Exploring the Impact of COVID-19 Stress on Sleep Outcomes Mediated by Technology Use Among Adolescents: A Cross-Sectional Study Restricted; Files Only

Abstract

Background: COVID-19 pandemic was an adversarial event globally and constituted unique mental health impacts on the adolescent populations, including psychological stress and worries. Though research exist on the impact of stress on adolescents’ sleep, studies are limited in the context of pandemic as well as potential mediating factors. This study sought to examine the impact of COVID-19 stress on sleep outcomes and to determine if technology use mediated this relationship.

Methods: This cross-sectional survey was conducted in two semi-rural schools during the Fall of 2020. Descriptive statistics were examined for all study measures. Bivariate analyses were conducted to assess associations between demographic variables, exposure (COVID-19 stress), and ou,tcome measures (sleep). Linear and logistic regression analyses were run to identify predictors of sleep duration and daytime sleepiness.

Results: More than one-third of adolescents reported short sleep (37.1%) and 28.1% reported excessive daytime sleepiness. A significant percentage of adolescents reported moderate (38.0%) and extreme (17.5%) COVID-19 stress. The bivariate analysis showed differences in COVID-19 stress by gender, race, and SES (p value <0.05). Technology use was high with 55.5% reported 4 or more hours of TV/digital media watching while 43.5% reported use of social media for 4 or more hours. COVID-19 stress was also associated with use of social media. Logistic regression indicated that as COVID-19 stress increased, the odds of short sleep duration were slightly greater (OR: 1.03, 95%CI: 1.004, 1.055) compared to the odds of recommended sleep duration when adjusting for gender, race, parent education and employment. For daytime sleepiness, as COVID-19 stress increased, the odds of excessive daytime sleepiness were slightly higher (OR: 1.04 95%CI: 1.004, 1.075) than the odds of no/small chance of daytime sleepiness after controlling for covariates.

Conclusion: While this study revealed no or very weak relationship between COVID-19 stress and sleep outcomes, it identifies high COVID-19 stress and technology use as well as important demographic differences in COVID-19 stress among 10th-graders. The study findings call for programmatic interventions at school and community levels and affirms the need for integrated activity guidelines to limit screen time, increase physical activity and meet sleep recommendations among adolescents.   

Table of Contents

1.   Introduction........................................................................... 1

2.   Literature Review.................................................................... 2

a.   Insufficient Sleep: A Public Health Epidemic............................. 2

b.   Adolescence Sleep During Covid-19 Pandemic.......................... 3

c.    Insufficient Sleep and Poor Health Outcomes........................... 5

d.   Risk Factors Associated with Poor Sleep Outcomes.................... 7

e.    Role of COVID-19 Stress......................................................... 7

f.    Effect of Technology Use......................................................... 9

3.   Methodology......................................................................... 10

a.   Conceptual Framework...........................................................10

b.   Study Design..........................................................................11

c.    Study Participants................................................................ .11

d.   Data Source. .........................................................................12

e.   Data Measures...................................................................... 12

f.    Statistical Analysis................................................................15

4.   Results. ................................................................................15

5.   Discussion............................................................................19

a.   Strengths and Limitations. .....................................................21

b.   Future Research Direction......................................................22

c.    Implications. ........................................................................22

References..................................................................................23

Tables and Figures......................................................................34

Appendix A. Supplemental Tables................................................43

About this Master's Thesis

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School	Rollins School of Public Health
Department	Epidemiology
Subfield / Discipline	Epidemiology - MPH & MSPH
Degree	M.P.H.
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health Health Sciences, Epidemiology
Keyword	Daytime sleepiness Technology use Sleep duration Adolescents COVID-19 related stress
Committee Chair / Thesis Advisor	Julie Gazmararian, Emory University

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