Journal Articles
Permanent URI for this collectionhttps://mro.massey.ac.nz/handle/10179/7915
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Item Enhancing maternal sleep health in Aotearoa New Zealand: insights from the Wāhi Kōrero platform(Taylor and Francis Group on behalf of the Royal Society of New Zealand, 2025-07-03) Walsh Z; Muller D; Signal TL; Breheny M; Severinsen C; Ware F; Reweti AMaternal sleep health is crucial for maternal wellbeing, particularly maternal mental health which has implications for the wellbeing of children, families and whānau. In Aotearoa New Zealand, the Well Child Tamariki Ora (WCTO) service provides a unique opportunity to support mothers, their families, and whānau by providing education on sleep health for both mothers and children. However, there is a need for a deeper understanding of mothers' experiences with WCTO and the sleep information they receive to enhance these services. This primary research used data gathered from the Wāhi Kōrero online story-sharing platform, with 181 stories focusing specifically on sleep. Using thematic analysis, three key themes were identified: maternal instinct as a guide in navigating child sleep practices, promoting strength-based rather than deficit-focused approaches, and the necessity to move beyond rigid, monocultural service models. Findings underscore the importance of tailoring maternal and child health services to better meet the needs and perspectives of mothers, their families, and whānau, particularly in the areas of sleep and maternal mental health. Implications of findings for future policy and practice are discussed, including developing strength-based, culturally responsive approaches within services like WCTO, and adapting policy to support more flexible, whānau-centred models of care.Item No Earlier Than 9:45 A.M. A Qualitative Study of Adolescents' Experiences of Later School Start Times in Aotearoa New Zealand(Taylor and Francis Group, 2025-03-04) Smith H; Barber C; Taylor R; Signal TL; Hetrick S; Alansari M; Oldehaver J; Galland BOBJECTIVES: Many teenagers suffer chronic sleep loss, which could potentially be mitigated by later school start times to accommodate the natural shift in their circadian timekeeping system favoring later bedtimes. This study explored experiences of senior students from a school in Aotearoa New Zealand with later school start times. METHOD: Semi-structured interviews were conducted with 14 students, purposively sampled for equivalent numbers starting later every day (9:45 A.M.), or on just one weekday (10:00 A.M.). Transcripts were analyzed using reflexive thematic analysis. RESULTS: Four themes were identified that addressed the impact of later starts on sleep struggles, daily functioning, student autonomy, and routines and scheduling. Most perceived later starts as positively influencing their sleep quality, concentration, productivity, and personal well-being. The importance of autonomy over their learning, and impact of different start times on students' schedules was also emphasized. Major disadvantages were lack of free classes and potentially later finish times. CONCLUSIONS: The experiences of later school start times for these adolescents were largely positive across a variety of life domains. Findings support the need for sleep health to be considered within school's health education and policy to address the unmet health concerns of chronic sleep loss in teens.Item Adolescents’ next-day perceptions of their sleep quality, quantity, sleepiness and sleepiness-related symptoms relative to actigraphy metrics(Elsevier B V, 2025-09-01) Tang C; Meredith-Jones K; Haszard JJ; Signal TL; Wickham S-R; Muller D; Taylor R; Galland BCBackground: Next-day perceptions of sleep and related symptoms are frequently collected in research and clinical practice, but how they correlate with objective sleep measures in adolescents has received little attention. Methods: Participants were aged 16–17 years and without a sleep disorder, anxiety or depression diagnosis. Seven-day wrist actigraphy was collected alongside daily survey ratings of sleep quality, sufficiency, morning and daytime sleepiness, and sleepiness-related mood and concentration. Within-person associations between daily actigraphic sleep metrics (6 variables representing quantity, quality and timing) and subjective ratings were estimated using mixed effects regression models with participant included as a random effect. Results: The sample comprised 71 adolescents (49 % female, 51 % male). No actigraphy metrics linked to sleep sufficiency ratings. Sleep onset was the strongest correlate of sleep quality and morning sleepiness in the expected direction e.g. every 10 min later onset led to a −1.4 point (95 % CI: −2.1, −0.7) drop in the sleep quality score (5-point