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The internet is widely used by children and adolescents, who generally have a high level of competency with technology. Thus, the internet has become a great resource for supporting youth self-care and health-related services. However, few studies have explored adolescents' internet use for health-related matters. The objective of this systematic literature review was to examine the phenomenon of children and adolescents' health-related internet use and to identify gaps in the research. A total of 19 studies were selected from a search of major electronic databases: PubMed, Cumulative Index of Nursing and Allied Health Literature, and PsycINFO using the following search terms: \"health-related internet use,\" \"eHealth,\" \"Internet use for health-related purpose,\" \"Web-based resource,\" \"health information seeking,\" and \"online resource,\" combined with \"child,\" \"adolescent,\" \"student,\" \"youth,\" and \"teen.\" The children's and adolescents' ages were limited to 24 years and younger. The search was conducted from September 2015 to October 2017. The studies identified to contain youth (<24 years) health-related internet use were all published in peer-reviewed journals in the past 10 years; these studies examined general internet use seeking health care services, resources, information, or using the internet for health promotion and self-care. Studies were excluded if they explored the role of the internet as a modality for surveys, recruitment, or searching for relevant literature without specifically aiming to study participants' health-related internet use; focused solely on quality assurance for specific websites; or were designed to test a specific internet-based intervention. Interesting patterns in adolescents' health-related internet use, such as seeking preventative health care and specific information about medical issues, were identified. Quantitative studies reported rates of the internet use and access among youth, and the purpose and patterns of health-related internet use among youth were identified. A major objective of health-related internet use is to gain information, but there are inconsistencies in adolescents' perceptions of health-related internet use. This study's findings provide important information on how youth seek information and related support systems for their health care on the internet. The conceptual and methodological limitations of the identified studies, such as the lack of a theoretical background and unrepresentative samples, are discussed, and gaps within the studies are identified for future research. This review also suggests important features for potential Web-based health interventions for children and adolescents.

With the increasing burden of professional burnout in physicians, attention is being paid to optimizing sleep health, starting in training. The multiple dimensions of physicians’ sleep are not well described due to obstacles to easily and reliably measuring sleep. This pilot study tested the feasibility of using commercial wearable devices and completing manual sleep logs to describe sleep patterns of medical students and residents. Prospective pilot study of 50 resident physicians and medical students during a single year of training. Participants completed a manual sleep log while concurrently wearing the Fitbit Inspire device for 14-consecutive days over three clinical rotations of varying work schedules: light, medium, and heavy clinical rotations. Study completion was achieved in 24/50 (48%) participants. Overall correlation coefficients between the sleep log and Fitbit were statistically low; however, the discrepancies were acceptable, i.e., Fitbit underestimated time in bed and total sleep time by 4.3 and 2.7 minutes, respectively. Sleep onset time and waketime were within 8 minutes, with good agreement. Treatment of sleep episodes during the day led to variance in the data. Average missingness of collected data did not vary between medical students or residents or by rotation type. When comparing the light to heavy rotations, hours slept went from 7.7 (±0.64) to 6.7 (±0.88), quality-of-life and sleep health decreased and stress, burnout, and medical errors increased. Burnout was significantly associated with worse sleep health, hours worked, and quality-of-life. Prospective data collection of sleep patterns using both sleep logs and commercial wearable devices is burdensome for physicians-in-training. Using commercial wearable devices may increase study success as long as attention is paid to daytime sleep. In future studies investigating the sleep of physicians, the timing of data collection should account for rotation type.

Abstract This White Paper addresses the current gaps in knowledge, as well as opportunities for future studies in pediatric sleep. The Sleep Research Society’s Pipeline Development Committee assembled a panel of experts tasked to provide information to those interested in learning more about the field of pediatric sleep, including trainees. We cover the scope of pediatric sleep, including epidemiological studies and the development of sleep and circadian rhythms in early childhood and adolescence. Additionally, we discuss current knowledge of insufficient sleep and circadian disruption, addressing the neuropsychological impact (affective functioning) and cardiometabolic consequences. A significant portion of this White Paper explores pediatric sleep disorders (including circadian rhythm disorders, insomnia, restless leg and periodic limb movement disorder, narcolepsy, and sleep apnea), as well as sleep and neurodevelopment disorders (e.g. autism and attention deficit hyperactivity disorder). Finally, we end with a discussion on sleep and public health policy. Although we have made strides in our knowledge of pediatric sleep, it is imperative that we address the gaps to the best of our knowledge and the pitfalls of our methodologies. For example, more work needs to be done to assess pediatric sleep using objective methodologies (i.e. actigraphy and polysomnography), to explore sleep disparities, to improve accessibility to evidence-based treatments, and to identify potential risks and protective markers of disorders in children. Expanding trainee exposure to pediatric sleep and elucidating future directions for study will significantly improve the future of the field.

