Running head: SLEEP HEALTH 1

Sleep Health While Attending School: 16 – 20 Year Olds

Abigail Hansen

Brigham Young University - Idaho

Running head: SLEEP HEALTH 2

Part 1: Defining the Population

Sleeping is something that everyone does. Every single person, from the day they were

born curls up at the end of the day to rejuvenate their body and sleep off the cares of the day.

Sleep is important for the adequate development of children and adolescents, can help fight off

infections, aid in the prevention of diabetes, influence the efficacy and safety of the work

environment, as well as impact school performance in those who attend (“Healthy People 2020”,

2018a). Not getting enough sleep can have many effects. Ignoring the human body’s need for

sleep can put people at a greater risk for heart disease, hypertension, obesity, diabetes, and other

major complications (“Healthy People 2020”, 2018a).

During the years of adolescence and young adulthood, the body goes through dramatic

changes which include the change of sleeping schedule and function (Levenson et al, 2016).

When people grow up and add high school and college into the mix they may become stressed

and start to put homework, a social life and school sports over adequate sleep. Increased

autonomy as adolescents age, decreased parental attachment, the possibly overwhelming

academic strains, and substance abuse can all have an impact on the amount of sleep obtained

(Levenson et al, 2016). According to the Centers for Disease Control and Prevention, 30.8% of

students slept less than seven hours in a 24-hour period (“Centers for Disease Control and

Prevention”, 2011). In a study done on 752 undergraduate students preparing for finals at three

different universities, it was found that 88.5% of college students report occasional sleep

difficulties, 54.5% complain of morning tiredness, and 74.3% believe they do not receive enough

sleep each night (Buboltz et al, 2009). It is recommended that young adults get at least eight

hours of sleep each night, and possibly more (“Healthy People 2020”, 2018a). Many people

attending school at this age have a hard time obtaining this recommended amount.
SLEEP HEALTH 3

Healthy People Goals

Healthy People 2020 is a guide for the medical field as well as the public that helps

define future goals of improving overall health of the population (Stanhope & Lancaster, 2018).

One of the newest topics on the Healthy People 2020 website is the importance of sleep health.

The two specific goals for this population include “Increase the proportion of students in grades

9 through 12 who get sufficient sleep” and “Increase the proportion of adults who get sufficient

sleep” (“Healthy People 2020”, 2018a). Baseline and target percentages are found in the graphs

below:

(“Healthy People 2020”, 2018a).

(“Healthy People 2020”, 2018a).

SLEEP HEALTH 4

Idaho states percentage of adults who get sufficient sleep:

(“Healthy People 2020”, 2018b).

These graphs show that Idaho, as well as the entire nation, have consistently fallen short of

the Healthy People 2020 goals. In 2015 the percentage of high schoolers getting 8 or more hours

of sleep decreased to 27.3%, which is well under the target of 33.1% (“Healthy People 2020”,

2018b). Those 18 years and older have also missed the target with 66.7% of adults getting sufficient

sleep (“Healthy People 2020”, 2018b).

Demographics

The population being evaluated for sleep health will be 16-20-year-old females who attend

high school or college in Madison County, Idaho. Madison County is found in southeast Idaho.

Gender. Madison County, Idaho is made up of 49.6% females and 50.4% males (United

States Census Bureau, 2018).

Age. For those native to Madison County the median age is 23.1 and the median age for

those foreign-born is 26.7 (Data USA, 2016). 27.3% of the population is under the age of 18 which

is around 5% more than the national average (United States Census Bureau, 2018).
SLEEP HEALTH 5

Income. The median household income in Madison County is $33,856 (Data USA, 2016).

The per capita income is $15,103 (United States Census Bureau, 2018). On average, female

salaries were found to be approximately $14,000 less than that of the male population (Data USA,

2016).