scale, higher worse), but significant relationships were only in females. While actigraphic sleep quantity metrics were linked to several ratings, all effect sizes were marginal. Sleep quality metrics in the overall sample were not correlated to any ratings. Unexpectedly, timing and quantity metrics linked to sleepiness-related mood ratings, but in the opposite direction hypothesized. Conclusions: The lack of correlation between objective and subjective sleep quality add to the complexity of defining sleep quality accurately. Sleep onset timing, rarely explored in these types of studies emerged as an important correlate of sleep quality perception and other subjective ratings.Item Characterizing the sleep location, patterns, and maternally perceived sleep problems of the infants of Māori and non-Māori mothers in Aotearoa New Zealand(Elsevier B.V., 2025-01-03) Carter ML; Paine S-J; Sweeney BM; Taylor JE; Signal TLObjectives To investigate potential sleep inequities between the infants of Māori and non-Māori mothers in Aotearoa New Zealand, identify socio-ecological factors associated with infant sleep, and determine features of infant sleep that contribute to a mother-perceived infant sleep problem. Design Secondary analysis of longitudinal data from the Moe Kura: Mother and Child, Sleep and Well-being in Aotearoa New Zealand study when infants were approximately 12 weeks old. Participants 383 Māori and 702 non-Māori mother-infant dyads. Methods Chi-square and independent t-tests measured bivariate associations between maternal ethnicity and infant sleep characteristics. Multivariable and ordinal logistic regression models assessed the relative impact of different socio-ecological factors on infant sleep outcome variables. Results Key developmental markers of infant sleep did not differ by maternal ethnicity. There were some ethnicity-based differences in sleep location. Maternal ethnicity, maternal age, parity, maternal depression, maternal relationship status, life stress, breastfeeding, work status, and bedsharing were related to different dimensions of infant sleep, and to maternal perceptions of a sleep problem. Conclusion Sleep at 12 weeks is highly variable between infants and is associated with numerous socio-ecological factors. Findings support a social determinants explanation for sleep health inequities seen later in childhood.Item Maternal depressive symptoms in and beyond the perinatal period: Associations with infant and preschooler sleep(Oxford University Press on behalf of Sleep Research Society, 2024-10-29) Carter ML; Paine S-J; Sweeney BM; Taylor J; Signal TLStudy Objectives (1) To describe sleep in infancy and early childhood among children born to mothers with and without clinically significant depressive symptoms, and (2) to explore the relationships between maternal depressive symptoms and sleep patterns and problems during infancy and early childhood. Methods Secondary analysis of longitudinal data from the Moe Kura: Mother and Child, Sleep and Wellbeing in Aotearoa/New Zealand study. Data were collected in pregnancy (T1), 12 weeks postpartum (T2), and 3 years post-birth (T3). Participants were 262 Māori and 594 non-Māori mother–child dyads. Chi-square and independent t-tests measured bivariate associations between maternal mood (T1, T2, and T3) and child sleep characteristics (T2 and T3). Binary logistic regression models examined longitudinal and concurrent associations between maternal depressive symptoms and infant and preschooler sleep. Adjusted models accounted for key socio-demographic variables, as well as infant sleep variables in preschooler models. Results Bivariate associations were found between prior and concurrent depressive symptomology and many of the infant and preschooler sleep outcomes. In adjusted models, prenatal depressive symptoms remained independently associated with shorter-than-recommended sleep durations in preschoolers. In these models, concurrent depression was also associated with night waking, night LSRSP, and perceived sleep problems at 12 weeks postpartum, and CSHQ-determined and perceived sleep problems at 3 years post-birth. Conclusions Longitudinal and cross-sectional associations were found between maternal depressive symptoms and child sleep. Sleep appears to be one pathway by which maternal depression confers risk for suboptimal child health outcomes. Findings support the need for earlier and better maternal mental health services.Item Associations between maternal stressful life events and child health outcomes in indigenous and non-indigenous groups in New Zealand(Taylor and Francis Group, 2023-12-13) Paine S-J; Walker R; Lee A; Loring B; Signal TLExposure to stressful life events (SLE) around the time of pregnancy is associated with adverse health outcomes for mothers and