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OBJECTIVES: To investigate ethnic inequities in, and social determinants of, adolescent sleep health in Aotearoa New Zealand. METHODS: Analysis of self-report data from a cross-sectional survey of secondary school students (12- to 18-year-olds). Analyses included weighted prevalence estimates of good and poor sleep health stratified by ethnicity, and multivariable logistic regression models concurrently adjusted for ethnicity, school year, gender, rurality, neighborhood deprivation, school decile, housing deprivation, sleeping elsewhere due to lack of adequate housing, unsafe environment, and racism. RESULTS: Inequities in social determinants of health were evident for Maori (Indigenous peoples of Aotearoa New Zealand; n = 1528) and minoritized (Pacific n = 1204; Asian n = 1927; Middle Eastern, Latin American, and African [MELAA] n = 210; and 'Other' ethnicity n = 225) adolescents. A greater proportion of Maori, Pacific, Asian, MELAA, and 'Other' adolescents had short sleep, compared to European (n = 3070). Maori, Pacific, Asian, and MELAA adolescents were more likely to report late bedtimes (after midnight), and Maori, Pacific, and 'Other' adolescents were more likely to report early waketimes (5 AM-6 AM or earlier), on school days. Rurality, neighborhood deprivation, school-level deprivation, housing deprivation, sleeping elsewhere due to inadequate housing, unsafe environments, and racism partially, but not fully, explained associations between ethnicity and short sleep, late bedtimes, and early waketimes. CONCLUSIONS: Ethnic inequities exist in adolescent sleep health in Aotearoa New Zealand. Socio-political actions are needed to address racism and colonialism as root causes of ethnic inequities in adolescent sleep, to ensure all young people are afforded the basic human right of good sleep health and associated mental and physical well-being.

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In Aotearoa/New Zealand, ethnic inequities in sleep health exist for young children and adults and are largely explained by inequities in socioeconomic deprivation. Poor sleep is related to poor mental health for these age groups but whether sleep inequities and associations with mental health exist for school-aged children is unclear. We aimed to (1) determine the prevalence of poor sleep health including sleep problems by ethnicity, (2) examine social determinants of health associated with poor sleep, and (3) investigate relationships between poor sleep and mental health for 5-14-year-olds using cross-sectional New Zealand Health Survey data (n = 8895). Analyses included weighted prevalence estimates and multivariable logistic regression. Short sleep was more prevalent for Indigenous Maori (17.6%), Pacific (24.5%), and Asian (18.4%) children, and snoring/noisy breathing during sleep was more prevalent for Maori (29.4%) and Pacific (28.0%) children, compared to European/Other (short sleep 10.2%, snoring/noisy breathing 17.6%). Ethnicity and neighborhood socioeconomic deprivation were independently associated with short sleep and snoring/noisy breathing during sleep. Short sleep was associated with increased odds of anxiety, attention deficit hyperactivity disorder, and activity-limiting emotional and psychological conditions after adjusting for ethnicity, deprivation, age, and gender. In addition, long sleep was independently associated with increased odds of depression. These findings demonstrate that for school-aged children ethnic inequities in sleep exist, socioeconomic deprivation is associated with poor sleep, and poor sleep is associated with poor mental health. Sociopolitical action is imperative to tackle social inequities to support sleep equity and mental health across the lifecourse.

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BACKGROUND: Cardiometabolic disease (CMD) risk often begins early in life. Healthy lifestyle behaviors can mitigate risk, but the optimal combination of behaviors has not been determined. This cross-sectional study simultaneously examined the associations between lifestyle factors (fitness, activity behaviors, and dietary patterns) and CMD risk in preadolescent children. METHODS: 1480 New Zealand children aged 8-10 years were recruited. Participants included 316 preadolescents (50% female, age: 9.5 ± 1.1 years, BMI: 17.9 ± 3.3 kg/m2). Fitness (cardiorespiratory fitness [CRF], muscular fitness), activity behaviors (physical activity, sedentary, sleep), and dietary patterns were measured. Factor analysis was used to derive a CMD risk score from 13 variables (adiposity, peripheral and central hemodynamics, glycemic control, and blood lipids). RESULTS: Only CRF (ß = -0.45, p < 0.001) and sedentary time (ß = 0.12, p = 0.019) were associated with the CMD risk score in the adjusted multivariable analysis. CRF was found to be nonlinear (VO2 max ≤ ≈42 mL/kg/min associated with higher CMD risk score), and thus a CRF polynomial term was added, which was also associated (ß = 0.19, p < 0.001) with the CMD risk score. Significant associations were not found with sleep or dietary variables. CONCLUSION: The findings indicate that increasing CRF and decreasing sedentary behavior may be important public health targets in preadolescent children.