Education status. The student population in this county is skewed towards females with

3,112 female graduates and 2,126 male graduates in 2016 (Data USA, 2016). 96.2% of the

population are high school graduates or higher and 36.8% hold a bachelor’s degree or higher

(United States Census Bureau, 2018).

Race/Ethnicity. Of the 38,114 people that reside in Madison County, 89.5% are Caucasian,

6.92% are Hispanic, 1.76% are mixed descent, 1.02% are Asian, and 0.59% are African American

(Data USA, 2016). There are several different languages that are spoken in Madison County.

English, Spanish, Portuguese, French, and Hmong speakers are all found in this area (Data USA,

2016).

Health. 4.5% of the population 65 years and younger in Madison County, Idaho have a

disability and 8.8% are without insurance (United States Census Bureau, 2018).

Community

Person. Though there are many languages and cultures in Madison County, the area is

not very ethnically diverse as shown in the graph below.

SLEEP HEALTH 6

(Data USA, 2016).

With Brigham Young University – Idaho in the middle of Madison County, students come

from all over the nation and bring many different cultures along with them. 4.6% of the county is

foreign-born which is far less than the 13.2% of the nation (United States Census Bureau, 2018).

Place. On the website Idaho.gov, the Madison County boundaries are found in red (2018).

(Idaho.gov, 2018).
SLEEP HEALTH 7

The population per square mile is only slightly less than that of the United States and the

land area is much smaller when compared to the surrounding counties (United States Census

Bureau, 2018). Madison county is surrounded by the counties of Fremont, Jefferson, Teton, and

Bonneville (Data USA, 2016).

(United States Census Bureau, 2018).

Madison County is near some major tourist attractions including Yellowstone National

Park and the Teton Mountain Range. Some of the Targhee National Forest is within Madison

Counties own borders and provides many hiking trails, camping grounds, trees, waterfalls and

rivers (USDA Forest Service, 2018).

(Explore Idaho, 2018).

SLEEP HEALTH 8

Function. On January 1, 1914, Madison branched off of the adjacent Fremont County

and became its own county (Madison County, Idaho, 2017). This county was named after the

fourth president of the United States, James Madison (Madison County, Idaho, 2017). The

courthouse, built from an old dance hall in 1920, is the same one that is used today (Madison

County, Idaho, 2017). Found within the county limits is Brigham Young University - Idaho, the

Madison Memorial Hospital, many libraries, and so much more. In the image below the

education, health, economy, transportation, and income statistics are found (United States

Census Bureau, 2018).

(United States Census Bureau, 2018).

Plan

For this community assessment the data will be gathered both primarily and secondarily.

There will be 3 interviews conducted, one with a sleep specialist in Madison County and two

with individual female students between the ages of 16-20 who reside within the county
SLEEP HEALTH 9

boundaries. A windshield survey will also be performed to gather information on sources

available for students struggling with sleep health in Madison County. This windshield survey

will be performed by contacting the public health office and obtaining which resources are

available for sleep health. The Student Health Center on BYU – Idaho’s campus as well as a high

school nurse here in Madison County will also be contacted and asked for resources for sleep

health.

The websites from the following organization will be used in the community assessment

on sleep health: The Center of Disease Control, Healthy People 2020, The American Sleep

Association, and The American Academy of Sleep Medicine.

SLEEP HEALTH 10

Part 2: Assessment

Primary Data

Key informant. As mentioned in Part 1, an interview was planned with a sleep specialist

in Madison County to gain more knowledge about sleep health and possible resources for female

students who have trouble sleeping.

Nurse Practitioner – Sleep Specialist

How would you define sleep health? There are so many components. I would

define sleep health as an assessment of one’s

quality of sleep, time to get to sleep, total

hours of sleep, how many times one wakes

up, and how long it takes to get back to sleep.

I would also include how one feels when they

wake up in the morning – awake, groggy, or

tired.

