Prepared by Bindu John, PhD, College of Health Sciences, the University of Bahrain for International Conference on Public Health and Well-being 2019, 4-5 April, Negombo, Sri Lanka

1. Prepared By:
Bindu John, PhD (N),
College of Health Sciences, University of Bahrain.
Health Promotion in School-going
adolescents: Does The
Biopsychosocial Correlates Have a
Significant Role Over Sleep
Behavioral Practices?

2. Contents
Significance of the study
Purpose
Objectives
Methodology
Results & Discussion
Conclusion

3. Significance of the study

4. Aim of the Study
The study aimed at examining the influence of various
biopsychosocial correlates on adolescents’ sleep
behavioral practices.

5. Objectives of the Study
Assess the sleep behavioral practices among adolescents (sleep
hygiene practices, sleep quality and daytime sleepiness).
Examine the various biopsychosocial correlates influencing sleep (age,
gender, grade level, problems at home, afterschool classes, extracurricular
activities).
Identify the association of various biopsychosocial correlates’ influence
on adolescents’ sleep behavioral practices.

6. Methodology
Design: Cross-sectional study design.
Setting: Six selected schools in Mangalore city, India.
Study Population: Healthy, school-going adolescents from grade VI
to grade VII.
Sample size: 660 adolescents.
Sampling technique: Stratified random sampling.

7. Data Collection
Tools
4. Cleveland
Adolescent
Sleepiness
Questionnaire .9
A 16-item
questionnaire with
score ranging from
16-80, with higher
scores indicating
higher daytime
sleepiness (DTS).
Cronbach’s alpha is
0.89.
1. Socio-
demographic and
sleep
questionnaire.
A 16-item
questionnaire on
socio-demographic
information with
few supplementary
questions on sleep
and activity (age,
gender, grade
level, problems at
home, afterschool
classes,
extracurricular
activities).
2. Sleep
Hygiene Index.7
A 13-item
questionnaire,
with score
ranging from 13-
65 on a five-point
Likert scale.
Higher score
indicates more
maladaptive
sleep hygiene
practices
Cronbach’s
alpha in
pretesting phase
0.708.
3. Pittsburgh
Sleep Quality
Index.8
For assessing
sleep quality, with
score range from
0-21, with score
greater than ‘5’
indicating worse
sleep quality.
Cronbach’s alpha
is 0.83.

8. Results

9. Demographic characteristics of
adolescents
Age: Between 11-
17 years.
11-14 Years (Early
adolescents)
15-17 years
(Middle
Adolescents)

10. Grade-wise distribution of participants
202 (31%)
200 (30%)
141 (21%)
117 (18%)
Grade-wise Distribution of the Participants
Grade 6 & 7
Grade 8 & 9
Grade 10
Grade 11 & 12

11. Sleep Hygiene Practices among
Adolescents
Least
maladaptive
sleep hygiene
practices
Moderate
maladaptive sleep
hygiene practices
Severe
maladaptive sleep
hygiene practices
0.2 %(1)
38.2%
(252)
61.7%
(407)
The mean sleep
hygiene score
among adolescents
was M = 28.6 ± 6.5.
Distribution of different levels of sleep hygiene among adolescents

12. Overall Sleep Quality among Adolescents
53% (347)
313 (47%)
Poor Sleep
Quality
Good Sleep
Quality
The mean global
overall sleep quality
score among
adolescents was
M= 5.8 ± 2.2.
Distribution of different levels of overall Sleep Quality
among adolescents

13. Daytime Sleepiness among Adolescents
70%(462)
29% (194)
1% (4)
Mild day time sleepiness
Moderate day time sleepiness
Excessive day time sleepiness
The mean daytime
sleepiness score among
adolescents was
M= 32.9 ± 8.8.

14. Association of Age with sleep behavioral
variables
Variables
Early Adolescents Middle Adolescents Test Statistics P-value
Mean ± SD Mean ± SD
Sleep Hygiene $ 28.3 ± 6.6 29.3 ± 6.3
1.92 0.056
Daytime Sleepiness $ 32.0 ± 8.3
34.6 ± 9.6 3.52** 0.000
Sleep Quality¥- (Count & Percent)
Good Sleep Quality 232; 52.3%
81; 37.5% 12.68**
0.000
Poor Sleep Quality 212; 47.7% 135; 62.5%
$- F- test ¥- Chi Square test **: - Significant at 0.01 level *Significant at 0.05 level

