September 28, 2024 • 18 mins
Medical student Akshay Krishnan and Dr. David Reichenberger explore the associations between childhood weeknight sleep and later alcohol and marijuana use. Their paper, “Childhood sleep is prospectively associated with adolescent alcohol and marijuana use,” can be found in the October 2024 (Vol. 98) issue of Annals of Epidemiology.
Read the full article here:
https://www.sciencedirect.com/science/article/abs/pii/S1047279724001674
UCSF-Bay Area CFAR’s Mentoring the Mentors Workshop:
https://cfar.ucsf.edu/mentoring/events/mentoring-mentors-workshop-hiv-researchers
Episode Credits:
- Executive Producer: Sabrina Debas
- Technical Producer: Paula Burrows
- Annals of Epidemiology is published by Elsevier.
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Patrick Sullivan (00:12):
Hello, you're listening to EpTalk Behind the
Paper, a monthly podcast fromthe Annals of Epidemiology.
I'm Patrick Sullivan,editor-in-chief of the journal,
and in this series we take youbehind the scenes of some of the
latest epidemiologic researchfeatured in our journal.
Today we're talking with MrAkshay Krishnan and Dr David
(00:36):
Reichenberger about theirarticle Childhood Sleep is
Prospectively Associated withAdolescent Alcohol and Marijuana
Use, respectively associatedwith adolescent alcohol and
marijuana use.
You can read the full articleonline in the October 2024 issue
of the journal atwwwanalystofepidemiologyorg.
First I'd like to introduce ourguests.
Akshay Krishnan is a second-yearmedical student at Sidney
(00:59):
Kimmel Medical College at ThomasJefferson University.
He's part of the seven-yearaccelerated Pennsylvania State
Sydney Medical College BS/MDprogram and his research centers
on health-related social needs,telehealth efficacy, and the
intersection of sleep and health.
Dr.
David Reichenberger, is apostdoctoral fellow at the
(01:19):
Knight Cardiovascular Instituteand the Oregon Institute of
Occupational Health Sciences atthe Oregon Health and Science
University.
His research examines themicro- and macro- longitudinal
associations of dailyhealth-related behaviors, like
substance use or screen time,with nightly sleep health and,
in turn, how changes in sleepinfluence cardiovascular health.
(01:41):
Dr Reichenberger is currentlylooking for tenure-track faculty
positions.
Thank you both for joining ustoday.
So this is a little bit of adifferent structure than we
usually do, and I'm so happywe're doing it this way, because
we have both the author of thepaper and the mentor.
So we're first going to talk alittle bit about the study
(02:01):
itself and then we'll spend alittle bit of time talking about
your mentoring relationship andhow that worked, preparing this
particular work.
Akshay, I first just want toask about the purpose of the
study.
What questions were you reallyinterested in answering?
Akshay Krishnan (02:15):
Yeah, the purpose of our study was to
investigate how childhood sleeppredicts adolescent alcohol and
marijuana use.
So when we were doing ourliterature search we found many
studies that looked atlongitudinal associations.
But those that were looking atlongitudinal associations only
looked at two time points onetime in childhood and one time
point in adolescence.
But we were curious to see howthis longitudinal relationship
would span all of childhood.
Patrick Sullivan (02:37):
Great.
So you've sort of alluded tothis a little bit, but what is
the study design and whatmethods did you have to, you
know, select in order to answerthe question that you were
seeking to answer?
David Reichenberger (02:49):
I'll actually answer that one.
Our study used data from theFuture of Families and Child
Well-Being Study.
This was a longitudinal birthcohort that had started in 1998
and has collected data fromchildren and their parents
across multiple waves.
This includes collecting dataat birth, when the child was at
ages 3, 5, 9, and age 15, andmost recently when the child was
(03:13):
age 22.
So collecting data when they'renow young adults.
So this study is just rich withdata.
Some of the variables that weused were parent reports of the
child's sleep, which has beencollected ever since the age
three wave and then during theage 15 wave, when the children
were teens.
They were finally old enough toself-report their own sleep and
(03:34):
whether they had tried alcoholor marijuana by that point in
their life.
We applied a logisticregression framework to evaluate
whether later bedtimes orshorter sleep duration at each
wave across childhood increasedthe odds of drinking alcohol or
trying marijuana by age 15.