Do females have different sleep needs than Not necessarily. Females do not sleep worse

their male counterpart? than males, but in all areas of health females

are more apt to go see a health care provider

to discuss problems they might be having

with sleep. In general, females find it easier to

speak about potential problems and I find this

to be accurate when it comes to sleep as well.

What percentage of female students do you I do not know the exact statistics on

think has trouble with sleep health? percentages of students who have sleep
SLEEP HEALTH 11

problems, which means that our resource is

probably underutilized. I’m sure that The

American Academy of Sleep Medicine would

have more on this topic.

What do you think is the number one reason There are multiple reasons that students may

students struggle with sleep health? struggle with sleep health. Staying up late to

study, shortened sleep times, anxiety over

testing or relationships, lack of proper

nutrition, unrecognized sleep apnea or restless

leg syndrome, and depression can all vastly

impact a student’s sleep health. I think that

the number one reason would be lack of a

consistent schedule.

How many female students utilize you as a I do not have a ton of female students that I

resource? see for sleep related concerns. Again, I would

say that my specialty is underutilized.

What are some coping strategies that college I think that a great resource for coping would

students might use in order to promote better be www.aasm.org. On this website you can

sleep? learn more about sleep hygiene and ways in

which you can deal with sleep troubles. I

think it would be great if we included this

information and other resources in new

student packets. Other great resources that

SLEEP HEALTH 12

could help students with sleep is “Sleep

Smarter” by Shawn Stevenson and an

audiobook called called “Why We Sleep.”

How receptive do you feel female students are I feel female students are very receptive to

to your teaching on sleep health? education on sleep health. They are also very

willing to make the necessary changes to

improve quality of health.

Interviews. Two interviews were conducted on female students in Madison County,

Idaho. An interview on a single 18 year-old and one on a married 20 year-old are found below.

Mandie – Single 18-year-old Female Student

How would you define sleep health? I would define sleep health as getting enough

sleep to function properly throughout the day.

Would you say that you get enough sleep each Honestly, most days I do not. I always end up

night? feeling tired throughout the day and want to

take a nap at some point.

On average how many hours of sleep do you I get around 6 to 7 hours tops.

get each night?

How does your sleep affect your day to day My sleep has a huge impact on how my day

life – such as school, work, social activities, goes. When I don’t get enough sleep I can get

etc.? really grumpy, lose my patience, and have a

hard time focusing.

SLEEP HEALTH 13

Is there anything specific that causes you to Any loud noises really make it hard for me to

have trouble sleeping? sleep but I think that is kind of normal. Ever

since I moved to college I’ve had a hard time

sleeping because of my roommate’s clock.

The ticking keeps me awake.

Are there any coping strategies that you use When I’m having trouble falling asleep I

when you are having trouble sleeping? usually put my pillow over my head to block

noise or put my headphones in and listen to

music.

In your opinion, what is priority: schoolwork, Schoolwork is usually priority for me. That’s

social life, work, sleep, or extracurricular kind of sad because I think sleep should be.

activities?

Shaylee – Married 20-year-old Female Student

How would you define sleep health? I would say getting at least 8 hours of sleep

each night.

Would you say that you get enough sleep each Most of the time. My husband and I try to

night? keep a consistent schedule and go to bed early

each night. I would say I sleep pretty easily

and deeply. I’m basically a professional.

On average how many hours of sleep do you I try to get about 9 hours of sleep each night

get each night? but sometimes it doesn’t work out.

SLEEP HEALTH 14

How does your sleep affect your day to day My sleep really affects the rest of my day. If I

life – such as school, work, social activities, don’t get at least 8 hours of sleep I’m

etc.? basically useless for the whole day. I’m tired,

grumpy, and cannot stay motivated to save

my life.

Is there anything specific that causes you to I can’t really think of anything. Like I said,

have trouble sleeping? I’m a pretty deep sleeper so I can sleep

through my husband tossing and turning or

making any noise.

