study was defined as taking medicine or pills without seeing a doctor.
Statistical analyses were performed using SPSS 22.0. The participants were classified into two groups according to their sleep duration (<7 h vs. ≥7 h). Participant characteristics were determined through descriptive analysis. The Student's t-test was employed to compare the results for the participant characteristics with sleep duration. A Chi-square test and a Fisher's exact test were used to assess categorical data. The six dimensions of the AHP were examined according to sleeping duration and gender with the Student's t-test. We examined the predictors of the sleep duration (coding: <7 h = 0; ≥7 h = 1) through the use of a logistic regression analysis with the six dimensions of the AHP and unsafe medicine consumption habits as independent variables, respectively. The regression analyses were adjusted for gender, age, body mass index, current smoker, current drinker, and betel nut chewing.
| Results|| |
[Table 1] displays demographic characteristics related to sleeping duration (<7 h vs. ≥7 h). There were 46.74% students who had insufficient sleep duration, who slept <7 h. There was no significant relationship between gender, age, body mass index, religion, smoking, alcohol consumption, betel nut chewing, and sleep duration. A majority of the students were not current smokers (84.8%), current drinkers (85.3%), and did not engage in betel nut chewing (95.1%). According to the results of AHP six dimensions, participants who slept >7 h had a significantly higher mean score on the six dimensions of the AHP on nutrition and stress management compared to participants who slept <7 h (P< 0.05). For habits related to taking medication, taking painkillers without consulting a doctor was associated with sleeping duration (P< 0.05): The number of participants who slept <7 h took painkillers without seeing doctor was greater than those who slept >7 h. In addition, participants who slept <7 h were more likely to take medicine or pills without seeing doctors than those who slept >7 h.
The mean score of the six dimensions of the AHP was grouped according to gender and sleep duration as shown in [Table 2]. There was no significant difference between the different genders. Both males and females who slept >7 h had better stress management than those who slept <7 h (P< 0.01). A logistic regression was to investigate the relationship between sleep duration and AHP/unsafe medicine consumption habits [Table 3]. Using our entire sample, sufficient sleep duration was associated with higher AHP scores on nutrition and stress management and less unsafe consumption of medicine (P< 0.05), and the total AHP scores were marginally significant. For males, sleeping >7 h was associated with better stress management (β = 1.13; confidence interval (CI) = 1.03–1.23), and for females, sleeping >7 h was also associated with better stress management (β = 1.15; CI = 1.05–1.26) as well.
|Table 2: Six dimensions of the adolescent health promotion scale after grouping by sleeping duration and gender|
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|Table 3: Coefficients based on a logistic regression to explore association between the sleeping duration, adolescent health promotion dimensions, and unsafe medicine consumption|
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| Discussion|| |
The results in [Table 1] show that significant sleeping duration differences existed in the AHP scores on nutrition and stress management. Specifically, [Table 1] reveals that the participants whose sleeping duration was ≥7 h had a greater tendency to have good nutritional behavior than those whose sleeping duration was <7 h. However, there was no significant gender difference in terms of sleeping duration [Table 2]. Further, [Table 3] shows that nutrition behavior was associated with sleeping duration. That is, students who have poor nutrition may obtain insufficient amounts of sleep. A past study  indicated that a shorter weekday sleep duration (<8 h) was associated with nutrient intake. Adolescents sleeping <8 h consumed higher amounts of calories and fats. High fat in the diet can have a negative effect on sleep time and sleep architecture. Rapid eye movement may be reduced with higher levels of fat intake  and the intake of fat and animal protein (meat) may increase in people between 19 and 30 years of age. Moreover, longer sleeping duration was positively associated with dietary patterns that included vegetables and fruit. Therefore, developing healthy nutrient intake behavior for college students should be highlighted. Reducing the intake of high-fat foods and calories could be one of the good ways to improve sleep health.
In addition, a past study  pointed out that too much stress is the main cause of insomnia because stress can lead to anxiety, tension, and other negative emotions and can, in turn, stimulate the sympathetic nerves to secrete new epinephrine and adrenaline, causing the arousal system to maintain tension and resulting in difficulty with going to sleep or remaining asleep. Some evidence indicates that having good stress management may be specifically effective in preventing sleep problems and developing regular sleeping habits., Based on our findings, both male and female students who had better stress management were shown to obtain more sufficient amounts of sleep. Thus, providing health information and guidelines related to stress management and relaxation techniques may be needed.