15. Association of Grade-level with sleep
behavioral variables
Association of Grade level with
Target Variables
Grade 6 & 7 Grade 8 & 9 Grade 10 Grade 11 & 12 Test
Statistics
P-value
Mean ± SD Mean ± SD Mean ±
SD
Mean ± SD
Sleep Hygiene $ 28.5 ± 6.8 27.8 ± 6.3 29.4 ± 6.4 29.5 ± 6.4 2.63* 0.049
Daytime Sleepiness $ 31.6 ± 8.3 31.7 ± 8.1 33.9 ± 9.4 35.7± 9.5
7.42**
0.000
Sleep Quality ¥-(Count & Percent)
Good Sleep Quality 117 (57.9%) 96 (48%) 58 (41.1%) 42 (35.9%) 17.42** 0.001
Poor Sleep Quality 85 (42.1%) 104 (52%) 83 (58.9%) 75 (64.1)
$- F- test ¥- Chi Square test **: - Significant at 0.01 level *Significant at 0.05 level

16. Problems at Home and its association with
Sleep Behavioral Variables
Association of Problems at home
with Target Variables
Yes No Test Statistics P-value
Mean ± SD Mean ± SD
Sleep Hygiene $ 31.6 ± 6.4
28.2 ± 6.5 4.59** 0. 000
Daytime Sleepiness $ 36.9 ± 9.1
32.2 ± 8.7 4.75** 0.000
Sleep Quality ¥- (Count & Percent)
Good Sleep Quality 24 (27 %) 289 (50.6 %)
17.27**
0.000
Poor Sleep Quality 65 (73 %) 282 (49.4 %)
$- F- test ¥- Chi Square test **: - Significant at 0.01 level *Significant at 0.05 level

17. Time Spent for Additional Classes and its
association with Sleep Behavioral Variables
$- F- test ¥- Chi Square test **: - Significant at 0.01 level *Significant at 0.05 level
Association of Average time in
hours Spent with Target
Variables
<=7 hours 8 - 14 hours 15 and more
hours
Test
Statistics
P-value
Mean ± SD Mean ± SD Mean ± SD
Sleep Hygiene $ 27.8 ± 6.7 29.8 ± 6.6 29.9 ± 6.0 3.31* 0. 038
Daytime Sleepiness $ 31.9 ± 9.1 35.0 ± 9.3
38.8 ± 11.3 8.87** 0.000
Sleep Quality ¥- (Count & Percent)
Good Sleep Quality 53 (52 %) 64 (37.4 %) 10 (22.2%) 12.48** 0.002
Poor Sleep Quality 49 (48.0%) 107 (62.6 %) 35 (77.8%)

18. Frequency of extra curricular activities and its
association with Sleep Behavioral Variables
$- F- test ¥- Chi Square test **: - Significant at 0.01 level *Significant at 0.05 level
Association Frequency of
Engagement of Activities
with Target Variables
Always Very Often Sometimes Rarely/Never Test
Statistics
P-value
Mean ± SD Mean ± SD Mean ± SD Mean ± SD
Sleep Hygiene $ 30.0 ± 6.8 28.0 ± 6.3 28.2 ± 6.4 28.5 ± 7.0 3.35* 0.019
Daytime Sleepiness $ 33.7 ± 9.2 30.9 ± 8.9 33.0 ± 8.0 35.9± 12.0 4.81** 0.003
Sleep
Quality¥
(Count &
Percent)
Good Sleep
Quality
70 (41.4%) 83 (53.2%) 144(48.5%) 16 (42.1)
5.1 0.165
Poor Sleep
Quality
99 (58.6%) 73 (46.8%) 153 (51.5%) 22 (57.9%)

19. In contrast to the present
study,
inconsistent bedtime was
associated with
increased age in a study
conducted in U.S.A.10
Total reduction in
sleep duration and
increased daytime
sleepiness with
higher age is
reported other
studies. 11
Similar to the present study
results, increasing levels of
daytime sleepiness and
negative trends in good sleep
quality with higher grade levels
is reported in other studies.12, 13
A study conducted in
Greece had shown an
influence of total hours
of sleep with excessive
tuition classes and social
activities. 14
In contrast to this study
results, vigorous
physical activity had
found to be associated
with sufficient sleep in
Georgia.15
In a Finland based study, home
atmosphere was found to be
linked with perceived sleep
quality, and in U.K., increased
sleep disturbances was reported
with non-shared environmental
factors such as family problems.
16, 17

20. Conclusion
The study highlights the
importance of
biopsychosocial correlates
in adolescent sleep
behaviors.
A healthy and supportive school atmosphere,
moderate levels of activity, measures to ease
stress, and load of school work gain a significant
weightage in adolescent sleep.
Healthy sleep, such as a
consistent bedtime
improves physical, mental
and emotional health and
well-being in adolescents.

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