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Relationship between Sleep Quality and Health Risk Behaviors in Undergraduate College Students

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Title: Relationship between Sleep Quality and Health Risk Behaviors in Undergraduate College Students
Language: English
Authors: Vail-Smith, Karen, Felts, W. Michael, Becker, Craig
Source: College Student Journal. Sep 2009 43(3):924-930.
Availability: Project Innovation, Inc. P.O. Box 8508 Spring Hill Station, Mobile, AL 36689-0508. Tel: 251-343-1878; Fax: 251-343-1878; Web site: http://www.projectinnovation.biz/csj.html
Peer Reviewed: Y
Physical Description: PDF
Page Count: 7
Publication Date: 2009
Document Type: Journal Articles
Reports - Research
Education Level: Higher Education
Descriptors: Sleep, Suicide, Drinking, Risk, Health Behavior, Surveys, Undergraduate Students, Smoking, Measures (Individuals)
ISSN: 0146-3934
Abstract: The Sleep Quality Index (SQI) and the Centers for Disease Control's National College Health Risk Survey (NCHRS) were administered to 859 undergraduates at a large southeastern university. Results indicated that 76.6% reported occasional sleep problems and 11.8 % experienced poor sleep quality. Among the problems reported, "general morning tiredness" (82%) and "insomnia" (28%) were the most common. Certain health risk behaviors appear to be associated with poor sleep quality including fighting, suicide ideation, smoking, and alcohol use. Implications and limitations of the study are identified. (Contains 1 table.)
Abstractor: As Provided
Number of References: 26
Entry Date: 2010
Access URL: https://www.projectinnovation.biz/csj_2006.html
Accession Number: EJ872309
Database: ERIC
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  Value: <anid>AN0043969294;cgl01sep.09;2019Feb22.05:50;v2.2.500</anid> <title id="AN0043969294-1">RELATIONSHIP BETWEEN SLEEP QUALITY AND HEALTH RISK BEHAVIORS IN UNDERGRADUATE COLLEGE STUDENTS </title> <p>The Sleep Quality Index (SQI) and the Centers for Disease Control's National College Health Risk Survey (NCHRS) were administered to 859 undergraduates at a large southeastern university. Results indicated that 76.6% reported occasional sleep problems and 11.8 % experienced poor sleep quality. Among the problems reported, "general morning tiredness" (82%) and "insomnia" (28%) were the most common. Certain health risk behaviors appear to be associated with poor sleep quality including fighting, suicide ideation, smoking, and alcohol use. Implications and limitations of the study are identified.</p> <p>Recently, the impact of insufficient sleep has been identified as a significant public health challenge in the United States. It is currently estimated that 10% of the American population experience chronic insomnia and more than one-quarter report occasionally not getting enough sleep. Insufficient sleep has been linked to a number of chronic disease states and has been identified as a significant contributor to both occupational and traffic accidents. (Division of Adult and Community Health, National Center for Chronic Disease Prevention and Health Promotion, 2008). Lack of sleep has also been linked to behavioral health risk factors. Data from the National Household Interview Study indicate that in adults aged 18-44 those who reported sleeping less than six hours per night were more likely to smoke and to have five or more drinks of alcohol in one day (Schoenborn & Adams, 2008).</p> <p>Mirroring the broader population, the quantity and quality of college student sleep have changed dramatically over the past several decades. From 1969 to 2001, the mean hours of sleep reported by college students dropped from 7.75 hours per night to 6.65 hours (Hicks, Fernandez, & Pellegrini, 2001a). Dissatisfaction with sleep rose from 24% to 71 % between 1978 and 2001 and in 1992 two-thirds (68.3%) of college students reported sleep problems (Hicks, Fernandez, & Pellegrini, 2001b). In 2001, Buboltz and colleagues (Buboltz, Brown, & Soper, 2001) found that 73% of college students studied reported some form of sleep disturbance, with women reporting more problems than men.</p> <p>While college students are certainly prone to the same risks associated with poor sleep in the general population, researchers have explored the specific effects of sleep difficulties on the lives of college students. This research has shown that college students with poor sleep are prone to a number of undesirable outcomes. Diminished sleep quality has been associated with anxiety, depression, and stress (Jensen, 2003; Carney, Edinger, Meyer, et al., 2006). Interrelated with these issues is the positive relationship between sleep quality and academic performance (Kelly, Kelly, & Clanton, 2001; Tsai, & Li, 2004; Campos-Morales, Valencia-Flores, Castaño-Meneses, Castañeda-Figueiras, & Martínez-Guerrero, 2005; Becker, Adams, Orr, & Quilter, 2008).