COVID-19 was a barrier to meeting recruitment goals in clinical trials particularly for behavioral interventions requiring innovative and evolving strategies. This paper explores recruitment approaches prior to, during, and after the in-person recruitment pause in a longitudinal randomized controlled trial (RCT) in which cancer survivors received one of two interventions to self-manage insomnia. An explanatory case study method was used to investigate pre, during, and post COVID-19 recruitment during a longitudinal RCT. Data analysis included descriptive frequencies of enrollment approaches and outcomes obtained from the research team’s weekly documented recruitment activities, and qualitative analysis of post-recruitment focus group of clinical partner experiences within the environmental context of the clinic settings. Team analysis included data triangulation between research team’s recruitment data and clinical staff experiences, and times series analysis with explanation building with team consensus on the final product. A total of 136 heterogenous cancer survivor participants were recruited utilizing both in-person and virtual strategies with an 87.5% retention rate. Variability in success of recruitment approaches over time was demonstrated within the environmental contexts. Overall, in-person recruitment was the most effective strategy (55.1%) followed by passive strategies of print outreach and social media (36.8%). A creative and persistent research team was needed to achieve the recruitment target with a high retention rate. Recruiting in-person post COVID-19 was challenging due to clinical staff barriers. The explanatory case study method offers insight into the complex recruitment process and potential approaches that could be implemented for future public health insomnia treatment studies.

Assessing the met and unmet needs of cancer survivors is critical in optimizing access to cancer services especially in underserved populations. The purpose of this study is to expand our understanding of the priority needs for cancer survivorship within racial/ethnic and underserved populations that speak either English or Spanish and seek health care in a federally qualified health center (FQHC). A convergent mixed methods design integrating survey and focus group data was utilized for this study. A total of 17 participants were enrolled in the study. The meta-inferences were drawn by looking across the top ten matched survey and focus group met and unmet needs including psychological, informational, and health system as well as patient care and support. The preferred languages of participants were Spanish 53% (n = 9) and English 47% (n = 8), and the survival breakdown was 65% (n = 11) within 0–5 years with 17.5% (n = 3), 6–10 years and 17.5% (n = 3), and 17.5% (n = 3) > 11 years. The most frequently met needs included health care providers and hospital staff being attentive to their physical and emotional needs and feeling they were treated with respect. Unmet needs were often related to physical and daily living needs such as pain, fatigue, sadness, depression, and not being able to work. Providing a needs-based approach of cancer health services in a FQHC or similar community-based health center is critical to meet the needs of cancer survivors to improve health outcomes and quality of life.

Background Electronic cigarettes (e-cigarettes) are relatively new tobacco products that are attracting public attention due to their unique features, especially their many flavor options and their potential as an alternative to cigarettes. However, uncertainties remain regarding the determinants and consequences of e-cigarette use because current research on e-cigarettes is made more difficult due to the lack of psychometrically sound instruments that measure e-cigarette related constructs. This systematic review therefore seeks to identify the instruments in the field that are designed to assess various aspects of e-cigarette use or its related constructs and analyze the evidence presented regarding the psychometric properties of the identified instruments. Methods This systematic review utilized six search engines: PubMed, Medline, CINAHL, PsycINFO, Web of Science, and EMBASE, to identify articles published in the peer-reviewed journals from inception to February 2022 that contained development or validation processes for these instruments. Results Eighteen articles describing the development or validation of 22 unique instruments were identified. Beliefs, perceptions, motives, e-cigarette use, and dependence, were the most commonly assessed e-cigarette related constructs. The included studies reported either construct or criterion validity, with 14 studies reporting both. Most studies did not report the content validity; for reliability, most reported internal consistencies using Cronbach’s alpha, with 15 instruments reporting Cronbach’s alpha > 0.70 for the scale or its subscales. Conclusions Twenty-two instruments with a reported development or validation process to measure e-cigarette related constructs are currently available for practitioners and researchers. This review provides a guide for practitioners and researchers seeking to identify the most appropriate existing instruments on e-cigarette use based on the constructs examined, target population, psychometric properties, and instrument length. The gaps identified in the existing e-cigarette related instruments indicate that future studies should seek to extend the validity of the instruments for diverse populations, including adolescents. Instruments that explore additional aspects of e-cigarette use and e-cigarette related constructs to help build a strong theoretical background and expand our current understanding of e-cigarette use and its related constructs, should also be developed.

