Enhancing a Technology and Digital Media Use Intervention to Address Youth Sleep Problems

About This Grant

Over half of adolescents obtain insufficient sleep duration (less than age-based guidance) on school nights, while 10-40% report difficulty falling/staying asleep and poor sleep quality, all of which are linked to mental health problems. While TDM use is highly prevalent in adolescence and a critical factor in sleep problems, few effective sleep interventions specifically address family TDM use rules and can be scaled in primary care, an accessible setting where families often raise sleep and TDM use concerns in pediatrician visits. Our prior randomized trial found that pediatricians can deliver brief TDM-related counseling with positive youth and family outcomes. These findings contributed to the American Academy of Pediatrics (AAP) Family Media Plan (FMP), a highly accessible online tool to support families’ TDM use rule creation. However, the FMP does not address sleep beyond age-appropriate duration guidance. Our long-term goal is to implement feasible, effective, and scalable interventions to address adolescent TDM use-related sleep problems and mental health. This R34’s goal is to optimize and evaluate a Sleep-enhanced Family Media Plan (sFMP) for early adolescents’ sleep problems, in partnership with the AAP’s large, heterogeneous practice-based Pediatric Research in Office Settings (PROS) network. Building on our AAP-funded qualitative work, Aim 1 is to further refine an sFMP prototype that addresses adolescent sleep and TDM use problems and includes clinician-delivered TDM use counseling. Aim 1a is to conduct usability interviews, guided by human-centered design principles and socio-technical theory, at up to 4 PROS sites with n=3-5 adolescent-caregiver dyads and n=3-5 pediatric clinicians (N=9-15). Aim 1b is to conduct an open pilot of the sFMP delivered by up to n=10 clinicians with n=5-10 adolescent-caregiver dyads (N=20-30) to examine feasibility, usability, acceptability, and fidelity. Aim 2 is to conduct a pilot stepped wedge cluster randomized trial in 4 new PROS sites with N=80 adolescent-caregiver dyads and N=12-16 clinicians to evaluate sFMP feasibility, acceptability, fidelity, and initial youth sleep and mental health outcomes. Aim 3 is to explore whether intervention-induced changes in sFMP targets are linked to changes in youth sleep and mental health. MPI Moreno’s established Youth Advisory Board and the PROS study advisor, Steering Committee (clinicians, caregivers), and Coordinators (clinicians) will provide feedback throughout this work to ensure our procedures, intervention content and delivery methods, and dissemination plans are feasible and acceptable to end-users (pediatricians) and recipients (youth, caregivers). Our MPI model includes expertise in pediatric sleep, TDM use, and adolescent health, while our Co-Is bring expertise in primary care-based clinical trials and human-centered design. Results will inform an R01 hybrid effectiveness-implementation trial scaling the sFMP across AAP PROS to effectively and sustainably improve youth sleep and mental health, consistent with RFA-MH-25-130 and NIMH’s broader goals.