Patrick Sullivan (03:54):
Great.
And so what was the mainfinding?
And then did it sort of line upwith what you were
hypothesizing when you started?
David Reichenberger (04:01):
Yeah, in general, we found that later
bedtimes and shorter sleepdurations at ages 5, 9, and 15
were associated with increasedodds of substance use by age 15.
And this ultimately alignedwith our hypothesis.
Patrick Sullivan (04:16):
So in terms of how you came to that hypothesis
, I mean, was there sort ofprevious literature or why would
you postulate that such arelationship might exist?
Akshay Krishnan (04:26):
So when we looked at previous literature,
we did find some associationsbetween childhood sleep and
adolescent alcohol and marijuanause, and what we found with our
studies is that our findingsmostly agreed with the previous
literature.
We found that insufficientsleep was cross-sectionally
associated with increasedadolescent alcohol use, but we
also found no associationbetween adolescent sleep
duration and marijuana use,which prior studies have found.
(04:48):
We think that the differencebetween our studies and prior
studies could be due to howsleep was assessed, with prior
studies focusing more on sleepproblems and our studies
focusing more on sleep durationand bedtime.
Patrick Sullivan (05:00):
Great.
Can you say a little bit aboutwhat you see as the strengths
and limitations of your study?
Akshay Krishnan (05:05):
I think one of the biggest strengths of our
study is the sample population.
The Future of Families cohortis a large, diverse national
sample of urban children and thestudy has been following them
since birth.
And I think one of thelimitations to our study is how
the data was collected, becauseit was parent report or
self-report data.
There could be some recall biasthere and also the way sleep
(05:27):
was assessed in each wave of thestudy was slightly different,
and daytime sleep, such as naps,was not asked about.
Patrick Sullivan (05:32):
And can I ask, was the alcohol drinking also
reported by the parents or bythe children?
David Reichenberger (05:38):
So that was actually answered by the
adolescents.
Patrick Sullivan (05:42):
By the adolescents, so also the
potential for some recall biasthere or some misclassification,
and whether they agreed tovolunteer that information.
Sure.
So what prompted you toinvestigate childhood sleep as a
risk factor for earlyadolescent substance use?
David Reichenberger (05:58):
So we really wanted to look at
childhood sleep as a risk factor, because childhood is just such
a crucial period for growth anddevelopment.
Sleep is often supporting manyof the changes that children
undergo as they age, with one ofthe notable changes being brain
maturation, and this isespecially important as the
child transitions from childhoodinto adolescence.
(06:21):
So there have been many studiesthat have linked poor sleep
with worse decision making, andworse decision making may be
linked to the decision to engagein substance use when they're
an adolescent.
So really we're most interestedin examining the possibility of
sleep as the predeterminingfactor of this more distal
(06:42):
outcome.
Patrick Sullivan (06:44):
Thanks.
So you've talked a little bitabout the nature of the exposure
here, which is the amount ofsleep, but I wonder whether it's
possible that there may beother characteristics of
households that might beconfounded with the sleep
exposure.
So what are your thoughts aboutwhether you think this is
really leaning towards a causalrelationship, or do you think
(07:04):
there might be some confoundinghere with other household
exposures in this period ofadolescence?
David Reichenberger (07:11):
It's certainly possible that other
factors are confounding thisrelationship, but we did our
best really to try to controlfor many of those potential
confounds by controlling formany sociodemographic
characteristics as well associoeconomic status.
In the past we've looked atwhether perhaps bedtime routines
(07:33):
could be related to sleep inparticular, especially because
without a bedtime routine it maymean that sleep is less of a
consistent habit and it couldreflect more potentially
household chaos or some otheraspect that the child is
experiencing in their life.
Patrick Sullivan (07:53):
Yeah, thanks for thinking that through.
So I want to last ask about acouple findings that were just
sort of striking to me.
And again, I know this is anobservational study so we're not
going to attribute causalitytoo strictly, but just your
thoughts about or whether youwere surprised by these.
So one is that the participantswho had later bedtimes at age
(08:14):
three had a lower odds ofdrinking alcohol by age 15.
And, in contrast, theparticipants that had later
bedtimes at age nine had greaterodds of drinking alcohol by
that age.