children. Previous New Zealand research found Indigenous Māori women are more likely to be exposed to SLE than non-Māori, and are exposed to a higher number of SLE. The consequences of this for ethnic inequities in child health outcomes are unknown. This paper examines the relationship between patterns of maternal SLE exposure with child health and development outcomes at age 3 years, for Indigenous and non-Indigenous children. We found most children had a stressful early life environment at least sometimes, but more than a quarter of Māori children had a mother experiencing multiple SLE on all occasions measured. We found a clear association between maternal experiences of SLE and disordered child sleep and development concerns. While not able to fully assess the contribution of maternal SLE to ethnic inequities in child health outcomes, we did clearly demonstrate that more Māori children have mothers exposed to multiple SLE, and that these maternal SLE are associated with poorer child outcomes. The impacts of chronic SLE exposure need to be better understood, especially given the large ethnic disparity in chronic SLE exposure.Item Inequities in adolescent sleep health in Aotearoa New Zealand: Cross-sectional survey findings.(Published by Elsevier Inc. on behalf of National Sleep Foundation, 2024-06-22) Muller D; Signal TL; Shanthakumar M; Fleming T; Clark TC; Crengle S; Donkin L; Paine S-JOBJECTIVES: To investigate ethnic inequities in, and social determinants of, adolescent sleep health in Aotearoa New Zealand. METHODS: Analysis of self-report data from a cross-sectional survey of secondary school students (12- to 18-year-olds). Analyses included weighted prevalence estimates of good and poor sleep health stratified by ethnicity, and multivariable logistic regression models concurrently adjusted for ethnicity, school year, gender, rurality, neighborhood deprivation, school decile, housing deprivation, sleeping elsewhere due to lack of adequate housing, unsafe environment, and racism. RESULTS: Inequities in social determinants of health were evident for Māori (Indigenous peoples of Aotearoa New Zealand; n = 1528) and minoritized (Pacific n = 1204; Asian n = 1927; Middle Eastern, Latin American, and African [MELAA] n = 210; and 'Other' ethnicity n = 225) adolescents. A greater proportion of Māori, Pacific, Asian, MELAA, and 'Other' adolescents had short sleep, compared to European (n = 3070). Māori, Pacific, Asian, and MELAA adolescents were more likely to report late bedtimes (after midnight), and Māori, Pacific, and 'Other' adolescents were more likely to report early waketimes (5 AM-6 AM or earlier), on school days. Rurality, neighborhood deprivation, school-level deprivation, housing deprivation, sleeping elsewhere due to inadequate housing, unsafe environments, and racism partially, but not fully, explained associations between ethnicity and short sleep, late bedtimes, and early waketimes. CONCLUSIONS: Ethnic inequities exist in adolescent sleep health in Aotearoa New Zealand. Socio-political actions are needed to address racism and colonialism as root causes of ethnic inequities in adolescent sleep, to ensure all young people are afforded the basic human right of good sleep health and associated mental and physical well-being.Item A Cross-Sectional Investigation of Preadolescent Cardiometabolic Health: Associations with Fitness, Physical Activity, Sedentary Behavior, Nutrition, and Sleep.(MDPI (Basel, Switzerland), 2023-02-09) Castro N; Zieff G; Bates LC; Pagan Lassalle P; Higgins S; Faulkner J; Lark S; Skidmore P; Hamlin MJ; Signal TL; Williams MA; Stoner L; Kambas ABACKGROUND: Cardiometabolic disease (CMD) risk often begins early in life. Healthy lifestyle behaviors can mitigate risk, but the optimal combination of behaviors has not been determined. This cross-sectional study simultaneously examined the associations between lifestyle factors (fitness, activity behaviors, and dietary patterns) and CMD risk in preadolescent children. METHODS: 1480 New Zealand children aged 8-10 years were recruited. Participants included 316 preadolescents (50% female, age: 9.5 ± 1.1 years, BMI: 17.9 ± 3.3 kg/m2). Fitness (cardiorespiratory fitness [CRF], muscular fitness), activity behaviors (physical activity, sedentary, sleep), and dietary patterns were measured. Factor analysis was used to derive a CMD risk score from 13 variables (adiposity, peripheral and central hemodynamics, glycemic control, and blood lipids). RESULTS: Only CRF (β = -0.45, p < 0.001) and sedentary time (β = 0.12, p = 0.019) were associated with the CMD risk score in the adjusted multivariable analysis. CRF was found to be nonlinear (VO2 max ≤ ≈42 mL/kg/min associated with higher CMD risk score), and thus a CRF polynomial term was added, which was also associated (β = 0.19, p < 0.001) with the CMD risk score. Significant associations were not found with sleep or dietary variables. CONCLUSION: The findings indicate that increasing CRF and decreasing sedentary behavior may be important public health targets in preadolescent children.Item Managing the challenge of fatigue for pilots operating ultra-long range flights.