Are there any coping strategies that you use It’s probably not good but I get on my phone

when you are having trouble sleeping? until I’m tired and ready to fall asleep.

In your opinion, what is priority: schoolwork, Probably schoolwork.

social life, work, sleep, or extracurricular

activities?

Windshield survey. As a part of the windshield survey, multiple resources were

contacted in Madison County, Idaho. The first potential resource contacted was BYU-Idaho

Student Health Center since BYU-Idaho is the largest school in Madison County. When asked

for any resources on sleep health or for students who have trouble sleeping it was reported that

they would not be of much help (personal communication, May 21, 2018). They reported no one

on staff having a specialty in sleep but that the family doctors would be happy to help anyone

who may have serious sleep troubles (personal communication, May 21, 2018).
SLEEP HEALTH 15

Other sleep resources were found in Madison County as well. Though the sleep institute

permanently closed in Rexburg, a sleep study lab at Madison Memorial Hospital opened last year

(Google Search “Madison County Sleep Centers”, 2018).

(Google Maps “Madison County Sleep Centers”, 2018).

In the map above it shows the only sleep centers, or sleep specialist doctors, available in

Madison County, Idaho. This does not include any resources from the counties surrounding

Madison County. This map shows that there are only two major resources found in this area for

those struggling with their sleep health.

Other observations. A survey was also done at Broulim’s, Wal-Mart, and Walgreens in

Madison County. Each of these stores were visited to see what sleep resources they might have.

In each of these stores found in Madison County, Idaho, pharmacies are available as well as

many over the counter medications. Many natural remedies and man-made products were found

on the shelves of these stores. Each store had teas, lotions, and bubble baths available for “sleep
SLEEP HEALTH 16

and relaxation” as well as medications that encouraged sleep for those who have a hard to falling

asleep, staying asleep, or sleeping soundly.

Secondary Data

Demographics. As mentioned previously, Madison County is home to BYU-Idaho and

the median age is 23.1 (Data USA, 2016). 27.3% of the population is under the age of 18 which

is around 5% more than the national average and higher than Idaho state’s 26.0% (United States

Census Bureau, 2018). In 2015 it was found that the female population was more likely to attend

college the fall after their high school graduation (McHugh, 2015). Idaho’s 2014 percentage for

“go-on rates” in students straight out of high school was 53% for females and 38% for their male

counterparts (McHugh, 2015). In the graph below it shows that this is a trend that has been

happening for multiple years.

(McHugh, 2015).

Government agencies. According to the Center for Disease Control and Prevention,

when students get the proper amount of sleep at night it helps them to stay focused, it improves

their concentration, and can help improve their academic performance (Center for Disease
SLEEP HEALTH 17

Control and Prevention, 2015). In a national CDC study done on high school students it was

found that the majority (72.7%) of high school students did not get enough sleep on school

nights (Center for Disease Control and Prevention, 2015). In order to promote sleep health and

overall wellness of those in school, it has been recommended that school starts no earlier than

8:30a.m. (American Academy of Sleep Medicine, 2017). It is also encouraged that schools

provide sleep education on proper sleeping patterns, sleep disorders, and healthy sleep habits

(Center for Disease Control and Prevention, 2015). Health care professionals and parents also

play a big part in educating students on good sleep habits, such as regular sleeping routines and a

strict media curfew (Center for Disease Control and Prevention, 2015).

Other data. As mentioned previously, sleep is a necessity for proper health. Improving

sleep hygiene would allow adolescents and young adults who attend school to obtain better

sleep. Sleep hygiene is defined as a “variety of practices that are necessary to have normal

quality sleep” (NAHIC, 2014). Suggested tips for improving sleep hygiene and coping with sleep

deprivation are included in the image below.

