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This study's purpose is to identify factors that may aid in answering the clinical question: Among adolescents 12-17 years old who are diagnosed with a mental health condition(s), does a family-based educational intervention improve healthy lifestyle knowledge and behaviors, including nutrition, PA, screen time, and sleep? The specific aims are to: Aim 1: To educate adolescents with mental health conditions and their family members about ways to improve healthy lifestyle behaviors. Aim 2: To evaluate an increase in knowledge on healthy lifestyle behaviors after a 45-minute online education session. Aim 3: To evaluate an increase in healthy lifestyle behaviors after the intervention.
This project utilizes a one-group pretest-posttest design study for 30 adolescents (aged 12-17 years) diagnosed with a mental health condition(s) and their parent/legal guardian. This project will implement best practices to promote healthy lifestyle knowledge and behaviors to adolescents and their parent(s)/legal guardian(s). This will be a 45-minute educational presentation delivered via Zoom. Participants will have option to select between 2-3 dates and times for educational presentation. The investigators will compare the effects of an educational program on healthy lifestyle knowledge and behaviors pre-and post-program (after one month) via a REDCap survey for the adolescent and their parent/legal guardian. The survey will utilize an adapted version of the 2021 National Youth Risk Behavior Survey (YRBS) and the 2020 National Survey of Children's Health (NSCH-T3). The analysis of this project will compare changes in healthy lifestyle knowledge and behaviors using a paired t-test. The educational presentation will be recorded and emailed to participants within 1 week of intervention to re-watch/review.
The pediatric population faces a public health crisis involving children and adolescents with overweight or obesity. Childhood obesity has become the most disconcerting and predominant pediatric nutritional disorder worldwide. From 2017 to 2018, 19.3% of the children and adolescents in the United States (US) were diagnosed with obesity. Childhood obesity has been linked to psychological conditions such as depression and anxiety. Children that are overweight or obese are more commonly diagnosed with depression than children with a healthy weight. In 2019, 13.6% of children five to seventeen years old received mental health treatment in twelve months, and 8.4% of that population had taken psychotropic medication for their mental health condition.
Healthy lifestyle behaviors impact short and long-term health and quality of life among children with depression. Physical activity (PA), healthy nutritional habits, and maintaining a healthy weight can improve children's quality of life with depression and overweight or obesity. Parents have the most significant influence on their children's health. Thus, family-based intervention studies have been conducted to promote children's healthy lifestyle behaviors. Behavioral interventions that combine nutritional, physical, and behavioral components and parental involvement have proven to be the best and most effective practice for treating and preventing childhood obesity among adolescents 12-17 years old.
Although there is evidence to support that adolescents benefit from peer and family support and group education, there are few in-depth studies documenting lifestyle modifications that can improve this population's overall physical and mental health. Given this lack of implementation into practice, this project aims to improve healthy lifestyle knowledge and behaviors among adolescents with a mental health condition(s) through preventative and detailed nutritional, physical activity, screen time, and sleep education.
This study's purpose is to identify factors that may aid in answering the clinical question: Among adolescents 12-17 years old who are diagnosed with a mental health condition(s), does a family-based educational intervention improve healthy lifestyle knowledge and behaviors, including nutrition, PA, screen time, and sleep? The specific aims are to: Aim 1: To educate adolescents with mental health conditions and their family members about ways to improve healthy lifestyle behaviors. Aim 2: To evaluate an increase in knowledge on healthy lifestyle behaviors after a 45-minute online education session. Aim 3: To evaluate an increase in healthy lifestyle behaviors after the intervention.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Parent-Adolescent Dyad | Experimental | Each parent-adolescent dyad will receive the intervention (educational program delivered via a 45-minute presentation via Zoom). The educational program will promote healthy lifestyle knowledge and behaviors through education evidenced by the CDC, WHO, and the American Academy of Pediatrics. Educational sessions will include the importance of healthy lifestyle modifications in the adolescent population with a mental health condition(s), lifestyle recommendations versus reality, nutrition, physical activity, screen time, and sleep recommendations and guidelines. The educational presentation will include 5-10 minutes of education regarding recommendations versus reality for nutrition, PA, screen time, and sleep, 20-25 minutes of education regarding ways to improve healthy lifestyle knowledge and behaviors, 10 minutes for questions and discussion. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Zoom Intervention | Behavioral | This educational program will be delivered via a 45-minute presentation via Zoom.
