Josiah Brown Poster Abstract


Katherine Makaroff
Zekun Feng, M.D.
Marcella Press M.D. Ph.D., Tamara Horwich M.D. M.S., Karol Watson M.D. Ph.D., Kimberly Uehisa, Jennifer P. Woo M.D.
Early Cardiovascular Health Outreach SMS: A Text-Messaging Preventive Health Program Applied To Promote Healthy Sleep Habits
Internal Medicine Chief's Fellowship


  1. Sleep has emerged as a significant target for improving cardiovascular risk profiles of adolescents and young adults. 1-2  
  2. This has immense implications given the widespread prevalence of chronic sleep deprivation in this population, which has been deemed a “public health epidemic” by the American Academy of Pediatrics in a detailed 2014 report.
  3. Early adoption of heart healthy behaviors can mitigate risk of cardiovascular disease later in life and thus, programs that encourage these habits are of particular importance.
  4. In the pilot study, Early Cardiovascular Health Outreach SMS (ECHOS), evaluated text-messaging to be an effective and feasible tool for promoting awareness and encouraging positive lifestyle behaviors in adolescents and young adults.  


The aim of the current study is to further investigate the use of ECHOS as a preventive health measure. We hypothesized that ECHOS can be applied to 1) effectively increase knowledge and awareness of sleep health in adolescents and young adults as well as 2) improve quantity and 3) quality of sleep.


  1. We performed a multi-center, prospective, observational cohort study of adolescents and young adults between the ages of 13 and 25 years old by recruiting participants from U.S. high schools and colleges via email dissemination of registration link, as well as in-person recruitment on UCLA’s undergraduate campus.
  2. Participation included signing a consent form (parental consent required if <18 years old), completing pre-program and post-program surveys, and receiving 14 texts on widely researched sleep facts/healthy sleep habits over a length of 30 days.
  3. Responses to the survey questions were open ended (i.e., hours slept) or used 5-point Likert-type scales and analyzed (using two tailed t-tests) to measure changes in sleep knowledge, implementation of health information, and quantity of sleep.
  4. To measure quality of sleep and the extent of sleep problems in this population, we also applied the Medical Outcomes Study (MOS) Sleep Scale–Revised (MOS Sleep–R).


            The study enrolled 47 participants in the first cohort with an average age (SD) of 19.36 (2.98). Pre-intervention surveys demonstrated, on average, participants ranked themselves as unsure (3) or somewhat knowledgeable (4) about healthy sleep habits (avg. = 3.65) and the impact of sleep on cardiovascular health as well as overall health (avg. = 3.38). 95.7% of participants knew the correct amount of sleep recommended by the CDC for their age. Overall, participants slept 7.42 hours per night on average, reporting slightly less sleep on weeknights (6.65) and slightly more sleep on weekends (8.19). A Pre-Intervention MOS Sleep Problem Index (SPI) of 55.4 was calculated as the average of scores on 3 sleep domains: sleep disturbance (47.4), sleep adequacy (63.8), and somnolence (55.0). The SPI is scored on a 0-100 possible range, with higher scores indicating more of the concept being measured.


            Future work can be done to elucidate barriers to proper sleep hygiene in adolescent and young adult populations, including lack of knowledge, stress, and broader structural influences (i.e., academic schedule, extracurricular). Continued efforts are needed to raise awareness for sleep as an integral component of overall health, and specifically, its relation to preventing cardiovascular disease. This study supports further assessment and implementation of digital media as a strategy for improving cardiovascular risk profiles and an important preventive health measure.