Assessing Changes in Adolescents’ Sleep Characteristics and Dietary Quality in the START Study, a Natural Experiment on Delayed School Start Time Policies
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Background Sleep duration, quality, and timing may influence dietary quality. In adults, poor dietary quality is a risk factor for numerous chronic diseases. It is unclear how these various sleep domains influence adolescents' diets because prior population-based studies have not effectively manipulated sleep, did not include objective sleep measures, and had short follow-up times. Objectives The objectives of this study were to examine 1) how adolescent sleep characteristics relate to dietary quality; and 2) how delay in high school start times (which lengthened sleep duration) affects dietary quality over 2 y. Methods In the START study, adolescents (grades 9-11, n = 423) attending 5 high schools in the Minneapolis, Minnesota metropolitan area were annually assessed in 3 waves (2016-2018). At Baseline, all schools started "early" (07:30 or 07:45). From Follow-up 1 through Follow-up 2, 2 "policy change schools" shifted to later start times (to 08:20 and 08:50). Three "comparison schools" maintained their early start throughout. Sleep characteristics were measured with actigraphy. Mixed-effect regression models were used to examine cross-sectional and longitudinal associations of sleep characteristics with dietary quality, and school start time policy change with dietary quality change. Results Cross-sectionally, later sleep midpoint and onset were associated with dietary quality scores 1.6-1.7 lower (both P < 0.05). However, no prospective associations were observed between sleep characteristics and dietary quality in longitudinal models. Shifting to later school start time tended to be associated with a 2.4-point increase in dietary quality score (P = 0.09) at Follow-up 1, but was not associated with change in dietary quality scores at Follow-up 2 (P = 0.35). Conclusions High school students attending delayed-start schools maintained better dietary quality than students in comparison schools; however, differences were not statistically significant. Overall study findings highlight the complexity of the relation between sleep behavior and diet in adolescence.
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Preliminary findings show better dietary quality and more healthful weight behaviors of students attending delayed-start schools compared to their peers.
“the preliminary findings show better dietary quality and more healthful weight behaviors of students attending delayed-start schools compared to their peers [68,105,106].”
From Later School Start Times as a Public Health Intervention to Promote Sleep Health in Adolescents (2023) · cites this paper as [106]
Cites
R: A Language and Environment for Statistical Computing
R Core Team (2000) · doi:10.32614/r.manuals · Cited by 355,706 · see citing works
National Sleep Foundation's sleep time duration recommendations: methodology and results summary.
Hirshkowitz, M., Whiton, K., Albert, S. M., Alessi, C., Bruni, O., DonCarlos, L., Hazen, N., Herman, J., Katz, E. S., Kheirandish-Gozal, L., et al. (2015) · Sleep Health · doi:10.1016/j.sleh.2014.12.010 · Cited by 4,404 · see citing works
The Role of Actigraphy in the Study of Sleep and Circadian Rhythms
Ancoli-Israel, S., Cole, R., Alessi, C., Chambers, M., Moorcroft, W., & Pollak, C. P. (2003) · Sleep · doi:10.1093/sleep/26.3.342 · Cited by 2,751 · see citing works
Life between Clocks: Daily Temporal Patterns of Human Chronotypes
Roenneberg, T., Wirz-Justice, A., & Merrow, M. (2003) · Journal of Biological Rhythms · doi:10.1177/0748730402239679 · Cited by 2,662 · see citing works
Update of the Healthy Eating Index: HEI-2015
Krebs‐Smith, S. M., Pannucci, T. E., Subar, A. F., Kirkpatrick, S. I., Lerman, J., Tooze, J. A., Wilson, M. M., & Reedy, J. (2018) · Journal of the Academy of Nutrition and Dietetics · doi:10.1016/j.jand.2018.05.021 · Cited by 2,303 · see citing works
Cappuccio, F. P., Cooper, D., D'Elia, L., Strazzullo, P., & Miller, M. A. (2011) · European Heart Journal · doi:10.1093/eurheartj/ehr007 · Cited by 2,146 · see citing works
Automatic sleep/wake identification from wrist activity.