|
| Measure | Description | Time Frame |
|---|---|---|
| Percent of Participants With Correct Responses for Healthy Lifestyle Behavior Knowledge Survey Questions. | Evaluate knowledge on healthy lifestyle behaviors before and one month after a 45-minute online educational session using a questionnaire (the same questionnaire for before and after intervention). | One Month |
| Median Score on a Scale of Participants Responses for Healthy Lifestyle Behavior Knowledge Survey Questions | Evaluate healthy lifestyle behaviors before and one month after a 45-minute online educational session using a questionnaire (the same questionnaire for before and after intervention). The scale was adapted from 2021 United States Census Bureau Questionnaire, 2001 PHQ-9, 2021 National Youth Physical Activity and Nutrition Study, and 2021 Youth Risk Behavior Surveillance System Questionnaire. High scores represent better outcomes. The subscale range for each question is as follows: Drink Water 1-7, Eat Breakfast 1-8, Eat dairy products 1-7, eat family dinner 1-8, eat fruit 1-7, eat whole grains 1-7, where do you eat dinner 1-7, eat vegetables 1-7, active 60min/day 1-8, aerobic activity 1-8, Muscle Strengthening Activity 1-8, sports teams 1-4, Bed at Same Time 1-6, Bedtime 7-12, Hours of Sleep 3-12, Nap during day 1-6, restless sleep 1-6, Tired during day 1-6, where do you sleep 1-7, awaken during night 1-6, WHO final score 0-25, afford food 1-3, family dinner 1-8, family exercise 1-8. | One Month |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Mary Livings | Florida State University | Study Chair |
| Rachel L Sharp, BSN | Florida State University | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Wolfson Children's Hospital- Intensive Outpatient Behavioral Health Program (IOP) and the Partial Hospitalization Program (PHP) and Bridge Program | Jacksonville | Florida | 32207 | United States |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 28639320 | Background | Al-Khudairy L, Loveman E, Colquitt JL, Mead E, Johnson RE, Fraser H, Olajide J, Murphy M, Velho RM, O'Malley C, Azevedo LB, Ells LJ, Metzendorf MI, Rees K. Diet, physical activity and behavioural interventions for the treatment of overweight or obese adolescents aged 12 to 17 years. Cochrane Database Syst Rev. 2017 Jun 22;6(6):CD012691. doi: 10.1002/14651858.CD012691. | |
| 31836627 |
| Label | URL |
|---|---|
| Related Info | View source |
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This project enrolled 86 parent-adolescent dyads total (1 parent and 1 adolescent per dyad), and nine parent-adolescent dyads total completed the study. The setting was the Intensive Outpatient Behavioral Health Program (IOP), the Partial Hospitalization Program (PHP), and the Bridge Program at Wolfson Children Hospital in Jacksonville, Fl. Recruitment included posting approved project flyers on social media platforms such as Facebook and Instagram.