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Lifestyle factors contribute to childhood obesity risk, however it is unclear which lifestyle factors are most strongly associated with childhood obesity. The purpose of this cross-sectional study was to simultaneously investigate the associations among dietary patterns, activity behaviors, and physical fitness with adiposity (body fat %, fat mass, body mass index [BMI], and waist to hip ratio) in preadolescent children. Preadolescent children (N = 392, 50% female, age: 9.5 ± 1.1year, BMI: 17.9 ± 3.3 kg/m2) were recruited. Body fat (%) and fat mass (kg) were measured with bioelectrical impedance analysis. Cardiorespiratory fitness (VO2 max), muscular strength (hand-grip strength), activity, sleep, and dietary pattern was assessed. Multivariable analysis revealed that cardiorespiratory fitness associated most strongly with all four indicators of adiposity (body fat (%) (ß = -0.2; p < .001), fat mass (ß = -0.2; p < .001), BMI (ß = -0.1; p < .001) and waist to hip ratio (ß = -0.2; p < .001). Additionally, fruit and vegetable consumption patterns were associated with body fat percentage, but the association was negligible (ß = 0.1; p = 0.015). Therefore, future interventions should aim to promote the use of cardiorespiratory fitness as a means of reducing the obesity epidemic in children.

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BACKGROUND: A woman's vulnerability to sleep disruption and mood disturbance is heightened during the perinatal period and there is a strong bidirectional relationship between them. Both sleep disruption and mood disturbance can result in significant adverse outcomes for women and their infant. Thus, supporting and improving sleep in the perinatal period is not only an important outcome in and of itself, but also a pathway through which future mental health outcomes may be altered. METHODS: Using scoping review methodology, we investigated the nature, extent and characteristics of intervention studies conducted during the perinatal period (pregnancy to one-year post-birth) that reported on both maternal sleep and maternal mental health. Numerical and descriptive results are presented on the types of studies, settings, sample characteristics, intervention design (including timeframes, facilitation and delivery), sleep and mood measures and findings. RESULTS: Thirty-seven perinatal interventions were identified and further described according to their primary focus (psychological (n = 9), educational (n = 15), lifestyle (n = 10), chronotherapeutic (n = 3)). Most studies were conducted in developed Western countries and published in the last 9 years. The majority of study samples were women with existing sleep or mental health problems, and participants were predominantly well-educated, not socio-economically disadvantaged, in stable relationships, primiparous and of White race/ethnicity. Interventions were generally delivered across a relatively short period of time, in either the second trimester of pregnancy or the early postnatal period and used the Pittsburgh Sleep Quality Index (PSQI) to measure sleep and the Edinburgh Postnatal Depression Scale (EPDS) to measure mood. Retention rates were high (mean 89%) and where reported, interventions were well accepted by women. Cognitive Behavioural Therapies (CBT) and educational interventions were largely delivered by trained personnel in person, whereas other interventions were often self-delivered after initial explanation. CONCLUSIONS: Future perinatal interventions should consider spanning the perinatal period and using a stepped-care model. Women may be better supported by providing access to a range of information, services and treatment specific to their needs and maternal stage. The development of these interventions must involve and consider the needs of women experiencing disadvantage who are predominantly affected by poor sleep health and poor mental health.