So do you have any thoughtsabout why bedtimes at early
versus later ages might appearto have different associations
with the drinking alcoholoutcome?
David Reichenberger (08:37):
Yeah, this was a really counterintuitive
finding that we didn't expectwhat we think and really we're
speculating here because we werenot able to assess daytime
sleep.
The question just simply wasn'tasked at age three.
But what we suspect is thatit's perhaps that these children
are having daytime sleep.
(08:58):
They're taking naps throughoutthe day and that is pushing back
their bedtime.
So they're still gettingsufficient sleep, but the later
bedtime is potentiallyreflecting better sleep health
at that age.
Patrick Sullivan (09:14):
Interesting.
I know that was a little riskyto speculate when you have these
kinds of associations, but Ithink that's part of the process
of seeing what you learn,figuring out what the hypotheses
are for the next round and theneither designing a new study to
try and answer that, collectingadditional data elements.
So thanks for that.
So now we're going to move to asegment we call Behind the
(09:35):
Paper, which really gets to youas people as well as researchers
, and I think it's reallyinteresting to understand how
ideas for studies come about andhow people work with mentors
and work in teams.
So we want to talk a little bitabout that.
So first I wonder for either ofyou how you came to be
interested in studying sleephealth.
Akshay Krishnan (09:57):
I think my interest in sleep health started
because I myself have a lot oftrouble sleeping, so I was
really interested in learningmore about how I could both
improve my sleep and also whysleep was so important to having
a healthy lifestyle.
Patrick Sullivan (10:09):
Yeah, I think sometimes, when there are topics
that we can relate to one,there's interest in studying
them.
But you may also have insightinto asking the right questions
or how you design something, andI think we bring our own
experiences for sure to ourresearch in that way.
What was the biggest challengeyou faced in conducting the
(10:30):
analysis and how did youovercome it?
Akshay Krishnan (10:32):
One of the biggest challenges I faced while
doing this research study cameat the end, when it came time to
write the paper.
I'd never written a paper fromstart to finish before, so even
though I knew all the parts thathad to go into a paper, I
didn't really know how to get itthere on my own, and to
overcome this challenge I workeda lot with Dr.
Reichenberger and Dr.
Anne- Marie Chang, who wasDavid's mentor at the time as
(10:53):
well.
They spent a lot of timefocusing on how to structure an
abstract, how to structure theintroduction, how to do the
statistical analysis, how tostructure your figures, and they
both really spent countlesshours teaching me how to go
through this whole process, andit really shaped me into the
researcher I am today.
Patrick Sullivan (11:05):
Great, it's great to hear about that process
and can I just ask like forthose sections, was part of that
process looking at examples ofintroductions, or was it more by
example, or was it more by sortof brainstorming together what
the components of each segmentmight be?
Akshay Krishnan (11:20):
I think it was more a combination of both,
because before I started writingthe paper we did a literature
search.
So as I was doing literaturesearch I was reading a lot of
papers on similar topics.
So from there I kind of got anidea of what needed to go into
each section.
And then, as we were writingthe paper, we would go through
section by section and pick outwhat was good from each section
and what could use more work,and then we'd brainstorm ideas
on how to make it better.
Patrick Sullivan (11:40):
That sounds like a great process and
actually, even when you're laterin your career, I think writing
with colleagues is more funthan writing alone, so that's a
great habit to start.
This again might be for eitherof you, but were you surprised
by any of the findings?
We talked a little bit about acouple of the findings, but
anything else surprise you, ordid you have any associations
that you predicted that didn'tpan out?
Akshay Krishnan (12:02):
Yeah, when we first started this project I
didn't believe that there wouldbe associations between
childhood sleep and adolescentalcohol and marijuana use,
especially if we were measuringthe sleep 10 to 12 years before
the substance use.
But while we were doing theproject we found that it was
associated.
So it was really interesting tokind of like have your opinions
tested and then be able to dosome digging into why that may
have happened.
Patrick Sullivan (12:23):
And does that suggest any sort of next step
questions?
You have this association nowin observational data.
Does it prompt you to thinkabout any next step questions or
any grant ideas, dissertationideas or any of those ways we
might pursue next steps?