Cole, R., Kripke, D., Gruen, W., Mullaney, D., & Gillin, J. (1992) · Sleep · doi:10.1093/sleep/15.5.461 · Cited by 1,971 · see citing works
Quantity and Quality of Sleep and Incidence of Type 2 Diabetes
Cappuccio, F. P., D'Elia, L., Strazzullo, P., & Miller, M. A. (2010) · Diabetes Care · doi:10.2337/dc09-1124 · Cited by 1,670 · see citing works
Insufficient Sleep in Adolescents and Young Adults: An Update on Causes and Consequences
Owens, J., ADOLESCENT SLEEP WORKING GROUP, COMMITTEE ON ADOLESCENCE, Au, R., Carskadon, M., Millman, R., Wolfson, A., Braverman, P. K., Adelman, W. P., Breuner, C. C., et al. (2014) · Pediatrics · doi:10.1542/peds.2014-1696 · Cited by 1,413 · see citing works
St-Onge, M.-P., Grandner, M. A., Brown, D., Conroy, M. B., Jean-Louis, G., Coons, M., & Bhatt, D. L. (2016) · Circulation · doi:10.1161/cir.0000000000000444 · Cited by 1,044 · see citing works
Subar, A. F., Kirkpatrick, S. I., Mittl, B., Zimmerman, T. P., Thompson, F. E., Bingley, C., Willis, G., Islam, N. G., Baranowski, T., McNutt, S., et al. (2012) · Journal of the Academy of Nutrition and Dietetics · doi:10.1016/j.jand.2012.04.016 · Cited by 934 · see citing works
Regulation of adolescent sleep: Implications for behavior
CARSKADON, M. A., ACEBO, C., & JENNI, O. G. (2004) · Annals of the New York Academy of Sciences · doi:10.1196/annals.1308.032 · Cited by 792 · see citing works
An update on adolescent sleep: New evidence informing the perfect storm model <sup>☆</sup>
Crowley, S. J., Wolfson, A. R., Tarokh, L., & Carskadon, M. A. (2018) · Journal of Adolescence · doi:10.1016/j.adolescence.2018.06.001 · Cited by 684 · see citing works
The SBSM Guide to Actigraphy Monitoring: Clinical and Research Applications
Ancoli‐Israel, S., Martin, J. L., BLACKWELL, T. L., Buenaver, L. F., Liu, L., Meltzer, L. J., Sadeh, A., Spira, A. P., & Taylor, D. J. (2015) · Behavioral Sleep Medicine · doi:10.1080/15402002.2015.1046356 · Cited by 561 · see citing works
The link between short sleep duration and obesity: we should recommend more sleep to prevent obesity
Taheri, S. (2006) · Archives of Disease in Childhood · doi:10.1136/adc.2005.093013 · Cited by 510 · see citing works
Sleepless in Chicago: Tracking the Effects of Adolescent Sleep Loss During the Middle School Years
Fredriksen, K., Rhodes, J., Reddy, R., & Way, N. (2004) · Child Development · doi:10.1111/j.1467-8624.2004.00655.x · Cited by 510 · see citing works
School Start Times for Adolescents
ADOLESCENT SLEEP WORKING GROUP, COMMITTEE ON ADOLESCENCE, COUNCIL ON SCHOOL HEALTH, Au, R., Carskadon, M., Millman, R., Wolfson, A., Braverman, P. K., Adelman, W. P., Breuner, C. C., et al. (2014) · Pediatrics · doi:10.1542/peds.2014-1697 · Cited by 468 · see citing works
Sleep patterns, diet quality and energy balance
Chaput, J. (2013) · Physiology & Behavior · doi:10.1016/j.physbeh.2013.09.006 · Cited by 466 · see citing works
The Prospective Association between Sleep Deprivation and Depression among Adolescents
ROBERTS, R. E., & Duong, H. T. (2014) · SLEEP · doi:10.5665/sleep.3388 · Cited by 459 · see citing works
Kirkpatrick, S. I., Subar, A. F., Douglass, D., Zimmerman, T. P., Thompson, F. E., Kahle, L., George, S. M., Dodd, K. W., & Potischman, N. A. (2014) · American Journal of Clinical Nutrition · doi:10.3945/ajcn.114.083238 · Cited by 451 · see citing works
Impact of Delaying School Start Time on Adolescent Sleep, Mood, and Behavior
Owens, J. A., Belon, K., & Moss, P. (2010) · Archives of Pediatrics & Adolescent Medicine · doi:10.1001/archpediatrics.2010.96 · Cited by 430 · see citing works
Garaulet, M., Ortega, F. B., Ruiz, J. R., Rey-López, J. P., Béghin, L., Μanios, Y., Cuenca‐García, M., Plada, M., Diethelm, K., Kafatos, A., et al. (2011) · International Journal of Obesity · doi:10.1038/ijo.2011.149 · Cited by 423 · see citing works
Associations of chronotype and sleep with cardiovascular diseases and type 2 diabetes