</p> <p>With regard to sleep research, college students are a special group because the campus culture presents many unique sleep-related challenges. These can include parties, stress, and work coupled with the communal living arrangements typically associated with dormitories and other student-focused housing (Buboltz, Soper, Brown, & Jenkins, 2002; Jensen, 2003). Sleep issues may be associated with other student risk behaviors related to voluntary lifestyle choices including drinking patterns (Wechsler, Kelley, Weitzman, San Giovanni, & Seibring, 2000) sexual activities (Clemens, Engler, & Chinn, 2004) and other lifestyle choices such as physical activity and working (Trockel, Barnes, & Egget, 2000). In a more general context, sleep length has been shown to be related to life satisfaction (Kelly, 2004) and sleep quality to several measures of health and well being (Pilcher & Ott, 1998).</p> <p>Sleep is interrelated to each of these issues and it has been found to be amendable to successful interventions (Buboltz, et al., 2002). Good quality sleep, in itself, is immediately reinforcing and can also serve as an enabling resource for students (Buboltz. et al., 2002; Trockel, Barnes, & Egget, 2000), suggesting that better sleep could have a significant impact on the well being of college students. The purpose of this study was to determine the prevalence of poor sleep quality among undergraduate college students, to examine certain behavioral factors associated with sleep quality, and to explore the relationship between sleep quality and certain behaviors generally accepted as health risk factors for college students.</p> <hd id="AN0043969294-2">Method</hd> <hd1 id="AN0043969294-3"> Participants </hd1> <p>The sample for this study consisted undergraduates from a public university in the southeast. Subjects were enrolled in a personal health course required for graduation. Participation was voluntary and anonymous. The survey was administered online and participating students completed it outside of class at their own convenience. Participants received extra credit for taking the survey by presenting their instructor a "receipt" that was produced when responses were submitted. Of the 1596 students enrolled in the course, 859 (53.8%) participated in the survey.</p> <p>More than two-thirds of the subjects were female (70%, n=596). Freshmen accounted for the largest percentage of the sample (70%, n=596) while 18% were sophomores (n=157), 9% juniors (n=74) and 3% seniors (n=26). Most of the respondents were white (77%, n=655), 16% were African American (n= 139), and the remaining 8% were other races (n=60). The reported ethnicity of the sample was similar to that of the university's undergraduate enrollment of the same period (77.9% white, 16.8% African American and 5.3% "other") (East Carolina University, 2007). The class distribution of the sample was consistent with the usual enrollment of this course that is typically about 80% freshmen and sophomores.</p> <hd1 id="AN0043969294-4"> Measures </hd1> <p>A 100-item survey instrument based on the CDC's National College Health Risk Survey (NCHRS) (Centers for Disease Control, 1997) was made available online to all students enrolled in a required personal health class. The NCHRS items explore six categories of priority health-risk behaviors among youth and young adults: behaviors that contribute to unintentional and intentional injuries, tobacco use, alcohol and other drug use, sexual behaviors, unhealthy dietary behaviors, and physical inactivity.</p> <p>The findings reported here were based on the responses from the NCHRS items and the Sleep Quality Index (SQI), an eight-item self-report inventory of general sleep difficulties (Urponen, Partinen, Vuori, & Hasan, 1991). The SQI items were added to the NCHRS for the April 2006 administration of the survey. The combined instrument received approval by the Institutional Review Board at East Carolina University.</p> <p>The SQI consists of eight items with three response categories weighted 0,1, or 2, with 2 indicating the most common or severe symptom. SQI developers report that summed scores on the eight items provide a total sleep quality score. They categorize sleep quality based on scale scores as follows: 0-1 = good sleep quality, 2-8 = occasional sleep difficulties, and 9-16 = poor sleep quality. A Cronbach's alpha of .73 for men and .75 for women indicates an acceptable internal consistency of the SQI. Support for the validity of the scale is provided by the significant positive relationship between sleep quality score and subjective health reported by Urponen, Partinen, Vuori, & Hasan (1991).