Abstract
Poor sleep confers significant morbidities and is highly prevalent among college students in the United States. This research assessed sleep quality and its association with health-related quality of life (HRQOL). Further, because sleep quality research often lacks a theoretical foundation, we applied a theoretical model using selected constructs from the Theory of Planned Behavior (TPB) and Health Belief Model (HBM). A random, stratified sample of undergraduate students participated in an online survey (N = 494). Structural equation modeling assessed the association between theoretical constructs, sleep quality, and HRQOL. The final model fit was acceptable, with ~ 20% of the variance in sleep quality explained by the theoretical constructs and control variables. HBM constructs were indirectly and negatively related to sleep quality, mediated through behavioral intention, and also positively and directly associated with behavioral intention. Behavioral intention was strongly and negatively associated with sleep quality. Approximately 31% of the variance in HRQOL was explained by poor sleep quality, behavioral intention, and gender. Poor sleep was most strongly associated with reduced HRQOL. HBM constructs and behavioral intention from TPB were significantly associated with poor sleep quality, and poor sleep was significantly related to poor HRQOL.
Similar content being viewed by others
References
Alamir, Y. A., Zullig, K. J., Wen, S., Montgomery-Downs, H., Kristjansson, A. L., Misra, R., & Zhang, J. (2019). Association between nonmedical use of prescription drugs and sleep quality in a large college student sample. Behavioral Sleep Medicine, 17(4), 470–480. https://doi.org/10.1080/15402002.2017.1403325
Andresen, E., Catlin, T., Wyrwich, K., & Jackson-Thompson, J. (2003). Retest reliability of surveillance questions on health related quality of life. Journal of Epidemiology and Community Health, 57, 339–343.
Andruškienė, J., Varoneckas, G., Martinkėnas, A., & Grabauskas, V. (2008). Factors associated with poor sleep and health-related quality of life. Medicina (kaunas, Lithuania), 44(3), 240.
Arbuckle, J. L. (2006). Amos (Version 7.0) [computer program]. Chicago: SPSS.
Bashirian, S., Hidarnia, A., Allahverdipour, H., & Hajizadeh, E. (2012). Application of the theory of planned behavior to predict drug abuse related behaviors among adolescents. Journal of Research in Health Sciences, 12(1), 54–60.
Becker, S. P., Jarrett, M. A., Luebbe, A. M., Garner, A. A., Burns, G. L., & Kofler, M. J. (2018). Sleep in a large, multi-university sample of college students: Sleep problem prevalence, sex differences, and mental health correlates. Sleep Health, 4(2), 174–181. https://doi.org/10.1016/j.sleh.2018.01.001
Benca, R. M. (2012). Sleep disorders: The clinician’s guide to diagnosis and management. Oxford: Springer.
Burgard, S. A., & Ailshire, J. A. (2012). Gender and time for sleep among U.S. adults. American Sociological Review, 78(1), 51–69. https://doi.org/10.1177/0003122412472048
Burgard, S., Ailshire, J. A., & Hughe, M. (2010). Gender and sleep duration among American adults population studies center. University of Michigan.
Buysse, D. J. (2014). Sleep health: Can we define it? Does it matter? Sleep, 37(1), 9–17. https://doi.org/10.5665/sleep.3298
Buysse, D. J., Reynolds, C. F., 3rd., Monk, T. H., Berman, S. R., & Kupfer, D. J. (1989). The pittsburgh sleep quality index: A new instrument for psychiatric practice and research. Psychiatry Research, 28(2), 193–213.
Carpenter, C. J. (2010). A meta-analysis of the effectiveness of health belief model variables in predicting behavior. Health Communication, 25(8), 661–669. https://doi.org/10.1080/10410236.2010.521906
Carskadon, M. A., & Dement, W. C. (2011). Monitoring and staging human sleep. In M. H. Kryger, T. Roth, & W. C. Dement (Eds.), Principles and practice of sleep medicine (5th ed., pp. 16–26). St. Louis: Elsevier Saunders.