According to our findings, there was a greater number of participants who slept <7 h who take painkillers without seeing a doctor as compared to those participants who slept >7 h. One possible explanation for this finding is that the students who sleep less may have a higher need for painkillers. Considering convenience, they may go directly to the pharmacy to purchase painkillers without consulting a doctor. In addition, our findings also indicated that sleeping duration is associated with unsafe medicine consumption. This implies that the students who sleep less may prefer to purchase and take medicine on their own. A past study  reported that sleep duration is associated to injury-related risk behavior such as drinking and driving among high school students. Hence, insufficient sleep could directly contribute to engagement in injury risk behavior. Taking medicine without consulting a doctor increases the risk related to medication safety, for example, polypharmacy or repeated use of medications. Thus, both medication safety and sleep health education are recommended.
The current study includes several limitations. Sleeping duration was assessed using a self-reported method. Although self-reported sleep parameters such as duration are frequently used, the use of more objective measures of sleep duration is strongly recommended. Another limitation is our small sample size and the fact that the entire sample was collected from one college. Therefore, the generalization of this study is relatively low. In addition, many confounders (e.g., family income or schoolwork stress) affecting the duration of sleep were not collected in the study. However, our findings might provide evidence that self-reported sleep duration is associated with health-related behavior.
| Conclusions|| |
In conclusion, we found that the college students with sufficient sleep had significantly better health-related behavior in the areas of nutrition and stress management compared to the students with insufficient sleep. This means that the students whose sleeping duration was ≥7 h had a greater tendency to have good nutritional behavior and stress management behavior than those whose sleeping duration was <7 h. Moreover, the students with insufficient sleep had a significantly greater tendency to have unsafe medicine consumption habits including taking painkillers without seeing a doctor compared to the students with sufficient sleep. The nutrition behavior, stress management behavior, and unsafe medicine consumption habits were also predictive of sleeping duration. Therefore, in order to obtain sufficient sleep, providing college students with lessons on nutritional intake, stress management, and medication safety may be a feasible approach to helping them improve their sleep habits.
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Conflicts of interest
There are no conflicts of interest.
| References|| |
Tang J, Liao Y, He H, Deng Q, Zhang G, Qi C, et al.
Sleeping problems in Chinese illicit drug dependent subjects. BMC Psychiatry 2015;15:28.
Wolfson AR, Carskadon MA. Understanding adolescents' sleep patterns and school performance: A critical appraisal. Sleep Med Rev 2003;7:491-506.
Ming X, Radhakrishnan V, Kang L, Pecor K. Gender, headaches, and sleep health in high school students. J Womens Health (Larchmt) 2016;25:930-5.
Lemola S, Perkinson-Gloor N, Brand S, Dewald-Kaufmann JF, Grob A. Adolescents' electronic media use at night, sleep disturbance, and depressive symptoms in the smartphone age. J Youth Adolesc 2015;44:405-18.
Yang CM, Wu CH, Hsieh MH, Liu MH, Lu FH. Coping with sleep disturbances among young adults: A survey of first-year college students in Taiwan. Behav Med 2003;29:133-8.
Vela-Bueno A, Fernandez-Mendoza J, Olavarrieta-Bernardino S. Sleep patterns in the transition from adolescence to young adulthood. Sleep Med Clin 2009;4:77-85.
Gaultney JF. The prevalence of sleep disorders in college students: Impact on academic performance. J Am Coll Health 2010;59:91-7.
Lund HG, Reider BD, Whiting AB, Prichard JR. Sleep patterns and predictors of disturbed sleep in a large population of college students. J Adolesc Health 2010;46:124-32.
Roth T, Jaeger S, Jin R, Kalsekar A, Stang PE, Kessler RC, et al.
Sleep problems, comorbid mental disorders, and role functioning in the national comorbidity survey replication. Biol Psychiatry 2006;60:1364-71.