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| ID | Title | Description |
|---|---|---|
| FG000 | Parent-Adolescent Dyad | Each parent-adolescent dyad will receive the intervention (educational program delivered via a 45-minute presentation via Zoom). The educational program will promote healthy lifestyle knowledge and behaviors through education evidenced by the CDC, WHO, and the American Academy of Pediatrics. Educational sessions will include the importance of healthy lifestyle modifications in the adolescent population with a mental health condition(s), lifestyle recommendations versus reality, nutrition, physical activity, screen time, and sleep recommendations and guidelines. The educational presentation will include 5-10 minutes of education regarding recommendations versus reality for nutrition, PA, screen time, and sleep, 20-25 minutes of education regarding ways to improve healthy lifestyle knowledge and behaviors, 10 minutes for questions and discussion. Zoom Intervention
|
| Title | Milestones | Reasons Not Completed | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Overall Study |
|
Participants (dyads) who completed the pre-survey
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| ID | Title | Description |
|---|---|---|
| BG000 | Pre-Intervention | Participants (Dyads) who completed the pre-survey |
| Units | Counts |
|---|---|
| Participants |
|
| Title | Description | Population Description | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Denominator Units Selected | Denominators | Classes |
|---|---|---|---|---|---|---|---|---|---|
| Age, Categorical | The Parent-Adolescent Dyad is presented separately to distinguish parent participants from adolescent participants. |
| Type | Title | Description | Population Description | Reporting Status | Anticipated Posting Date | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Time Frame | Units Analyzed | Denominator Units Selected | Arm/Group Information | Denominators | Classes | Analyses | |||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Primary | Percent of Participants With Correct Responses for Healthy Lifestyle Behavior Knowledge Survey Questions. | Evaluate knowledge on healthy lifestyle behaviors before and one month after a 45-minute online educational session using a questionnaire (the same questionnaire for before and after intervention). | This project included nine parent-adolescent dyads. Examples of eligible diagnosed mental health conditions include major depressive disorder (MDD), generalized anxiety disorder (GAD), attention-deficit disorder (ADD)/ attention deficit hyperactivity disorder (ADHD), and bipolar disorder (BPD). Participants' exclusion criteria include children under 12 years old or older than 18 years old. Non-legal guardians were unable to participate in the project. | Posted | Number | percentage of participants | One Month |
|
All-Cause Mortality, Serious, and Other (Not Including Serious) Adverse Events were not monitored/assessed.
All-Cause Mortality, Serious, and Other (Not Including Serious) Adverse Events were not monitored/assessed.
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| ID | Title | Description | Deaths (Affected) | Deaths (At Risk) | Serious Events (Affected) | Serious Events (At Risk) | Other Events (Affected) | Other Events (At Risk) |
|---|---|---|---|---|---|---|---|---|
| EG000 | Parent/Legal Guardian (LG) Pre-Intervention Knowledge Changes | Parent/legal guardians of adolescents 12-17 years old with a clinical diagnosis of a mental health condition(s) |
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| Title | Organization | Phone | Extension | |
|---|---|---|---|---|
| Rachel Sharp | Florida State University | 850-865-4443 | rls14c@fsu.edu |
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| Type | Includes Protocol | Includes SAP | Includes ICF | Document Label | Document Date | Document Uploaded Date | Document File Name |
|---|---|---|---|---|---|---|---|
| Prot_SAP | Yes | Yes | No | Study Protocol and Statistical Analysis Plan | Nov 26, 2022 | Jan 15, 2024 | Prot_SAP_004.pdf |
| ICF | No | No | Yes | Informed Consent Form: Adult- General Informed Consent Form | Aug 25, 2022 | Dec 14, 2022 | ICF_001.pdf |
| ICF | No | No | Yes | Informed Consent Form: Adolescent 14-17yr - Informed Consent Form | Aug 25, 2022 | Dec 14, 2022 | ICF_002.pdf |