Despite the increasing number of youth seeking health information on the internet, few studies have been conducted to measure digital health literacy in this population. The digital health literacy instrument (DHLI) is defined as a scale that measures the ability to operate digital devices and read and write in web-based modes, and it assesses seven subconstructs: operational skills, navigation skills, information searching, evaluating reliability, determining relevance, adding self-generated content to a web-based app, and protecting privacy. Currently, there is no validation process of this instrument among adolescents. This study aims to explore the usability and content validity of DHLI. Upon the approval of institutional review board protocol, cognitive interviews were conducted. A total of 34 adolescents aged 10-18 years (n=17, 50% female) participated in individual cognitive interviews. Two rounds of concurrent cognitive interviews were conducted to assess the content validity of DHLI using the thinking aloud method and probing questions. Clarity related to unclear wording, undefined technical terms, vague terms, and difficult vocabularies was a major issue identified. Problems related to potentially inappropriate assumptions were also identified. In addition, concerns related to recall bias and socially sensitive phenomena were raised. No issues regarding response options or instrument instructions were noted. The initial round of interviews provided a potential resolution to the problems identified with comprehension and communication, whereas the second round prompted improvement in content validity. Dual rounds of cognitive interviews provided substantial insights into survey interpretation when introduced to US adolescents. This study examined the validity of the DHLI and suggests revision points for assessing adolescent digital health literacy.

Electronic cigarettes (e-cigarettes) have been widely promoted on the internet, and subsequently, social media has been used as an important informative platform by e-cigarette users. Beliefs and knowledge expressed on social media platforms have largely influenced e-cigarette uptake, the decision to switch from conventional smoking to e-cigarette smoking, and positive and negative connotations associated with e-cigarettes. Despite this, there is a gap in our knowledge of people's perceptions and sentiments on e-cigarettes as depicted on social media platforms. This study aimed to (1) provide an overview of studies examining the perceptions and sentiments associated with e-cigarettes on social media platforms and online discussion forums, (2) explore people's perceptions of e-cigarette therein, and (3) examine the methodological limitations and gaps of the included studies. Searches in major electronic databases, including PubMed, Cumulative Index of Nursing and Allied Health Literature, EMBASE, Web of Science, and Communication and Mass Media Complete, were conducted using the following search terms: \"electronic cigarette,\" \"electronic vaporizer,\" \"electronic nicotine,\" and \"electronic nicotine delivery systems\" combined with \"internet,\" \"social media,\" and \"internet use.\" The studies were selected if they examined participants' perceptions and sentiments of e-cigarettes on online forums or social media platforms during the 2007-2017 period. A total of 21 articles were included. A total of 20 different social media platforms and online discussion forums were identified. A real-time snapshot and characteristics of sentiments, personal experience, and perceptions toward e-cigarettes on social media platforms and online forums were identified. Common topics regarding e-cigarettes included positive and negative health effects, testimony by current users, potential risks, benefits, regulations associated with e-cigarettes, and attitude toward them as smoking cessation aids. Although perceptions among social media users were mixed, there were more positive sentiments expressed than negative ones. This study particularly adds to our understanding of current trends in the popularity of and attitude toward e-cigarettes among social media users. In addition, this study identified conflicting perceptions about e-cigarettes among social media users. This suggests that accurate and up-to-date information on the benefits and risks of e-cigarettes needs to be disseminated to current and potential e-cigarette users via social media platforms, which can serve as important educational channels. Future research can explore the efficacy of social media-based interventions that deliver appropriate information (eg, general facts, benefits, and risks) about e-cigarettes. PROSPERO CRD42019121611; https://tinyurl.com/yfr27uxs.

