Inadequate and/or poor quality sleep in early childhood impairs social-emotional and cognitive function (via effects on the developing brain), and markedly increases obesity risk (via hormonal and endocrine effects). Short sleep duration, behavioral sleep problems and sleep-disordered breathing peak at 20%-50%, during the preschool years (ages 3-5). Healthy sleep habits increase sleep duration and prevent behavioral sleep problems. Awareness of sleep-disordered breathing symptoms leads to timely treatment for it. Despite ample data on sleep problems ...much less work has been done on effective strategies to promote sleep as a healthy behavior (CDC 2013). This study's overarching goal is to empower families of preschool children with the knowledge and skills needed for healthy sleep, and to recognize a sleep problem. It builds on our work in Head Start, an early childhood education (ECE) program for disadvantaged preschool children and their families: Our Early Childhood Sleep Education Program (ECSEP(tm)) educates Head Start teachers, children, and parents about healthy sleep in a way they can process and understand. In a randomized controlled trial, the children in the ECSEP group slept 30 minutes longer/night. As well, our UCLA Health Care Institute's structured approach to low literacy health training in Head Start (to reduce ER visits, obesity, etc.) has reached >100,000 families. The proposed study will implement a Social-Ecological web of multi-level interventions to reinforce the ECSEP, and to promote healthy sleep throughout ECE. Within Head Start, we will create new delivery platforms (print & video, family visits) that 'amplify' the ECSEP. Beyond Head Start, we will educate communities, and partner with stakeholders on strategies designed to embed `sleep health literacy' in ECE policy. This project will: 1) Adapt sleep education material into additional multi media formats, and; apply the Health Care Institute model to train Head Start staff to mount interventions and collect data. 2) Enroll 540 parent-child dyads from 7 Head Start agencies in New York in a stepped wedge randomized controlled trial. We will analyze trial effects on primary outcomes: a) child sleep duration, b) parent knowledge, attitudes, self-efficacy and behavior, and c) child sleep difficulties. 3) Assess the feasibility of screening and guidance for sleep problems (vs. sleep health) for a future efficacy study. Secondary outcomes are: classroom behaviors, policy change, and process data. Poor sleep in early development has ramifications for years to come, perhaps through adulthood. Head Start serves low-income, mainly racial-ethnic minority families, in whom sleep health disparities are greatest-- but are modifiable. This study joins together proven methods of delivering health literacy (Health Care Institute) and sleep health (ECSEP) programs in Head Start. Intervening at every level of the Social-Ecological model maximizes the study's reach and sustainability. Integrating sleep health literacy into ECE nationwide could ultimately benefit upwards of 4 million children. The potential impact upon human health is far-reaching.

Public Health Relevance

This study aims to empower families in early childhood programs with the knowledge and self- management skills needed to obtain healthy sleep via interpersonal, organizational, community, and policy level interventions. A stepped wedge cluster randomized trial in Head Start will test effects upon child, parent, and classroom outcomes; a policy evaluation will assess the impact of knowledge translation strategies. Integrating `sleep health literacy' throughout early childhood programs could affect the life-course development of 4 million children, and meets the national health literacy goal to: 'embed accurate, accessible, and actionable information in...Head Start' and 'increase the amount of health education instruction in early childhood education,' (DHHS, 2010). .

National Institute of Health (NIH)
Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD)
Research Project (R01)
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Special Emphasis Panel (ZRG1)
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Lee, Karen
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Albert Einstein College of Medicine, Inc
United States
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Bonuck, Karen A; Goodlin-Jones, Beth L; Schechter, Clyde et al. (2017) Modified Children's sleep habits questionnaire for behavioral sleep problems: A validation study. Sleep Health 3:136-141
Bonuck, Karen A; Blank, Arthur; True-Felt, Barbara et al. (2016) Promoting Sleep Health Among Families of Young Children in Head Start: Protocol for a Social-Ecological Approach. Prev Chronic Dis 13:E121
Bonuck, Karen A; Schwartz, Barbara; Schechter, Clyde (2016) Sleep health literacy in head start families and staff: exploratory study of knowledge, motivation, and competencies to promote healthy sleep. Sleep Health 2:19-24