| ICF | No | No | Yes | Informed Consent Form: Child 7-13yr- Informed Consent Form | Aug 25, 2022 | Dec 21, 2022 | ICF_003.pdf |
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| ID | Term |
|---|---|
| D001519 | Behavior |
| D001523 | Mental Disorders |
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|
| Background |
| Barnett ER, Trepman AZ, Fuson HA, Acquilano SC, McLaren JL, Woloshin S, Leyenaar JK. Deprescribing psychotropic medications in children: results of a national qualitative study. BMJ Qual Saf. 2020 Aug;29(8):655-663. doi: 10.1136/bmjqs-2019-010033. Epub 2019 Dec 13. |
| 32839242 | Background | Bean MK, Caccavale LJ, Adams EL, Burnette CB, LaRose JG, Raynor HA, Wickham EP 3rd, Mazzeo SE. Parent Involvement in Adolescent Obesity Treatment: A Systematic Review. Pediatrics. 2020 Sep;146(3):e20193315. doi: 10.1542/peds.2019-3315. |
| 32777922 | Background | Blasco BV, Garcia-Jimenez J, Bodoano I, Gutierrez-Rojas L. Obesity and Depression: Its Prevalence and Influence as a Prognostic Factor: A Systematic Review. Psychiatry Investig. 2020 Aug;17(8):715-724. doi: 10.30773/pi.2020.0099. Epub 2020 Aug 12. |
| 28274260 | Background | Faught EL, Ekwaru JP, Gleddie D, Storey KE, Asbridge M, Veugelers PJ. The combined impact of diet, physical activity, sleep and screen time on academic achievement: a prospective study of elementary school students in Nova Scotia, Canada. Int J Behav Nutr Phys Act. 2017 Mar 9;14(1):29. doi: 10.1186/s12966-017-0476-0. |
| 30165751 | Background | Gidugu V, Jacobs ML. Empowering individuals with mental illness to develop healthy eating habits through mindful eating: results of a program evaluation. Psychol Health Med. 2019 Feb;24(2):177-186. doi: 10.1080/13548506.2018.1516295. Epub 2018 Aug 31. |
| 32817610 | Background | Ivey-Stephenson AZ, Demissie Z, Crosby AE, Stone DM, Gaylor E, Wilkins N, Lowry R, Brown M. Suicidal Ideation and Behaviors Among High School Students - Youth Risk Behavior Survey, United States, 2019. MMWR Suppl. 2020 Aug 21;69(1):47-55. doi: 10.15585/mmwr.su6901a6. |
| 28242200 | Background | Jacka FN. Nutritional Psychiatry: Where to Next? EBioMedicine. 2017 Mar;17:24-29. doi: 10.1016/j.ebiom.2017.02.020. Epub 2017 Feb 21. |
| 33511092 | Background | Kansra AR, Lakkunarajah S, Jay MS. Childhood and Adolescent Obesity: A Review. Front Pediatr. 2021 Jan 12;8:581461. doi: 10.3389/fped.2020.581461. eCollection 2020. |
| 33180751 | Background | Leeb RT, Bitsko RH, Radhakrishnan L, Martinez P, Njai R, Holland KM. Mental Health-Related Emergency Department Visits Among Children Aged <18 Years During the COVID-19 Pandemic - United States, January 1-October 17, 2020. MMWR Morb Mortal Wkly Rep. 2020 Nov 13;69(45):1675-1680. doi: 10.15585/mmwr.mm6945a3. |
| 32079538 | Background | Lindberg L, Hagman E, Danielsson P, Marcus C, Persson M. Anxiety and depression in children and adolescents with obesity: a nationwide study in Sweden. BMC Med. 2020 Feb 21;18(1):30. doi: 10.1186/s12916-020-1498-z. |
| 31004047 | Background | Loewen OK, Maximova K, Ekwaru JP, Faught EL, Asbridge M, Ohinmaa A, Veugelers PJ. Lifestyle Behavior and Mental Health in Early Adolescence. Pediatrics. 2019 May;143(5):e20183307. doi: 10.1542/peds.2018-3307. Epub 2019 Apr 19. |
| 32817612 | Background | Merlo CL, Jones SE, Michael SL, Chen TJ, Sliwa SA, Lee SH, Brener ND, Lee SM, Park S. Dietary and Physical Activity Behaviors Among High School Students - Youth Risk Behavior Survey, United States, 2019. MMWR Suppl. 2020 Aug 21;69(1):64-76. doi: 10.15585/mmwr.su6901a8. |
| 25451390 | Background | Morrison KM, Shin S, Tarnopolsky M, Taylor VH. Association of depression & health related quality of life with body composition in children and youth with obesity. J Affect Disord. 2015 Feb 1;172:18-23. doi: 10.1016/j.jad.2014.09.014. Epub 2014 Sep 23. |
| 30951586 | Background | Naar S, Ellis D, Idalski Carcone A, Jacques-Tiura AJ, Cunningham P, Templin T, Hartlieb KB, Jen KC. Outcomes From a Sequential Multiple Assignment Randomized Trial of Weight Loss Strategies for African American Adolescents With Obesity. Ann Behav Med. 2019 Aug 29;53(10):928-938. doi: 10.1093/abm/kaz003. |