Centers for Disease Control and Prevention. (2000). Measuring healthy days: Population assessment of health-related quality of life. Atlanta: CDC.
Centers for Disease Control and Prevention. (2011a). Health-related quality of life (HRQOL). HRQOL Concepts. Retrieved from http://www.cdc.gov/hrqol/concept.htm.
Centers for Disease Control and Prevention. (2011b). Health-related quality of life (HRQOL). CDC HRQOL–14 “Healthy Days Measure”. Retrieved from http://www.cdc.gov/hrqol/hrqol14_measure.htm.
Centers for Disease Control and Prevention. (2011c). Methods and measures. Health-Related Quality of Life (HRQOL). Retrieved from http://www.cdc.gov/hrqol/methods.htm.
Centers for Disease Control and Prevention. (2013). How much sleep do i need? Sleep and Sleep Disorders. Retrieved from http://www.cdc.gov/sleep/about_sleep/how_much_sleep.htm.
Darchia, N., Oniani, N., Sakhelashvili, I., Supatashvili, M., Basishvili, T., Eliozishvili, M., Maisuradze, L., & Cervena, K. (2018). Relationship between sleep disorders and health related quality of life—results from the Georgia SOMNUS study. International Journal of Environmental Research and Public Health, 15(8), 1588. https://doi.org/10.3390/ijerph15081588
Faubel, R., Lopez-Garcia, E., Guallar-Castillón, P., Balboa-Castillo, T., Gutiérrez-Fisac, J., Banegas, J., & Rodríguez-Artalejo, F. (2009). Sleep duration and health-related quality of life among older adults: A population-based cohort in Spain. Sleep, 32(8), 1059–1068. https://doi.org/10.1093/sleep/32.8.1059
Glanz, K., Rimer, B. K., & Viswanath, K. (2008). Health behavior and health education: theory, research, and practice. K. Glanz, B. K. Rimer, K. Viswanath (Eds.) (4th ed.). Jossey-Bass, San Francisco.
Glanz, K., & Bishop, D. B. (2010). The role of behavioral science theory in development and implementation of public health interventions. Annual Review of Public Health, 31, 399–418. https://doi.org/10.1146/annurev.publhealth.012809.103604
Herrick, H. (2010). The association of insufficient sleep with smoking, obesity, physical inactivity, and poor quality of life: Results from the 2008 North Carolina behavorial risk factor surveillance system (BRFSS) survey. Raleigh: State Center for Health Statistics.
Hu, L., & Bentler, B. (1999). Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives. Structural Equation Modeling: A Multidisciplinary Journal, 6(1), 1–55. https://doi.org/10.1080/10705519909540118
Jean-Louis, G., Kripke, D. F., & Ancoli-Israel, S. (2000). Sleep and quality of well-being. Sleep, 23(8), 1–7.
Knowlden, A. (2011). Theory of planned behavior based predictors of sleep intentions and behaviors in undergraduate college students at a Midwestern University. University of Cincinnati.
Knowlden, A., & Sharma, M. (2012). The theory of planned behavior as a model for predicting the sleep intentions and behaviors of undergraduate minority students. International Journal of Medicine and Molecular Medicine. https://doi.org/10.9754/journal.wmc.2012.00285
Knowlden, A., & Sharma, M. (2014). Health belief structural equation model predicting sleep behavior of employed college students. Family and Community Health, 37(4), 271–278. https://doi.org/10.1097/FCH.0000000000000043
Knowlden, A. P., Sharma, M., & Bernard, A. L. (2012). A theory of planned behavior research model for predicting the sleep intentions and behaviors of undergraduate college students. The Journal of Primary Prevention, 33(1), 19–31. https://doi.org/10.1007/s10935-012-0263-2
Kryger, M. H., Roth, T., & Dement, W. C. (2017). Principles and practice of sleep medicine. Elsevier.