(NAHIC, 2014).
SLEEP HEALTH 18

Local, State, and National Data

Exercise. In a poll done by the National Sleep Association it was found that those who

exercise report better sleep, those that do not exercise deal with more day-time sleepiness and

have a greater risk of developing sleep apnea, and those who sit for fewer than 8 hours reported

significantly better sleep (National Sleep Foundation, 2013). The recommended daily physical

activity is 30 minutes of moderate-intensity aerobic activity at least 5 days a week with muscle-

strengthening activities included in 2 of those days (American Heart Association, 2017). In

Madison County it was found that 56.4% of females achieved the recommended amount of

physical activity, compared to Idaho state’s 58.7% and the nation’s 52.6% (Institute for Health

Metrics and Evaluation, 2016). Though over half of Madison County women get the

recommended amount of exercise, there is still 43.6% of females who do not. This lack of

exercise could potentially be influencing their sleep health.

Diet. Beverages that contain caffeine such as coffee or soda, are popular and can help

students feel more awake. Though many see caffeine as a treat, there are many adverse effects.

Caffeine can cause anxiety, irritability, insomnia, and overall sleep disturbance (National Sleep

Foundation, 2001). Along with caffeine having harmful effects on the sleep schedule, it can also

cause caffeine dependence and withdrawal symptoms when consumed (Tremblay, 2017). The

United States is the country with the highest amount of caffeine consumption with 971 tons

consumed per year (Health Research Funding, 2014). The state of Idaho has less than one coffee

shop per 100,000 people (Health Research Funding, 2014). In Madison County there are

approximately 10 coffee shops or cafes where coffee is readily available (Google Maps, 2018).

Though specific statistics are not available for Madison County, caffeinated drinks are available

in almost every store.

SLEEP HEALTH 19

Income. Using the National Health Interview Survey, the CDC was able to find a

relationship between sleep and family income (EOS Sleep, 2013). In this research, they found

that the one-third of people living beneath the federal poverty line were not getting 6 hours of

sleep each night, but only one-fourth of those living above the poverty line reported the same

thing (EOS Sleep, 2013). This studies shows that there is a possible correlation between

struggling for money and struggling with sleep. This lack of sleep among the impoverished

people of the United States could be related to working more hours to try and make money.

Idaho state had 14.4% of people in poverty and the United States had 12.7% as of 2016 (United

States Census Bureau, 2016). Madison County had the largest number of the three with 24.1% of

all population in poverty (United States Census Bureau, 2018). Females aged 18-24 are the

largest demographic of people living in poverty (Data USA, 2016).

School start time. As mentioned previously, it is recommended that teenagers and young

adults get 8 or more hours of sleep a night. There is some research that shows that delaying

school start times may enable students to get the sleep that they need (American Academy of

Sleep Medicine, 2017). Studies conducted on multiple public schools in different states, found

that when school started at 8:30 a.m. or later more than 60% of students were able to get the

recommended hours of sleep and academic performance improved (NAHIC, 2014). According to

the CDC, the average school start time in the United States was 8:03 a.m. and only 17.7% of

schools started after 8:30 a.m. (Centers for Disease Control and Prevention, 2015b). Idaho’s

average school start time, 8:13 a.m., was slightly later than the nation’s but still earlier than the

recommended (Centers for Disease Control and Prevention, 2015b). BYU-Idaho, the biggest

school in Madison County, Idaho, starts classes as early as 7:45 a.m.

SLEEP HEALTH 20

Climate. Environment and temperature can play a huge role in sleep deprivation. As the

temperature rises, it becomes harder for individuals to sleep fitfully (Reed, 2017). When an

individual falls asleep, the blood vessels dilate leading to a drop in body temperature that is

maintained throughout the night (Reed, 2017). As the morning arrived, the body temperature

begins to rise, signaling to the body that it is time to wake up (Reed, 2017). When weather is

unusually warm and an individual cannot afford air conditioning, it can greatly impact their

sleep. The ideal temperature for sleep is between 60 and 67 degrees Fahrenheit (Sleep, 2018).