| 33524119 | Background | Nigg CR, Wunsch K, Nigg C, Niessner C, Jekauc D, Schmidt SCE, Woll A. Are Physical Activity, Screen Time, and Mental Health Related During Childhood, Preadolescence, and Adolescence? 11-Year Results From the German Motorik-Modul Longitudinal Study. Am J Epidemiol. 2021 Feb 1;190(2):220-229. doi: 10.1093/aje/kwaa192. |
| 31509167 | Background | Riehm KE, Feder KA, Tormohlen KN, Crum RM, Young AS, Green KM, Pacek LR, La Flair LN, Mojtabai R. Associations Between Time Spent Using Social Media and Internalizing and Externalizing Problems Among US Youth. JAMA Psychiatry. 2019 Dec 1;76(12):1266-1273. doi: 10.1001/jamapsychiatry.2019.2325. |
| 30783405 | Background | Rippe JM. Lifestyle Medicine: The Health Promoting Power of Daily Habits and Practices. Am J Lifestyle Med. 2018 Jul 20;12(6):499-512. doi: 10.1177/1559827618785554. eCollection 2018 Nov-Dec. |
| 30993594 | Background | Rodriguez-Ayllon M, Cadenas-Sanchez C, Estevez-Lopez F, Munoz NE, Mora-Gonzalez J, Migueles JH, Molina-Garcia P, Henriksson H, Mena-Molina A, Martinez-Vizcaino V, Catena A, Lof M, Erickson KI, Lubans DR, Ortega FB, Esteban-Cornejo I. Role of Physical Activity and Sedentary Behavior in the Mental Health of Preschoolers, Children and Adolescents: A Systematic Review and Meta-Analysis. Sports Med. 2019 Sep;49(9):1383-1410. doi: 10.1007/s40279-019-01099-5. |
| 27804225 | Background | Schwartz BS, Glass TA, Pollak J, Hirsch AG, Bailey-Davis L, Moran TH, Bandeen-Roche K. Depression, its comorbidities and treatment, and childhood body mass index trajectories. Obesity (Silver Spring). 2016 Dec;24(12):2585-2592. doi: 10.1002/oby.21627. Epub 2016 Nov 2. |
| 22531090 | Background | Skelton JA, Buehler C, Irby MB, Grzywacz JG. Where are family theories in family-based obesity treatment?: conceptualizing the study of families in pediatric weight management. Int J Obes (Lond). 2012 Jul;36(7):891-900. doi: 10.1038/ijo.2012.56. Epub 2012 Apr 24. |
| 32837149 | Background | Williams YV, Cowan PA, Graff JC. Depressive Symptoms, Body Mass Index, and Physical Activity Self-Efficacy in African American Children. J Child Fam Stud. 2020;29(9):2580-2589. doi: 10.1007/s10826-020-01761-x. Epub 2020 Jun 27. |
| 29439784 | Background | Wu X, Bastian K, Ohinmaa A, Veugelers P. Influence of physical activity, sedentary behavior, and diet quality in childhood on the incidence of internalizing and externalizing disorders during adolescence: a population-based cohort study. Ann Epidemiol. 2018 Feb;28(2):86-94. doi: 10.1016/j.annepidem.2017.12.002. Epub 2017 Dec 11. |
| 11556941 | Background | Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med. 2001 Sep;16(9):606-13. doi: 10.1046/j.1525-1497.2001.016009606.x. |
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| Count of Participants |
| Participants |
|
| Age, Continuous | Median | Full Range | years |
|
| Age, Customized | The Parent-Adolescent Dyad is presented separately to distinguish parent participants from adolescent participants. | Median | Full Range | years |
|
| Sex/Gender, Customized | Separate parent/legal guardians from adolescents. | Count of Participants | Participants |
|
| Sex: Female, Male | Count of Participants | Participants |
|
| Ethnicity (NIH/OMB) | The Parent-Adolescent Dyad is presented separately to distinguish parent participants from adolescent participants. | Count of Participants | Participants |
|
| Race (NIH/OMB) | The Parent-Adolescent Dyad is presented separately to distinguish parent participants from adolescent participants. | Count of Participants | Participants |
|
| Region of Enrollment | The Parent-Adolescent Dyad is presented separately to distinguish parent participants from adolescent participants. | Count of Participants | Participants |
|
| Age of Diagnosis for Adolescent Participants Only | Parent-reported age that adolescent was diagnosed with mental health condition. | The Parent-Adolescent Dyad is presented separately to distinguish parent participants from adolescent participants. | Median | Full Range | years |
|
| Parent/Legal Guardian Mood | Parent-reported current mental health status. Represented on the following 1-5 scale: poor (1), fair (2), good (3), very good (4), excellent (5). Higher values represent better outcomes. The question was copied from the 2021 United States Census Bureau Questionnaire. | The Parent-Adolescent Dyad is presented separately to distinguish parent participants from adolescent participants. | Median | Full Range | Units on a scale |