Lee, M., Choh, A., Demerath, E., Knuston, K., Duren, D., Sherwood, R., & Czerwinski, S. (2009). Sleep disturbance in relation to health-related quality of life in adults: The Fels longitudinal study. The Journal of Nutrition, Health and Aging, 13(6), 576–583.
von Linden, M. (2011). The theory of planned behavior as a predictor of sleep hygiene and sleep quality (Doctoral Dissertation, Saint Louis University). Available from ProQuest Dissertations and Theses database (UMI No. 884066959).
Lopes, C., Esteves, A., Bittencourt, L., Tufik, S., & Mello, M. (2008). Relationship between the quality of life and the severity of obstructive sleep apnea syndrome. Brazilian Journal of Medical and Biological Research, 41, 908–913.
Lund, H. G., Reider, B. D., Whiting, A. B., & Prichard, J. R. (2010). Sleep patterns and predictors of disturbed sleep in a large population of college students. Journal of Adolescent Health, 46(2), 124–132. https://doi.org/10.1016/j.jadohealth.2009.06.016
Matthews, K. A., Patel, S. R., Pantesco, E. J., Buysse, D. J., Kamarck, T. W., Lee, L., & Hall, M. H. (2018). Similarities and differences in estimates of sleep duration by polysomnography, actigraphy, diary, and self-reported habitual sleep in a community sample. Sleep Health, 4(1), 96–103. https://doi.org/10.1016/j.sleh.2017.10.011
McKnight-Eily, L. R., Eaton, D. K., Lowry, R., Croft, J. B., Presley-Cantrell, L., & Perry, G. S. (2011). Relationships between hours of sleep and health-risk behaviors in US adolescent students. Preventive Medicine, 53(4–5), 271–273. https://doi.org/10.1016/j.ypmed.2011.06
McLaughlin Crabtree, V., & Williams, N. A. (2009). Normal sleep in children and adolescents. Child and Adolescent Psychiatric Clinics of North America, 18(4), 799–811. https://doi.org/10.1016/j.chc.2009.04.013
Mezick, E. J., Matthews, K. A., Hall, M., Strollo, P. J., Jr., Buysse, D. J., Kamarck, T. W., & Reis, S. E. (2008). Influence of race and socioeconomic status on sleep: Pittsburgh sleep SCORE project. Psychosomatic Medicine, 70(4), 410–416. https://doi.org/10.1097/PSY.0b013e31816fdf21
Ming, X., Koransky, R., Kang, V., Buchman, S., Sarris, C. E., & Wagner, G. C. (2011). Sleep insufficiency, sleep health problems and performance in high school students. Clin Med Insights Circ Respir Pulm Med, 5, 71–79. https://doi.org/10.4137/CCRPM.S7955
Moriarty, D., Zack, M., & Kobau, R. (2003). The centers for disease control and prevention’s healthy days measures–population tracking of perceived physical and mental health over time. Health and Quality of Life Outcomes. https://doi.org/10.1186/1477-7525-1-37
Natal, C., Lourenco, T., Silva, L., Boscolo, R., Silva, A., Tufik, S., & Mello, M. (2009). Gender differences in the sleep habits of 11–13 year olds. Brazilian Journal of Psychiatry. https://doi.org/10.1590/S1516-44462009000400013
National Institute of Health. (2012). How much sleep is enough? Sleep deprivation and deficiency. Retrieved from https://www.nhlbi.nih.gov/health/health-topics/topics/sdd/howmuch.
Nursalam, M., Apriani, N. K., Has, E. M. M. A., & Efendi, F. (2014). Sleep hygiene behavior among Balinese adolescents. Journal of Nursing Education and Practice. https://doi.org/10.5430/jnep.v4n3p155
Oginska, H., & Pokorski, J. (2006). Fatigue and mood correlates of sleep length in three age-social groups: School children, students, and employees. Chronobiology International, 23(6), 1317–1328. https://doi.org/10.1080/07420520601089349
Painter, J. E., Borba, C. P., Hynes, M., Mays, D., & Glanz, K. (2008). The use of theory in health behavior research from 2000 to 2005: A systematic review. Annals of Behavioral Medicine, 35(3), 358–362. https://doi.org/10.1007/s12160-008-9042-y
Preišegolavičiūtė, E., Leskauskas, D., & Adomaitienė, V. (2010). Associations of quality of sleep with lifestyle factors and profile of studies among Lithuanian students. Medicina (kaunas, Lithuania), 46(7), 482–489.