Throughout the contiguous United States, the average summer temperature was 72.7 degrees

Fahrenheit (NCEI, 2017). In Idaho state the average temperature is 63.7 degrees Fahrenheit

(Current Results, 2000). In Madison County the hottest month of year, July, usually has a high

around 84 degrees Fahrenheit (Sperlings, 2018). With Idaho’s cooler temperatures throughout

the year, it is possible that its climate may promote better sleep.
SLEEP HEALTH 21

Part 3: Data Interpretation

Similarities

One of the major similarities between the primary and secondary data is how female

students reported feeling when losing sleep. It was reported by both female students that when

they do not get enough sleep they are grumpy, struggle to stay motivated, and have a hard time

staying focused (M. Withers, personal communication, May 21, 2018; S. Smith, personal

communication, May 22, 2018). This same information was found to be true by the Center for

Disease Control and Prevention. It was found that when students do not get the appropriate

amount of sleep, it is hard to concentrate, stay focused, and have the best possible academic

performance (Center for Disease Control and Prevention, 2015).

Both the primary and secondary data stress the importance of sleep hygiene. The sleep

specialist stated that in order to cope with sleep troubles it is best to learn about improving sleep

hygiene (C. Finnerty, personal communication, May 22, 2018). As mentioned above, sleep

hygiene is defined as a “variety of practices that are necessary to have normal quality sleep”

(NAHIC, 2014). Ways to improve sleep hygiene include keeping a routine and going to bed at

the same time each day, keep the room dark and quiet, minimize napping, and many other

strategies given throughout the secondary data gathered (NAHIC, 2014).

It was found that almost every source suggested that teenagers and young adults get at

least 8 hours of sleep each night. In an interview with one of the female students they defined

sleep health as “getting at least 8 hours of sleep each night” (S. Smith, personal communication,

May 22, 2018). The recommended hours found on several government websites was 8 hours of

sleep every night (NAHIC, 2014).

SLEEP HEALTH 22

Differences

There were only a few differences between the primary and secondary data collected.

Among these differences is the information on media. The sleep specialist never mentioned the

importance of media curfew however, both female students mentioned that they use media for

coping when struggling with sleep (M. Withers, personal communication, May 21, 2018; S.

Smith, personal communication, May 22, 2018). In the secondary data it was stated that

incorporating a strict media curfew can promote better sleep curfew (Center for Disease Control

and Prevention, 2015).

Another difference that was found between the data is the importance of school and

school start time. Both female students who were interviewed prioritized school work over

everything else (M. Withers, personal communication, May 21, 2018; S. Smith, personal

communication, May 22, 2018). In the secondary data it was mentioned that when school started

at 8:30 or later, more than 60% of students were able to get the recommended hours of sleep

(NAHIC, 2014). In the primary data it was not mentioned that starting school later would be

beneficial even though school work was named the top priority.

The last difference found between the data is that the primary data mentioned how

females are more receptive to sleep health teaching (C. Finnerty, personal communication, May

22, 2018). This information was not found throughout the secondary data. It is possible that this

is a professional opinion and that there is no hard data found on this subject.

Strengths of the Population

There are many strengths found in the community of Madison County, Idaho that can

help promote sleep health. The greatest strength is the availability of resources throughout the

county. There are multiple sleep centers, a student health center, and several pharmacies and
SLEEP HEALTH 23

other stores with over-the-counter medications that promote sleep. These resources all have

healthcare professionals available that can help educate female students on the importance of

sleep health and ways that they can improve sleep hygiene (Center for Disease Control and

Prevention, 2015).

Another strength of this population is the relatively high exercise rate among females in

Madison County. 56.4% of females in Madison County get the recommended exercise each week

(Institute for Health Metrics and Evaluation, 2016). According to the National Sleep Foundation,

getting enough exercise each day is supposed to help promote sleep health (National Sleep

Foundation, 2013). The majority of females in Madison County obtaining the right amount of

exercise can lead to better sleep hygiene and proper sleep health.