</p> <hd id="AN0043969294-5">Results</hd> <p>The Sleep Quality Index scores for the 859 respondents indicated that 6.3% reported very good sleep quality (a score of 0-1), 76.6% indicated occasional sleep problems (a score of 2 — 8) and 11.8% reported poor sleep quality (a score of 9 — 16). These findings were similar to those of Buboltz, et al. (2002). They reported 11%, 73%, and 15% of college student's scores fell into the three respective categories. Similarities also exist between our findings and Bublotz et al. (2002) with respect to the frequency of responses to most of the individual SQI items. Table 1 summarizes those similarities.</p> <p>Our results indicated that sleep quality (mean SQI scores) was associated with several health risk behaviors including physical aggression, suicide ideation, smoking, alcohol and marijuana use and physical inactivity. Students were asked if they experienced a physical fight during the twelve months preceding survey administration. For our analysis the eight response categories to this item were collapsed to two; "yes" (n = 74) and "no" (n = 776). Mean SQI scores were significantly higher (F (<reflink idref="bib1" id="ref1">1</reflink>, 848) = 4.73, p = .03) for those who reported experiencing a fight (M = 6.66, SD = 3.12) than those who did not (M = 5.86, SD = 3.04) report fighting.</p> <p>Sixty students (7.0%) reported that they had seriously considered suicide in the twelve months prior to completing the survey. These students' SQI score (M= 7.73, SD = 2.98) were significantly higher (F (<reflink idref="bib1" id="ref2">1</reflink>, 847) = 11.73, p < .001) than students not reporting having considered suicide (n = 788, M = 5.78, SD = 3.02).</p> <p>The survey item assessing smoking behavior has seven categories. For our analysis these categories were collapsed resulting in respondents being classified as (a) non-smokers (n = 568), (b) those who smoked one or fewer cigarettes per day (n = 102) and (c) those smoking more than one cigarette per day (n = 180). ANOVA of mean SQI scores indicated that significant differences did exist between the scores (F (<reflink idref="bib2" id="ref3">2</reflink>, 847) = 6.53, p = .002). Post-hoc analysis (Tukey HSD) revealed that the SQI for non-smokers (M = 5.67, SD = 3.01) was significantly lower than both the one or fewer cigarette per day group (M = 6.62, SD = 3.28) and the more than one cigarette per day group (M=6.36, SD = 3.00).</p> <p>To ascertain the constancy of alcohol consumption, students were asked to indicate on how many of the 30 days prior to the survey administration they consumed at least one drink of alcohol. Seven response categories ranged from no days to all 30 days. ANOVA performed on the mean SQI scores within each category indicated that significant differences existed (F (<reflink idref="bib6" id="ref4">6</reflink>,<reflink idref="bib843" id="ref5">843</reflink>) = 2.85, p = .009). Post-hoc analysis (Tukey HSD) revealed that non-drinkers (n = 218, M = 5.50, SD = 3.14) had a significantly lower SQI score (thus better sleep quality) than those reporting alcohol use on 20 to 29 days (n = 35, M = 7.23, SD = 2.87).</p> <p>Students were also asked how many times in the 30 days prior to the survey they had used marijuana. There were six response categories ranging from none to 40 or more times. Mean SQI scores did not vary significantly as a function marijuana use (F (<reflink idref="bib5" id="ref6">5</reflink>, 844) = .453, p = .811).</p> <p>We also examined two behavioral factors that have been shown to be associated with sleep quality; exercise patterns and work (Trockel et al, 2005). Students were asked to report how many days in the week preceding survey administration mat they exercised vigorously or participated in sports activity for at least 20 minutes. There was no relationship found between exercise frequency and mean SQI scores (F (<reflink idref="bib7" id="ref7">7</reflink>, 842) = 0.95, p = .464). Students categorized their work experience by selecting one of seven categories ranging from no hours worked to more than 40. ANOVA did reveal significant between group differences (F (<reflink idref="bib7" id="ref8">7</reflink>, 826) = 3.16,p = .003). Post-hoc pairwise comparisons showed a single significant difference with those reporting working zero hours (n = 530, M = 6.18, SD = 3.07) having higher mean SQI scores than those reporting working one to nine hours (n = 89, M = 5.01, SD = 2.75).