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INTRODUCTION: Poor sleep and depressive symptoms are common throughout the perinatal period, but little is known about the extended time course of depression and the sleep dimensions associated with these trajectories. OBJECTIVE: This study investigated different depression trajectories in New Zealand Maori and non-Maori women from late pregnancy to 3 years postnatal. Relationships between multiple dimensions of sleep and these depression trajectories were also investigated. METHODS: Data from 856 women (30.6% Maori and 69.4% non-Maori) from the longitudinal Moe Kura cohort study were used. Depressive symptoms and multiple dimensions of sleep (quality, duration, latency, continuity and daytime sleepiness) were collected at 36 weeks' gestation, 12 weeks postnatal and 3 years postnatal. Trajectory analysis was completed using latent class analysis. RESULTS: Latent class analysis revealed two distinct groups of depressive symptom trajectories: 'chronic high' and 'stable mild' for both Maori and non-Maori women. Maori women in both trajectories were more likely than non-Maori women to have clinically significant depressive symptoms at every time point. Poorer sleep quality, latency, continuity and greater daytime sleepiness were consistently associated with the chronic high depressive symptom trajectory at all three time points, after controlling for sociodemographic factors. CONCLUSION: A significant proportion of Maori and non-Maori women experience chronically high depressive symptoms during the perinatal period and the following years. Across this extended time frame, Maori women have a higher probability of experiencing clinically significant depressive symptoms compared to non-Maori women. These persistent patterns of depressive symptoms occur concurrently with multiple dimensions of poor sleep. Given the well-described impact of maternal depression on the mother, child, family and community, this highlights the importance of healthcare professionals asking about mothers' sleep quality, continuity, latency and daytime sleepiness as potential indicators of long-term mood outcomes.

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Background: Poor sleep and prior depression are key predictors of perinatal depression, with research suggesting depressive symptoms may emerge in early pregnancy. Sleep is a potentially modifiable risk factor for depression. This pilot study examined the feasibility and acceptability of a six-month sleep education intervention designed to optimize sleep and minimize depressive symptoms throughout pregnancy. Sleep measures and depressive symptoms are described from 12 weeks gestation to 12 weeks postpartum.Participants: A community sample of nulliparous pregnant women with a history of depression were recruited prior to 14 weeks gestation.Methods: An individualized sleep education program was developed and participants engaged in three trimester specific sleep education sessions. Feasibility and acceptability were determined via recruitment and retention rates and participant feedback. Depressive symptoms and sleep were measured at five time points throughout the study.Results: 22 women enrolled in the study and 15 completed the intervention. Participants reported the intervention as highly acceptable. There was minimal change in all dimensions of sleep across pregnancy, but sleep measures were significantly worse at six weeks postpartum and improved by 12 weeks postpartum. Depressive symptoms were significantly lower at the conclusion of the intervention and 12 weeks postpartum compared to trimester 1.Conclusions: This sleep education program appears feasible, acceptable and may be effective in minimizing depressive symptoms in pregnant women with a history of depression. Trials with larger and more diverse samples are warranted and further studies to ascertain efficacy should be undertaken with a control group.

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OBJECTIVES: To provide descriptive sleep data and explore sleep inequities, we investigated maternal reports of when and how well Maori (Indigenous) and non-Maori preschoolers sleep, and examined relationships between ethnicity (child and maternal), socioeconomic position (SEP) and sleep timing and problems of 3-4 year old children in Aotearoa/New Zealand (NZ). METHODS: This study involved cross-sectional analysis of data from the Moe Kura: Mother and Child, Sleep and Wellbeing in Aotearoa/New Zealand longitudinal study. Log-binomial regression models were used to investigate associations between child and maternal demographic variables and preschooler bedtimes, social jetlag and maternally-reported sleep problems. Child models included child ethnicity, child gender, area- and individual-level deprivation. Maternal models included maternal ethnicity, maternal age, area- and individual-level deprivation. RESULTS: 340 Maori and 570 non-Maori preschoolers and their mothers participated. Maori preschoolers had later average bedtimes and wake times than non-Maori preschoolers. Ethnicity and area-level deprivation were independently associated with later bedtimes. Ethnicity was associated with social jetlag and sleep problems, independent of SEP. Individual-level deprivation was associated with problems falling asleep. Preschoolers of Maori mothers in least deprived areas were more likely to have problems falling asleep than preschoolers of non-Maori mothers in least deprived areas. CONCLUSIONS: Research is needed to understand what sleep timing differences mean for preschoolers' wellbeing in NZ. Fundamental causes of social and economic disadvantage experienced by Indigenous children and mothers and by families who hold low SEP must be addressed, in order to eliminate sleep health inequities in early childhood.