The last strength in Madison County’s community is the climate. As mentioned

previously, climate has a large impact on quality of sleep. The ideal temperature for best sleep is

between 60 and 67 degrees Fahrenheit (Sleep, 2018). July, the warmest month of the year, only

averages temperature highs around 85 degrees Fahrenheit (Sperlings, 2018). Madison County’s

cooler temperatures are a strength in the community and can potentially have a very positive

influence on sleep health.

Challenges of the Population

There are many challenges that face this population and their ability to get the proper

amount of sleep. The prioritization of school and its early start really have an impact on sleep

health. Both female students interviewed prioritized school over a social life, work, sleep, or

extracurricular activities (M. Withers, personal communication, May 21, 2018; S. Smith,

personal communication, May 22, 2018). According to the sleep specialist in Madison County,

students struggle with sleep health due to staying up late to study, shortened sleep times, anxiety
SLEEP HEALTH 24

over testing or relationships, lack of proper nutrition, and lack of a consistent schedule (C.

Finnerty, personal communication, May 22, 2018). Prioritizing school over the health of one’s

body is a major challenge and can influence the overall health of an individual.

Another major challenge for this population is low income. Low income and poverty

have been shown to correlate with an individual’s ability to get the proper amount of sleep (EOS

Sleep, 2013). Compared to the United States and the state of Idaho, Madison County had the

highest poverty rate at 24.1% (United States Census Bureau, 2018). Of the entire population of

Madison County, females between age 18 and 24 were the largest demographic of people living

in poverty (Data USA, 2016). This large female population living in poverty throughout

Madison County could be struggling with sleep.

Diet is another challenge that is influencing the female student population in Madison

County. Many students drink beverages that contain caffeine or have a high sugar content

because it helps them feel more awake. The consumption of caffeine among teenagers and young

adults can cause anxiety, irritability, insomnia, and sleep disturbances (National Sleep

Foundation, 2001). The availability of caffeine in stores, gas stations, and at restaurants in

Madison County can potentially pose a great threat to proper sleep health.

Validating Information

Throughout the data gathering process it has been found that as many as 72.7% of

students do not get enough sleep on school nights (Center for Disease Control and Prevention,

2015). This lack of sleep can really affect their focus and their overall academic performance.

With Brigham Young University – Idaho being a large part of Madison County’s population, it

was decided that students would be assessed throughout this research.

SLEEP HEALTH 25

Other significant data includes the female population that attends college. In 2015 it was

found that females were more likely than males to attend college the fall after they graduated

high school (McHugh, 2015). In 2014, 53% of females and only 38% of males attended college

right after high school graduation and this trend continues (McHugh, 2015). The high percentage

of females attending college in Madison County is the reason females were chosen for this

community assessment.

It is also important to note that Madison County has a young population with a median

age of 23.1 (Data USA, 2016). More than 27% of Madison County’s population is under the age

of 18, this is 5% greater than the national average (United States Census Bureau, 2018). This

young population is the why ages 16 to 20 were chosen to be assessed.

SLEEP HEALTH 26

Part 4: Population Health Plan

Education

Area for improvement. Based off of the data gathered throughout Madison County,

there is a lack of knowledge found among female students age 16-20. The studies population is

in need of more education on sleep health and hygiene. Though the definition of sleep health

seems to be understood by female students, education on resources, sleep hygiene, and the

importance of sleep is needed. According to the interview with the sleep specialist, the sleep

center is an underutilized resource for female students (C. Finnerty, personal communication,

May 22, 2018). Increased awareness of these three things would be very beneficial for the

community.

Recommendations. There are multiple ways that the community can improve the

education of young female students. Bringing the importance of sleep into the school’s education

could be a huge step in increasing awareness of this problem. Providing brochures and brief

education on the importance of sleep health during school orientations is one way these young

female students could become aware of sleep health and how it impacts their daily lives.