</p> <hd id="AN0043969294-6">Discussion</hd> <p>Our research supports results from previous studies indicating that many college students report at least occasional sleep disturbance. In our study almost 12% could be classified as experiencing poor sleep quality as measured by the SQI. Among the problems reported, "general morning tiredness" (82%) and "insomnia" (28%) were the most common.</p> <p>Certain health risk behaviors appear to be associated with poor sleep quality. These include fighting, suicide ideation and smoking, and alcohol use. Our finding that sleep quality is related to suicide ideation is consistent with results reported by Bernert who found that poor sleep quality predicted elevated suicidal symptoms even after controlling for depression in a sample of 322 college undergraduates between 19 and 24 years of age (American Academy of Sleep Medicine, 2008). Similar to our findings, Liu found significant relationships between sleep quality and both smoking and alcohol use in large sample of Chinese adolescents. The author suggested that education related to sleep hygiene might be indicated as a measure to prevent adolescent substance abuse (American Academy of Sleep Medicine, 2007). These recommendations must be tempered, however, by the recognition that the cause/effect relationship between both alcohol and tobacco use is complicated by the psychoactive properties of the drugs. This fact is reinforced by recent research findings of Punjabi (American College of Chest Physicians, 2008) comparing the sleep patterns of 'healthy' smokers (the authors noted the difficulty and care taken to recruit smokers without the comorbidities typically associated with smoking) and non-smokers. In this study 22.0% of non-smokers reported restful sleep compared to only 5.0% of smokers.</p> <p>While there is only limited evidence that instructional programs designed to improve the sleep quality of college students can be effective (Brown, Buboltz, & Soper, 2002; Brown, Buboltz, & Soper, 2006), the growing recognition of the importance of sleep in maintaining overall health suggests that campus based programs to address this issue are worth further exploration. To be effective, such initiatives will likely need to include both environmental and instructional program initiatives. A comprehensive approach to the problem might include (<reflink idref="bib1" id="ref9">1</reflink>) a sleep hygiene program similar to the STEP program developed by Brown et al. (2006) integrated in a comprehensive personal health or as part of general freshman orientation programs, (<reflink idref="bib2" id="ref10">2</reflink>) institution of university policies that support better sleep habits including quiet hours and noise ordinances and (<reflink idref="bib3" id="ref11">3</reflink>) working with those responsible for student housing to design spaces that are conducive to sleep.</p> <hd1 id="AN0043969294-7"> Limitations </hd1> <p>The data should be interpreted cautiously. The convenience sample of 859 respondents is not representative of the 17.4 million U.S. college students (U.S. Bureau of the Census, 2007). More importantly, like other research relating sleep experience to other variables, our research is correlational. The relationships between sleep experience, health-related behaviors and general health indices such as well-being and life satisfaction are certainly complex and non-linear. Prospective, longitudinal follow-up methods are required to more thoroughly examine the nature of these relationships. Finally, subsequent research should move beyond the exploratory analysis of these data to multivariate analysis to develop a more complete and accurate understanding of the sleep behavior of women and men.</p> <hd id="AN0043969294-8">Table 1 Comparative Response Percentage to Individual Sleep Quality Index Items</hd> <ct id="AN0043969294-9"> Legend fro chart: A - Item B - Current Study C - Buboltz A B C Took more than 30 minute to fall asleep 18% 20% Insomnia in last 3 months 28% 25% Difficulty falling asleep 3 or more days/week 11% 12% Disturbed sleep 3 or more days/week 11% 15% Nocturnal awakenings 3 or more days/week 13% 14% Awakened too early 3 or more days/week 11% 14% General morning tiredness 82% 54% Use sleep medication at least once/week for in past 3 weeks 2.0% 1.0%</ct> <ref id="AN0043969294-10"> <title> References </title> <blist> <bibl id="bib1" idref="ref1" type="bt"></bibl> <bibtext>American College of Chest Physicians (2008). Smoking Linked To Sleep Disturbances. Science Daily. Retrieved August 5, 