David Reichenberger (12:41):
Uh so, not yet for grants, certainly, but
it definitely inspires me toreally consider the
bidirectional relationshipbetween sleep and substance use,
that sleep can indeed influenceour choices, potentially, of
course, and that substance usecan affect subsequent sleep, and
(13:02):
then looking at how thatreciprocity may change over time
.
Patrick Sullivan (13:10):
Interesting.
So you've sort of alreadyalluded to this, but we're lucky
to have both of you on the calltoday.
I love interviewing trainees-Hopefully we're all learners at
any age but someone in thattraining phase and a mentor.
But it sounds like there'sanother sort of colleague that's
in the mix here of your work.
So I wonder if you could talkabout that mentorship situation
either how you work together orit sounds like there may be
(13:32):
another colleague who's alsocontributing to this and how
does the structure of thatmentoring work and how do you
think that's impacted yourcareer development?
Akshay Krishnan (13:41):
Yeah.
So when I was at Penn State, Ireally had the privilege of
being mentored by both Dr.
Reichenberger, who was agraduate student when he was
mentoring me, and then also Dr.
Anne- Marie Chang, who was Dr.
Reichenberger's graduateadvisor.
They both had a lot of researchexperience which they really
imparted onto me.
So during this mentorshipprocess I worked with them
(14:01):
during different times of dayand they would help me with
different things, and we'd alsohave some time where I'll be
working together.
So when I talked to Dr.
Reichenberger, we talked a lotabout the research process
itself how to come up with agood question, how to fill out
an IRB, how to design studymethods and how to do
statistical analysis once youfinish the study.
And then, when I talked to Dr.
Chang, we talked a lot abouthow to structure a paper, what
(14:23):
type of language I should beusing and how to design figures,
and so, because I was able toget advice and mentorship from
both of these amazingresearchers, I was really able
to develop my own passion forresearch, which I've continued
now, even in medical school,when classes are a lot more busy
.
Patrick Sullivan (14:38):
It's great that you're able to keep that
research interest while you'rein medical school.
It's juggling a lot.
And, Dr.
Reichenberger, can I just askyou, in that relationship you're
sort of probably mostfrequently working with Akshay,
but you also have this otherresource, so did you get sort of
mentoring on mentoring?
Was there any sort of coachingin that relationship with Dr.
(14:59):
Chang?
David Reichenberger (14:59):
Yeah, absolutely.
There were very few times whereAkshay gave me trouble, but I
still had questions about, like,how to interact with him or how
to broach a certain topic, andso Dr.
Chang was always there for meto teach me how to mentor Akshay
.
And Dr Chang was just anamazing advisor as well, and so
(15:22):
just by working with her, I kindof already knew the kind of
mentor I wanted to be and how Iwanted to interact with Akshay
as my mentee.
Patrick Sullivan (15:32):
And I'm going to shout out Dr.
Ted McDonald, who is my majorprofessor, who I'll send this
podcast to but it really is likethat investment that Dr.
Chang made in you enables thisrelationship that you can have
with Akshay, and so I think it'sreally worth thinking about why
these relationships work wellwhen they do, and this sort of
(15:54):
tiered mentorship maybe becauseit's not intuitive always how to
be the best mentor even ifyou've had great ones being able
to go back and and beingmentored on mentor.
There's also a great curriculumin UCSF called Mentoring the
Mentors.
That is like a two or three dayprogram that you could find
online that really addresses alot of these things for earlier
(16:15):
career mentors.
So thank you both for sharingthat and I guess I'll just sort
of wrap up by saying, maybe foreach of you, what advice do you
have for aspiring students orfor earlier career researchers
who want to pursue research?
You know what steps werehelpful to you.
How did you seek and findmentorship?
What advice would you have?
Akshay Krishnan (16:35):
I think my advice for other students trying
to pursue research is to find atopic they're truly passionate
about, because if you'repassionate about the field
you're researching, the hours ittakes to do data collection and
writing won't feel like aburden and you'll be really able
to explore something you wantto learn more about.
I would also advise students tofind a good mentor, because
there's a lot that goes intohaving a successful study, not
just you going and talking tothe participants.
(16:58):
It's a lot more about the wholeprocess behind it and it's
really hard to learn that byyourself.
