College of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China.
College of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China.
Sleep Med. 2020 May;69:179-188. doi: 10.1016/j.sleep.2020.01.022. Epub 2020 Feb 4.
To examine the unique contribution of bully victimization to sleep loss over worry (SLOW) among adolescents in four Southeast Asian countries, while controlling for loneliness and selected lifestyle factors.
Data was derived from the Global School-Based Student Health Survey (2014-2015). Responses from a total of 13,043 adolescents in four Southeast Asian countries (Bangladesh, Brunei, Indonesia, and Timor Leste) were examined. Weighted frequencies of SLOW, bully victimization, loneliness, and selected lifestyle factors were first calculated, and Pearson's chi-square test was used to compare sample characteristics by severity of SLOW. A multivariate logistic regression analysis was constructed for each country to assess the unique contribution of bully victimization to SLOW, adjusting for demographics, loneliness, and selected lifestyle factors.
The prevalence of SLOW and bully victimization ranged between 38.0% and 44.6%, and 20.5%-24.9% respectively. Bully victimization and loneliness were consistently and positively linked to SLOW, with greater odds seen among students with severe SLOW who were bullied for 3 days or more (adjusted odds ratios (AORs) and 95% confidence intervals (CIs) Bangladesh: 6.00 [2.57-14.01]; Brunei: 2.48 [1.42-4.32]; Indonesia: 3.36 [2.02-5.59]; Timor Leste: 4.27 [2.15-8.48]) and experienced high level of loneliness (AORs and 95% CIs Bangladesh: 7.03 [3.46-14.29]; Brunei: 4.97 [3.63-6.79]; Indonesia: 8.71 [4.55-16.69]; Timor Leste: 2.97 [2.25-3.93]). Increased odds of severe SLOW were also seen among those engaged in sedentary behavior for 3 h or more per day (AORs and 95% CIs Indonesia: 1.85 [1.40-2.45]; Timor Leste: 1.61 [1.18-2.19]), and among those consuming fast food for three or more days per week (AORs and 95% CIs Brunei: 2.20 [1.26-3.86]; Indonesia: 1.98 [1.19-3.31]). The association of lifestyle factors and SLOW differed across countries.
Given the unique contributions of bully victimization to SLOW, we recommend countries in Southeast Asia to include sleep health as a component of adolescent health promotion, and to include reducing bully and bully victimization in strategies aimed at improving sleep health.
在控制孤独感和部分生活方式因素的情况下，研究东南亚四个国家青少年中受欺凌与担忧导致的睡眠不足（SLOW）之间的独特关系。
数据来源于全球学校学生健康调查（2014-2015 年）。对来自东南亚四个国家（孟加拉国、文莱、印度尼西亚和东帝汶）的 13043 名青少年的调查结果进行了分析。首先计算了 SLOW、受欺凌、孤独感和部分生活方式因素的加权频率，并使用 Pearson 卡方检验比较了按 SLOW 严重程度划分的样本特征。对每个国家都进行了多变量逻辑回归分析，以评估欺凌对 SLOW 的独特贡献，并调整了人口统计学、孤独感和部分生活方式因素。
SLOW 和受欺凌的发生率分别在 38.0%至 44.6%和 20.5%-24.9%之间。欺凌和孤独感与 SLOW 呈持续正相关，在受欺凌严重程度为 3 天或以上（调整后的优势比（AOR）和 95%置信区间（CI）：孟加拉国 6.00[2.57-14.01]；文莱 2.48[1.42-4.32]；印度尼西亚 3.36[2.02-5.59]；东帝汶 4.27[2.15-8.48]）和经历高水平孤独感（AOR 和 95%CI：孟加拉国 7.03[3.46-14.29]；文莱 4.97[3.63-6.79]；印度尼西亚 8.71[4.55-16.69]；东帝汶 2.97[2.25-3.93]）的学生中，SLOW 的发生风险更高。每天进行 3 小时或以上久坐行为（AOR 和 95%CI：印度尼西亚 1.85[1.40-2.45]；东帝汶 1.61[1.18-2.19]）和每周食用快餐 3 天或以上（AOR 和 95%CI：文莱 2.20[1.26-3.86]；印度尼西亚 1.98[1.19-3.31]）的学生中，SLOW 严重程度的发生风险也更高。生活方式因素与 SLOW 的关联在不同国家有所差异。
鉴于欺凌对 SLOW 的独特贡献，我们建议东南亚国家将睡眠健康作为青少年健康促进的一个组成部分，并将减少欺凌和受欺凌纳入改善睡眠健康的策略中。