2008, from <ulink href="http://www.sciencedaily.com/releases/2008/0">http://www.sciencedaily.com/releases/2008/0</ulink> 2/080204172250 .htm</bibtext> </blist> <blist> <bibl id="bib2" idref="ref3" type="bt"></bibl> <bibtext>American Academy of Sleep Medicine (2008). Poor Sleep Quality And Insomnia Associated With Suicidal Symptoms Among College Students. Science Daily. Retrieved August 5, 2008, from <ulink href="http://www.sciencedaily.com/releases/2008/0">http://www.sciencedaily.com/releases/2008/0</ulink> 6/080609071355 .htm</bibtext> </blist> <blist> <bibl id="bib3" idref="ref11" type="bt"></bibl> <bibtext>American Academy of Sleep Medicine (2007). Sleep Deprivation Can Lead To Smoking, Drinking. Science Daily. Retrieved August 5, 2008, from <ulink href="http://www.sciencedaily.com/releases/2007/0">http://www.sciencedaily.com/releases/2007/0</ulink> 6/070612075012.htm</bibtext> </blist> <blist> <bibl id="bib4" type="bt"></bibl> <bibtext>Becker, C., Adams, T., Orr, C., & Quilter, L. (2008). Correlates of quality sleep and academic performance. Health Educator, 40(2), 82-89.</bibtext> </blist> <blist> <bibl id="bib5" idref="ref6" type="bt"></bibl> <bibtext>Brown, F., Buboltz, W., & Soper, B. (2002). Sleep hygiene practices and sleep quality in university students. Behavioral Medicine, 28, 33-38.</bibtext> </blist> <blist> <bibl id="bib6" idref="ref4" type="bt"></bibl> <bibtext>Brown, F., Buboltz, W., & Soper, B. (2006). Development and evaluation of the sleep treatment and education program for students (STEPS). Journal of American College Health, 54(4), 231-237.</bibtext> </blist> <blist> <bibl id="bib7" idref="ref7" type="bt"></bibl> <bibtext>Buboltz, W., Brown, F., & Soper, B. (2001). Sleep habits and patterns of college students: a preliminary study. Journal of American College Health, 50(3), 131-135.</bibtext> </blist> <blist> <bibl id="bib8" type="bt"></bibl> <bibtext>Buboltz, W., Soper, B., Brown, F., & Jenkins, S. (2002). Treatment approaches for sleep difficulties in college students. Counseling Psychology Quarterly, 15(3; 3), 229-237.</bibtext> </blist> <blist> <bibl id="bib9" type="bt"></bibl> <bibtext>Campos-Morales, R., Valencia-Flores, M., Castaño-Meneses, A., Castañeda-Figueiras, S., & Martínez-Guerrero, J. (2005). Sleepiness, performance and mood state in a group of Mexican undergraduate students. Biological Rhythm Research, 36(1; 1), 9-13.</bibtext> </blist> <blist> <bibl id="bib10" type="bt"></bibl> <bibtext>Carney, C., Edinger, J., Meyer, B., Lindman, L., Istre, T. (2006). Daily activities and sleep quality in college students. The Journal of Biological and Medical Rhythm Research, 23, 623-637.</bibtext> </blist> <blist> <bibl id="bib11" type="bt"></bibl> <bibtext>Centers for Disease Control. (1997). National college health risk behavior survey — United States, 1995. Mortality and Morbidity Weekly Report, 46(Suppl. 55-6), 1-56.</bibtext> </blist> <blist> <bibl id="bib12" type="bt"></bibl> <bibtext>Division of Adult and Community Health, National Center for Chronic Disease Prevention and Health Promotion. (2008). Sleep and sleep disorders: A public health challenge. Retrieved August 6,2008 from <ulink href="http://www.cdc.gov/sleep/index.htm">http://www.cdc.gov/sleep/index.htm</ulink></bibtext> </blist> <blist> <bibl id="bib13" type="bt"></bibl> <bibtext>Clemmens, D., Engler, A., & Chinn, P. L. (2004). Learning and living health: College students' experiences with an introductory health course. The Journal of Nursing Education, 43(1), 313.</bibtext> </blist> <blist> <bibl id="bib14" type="bt"></bibl> <bibtext>East Carolina University. (2006). The common data set (CDS) 2005-2006. Retrieved February 20, 2008, from <ulink href="http://www.ecu.edu/cs-admin/ipre/">http://www.ecu.edu/cs-admin/ipre/</ulink> Institutional-Research .cfm#factbook.</bibtext> </blist> <blist> <bibl id="bib15" type="bt"></bibl> <bibtext>Hicks, R., Fernandez, C., & Pellegrini, R. (2001a). Self-reported sleep durations of college students: Normative data for 1978-79, 1988-89 and 2000-01. Perceptual and Motor Skills, 97(1), 139-141.</bibtext> </blist> <blist> <bibl id="bib16" type="bt"></bibl> <bibtext>Hicks, R., Fernandez, C., & Pellegrini, R. (2001b). Striking changes in the sleep satisfaction of university students over the last two decades. Perceptual and Motor Skills, 93(3), 660.</bibtext> </blist> <blist> <bibl id="bib17" type="bt"></bibl> <bibtext>Jensen, D. (2003). Understanding sleep disorders in a college student population. Journal of College Counseling, 6(1), 25.</bibtext> </blist> <blist> <bibl id="bib18" type="bt"></bibl> <bibtext>Kelly, W. (2004). Sleep length and life satisfaction in a college student sample. College Student Journal, 38(3), 438-440.