Introduction Considering the increasing number of studies that report on ecological momentary assessment by uses of sleep diary and actigraphy, it may also be valuable to consider the relationship between fluctuations that exists in sleep measures on adolescent health outcomes. Above the impact of mean sleep measures, intraindividual variability (IIV) in sleep provides information on the degree to which daily variations or fluctuations in sleep/wake patterns are occurring and may prompt important cues to adolescents’ health outcome. The present study examined the objective IIV in sleep and its relationship to their sleep and mental health outcomes among adolescents with history of alcohol use. Methods The study analyzed 8 days of wrist actigraphy data from 72 high school students reporting prior alcohol use (58.3% female; mean age 17.0 years). Bayesian variability method using varian (R package) was performed to calculate IIV in total sleep time (TST), time in bed (TIB), midpoint sleep, bedtime, and risetime. Participants also completed Pittsburgh Sleep Quality Index (PSQI), Cleveland Adolescent Sleepiness Questionnaire (CASQ), Inventory of Depressive Symptomatology (IDS-SR-30), Chapman’s Inventories – Social Anhedonia (CHAPSAS), and Rutgers Alcohol Problem Index (RAPI). Multiple linear regression models were adjusted for biological sex, age, and the sum of alcohol drinks in the past 3 months. Results Participants reported average of 18.52 (SD=23.10) total drinks consumed over the past 3 months. IIV in TST, TIB, and risetime were associated with lower sleep quality (B=3.04, 95% CI, 0.02, 7.39, p< 0.05 for IIV in TST; B=2.87, 95% CI, 0.39, 5.88, p< 0.05 for IIV in TIB; and B=2.74, 95% CI, 0.57, 6.19, p< 0.05 for IIV in risetime, respectively). There was no statistically significant association between IIV of sleep measures and excessive daytime sleepiness or mental health outcomes such as social anhedonia, depressive symptoms, and problematic alcohol use. Conclusion Greater fluctuation in TST, TIB, and risetime were negatively associated with overall sleep quality. Our findings add to a growing body of research on IIV in sleep/wake patterns and clinical implications. Future studies should explore the prospective relationship between variability in sleep and other various health outcomes. Support (if any) NIH/NIAAA R01AA025626 (Hasler); Sleep Research Society Foundation Mentor-Mentee Award (Kwon)

Introduction More than 50% of cancer survivors suffer from insomnia symptoms before, during or after cancer treatments, which may eventually progress to an insomnia disorder if not addressed. The current study aims to identify which of the demographic and clinical characteristics relate to subthreshold and clinical insomnia categorized according to Insomnia Severity Index (ISI), among heterogeneous sample of cancer survivors with insomnia symptoms (ISI score >7). Methods Baseline data from participants (n=136) from an ongoing trial were used. All participants completed demographic and clinical characteristic assessments (e.g., ISI, Pittsburgh Sleep Quality Index [PSQI], Hospital Anxiety and Depression Scale [HADS], 7-day sleep diary). Descriptive statistics were calculated for demographic and clinical variables. Bivariate comparisons of these variables by insomnia subgroups (subthreshold vs. clinical insomnia) were performed using Fisher's exact test. Results The sample included 60 breast, 48 prostate, 19 colorectal, and 7 lung cancer survivors (55.9% female; age=63.8 y, range: 32-82; 87.5% White; BMI=27.9±6.1 kg/m2). The analytical sample (n=134) comprised of 64.7% (n=88) subthreshold and 33.8% (n=46) clinical insomnia subgroups. Those in subthreshold subgroup consisted of more females (n=54, 40.3% vs. n=20, 14.9%), ≥ 65 y (n=51, 38.1% vs. n=22, 16.4%), and >25 BMI (n=55, 41.0% vs. n=35, 26.1%) than those in clinical subgroup. No statistically significant association between previously discussed variables were found. Both subthreshold and clinical insomnia groups had higher number of those with poor sleep quality than good, and sleep efficiency less than 85% than those with ≥85%, by PSQI and sleep diary, respectively. Of the subthreshold subgroup, 87 (64.9%) were identified as having no symptoms of depression, and 80 (59.7%) as having no anxiety, compared to those with symptoms. This was similar for the clinical subgroup where 37 (27.6%) had no symptoms of depression and 27 (20.1%) with no anxiety, compared to those with symptoms. There were statistically significant associations between insomnia subgroups and depression (p<.001) and anxiety (p<.001), respectively. Conclusion Preliminary descriptive findings highlight significant characteristics of cancer survivors with subthreshold and clinical insomnia. More clinical symptoms were present among clinical insomnia group. PSQI may identify poor sleepers in cancer survivors. Support (if any) NIH/NINR R01NR018215 (Dean), ClinicalTrials-NCT03810365