Merikanto, I., Lahti, T., Puolijoki, H., Vanhala, M., Peltonen, M., Laatikainen, T., Vartiainen, E., Salomaa, V., Kronholm, E., & Partonen, T. (2013) · Chronobiology International · doi:10.3109/07420528.2012.741171 · Cited by 368 · see citing works
Evening chronotype is associated with metabolic disorders and body composition in middle-aged adults
Yu, J. H., Yun, C.-H., Ahn, J. H., Suh, S., Cho, H. J., Lee, S. K., Yoo, H. J., Seo, J. A., Kim, S. G., Choi, K. M., et al. (2015) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2014-3754 · Cited by 358 · see citing works
Delayed school start times and adolescent sleep: A systematic review of the experimental evidence
Minges, K. E., & Redeker, N. S. (2016) · Sleep Medicine Reviews · doi:10.1016/j.smrv.2015.06.002 · Cited by 338 · see citing works
The Association of Sleep Duration with Adolescents' Fat and Carbohydrate Consumption
Weiss, A. R., Xu, F., Storfer‐Isser, A., Thomas, A., Ievers‐Landis, C. E., & Redline, S. S. (2010) · SLEEP · doi:10.1093/sleep/33.9.1201 · Cited by 295 · see citing works
Self-citationGolley, R. K., Maher, C. A., Matricciani, L., & Olds, T. S. (2013) · International Journal of Obesity · doi:10.1038/ijo.2012.212 · Cited by 286 · see citing works
Crowley, S. J., Van Reen, E., LeBourgeois, M. K., Acebo, C., Tarokh, L., Seifer, R., Barker, D. H., & Carskadon, M. A. (2014) · PLoS ONE · doi:10.1371/journal.pone.0112199 · Cited by 273 · see citing works
Associations among late chronotype, body mass index and dietary behaviors in young adolescents
Arora, T., & Taheri, S. (2014) · International Journal of Obesity · doi:10.1038/ijo.2014.157 · Cited by 256 · see citing works
Lack of sleep as a contributor to obesity in adolescents: impacts on eating and activity behaviors
Chaput, J.-P., & Dutil, C. (2016) · International Journal of Behavioral Nutrition and Physical Activity · doi:10.1186/s12966-016-0428-0 · Cited by 243 · see citing works
Changing Times: Findings From the First Longitudinal Study of Later High School Start Times
Wahistrom, K. (2002) · NASSP Bulletin · doi:10.1177/019263650208663302 · Cited by 237 · see citing works
Dietary Intake Following Experimentally Restricted Sleep in Adolescents
Beebe, D. W., Simon, S., Summer, S., Hemmer, S., Strotman, D., & Dolan, L. M. (2013) · Sleep · doi:10.5665/sleep.2704 · Cited by 232 · see citing works
Validity of Activity-Based Devices to Estimate Sleep
Weiss, A. R., Johnson, N. L., Berger, N. A., & Redline, S. S. (2010) · Journal of Clinical Sleep Medicine · doi:10.5664/jcsm.27874 · Cited by 225 · see citing works
Self-citationEaton, D. K., McKnight-Eily, L. R., Lowry, R., Perry, G. S., Presley-Cantrell, L., & Croft, J. B. (2010) · Journal of Adolescent Health · doi:10.1016/j.jadohealth.2009.10.011 · Cited by 202 · see citing works
The Association between Chronotype and Dietary Pattern among Adults: A Scoping Review
Mazri, F. H., Manaf, Z. A., Shahar, S., & Mat Ludin, A. F. (2019) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph17010068 · Cited by 198 · see citing works
Sleep and Obesity in Children and Adolescents
Hart, C. N., Cairns, A., & Jelalian, E. (2011) · Pediatric Clinics of North America · doi:10.1016/j.pcl.2011.03.007 · Cited by 181 · see citing works
Association between chronotype and diet in adolescents based on food logs
Fleig, D., & Randler, C. (2009) · Eating Behaviors · doi:10.1016/j.eatbeh.2009.03.002 · Cited by 175 · see citing works
Paiva, T., Gaspar, T., & de Matos, M. G. (2015) · Sleep Medicine · doi:10.1016/j.sleep.2014.10.010 · Cited by 160 · see citing works
Bowers, J. M., & Moyer, A. (2017) · Sleep Health · doi:10.1016/j.sleh.2017.08.004 · Cited by 156 · see citing works
Westerlund, L., Ray, C., & Roos, E. (2009) · British Journal Of Nutrition · doi:10.1017/s0007114509990730 · Cited by 148 · see citing works
Sweet/Dessert Foods Are More Appealing to Adolescents after Sleep Restriction
Simon, S. L., Field, J., Miller, L. E., DiFrancesco, M. W., & Beebe, D. W. (2015) · PLoS ONE · doi:10.1371/journal.pone.0115434 · Cited by 112 · see citing works
Restricted Sleep Among Adolescents: Prevalence, Incidence, Persistence, and Associated Factors