But if you have a strong mentor, a strong set of mentors, it
makes the process go a loteasier and really helps you take
a lot more out of the processand can really help you ignite
your passion for research andkeep doing it even later on in
your career.
David Reichenberger (17:14):
Yeah, I totally echo that sentiment.
Really having the right mentorfor you as an individual can
make or break your researchexperience or your experience in
graduate school.
Patrick Sullivan (17:27):
All right, any last thoughts that either of
you would like to share with ourlisteners?
David Reichenberger (17:30):
No, I just really want to take the time to
thank you for giving us thisopportunity to chat.
Patrick Sullivan (17:37):
Thank you.
It's our pleasure and weappreciate you bringing your
work to Annals and appreciatethe chance to you know, spread
the word a little bit more aboutyour work, but also about this
process.
So that brings us to the end ofthis episode.
I want to thank again AkshayKrishnan and Dr.
David Reichenberger for joiningus today.
It's such a pleasure to haveyou on the podcast.
David Reichenberger (17:59):
Thank you so much.
Patrick Sullivan (18:00):
Thank you.
I'm your host, Patrick Sullivan.
Thanks for tuning in to thisepisode and see you next time on
EPITalk, brought to you byAnnals of Epidemiology, the
official journal of the AmericanCollege of Epidemiology.
For a transcript of thispodcast or to read the article
featured on this episode andmore from the journal, you can
(18:21):
visit us online at www.
annalsofepidemiology.
org.
Hello, you're listening to EpTalk Behind the
Paper, a monthly podcast fromthe Annals of Epidemiology.
I'm Patrick Sullivan,editor-in-chief of the journal,
and in this series we take youbehind the scenes of some of the
latest epidemiologic researchfeatured in our journal.
Today we're talking with MrAkshay Krishnan and Dr David
(00:36):
Reichenberger about theirarticle Childhood Sleep is
Prospectively Associated withAdolescent Alcohol and Marijuana
Use, respectively associatedwith adolescent alcohol and
marijuana use.
You can read the full articleonline in the October 2024 issue
of the journal atwwwanalystofepidemiologyorg.
First I'd like to introduce ourguests.
Akshay Krishnan is a second-yearmedical student at Sidney
(00:59):
Kimmel Medical College at ThomasJefferson University.
He's part of the seven-yearaccelerated Pennsylvania State
Sydney Medical College BS/MDprogram and his research centers
on health-related social needs,telehealth efficacy, and the
intersection of sleep and health.
Dr.
David Reichenberger, is apostdoctoral fellow at the
(01:19):
Knight Cardiovascular Instituteand the Oregon Institute of
Occupational Health Sciences atthe Oregon Health and Science
University.
His research examines themicro- and macro- longitudinal
associations of dailyhealth-related behaviors, like
substance use or screen time,with nightly sleep health and,
in turn, how changes in sleepinfluence cardiovascular health.
(01:41):
Dr Reichenberger is currentlylooking for tenure-track faculty
positions.
Thank you both for joining ustoday.
So this is a little bit of adifferent structure than we
usually do, and I'm so happywe're doing it this way, because
we have both the author of thepaper and the mentor.
So we're first going to talk alittle bit about the study
(02:01):
itself and then we'll spend alittle bit of time talking about
your mentoring relationship andhow that worked, preparing this
particular work.
Akshay, I first just want toask about the purpose of the
study.
What questions were you reallyinterested in answering?
Akshay Krishnan (02:15):
Yeah, the purpose of our study was to
investigate how childhood sleeppredicts adolescent alcohol and
marijuana use.
So when we were doing ourliterature search we found many
studies that looked atlongitudinal associations.
But those that were looking atlongitudinal associations only
looked at two time points onetime in childhood and one time
point in adolescence.
But we were curious to see howthis longitudinal relationship
would span all of childhood.
Patrick Sullivan (02:37):
Great.
So you've sort of alluded tothis a little bit, but what is
the study design and whatmethods did you have to, you
know, select in order to answerthe question that you were
seeking to answer?
David Reichenberger (02:49):
I'll actually answer that one.
Our study used data from theFuture of Families and Child
Well-Being Study.
This was a longitudinal birthcohort that had started in 1998
and has collected data fromchildren and their parents
across multiple waves.