Providing knowledge on the resources available, such as the sleep center and sleep lab here in

Madison County, would also be very beneficial. Promotion of resources and overall sleep health

could take place at BYU-Idaho, the local high schools, the grocery stores, or at local hang-outs

using fliers and brochures.

Evaluation. Number of brochures and fliers handed out can be evaluated to see how

many individuals are being reached. Although brochures can be left unread or thrown away, the

more educational materials handed out, the more female students are receiving education on

sleep health.
SLEEP HEALTH 27

Resources

Area of improvement. Throughout all of Madison County there are only two major

resources found for those struggling with sleep health (Google Maps “Madison County Sleep

Centers”, 2018). When the BYU-Idaho Student Health Center was contacted, it was found that

no one on staff was specialized in sleep health (personal communication, May 21, 2018). BYU-

Idaho, the biggest school in Madison County, does not have an available sleep specialist to help

female students improve their sleep health.

Recommendations. If there were more resources available to female students from ages

16-20, improved sleep health may increase throughout the community. Having a sleep specialist

available at the school’s health center, educating high school nurses on the importance of sleep

health, and implementing more resources in Madison County could create an environment that

promotes the best sleep health possible. Having available information on sleep specialists and

other resources in surrounding counties could also be very beneficial.

Evaluation. Interviews completed six months after these recommendations are

implemented could help in the evaluating the success rate. Female students in Madison County

between the age of 16 and 20 will be interviewed to assess their awareness of sleep health and

any resources they have heard of or have used. Another windshield survey of any other resources

can also be conducted. This windshield survey could include a follow up with BYU-Idaho’s

Student Health Center to inquire about newly hired sleep specialists. By providing more

resources in the community, sleep health could potentially improve greatly among the researched

population.
SLEEP HEALTH 28

School Start Times

Area of recommendation. As mentioned in the secondary data, starting school too early

can cause students to struggle with their sleep health (NAHIC, 2014). BYU-Idaho, the school

with the biggest attendance rate in Madison County, has classes that start as early as 7:45 a.m.

This early start paired with students placing school work as the top priority, could potentially be

causing students to struggle with sleep hygiene and overall sleep health (M. Withers, personal

communication, May 21, 2018; S. Smith, personal communication, May 22, 2018). School

starting too early can impact students’ focus and impair their academic performance (American

Academy of Sleep Medicine, 2017).

Recommendations. Starting high school and college classes at 8:30 a.m. or later, as

recommended by the CDC, could increase the amount of sleep female students receive and

improve their overall sleep health (Centers for Disease Control and Prevention, 2015b). Moving

BYU-Idaho’s early morning start to only 45 minutes later could potentially increase the amount

of sleep obtained each night. Ensuring that high schools in Madison County also start at 8:30

a.m. or later could also help create benefits for sleep health in young female students.

Evaluation. A follow up with all the schools after six months will be conducted to see if

the implementation of later school start times has been effective. Interviewing students to see

how many hours of sleep they started getting each night after school start times changed will also

be beneficial data.

Reflection

This community assessment as really opened my eyes to how important population health

nursing is in the health care field. I not only learned about sleep health but I also learned about

community weaknesses and ways that we, as nurses, can try to remedy these problems. Reading
SLEEP HEALTH 29

all of the Healthy People 2020 goals was shocking. There are so many preventative things that

can promote great health, yet a lot of communities here in the United States are disregarding how

important it is to take these measures. I think that it is our job as nurses to go out into the

community and find ways to motivate the them to be healthy, especially those who are among

the vulnerable populations. As I continue on my journey of learning and educating others as a

nurse, I want to remember what I have learned while performing this community assessment. I

learned the importance of health literacy, background knowledge, and never being afraid to

become involved to promote the greater good of everyone.

SLEEP HEALTH 30

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