ROBERTS, R. E., Roberts, C. R., & Xing, Y. (2011) · Behavioral Sleep Medicine · doi:10.1080/15402002.2011.533991 · Cited by 101 · see citing works
Association of Delaying School Start Time With Sleep Duration, Timing, and Quality Among Adolescents
Widome, R., Berger, A. T., Iber, C., Wahlstrom, K. L., Laska, M. N., Kilian, G., Redline, S. S., & Erickson, D. J. (2020) · Archives of Pediatrics and Adolescent Medicine · doi:10.1001/jamapediatrics.2020.0344 · Cited by 99 · see citing works
Self-citationAssociation between self-reported sleep duration and dietary quality in European adolescents
Bel, S., Michels, N., Vriendt, T. D., Patterson, E., Cuenca‐García, M., Diethelm, K., Gutin, B., Grammatikaki, E., Μanios, Y., Leclercq, C., et al. (2013) · British Journal Of Nutrition · doi:10.1017/s0007114512006046 · Cited by 90 · see citing works
An alternative measure of sleep fragmentation in clinical practice: the sleep fragmentation index
Haba‐Rubio, J., IBANEZ, V., & Sforza, E. (2004) · Sleep Medicine · doi:10.1016/j.sleep.2004.06.007 · Cited by 87 · see citing works
Grummon, A. H., Sokol, R. L., & Lytle, L. A. (2020) · Public Health Nutrition · doi:10.1017/s1368980020002050 · Cited by 57 · see citing works
Sleep, Hunger, Satiety, Food Cravings, and Caloric Intake in Adolescents
Landis, A. M., Parker, K. P., & Dunbar, S. B. (2009) · Journal of Nursing Scholarship · doi:10.1111/j.1547-5069.2009.01262.x · Cited by 54 · see citing works
Agostini, A., Lushington, K., Kohler, M. J., & Dorrian, J. (2018) · Journal of Sleep Research · doi:10.1111/jsr.12682 · Cited by 37 · see citing works
Troxel, W., & Wolfson, A. R. (2017) · Sleep Health · doi:10.1016/j.sleh.2017.10.001 · Cited by 28 · see citing works
Widome, R., Wahlstrom, K. L., Laska, M. N., Erickson, D. J., Berger, A. T., Iber, C., & Kilian, G. (2020) · Observational Studies · doi:10.1353/obs.2020.0013 · Cited by 13 · see citing works
Self-citationLater start time for teens improves grades, mood, and safety
Wahlstrom, K. L. (2016) · Phi Delta Kappan · doi:10.1177/0031721716681770 · Cited by 10 · see citing works
Adams, C. D., & Neuhausen, S. L. (2019) · Nutrition Metabolism and Cardiovascular Diseases · doi:10.1016/j.numecd.2019.06.020 · Cited by 9 · see citing works
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Mousavi, Z., & Troxel, W. M. (2023) · Current Sleep Medicine Reports · doi:10.1007/s40675-023-00263-8 · Cited by 18 · see citing works
Sugimoto, M., Murakami, K., & Sasaki, S. (2022) · Public Health Nutrition · doi:10.1017/s1368980022001148 · Cited by 11 · see citing works
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- Authors
- Full, K. M., Berger, A. T., Erickson, D., Berry, K. M., Laska, M. N., Lenk, K. M., Iber, C., Redline, S., & Widome, R.
- Affiliations
- University of Minnesota (US)
- Brigham and Women's Hospital (US)
- Corresponding author
- Full, Kelsie M
- ORCID
- Venue
- The Journal of Nutrition
- Publisher
- Elsevier BV
- Published
- 2021-09
- Volume
- 151
- Issue
- 9
- Pages
- 2808-2815
- ISSN
- 0022-3166 (ISSN-L)
- PMC
- PMC8417921
- OpenAlex
- W3165083554
- Cited by
- 7
- References
- 52
- Citations by year
- 2025: 3 · 2023: 3 · 2022: 1
- FWCI
- 0.97
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of Nutrition (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Eunice Kennedy Shriver National Institute of Child Health and Human Development (R01 HD088176, T32 HD095134)
- National Heart, Lung, and Blood Institute (T32 HL007779)
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Life Sciences › Neuroscience › Endocrine and Autonomic Systems › Circadian rhythm and melatonin
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and Work-Related Fatigue
- Keywords
- adolescent sleep, diet quality, school start time, sleep duration, sleep timing, sleep midpoint, sleep onset, actigraphy, high school students, nutrition policy
- MeSH terms
- Adolescent, Cross-Sectional Studies, Diet, Humans, Schools, Sleep, Time Factors, Policy
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