Léger D, Scheuermaier K, Philip P, Paillard M, Guilleminault C. SF-36: Evaluation of quality of life in severe and mild insomniacs compared with good sleepers. Psychosom Med 2001;63:49-55.
Chakravorty S, Grandner MA, Mavandadi S, Perlis ML, Sturgis EB, Oslin DW, et al.
Suicidal ideation in veterans misusing alcohol: Relationships with insomnia symptoms and sleep duration. Addict Behav 2014;39:399-405.
Wheaton AG, Olsen EO, Miller GF, Croft JB. Sleep duration and injury-related risk behaviors among high school students – United States, 2007-2013. MMWR Morb Mortal Wkly Rep 2016;65:337-41.
Cho JH, Guilminault C, Joo YH, Jin SK, Han KD, Park CS, et al.
Apossible association between dysphonia and sleep duration: A cross-sectional study based on the Korean National Health and nutrition examination surveys from 2010 to 2012. PLoS One 2017;12:e0182286.
Matthews KA, Hall MH, Cousins J, Lee L. Getting a good night's sleep in adolescence: Do strategies for coping with stress matter? Behav Sleep Med 2016;14:367-77.
Xiao RS, Moore Simas TA, Pagoto SL, Person SD, Rosal MC, Waring ME, et al.
Sleep duration and diet quality among women within 5 Years of childbirth in the United States: A Cross-sectional study. Matern Child Health J 2016;20:1869-77.
Vaughn BE, Elmore-Staton L, Shin N, El-Sheikh M. Sleep as a support for social competence, peer relations, and cognitive functioning in preschool children. Behav Sleep Med 2015;13:92-106.
Dolezal BA, Neufeld EV, Boland DM, Martin JL, Cooper CB. Interrelationship between sleep and exercise: A Systematic review. Adv Prev Med 2017;2017:1364387.
Wong MM, Brower KJ, Zucker RA. Childhood sleep problems, early onset of substance use and behavioral problems in adolescence. Sleep Med 2009;10:787-96.
Chen MY, Wang EK, Yang RJ, Liou YM. Adolescent health promotion scale: Development and psychometric testing. Public Health Nurs 2003;20:104-10.
Chen MY, Lai LJ, Chen HC, Gaete J. Development and validation of the short-form adolescent health promotion scale. BMC Public Health 2014;14:1106.
Weiss A, Xu F, Storfer-Isser A, Thomas A, Ievers-Landis CE, Redline S, et al.
The association of sleep duration with adolescents' fat and carbohydrate consumption. Sleep 2010;33:1201-9.
Awad KM, Drescher AA, Malhotra A, Quan SF. Effects of exercise and nutritional intake on sleep architecture in adolescents. Sleep Breath 2013;17:117-24.
Moreira P, Santos S, Padrão P, Cordeiro T, Bessa M, Valente H, et al.
Food patterns according to sociodemographics, physical activity, sleeping and obesity in portuguese children. Int J Environ Res Public Health 2010;7:1121-38.
Chen SH, Tsai JC. Exercise, nutrition and sleep of adolescents. NCUE Phys Educ 2015;14:105-16.
Chen CI. The Relationship between practicum-related stress and sleep quality in healthcare administration students. Chang Gung J Sci 2016;24:79-94.
Teraoka S, Hayashida N, Shinkawa T, Taira Y, Nagai-Sekitani Y, Irie S, et al.
Good stress management capability is associated with lower body mass index and restful sleep in the elderly. Tohoku J Exp Med 2013;229:5-10.
Herr RM, Barrech A, Riedel N, Gündel H, Angerer P, Li J, et al.
Long-term effectiveness of stress management at work: Effects of the changes in perceived stress reactivity on mental health and sleep problems seven years later. Int J Environ Res Public Health 2018;15. pii: E255.
Campbell CM, Bounds SC, Kuwabara H, Edwards RR, Campbell JN, Haythornthwaite JA, et al.
Individual variation in sleep quality and duration is related to cerebral mu opioid receptor binding potential during tonic laboratory pain in healthy subjects. Pain Med 2013;14:1882-92.
[Table 1], [Table 2], [Table 3]