</bibtext> </blist> <blist> <bibl id="bib19" type="bt"></bibl> <bibtext>Kelly, W., Kelly, K., & Clanton, R. (2001). The relationship between length of sleep and grade-point average among college students. College Student Journal, 35(1), 84-86.</bibtext> </blist> <blist> <bibl id="bib20" type="bt"></bibl> <bibtext>Pilcher, J., & Ott, E. (1998). The relationships between sleep and measures of health and well-being in college students: A repeated measures approach. Behavioral Medicine, 23(4), 170-178.</bibtext> </blist> <blist> <bibl id="bib21" type="bt"></bibl> <bibtext>Schoenborn, C. & Adams, P. (2008). Sleep duration as a correlate of smoking, alcohol use, leisure-time inactivity, and obesity among adults; United States, 2004-2006. Centers for Disease Control and Prevention. Retrieved August 6, 2008 from <ulink href="http://www.cdc.gov/nchs/products/pubs/pubd/hestat">www.cdc.gov/nchs/products/pubs/pubd/hestat</ulink> s/sleep04-06/sleep04-06 .pdf.</bibtext> </blist> <blist> <bibl id="bib22" type="bt"></bibl> <bibtext>Trockel, M., Barnes, M., & Egget, D. (2005). Health-related variables and academic performance among first-year college students: Implications for sleep and other behaviors. Journal of American College Health. 49, 125-132.</bibtext> </blist> <blist> <bibl id="bib23" type="bt"></bibl> <bibtext>Tsai, L., & Li, S. (2004). Sleep patterns in college students: Gender and grade differences. Journal of Psychosomatic Research, 56, 231.</bibtext> </blist> <blist> <bibl id="bib24" type="bt"></bibl> <bibtext>Urponen, H., Partinen, M., Vuori, I., & Hasan, J. (1991). Sleep quality and health: description of the Sleep Quality Index. In J. Peter (Ed.), Sleep and Health Risk. Berlin: Springer, p. 555-558.</bibtext> </blist> <blist> <bibl id="bib25" type="bt"></bibl> <bibtext>U.S. Bureau of the Census. (2007). Statistical abstract of the United States: 2007 (126th ed.) Washington, DC.</bibtext> </blist> <blist> <bibl id="bib26" type="bt"></bibl> <bibtext>Wechsler, H., Kelley, K., Weitzman, E., San Giovanni, J., & Seibring, M. (2000). What colleges are doing about student binge drinking: A survey of college administrators. Journal of American College Health, 48, 219-226.</bibtext> </blist> </ref> <aug> <p>By Karen Vail-Smith, East Carolina University; W. Michael Felts, East Carolina University and Craig Becker, East Carolina University</p> </aug> <nolink nlid="nl1" bibid="bib843" firstref="ref5"></nolink>
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  Data: The Sleep Quality Index (SQI) and the Centers for Disease Control's National College Health Risk Survey (NCHRS) were administered to 859 undergraduates at a large southeastern university. Results indicated that 76.6% reported occasional sleep problems and 11.8 % experienced poor sleep quality. Among the problems reported, "general morning tiredness" (82%) and "insomnia" (28%) were the most common. Certain health risk behaviors appear to be associated with poor sleep quality including fighting, suicide ideation, smoking, and alcohol use. Implications and limitations of the study are identified. (Contains 1 table.)
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        StartPage: 924
    Subjects:
      – SubjectFull: Sleep
        Type: general
      – SubjectFull: Suicide
        Type: general
      – SubjectFull: Drinking
        Type: general
      – SubjectFull: Risk
        Type: general
      – SubjectFull: Health Behavior
        Type: general
      – SubjectFull: Surveys
        Type: general
      – SubjectFull: Undergraduate Students
        Type: general
      – SubjectFull: Smoking
        Type: general
      – SubjectFull: Measures (Individuals)
        Type: general
    Titles:
      – TitleFull: Relationship between Sleep Quality and Health Risk Behaviors in Undergraduate College Students
        Type: main
  BibRelationships:
    HasContributorRelationships:
      – PersonEntity:
          Name:
            NameFull: Vail-Smith, Karen
      – PersonEntity:
          Name:
            NameFull: Felts, W. Michael
      – PersonEntity:
          Name:
            NameFull: Becker, Craig
    IsPartOfRelationships:
      – BibEntity:
          Dates:
            – D: 01
              M: 09
              Type: published
              Y: 2009
          Identifiers:
            – Type: issn-print
              Value: 0146-3934
          Numbering:
            – Type: volume
              Value: 43
            – Type: issue
              Value: 3
          Titles:
            – TitleFull: College Student Journal
              Type: main
ResultId 1