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STUDY OBJECTIVES: This study tested the acceptability and efficacy of a perinatally delivered behavioral-educational sleep intervention. METHODS: Participants were 40 primiparous women assigned in late pregnancy to either an intervention (n = 20) or control (n = 20) group. The sleep intervention group (SIG) received prenatal anticipatory education and guidance regarding their own and their infant's sleep during the first 3 months postpartum. This was reinforced during phone calls within the first 6 weeks postpartum. The control group (CG) received brief sleep hygiene information at a prenatal session, followed by 2 phone calls during the same period. Mother-infant pairs wore actigraphs for 48 hours at 6 and 12 weeks postpartum, and mothers kept sleep diaries. Questionnaires completed in late pregnancy and 6 and 12 weeks postpartum related to sleep, newborn care, and mood. The main outcome measures included maternal sleep quantity, efficiency, and self-reported quality and infant sleep duration and consolidation. RESULTS: Mothers reported high acceptability of the study processes. Sleep duration and quality increased for mothers and infants across time in both groups, with a significantly greater increase in nocturnal sleep duration for mothers in the SIG. CONCLUSIONS: Prenatal sleep guidance and postnatal follow-up seems to enhance nocturnal sleep of mothers, change their perceptions of their own sleep, and increase confidence in managing their infant's sleep. Follow-up at later intervals and replication with larger, more diverse samples may reveal further differences.

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OBJECTIVES: Investigate the efficacy of a pilot longitudinal sleep education program for optimizing sleep and minimizing depressive symptoms in nulliparous pregnant women. DESIGN: Early and longitudinal sleep education intervention pilot study. SETTING: Community-based convenience sample of New Zealand women. PARTICIPANTS: 15 nulliparous women who were involved in a pilot of a longitudinal sleep education intervention during pregnancy (N = 15) were compared to a comparison group (n = 76) from another observational study with the same time points. Groups were matched on depression history and parity. INTERVENTION: A longitudinal sleep education program was developed. Women in the intervention group participated in three individualized and trimester specific education sessions designed to increase sleep knowledge and improve sleep practices. The comparison group received no sleep education. MEASUREMENTS: Self-reports of depressive symptoms and five dimensions of sleep (duration, quality, continuity, latency, daytime sleepiness) were compared between groups using linear mixed model analysis of variance. RESULTS: At the conclusion of the intervention, the intervention group had fewer depressive symptoms with none experiencing clinically significant depressive symptoms, while 21% of the comparison group were considered to have clinically significant depressive symptoms. The intervention group also had better sleep quality, sleep initiation and sleep continuity than the comparison group at late pregnancy. CONCLUSIONS: Findings suggest that a longitudinal sleep education intervention commencing early in pregnancy may be effective in optimizing sleep and minimizing depressive symptoms for nulliparous women with a history of depression. Further investigation of sleep education interventions to improve maternal mental health in pregnancy and postnatally is warranted.

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OBJECTIVES: To investigate the association between measures of sleep quality, sleep duration and sleep disorder symptoms in late pregnancy and likelihood of emergency caesarean section. DESIGN: Population-based prospective cohort study SETTING: New Zealand PARTICIPANTS: 310 Maori (Indigenous New Zealanders) and 629 non-Maori women MEASUREMENTS: Multivariable logistic regression models were used to investigate the association between type of delivery (emergency caesarean section vs. spontaneous vaginal delivery) and self-reported sleep duration, sleep quality and sleep-related symptoms, (e.g. snoring, breathing pauses during sleep, legs twitching/jerking) in the third trimester of pregnancy. Models were adjusted by ethnicity (ref=non-Maori), age (ref=16-19 y), parity (ref=nulliparous), clinical indicators (any vs. none), area deprivation (ref=least deprived quintile), BMI and for some models smoking. RESULTS: Women who reported poor quality sleep as measured by the General Sleep Disturbance Scale in later pregnancy had almost twice the odds of delivering via emergency caesarean than women with good sleep quality (OR=1.98, 95% CI 1.18-3.31). Reporting current breathing pauses during sleep (OR=3.27, 95% CI 1.38-7.74) or current snoring (OR=1.65, 95% CI 1.00-2.72) were also independently associated with a higher likelihood of an emergency caesarean. Short sleep duration and leg twitching/jerking were not independently associated with emergency caesarean section in this study. CONCLUSIONS: Supporting healthy sleep during pregnancy could be a novel intervention to reduce the risks associated with emergency caesarean section. Research on the effectiveness of sleep interventions for reducing caesarean section risk is required.