|
| Adolescent Weight | The Parent-Adolescent Dyad is presented separately to distinguish parent participants from adolescent participants. | Mean | Full Range | lbs |
|
Parent/legal guardians of adolescents 12-17 years old with a clinical diagnosis of a mental health condition(s)
| OG001 | Parent/Legal Guardian (LG) Post-Intervention Knowledge Changes | Parent/legal guardians of adolescents 12-17 years old with a clinical diagnosis of a mental health condition(s) |
| OG002 | Adolescent Pre-Intervention Knowledge Changes | Adolescents 12-17 years old with a clinical diagnosis of a mental health condition(s) |
| OG003 | Adolescent Post-Intervention Knowledge Changes | Adolescents 12-17 years old with a clinical diagnosis of a mental health condition(s) |
|
|
|
| Primary | Median Score on a Scale of Participants Responses for Healthy Lifestyle Behavior Knowledge Survey Questions | Evaluate healthy lifestyle behaviors before and one month after a 45-minute online educational session using a questionnaire (the same questionnaire for before and after intervention). The scale was adapted from 2021 United States Census Bureau Questionnaire, 2001 PHQ-9, 2021 National Youth Physical Activity and Nutrition Study, and 2021 Youth Risk Behavior Surveillance System Questionnaire. High scores represent better outcomes. The subscale range for each question is as follows: Drink Water 1-7, Eat Breakfast 1-8, Eat dairy products 1-7, eat family dinner 1-8, eat fruit 1-7, eat whole grains 1-7, where do you eat dinner 1-7, eat vegetables 1-7, active 60min/day 1-8, aerobic activity 1-8, Muscle Strengthening Activity 1-8, sports teams 1-4, Bed at Same Time 1-6, Bedtime 7-12, Hours of Sleep 3-12, Nap during day 1-6, restless sleep 1-6, Tired during day 1-6, where do you sleep 1-7, awaken during night 1-6, WHO final score 0-25, afford food 1-3, family dinner 1-8, family exercise 1-8. | WHO-5 Analysis for Adolescent participants only. | Posted | Median | Full Range | score on a scale | One Month |
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| 0 |
| 0 |
| 0 |
| 0 |
| 0 |
| 0 |
| EG001 | Parent/Legal Guardian (LG) Post-Intervention Knowledge Changes | Parent/legal guardians of adolescents 12-17 years old with a clinical diagnosis of a mental health condition(s) | 0 | 0 | 0 | 0 | 0 | 0 |
| EG002 | Adolescent Pre-Intervention Knowledge Changes | Adolescents 12-17 years old with a clinical diagnosis of a mental health condition(s) | 0 | 0 | 0 | 0 | 0 | 0 |
| EG003 | Adolescent Post-Intervention Knowledge Changes | Adolescents 12-17 years old with a clinical diagnosis of a mental health condition(s) | 0 | 0 | 0 | 0 | 0 | 0 |
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| Black or African American |
|
| White |
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| More than one race |
|
| Unknown or Not Reported |
|
|
| Eat Breakfast |
|
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| Eat Dairy Products |
|
|
| Eat Family Dinner |
|
|
| Eat Fruit |
|
|
| Eat Whole Grains |
|
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| Where do You Eat Dinner |
|
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| Eat Vegetables |
|
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| Active 60min/day |
|
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| Aerobic Activity |
|
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| Muscle Strengthening Activity |
|
|
| Sports Teams |
|
|
| Bed at Same Time |
|
|
| Bedtime |
|
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| Hours of Sleep |
|
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| Nap During Day |
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| Restless Sleep |
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| Tired During Day |
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| Where do You Sleep |
|
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| Awaken During Night |
|
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| WHO-5 Final Score |
|
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| Afford Food |
|
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| Family Dinner |
|
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| Family Exercise |
|
|