Date of Award

Spring 2025

Document Type

Open Access Dissertation

Department

Epidemiology and Biostatistics

First Advisor

Monique J. Brown

Abstract

Background: Insufficient sleep and poor sleep quality are major public health issues among adolescents in the United States (U.S.). Mental health and substance use challenges are also common among adolescents, particularly those with sleep problems. Although exposures in adolescence have been evidenced to significantly impact future health, little is known about how adolescent sleep health, mental health, and substance use influence future cardiovascular disease (CVD) risk. We, therefore, examined the association between sleep health in adolescence and CVD risk in adulthood and assessed whether the association is mediated by depressive symptoms and substance use in adolescents. Further, we explored the association between parent-set bedtimes and future CVD risk. Methods: We performed a secondary analysis using Waves I, II, and IV of the Add Health dataset. Using survey logistic procedures in SAS, we examined 1) the associations between adolescent sleep health, individual sleep health dimensions, and CVD risk in adulthood and 2) the association between parent-set bedtimes and CVD risk in adulthood. Further, we used CAUSALMED procedures in SAS to investigate whether substance use and depressive symptoms in adolescence mediate the relationship between adolescent sleep health and CVD risk in adulthood. Results: Short sleep duration, bedtimes after 11 PM, and experiencing two or more sleep problems in adolescence were associated with high CVD risk in adulthood. The effect of adolescent sleep health on CVD risk in adulthood was partially mediated by depressive symptoms and fully mediated by substance use in adolescence. Adolescents with later parent-set bedtimes (by or after midnight) and those without a parent-set bedtime had a significantly higher CVD risk in adulthood, compared to adolescents with earlier parent-set bedtimes (by 10 PM). Sleep factors partially mediated the effect of parent-set bedtimes on future CVD risk. Conclusion: Poor sleep quality, depressive symptoms, and substance use in adolescence have far-reaching effects in adulthood. Hence, interventions to improve adolescent sleep health and mental health could have a positive impact on their cardiovascular health in adulthood. Additionally, encouraging parents to set early bedtimes for their teenagers may improve their sleep health and reduce their risk for CVD in adulthood.

Rights

© 2025, Prince Nii Ossah Addo

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