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Knowledge about cabin crew fatigue associated with ultra-long range (ULR) flights is still limited. Current ULR scheduling for cabin crew is therefore predominantly based on flight crew data. Cabin crews' views on fatigue, and their strategies for mitigating it, have seldom been sought. To better understand the causes and consequences of cabin crew fatigue, semi-structured focus group discussions were held. Thematic analysis was undertaken with data from 25 cabin crew. Participants indicated that the consequences of fatigue are twofold, affecting 1) cabin crew health and wellbeing and 2) safety (cabin, passenger and personal) and cabin service. While the primary causes of fatigue were sleep loss and circadian disruption, participants also identified other key factors including: insufficient rest, high workload, the work environment, a lack of company support, and insufficient fatigue management training. They highlighted the importance of sufficient rest, not only for obtaining adequate recovery sleep but also for achieving a work-life balance. They also highlighted the need for company support, effective communication, and management's engagement with cabin crew in general. We recommend that priority is given to fatigue management training for cabin crew, which may also enhance perceived company support and assist with achieving a better work-life balance.

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BACKGROUND: The study aimed to identify factors associated with an increased likelihood of aircraft maintenance personnel reporting a fatigue-related error.METHODS: There were 966 maintenance engineering personnel (mean age = 42 yr, 98% male) who completed a survey with items on personal factors, work factors and a question asking whether during the last month they had made an error in their work due to tiredness. Logistic regression analyses were used to determine factors independently associated with making an error at work due to tiredness.RESULTS: Respondents obtained on average 7.0 h sleep and nearly half (45%) reported that they had felt close to falling asleep while driving home from work in the past 12 mo. Most respondents (70%) had received no education on strategies for coping with shift work. Among respondents, 22% agreed/strongly agreed with the statement "During the last month, I have made an error in my work due to tiredness." Unexpected roster changes independently predicted the likelihood of reporting an error in work due to tiredness and for certain groups of aircraft maintenance personnel, < 6.5 h sleep increased the odds of an error in work due to tiredness fivefold, whereas > 7.5 h sleep almost halved the odds of reporting such an error.DISCUSSION: These findings indicate the importance of stable and predictable work patterns to minimize the risk of fatigue-related errors in this safety critical environment, and also the need for education on coping with shift work to ensure the workforce are best placed to manage their sleep away from work.Signal TL, van den Berg MJ, Mulrine HM. Personal and work factors that predict fatigue-related errors in aircraft maintenance engineering. Aerosp Med Hum Perform. 2019; 90(10):860-866.

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BACKGROUND: The prevalence of obesity has increased substantially over recent decades and is associated with considerable health inequalities. Although the causes of obesity are complex, key drivers include overconsumption of highly palatable, energy-dense, and nutrient-poor foods, which have a profound impact on the composition and function of the gut microbiome. Alterations to the microbiome may play a critical role in obesity by affecting energy extraction from food and subsequent energy metabolism and fat storage. OBJECTIVE: We report the study protocol and recruitment strategy of the PRedictors linking Obesity and the gut MIcrobiomE (PROMISE) study, which characterizes the gut microbiome in 2 populations with different metabolic disease risk (Pacific and European women) and different body fat profiles (normal and obese). It investigates (1) the role of gut microbiome composition and functionality in obesity and (2) the interactions between dietary intake; eating behavior; sweet, fat, and bitter taste perception; and sleep and physical activity; and their impact on the gut microbiome, metabolic and endocrine regulation, and body fat profiles. METHODS: Healthy Pacific and New Zealand (NZ) European women aged between 18 and 45 years from the Auckland region were recruited for this cross-sectional study. Participants were recruited such that half in each group had either a normal weight (body mass index [BMI] 18.5-24.9 kg/m2) or were obese (BMI ≥30.0 kg/m2). In addition to anthropometric measurements and assessment of the body fat content using dual-energy x-ray absorptiometry, participants completed sweet, fat, and bitter taste perception tests; food records; and sleep diaries; and they wore accelerometers to assess physical activity and sleep. Fasting blood samples were analyzed for metabolic and endocrine biomarkers and DNA extracted from fecal samples was analyzed by shotgun sequencing. Participants completed questionnaires on dietary intake, eating behavior, sleep, and physical activity. Data were analyzed using descriptive and multivariate regression methods to assess the associations between dietary intake, taste perception, sleep, physical activity, gut microbiome complexity and functionality, and host metabolic and body fat profiles. RESULTS: Of the initial 351 women enrolled, 142 Pacific women and 162 NZ European women completed the study protocol. A partnership with a Pacific primary health and social services provider facilitated the recruitment of Pacific women, involving direct contact methods and networking within the Pacific communities. NZ European women were primarily recruited through Web-based methods and special interest Facebook pages. CONCLUSIONS: This cross-sectional study will provide a wealth of data enabling the identification of distinct roles for diet, taste perception, sleep, and physical activity in women with different body fat profiles in modifying the gut microbiome and its impact on obesity and metabolic health. It will advance our understanding of the etiology of obesity and guide future intervention studies involving specific dietary approaches and microbiota-based therapies. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry ACTRN12618000432213; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=370874. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR1-10.2196/14529.

