A school-based sleep education program for adolescents: a cluster randomized trial

Objectives: To evaluate the effectiveness of a multilevel and multimodal school-based education program.

Methods: A cluster randomized controlled trial with 14 secondary schools in Hong Kong and a total of 3713 students (intervention: 1545 vs control: 2168; 40.2% boys; mean age ± SD: 14.72 ± 1.53 years) were included in the final analysis. The intervention included a town hall seminar, small class workshops, a slogan competition, a brochure, and an educational Web site. Their parents and teachers were offered sleep education seminars. The control schools did not receive any sleep program. Data were collected before and 5 weeks after the intervention.

Results: The students in the intervention group had significantly improved sleep knowledge compared with the control group (mean difference: 3.64 [95% confidence interval (CI): 3.21 to 4.07]; Cohen's d = 0.51) as measured by using a sleep knowledge questionnaire. Weekday sleep duration was reduced in both groups, and the significant difference in weekday sleep duration was lost in the intention-to-treat analysis (mean difference: 0:01 [95% CI: -0:00 to 0:04]). In addition, the intervention group had a lower incidence of consuming caffeine-containing energy drinks (adjusted odds ratio: 0.46 [95% CI: 0.22 to 0.99]) and had better behavioral (mean difference: -0.56 [95% CI: -1.02 to -0.10]; Cohen's d = 0.13) and mental health (mean difference: -0.30 [95% CI: -0.15 to -0.46]; Cohen's d = 0.11) outcomes.

Conclusions: A school-based sleep education program was effective in enhancing sleep knowledge and improving behavioral and mental health, but it had no significant impact on sleep duration or pattern among adolescents.