Ram, S., Seirawan, H., Kumar, S. K., & Clark, G. T. (2010). Prevalence and impact of sleep disorders and sleep habits in the United States. Sleep Breath, 14(1), 63–70. https://doi.org/10.1007/s11325-009-0281-3
Robotham, D., Chakkalackal, L., & Cyhlarova, E. (2011). Sleep matters: the impact of sleep on health and wellbeing. Retrieved from http://www.mentalhealth.org.uk/publications/sleep-report/.
Ruiter, M. E., Decoster, J., Jacobs, L., & Lichstein, K. L. (2011). Normal sleep in African-Americans and Caucasian-Americans: A meta-analysis. Sleep Medicine, 12(3), 209–214. https://doi.org/10.1016/j.sleep.2010.12.010
Sax, L., Gilmartin, S., & Bryant, A. (2003). Assessing response rates and nonresponse bias in web and paper surveys. Research in Higher Education, 44(4), 209–214. https://doi.org/10.1016/j.sleep.2010.12.010
Sharma, M., & Romas, J. A. (2012). Theoretical foundations of health education and health promotion. Jones & Bartlett Learning.
Stanko, K. (2013). Predicting sleep duration in college students: A reasoned action approach. Muncie: Ball State University.
Strine, T. W., & Chapman, D. P. (2005). Associations of frequent sleep insufficiency with health-related quality of life and health behaviors. Sleep Medicine, 6(1), 23–27. https://doi.org/10.1016/j.sleep.2004.06.003
Sweileh, W. M., Ali, I., Sawalha, A. F., Abu-Tah, A. S., Zyoud, S. E. H., & Al-Jabi, S. W. (2012). Gender differences in sleep habits and sleep-related problems in Arab Palestinian university students. International Journal on Disability and Human Development. https://doi.org/10.1515/ijdhd-2012-0041
Troynikov, O., Watson, C. G., & Nawaz, N. (2018). Sleep environments and sleep physiology: A review. Journal of Thermal Biology, 78, 192–203. https://doi.org/10.1016/j.jtherbio.2018.09.012
Wells, M., & Vaughn, B. (2012). Poor sleep challenging the health of a nation. Neurodiagn J, 52, 233–249.
Wolfe, E. W., & Prichard, J. R. R. (2019). Using the theory of planned behavior to assess sleep intentions and behaviors of collegiate athletes. Sleep, 42(Supplement_1), A76–A77. https://doi.org/10.1093/sleep/zsz067.186
Wuertz, C., Chia, Y., & Lee, J. (2012). Relationship of body mass index and activity level with sleep quality among college women. DISCOVERY: Georgia State Honors College Undergraduate Research Journal, 1(1), Article 14. https://scholarworks.gsu.edu/discovery/vol1/iss1/14
Yi, H., Shin, K., & Shin, C. (2006). Development of the sleep quality scale. Journal of Sleep Research, 15, 309–316.
Acknowledgements
We thank all study participants for their cooperation.
Funding
None.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
All authors declare that they have no conflict of interest.
Human and animal rights and informed consent
All procedures followed were in accordance with ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000. Informed consent was obtained from all patients for being included in the study.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
Springer Nature or its licensor holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Alamir, Y.A., Zullig, K.J., Kristjansson, A.L. et al. A theoretical model of college students’ sleep quality and health-related quality of life. J Behav Med 45, 925–934 (2022). https://doi.org/10.1007/s10865-022-00348-9
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10865-022-00348-9