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OBJECTIVES: To investigate potential sleep inequities in preschoolers in Aotearoa/New Zealand, by examining sleep durations and week/weekend sleep duration differences of Maori (indigenous) and non-Maori preschoolers; and independent associations between ethnicity (child and maternal), socioeconomic position (SEP) and preschoolers' sub-optimal and inconsistent week/weekend sleep durations. DESIGN: Cross-sectional analysis of questionnaire data from the Moe Kura: Mother and Child, Sleep and Wellbeing in Aotearoa/New Zealand longitudinal study when children were 3 to 4 years old. PARTICIPANTS: 340 Maori and 570 non-Maori preschoolers and their mothers. MEASUREMENTS: Measures included preschoolers' usual nighttime sleep duration on week nights (week nighttime sleep) and weekends (weekend nighttime sleep); usual sleep duration across 24 hours, including naps, on week nights (week sleep [24 h]) and weekends (weekend sleep [24 h]) (≪10 h/10-13 h/≫13 h); and the difference between week and weekend sleep durations per 24 hours (sleep [24 h] difference) (≫1 h/≤1 h). Log-binomial regression models investigated associations between child and maternal characteristics and sleep duration measures. Child models included child ethnicity, child gender and child SEP (area and individual socioeconomic deprivation). Maternal models included maternal ethnicity, maternal age and maternal SEP (area and individual socioeconomic deprivation). RESULTS: Ethnicity and low SEP were independently associated with week day sleep (24 h) ≪10 h, weekend sleep (24 h) ≪10 h, and with sleep (24 h) difference ≫1 h. CONCLUSIONS: Ethnic and socioeconomic inequities in sleep durations are evident as early as 3 to 4 years of age in NZ, highlighting the importance of addressing the socio-political drivers of sleep inequities early in the life course.

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OBJECTIVES: This study considered sleep from a social determinants of health and socioecological perspective. It aimed to explore facilitators and barriers to 4-year-old children sleeping well, as experienced by Maori and non-Maori mothers, with low and high socioeconomic position (SEP), in Aotearoa/New Zealand. DESIGN: Experiential qualitative research involving face-to-face, semistructured individual interviews. PARTICIPANTS: Fifteen Maori (low SEP = 7; high SEP = 8) and 16 non-Maori (low SEP = 7; high SEP = 9) mothers of preschoolers. MEASUREMENTS: Interviews were guided by questions about how preschoolers slept and what mothers thought made a difference to their child's sleep. Data were analyzed inductively using thematic analysis. RESULTS: Four themes were identified: "health, activity, and diet"; "sleep-promoting physical environments"; "consistency"; and "doing it our way." Children being healthy and active, sleep-conducive bedroom spaces, consistent routines, and supportive social environments assisted preschoolers to sleep well. However, broader contextual factors beyond mothers' control influenced the degree of autonomy they had over implementing sleep-supporting strategies that worked for their families. External influences included access to financial resources; parental work patterns; early childhood education service practices; access to quality housing; and affordable, culturally responsive, and respectful professional sleep advice. CONCLUSION: Efforts aimed at facilitating healthy sleep among preschoolers and effective preschooler sleep interventions must go beyond simply recommending individual-focused sleep-promoting tips to include actions on the social determinants of sleep and the sociopolitical drivers that influence these.