(Frontiers Media S.A., 2024-01-11) Signal TL; van den Berg MJ; Zaslona JL; Wu L; Hughes M; Johnston B; Dyer C; Drane M; Glover M; Fischer DIntroduction: Ultra-long range (ULR) flights are defined as exceeding regulatory limits: normally 16 h flight time. They pose challenges due to long duty periods that could result in extended wakefulness and sleep loss, increasing the risk of fatigue. This study describes the mitigations used to manage fatigue in these operations. Two data collection phases were conducted on the Auckland-Chicago ULR route: when the route commenced (Study 1) and when the flight crew complement was altered (Study 2). Seasonal differences were also investigated. Methods: Study 1 involved 72 crew who completed diaries and wore an actigraph to record sleep pre-departure, throughout the trip, and on return. In-flight, fatigue, sleepiness and workload were reported, and reaction time performance was measured. Study 2 involved 75 crew and data collection in the northern summer and northern winter. Crew completed diaries throughout the trip. Results: Study 1 data found crew sleep longer than usual in the 24 h pre trip and post flights. On the shorter outbound flight in-flight sleep averaged 3.3 h and on the longer inbound flight, 3.3–3.8 h, with most crew taking 3 breaks. Ratings of sleepiness and fatigue increased, and reaction time performance declined across flights, with greater decrements on longer inbound flights. Pilots did not fully adjust their sleep patterns to local time during the layover and no seasonal differences were found. Comparisons between Study 1 and 2 showed no difference in ratings of fatigue and sleepiness or in-flight sleep duration with an altered crew complement. There was a trend for Captains to report greater workload and less in-flight sleep in Study 2. Discussion: Mitigations that allow for preparation and recovery are well utilized by crew. In-flight sleep is relatively short and ways of increasing the amount of sleep obtained should be considered. The incomplete adaptation of sleep during the layover has implications for rest break strategies on the return flight. The altered crew complement did not result in higher levels of fatigue or sleepiness or less in-flight sleep on average, although findings suggest a need to understand the effects of changing the crew complement on workload and in-flight sleep for Captains.Item Sleep inequities and associations between poor sleep and mental health for school-aged children: findings from the New Zealand Health Survey(Oxford University Press on behalf of Sleep Research Society, 2023-11-18) Muller D; Signal TL; Shanthakumar M; Paine S-JIn Aotearoa/New Zealand, ethnic inequities in sleep health exist for young children and adults and are largely explained by inequities in socioeconomic deprivation. Poor sleep is related to poor mental health for these age groups but whether sleep inequities and associations with mental health exist for school-aged children is unclear. We aimed to (1) determine the prevalence of poor sleep health including sleep problems by ethnicity, (2) examine social determinants of health associated with poor sleep, and (3) investigate relationships between poor sleep and mental health for 5-14-year-olds using cross-sectional New Zealand Health Survey data (n = 8895). Analyses included weighted prevalence estimates and multivariable logistic regression. Short sleep was more prevalent for Indigenous Māori (17.6%), Pacific (24.5%), and Asian (18.4%) children, and snoring/noisy breathing during sleep was more prevalent for Māori (29.4%) and Pacific (28.0%) children, compared to European/Other (short sleep 10.2%, snoring/noisy breathing 17.6%). Ethnicity and neighborhood socioeconomic deprivation were independently associated with short sleep and snoring/noisy breathing during sleep. Short sleep was associated with increased odds of anxiety, attention deficit hyperactivity disorder, and activity-limiting emotional and psychological conditions after adjusting for ethnicity, deprivation, age, and gender. In addition, long sleep was independently associated with increased odds of depression. These findings demonstrate that for school-aged children ethnic inequities in sleep exist, socioeconomic deprivation is associated with poor sleep, and poor sleep is associated with poor mental health. Sociopolitical action is imperative to tackle social inequities to support sleep equity and mental health across the lifecourse.