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Viewing sleep through a socioecological lens, maternal perceptions, and experiences of preschoolers' sleep were explored using semistructured interviews with 15 Maori (indigenous) and 16 non-Maori mothers, with low- and high socioeconomic position. Thematic analysis identified four themes: child happiness and health, maternal well-being, comfort and connection, and family functioning and harmony. Mothers perceived healthy preschooler sleep as supporting children's mental and physical health, parents' sleep/wake functioning, family social cohesion and emotional connectedness, and poor preschooler sleep as negatively influencing child, maternal and family well-being. Although many experiences were shared, some perceptions of sleep and sleep practices differed between mothers. Influences included health paradigms, socioeconomic circumstances, maternal autonomy, employment, parenting approaches, and societal expectations. Healthy preschooler sleep is valued by mothers and may play a protective role in family health and resilience. Preschooler sleep initiatives need to be responsive to maternal perspectives and address societal drivers of sleep experiences.

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Using scoping review methodology, this article investigates the literature on sleep duration, continuity/efficiency, timing, daytime sleepiness/alertness, and perceived sleep quality in each trimester of a healthy pregnancy. Data suggest significant variability in sleep between women, with less evidence to support major changes in sleep health across trimesters. There is a need for further research on this topic to better inform women and their health providers.

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In commercial aviation, fatigue is defined as a physiological state of reduced mental or physical performance capability resulting from sleep loss, extended wakefulness, circadian phase, and/or workload. The International Civil Aviation Organisation mandates that responsibility for fatigue risk management is shared between airline management, pilots, and support staff. However, to date, the majority of research relating to fatigue mitigations in long range operations has focused on the mitigations required or recommended by regulators and operators. Little research attention has been paid to the views or operational experience of the pilots who use these (or other) mitigations. This study focused on pilots' views and experiences of in-flight sleep as the primary fatigue mitigation on long range flights. It also sought information about other fatigue mitigation strategies they use. Thematic analysis was used to explore written comments from diary and survey data collected during long range and ultra-long range trips (N = 291 pilots on three different aircraft types, 17 different out-and-back trips, and four airlines based on three continents). The findings indicate that the recommended fatigue mitigation strategies on long-haul flights (particularly in-flight sleep) are effective and well-utilised, consistent with quantitative findings from the same trips. Importantly however, the analyses also highlight areas that require further investigation, including flight preparation strategies in relation to the uncertainty of in-flight break allocation. There were two strategies for sleep prior to a flight: maximising sleep if pilots were expecting later breaks in the flight; or minimising sleep if they were expecting breaks earlier or at unfavourable times in the circadian cycle. They also provide a broader view of the factors that affect the amount and quality of pilots' in-flight sleep, about which evidence has previously been largely anecdotal. The study underscores the value of including the views and experience of pilots in fatigue risk management.

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BACKGROUND: Many civilian aviation regulators favor evidence-based strategies that go beyond hours-of-service approaches for managing fatigue risk. Several countries now allow operations to be flown outside of flight and duty hour limitations, provided airlines demonstrate an alternative method of compliance that yields safety levels "at least equivalent to" the prescriptive regulations. Here we discuss equivalence testing in occupational fatigue risk management. We present suggested ratios/margins of practical equivalence when comparing operations inside and outside of prescriptive regulations for two common aviation safety performance indicators: total in-flight sleep duration and psychomotor vigilance task reaction speed. Suggested levels of practical equivalence, based on expertise coupled with evidence from field and laboratory studies, are ≤ 30 min in-flight sleep and ± 15% of reference response speed. METHODS: Equivalence testing is illustrated in analyses of a within-subjects field study during an out-and-back long-range trip. During both sectors of their trip, 41 pilots were monitored via actigraphy, sleep diary, and top of descent psychomotor vigilance task. Pilots were assigned to take rest breaks in a standard lie-flat bunk on one sector and in a bunk tapered 9 from hip to foot on the other sector. RESULTS: Total in-flight sleep duration (134 ± 53 vs. 135 ± 55 min) and mean reaction speed at top of descent (3.94 ± 0.58 vs. 3.77 ± 0.58) were equivalent after rest in the full vs. tapered bunk. DISCUSSION: Equivalence testing is a complimentary statistical approach to difference testing when comparing levels of fatigue and performance in occupational settings and can be applied in transportation policy decision making.Wu LJ, Gander PH, van den Berg M, Signal TL. Equivalence testing as a tool for fatigue risk management in aviation. Aerosp Med Hum Perform. 2018; 89(4):383-388.

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