This includes collecting dataat birth, when the child was at
ages 3, 5, 9, and age 15, andmost recently when the child was
(03:13):
age 22.
So collecting data when they'renow young adults.
So this study is just rich withdata.
Some of the variables that weused were parent reports of the
child's sleep, which has beencollected ever since the age
three wave and then during theage 15 wave, when the children
were teens.
They were finally old enough toself-report their own sleep and
(03:34):
whether they had tried alcoholor marijuana by that point in
their life.
We applied a logisticregression framework to evaluate
whether later bedtimes orshorter sleep duration at each
wave across childhood increasedthe odds of drinking alcohol or
trying marijuana by age 15.
Patrick Sullivan (03:54):
Great.
And so what was the mainfinding?
And then did it sort of line upwith what you were
hypothesizing when you started?
David Reichenberger (04:01):
Yeah, in general, we found that later
bedtimes and shorter sleepdurations at ages 5, 9, and 15
were associated with increasedodds of substance use by age 15.
And this ultimately alignedwith our hypothesis.
Patrick Sullivan (04:16):
So in terms of how you came to that hypothesis
, I mean, was there sort ofprevious literature or why would
you postulate that such arelationship might exist?
Akshay Krishnan (04:26):
So when we looked at previous literature,
we did find some associationsbetween childhood sleep and
adolescent alcohol and marijuanause, and what we found with our
studies is that our findingsmostly agreed with the previous
literature.
We found that insufficientsleep was cross-sectionally
associated with increasedadolescent alcohol use, but we
also found no associationbetween adolescent sleep
duration and marijuana use,which prior studies have found.
(04:48):
We think that the differencebetween our studies and prior
studies could be due to howsleep was assessed, with prior
studies focusing more on sleepproblems and our studies
focusing more on sleep durationand bedtime.
Patrick Sullivan (05:00):
Great.
Can you say a little bit aboutwhat you see as the strengths
and limitations of your study?
Akshay Krishnan (05:05):
I think one of the biggest strengths of our
study is the sample population.
The Future of Families cohortis a large, diverse national
sample of urban children and thestudy has been following them
since birth.
And I think one of thelimitations to our study is how
the data was collected, becauseit was parent report or
self-report data.
There could be some recall biasthere and also the way sleep
(05:27):
was assessed in each wave of thestudy was slightly different,
and daytime sleep, such as naps,was not asked about.
Patrick Sullivan (05:32):
And can I ask, was the alcohol drinking also
reported by the parents or bythe children?
David Reichenberger (05:38):
So that was actually answered by the
adolescents.
Patrick Sullivan (05:42):
By the adolescents, so also the
potential for some recall biasthere or some misclassification,
and whether they agreed tovolunteer that information.
Sure.
So what prompted you toinvestigate childhood sleep as a
risk factor for earlyadolescent substance use?
David Reichenberger (05:58):
So we really wanted to look at
childhood sleep as a risk factor, because childhood is just such
a crucial period for growth anddevelopment.
Sleep is often supporting manyof the changes that children
undergo as they age, with one ofthe notable changes being brain
maturation, and this isespecially important as the
child transitions from childhoodinto adolescence.
(06:21):
So there have been many studiesthat have linked poor sleep
with worse decision making, andworse decision making may be
linked to the decision to engagein substance use when they're
an adolescent.
So really we're most interestedin examining the possibility of
sleep as the predeterminingfactor of this more distal
(06:42):
outcome.
Patrick Sullivan (06:44):
Thanks.
So you've talked a little bitabout the nature of the exposure
here, which is the amount ofsleep, but I wonder whether it's
possible that there may beother characteristics of
households that might beconfounded with the sleep
exposure.
So what are your thoughts aboutwhether you think this is
really leaning towards a causalrelationship, or do you think
(07:04):
there might be some confoundinghere with other household
exposures in this period ofadolescence?
David Reichenberger (07:11):
It's certainly possible that other
factors are confounding thisrelationship, but we did our
best really to try to controlfor many of those potential
confounds by controlling formany sociodemographic
characteristics as well associoeconomic status.
In the past we've looked atwhether perhaps bedtime routines
(07:33):
could be related to sleep inparticular, especially because
without a bedtime routine it maymean that sleep is less of a
consistent habit and it couldreflect more potentially
household chaos or some otheraspect that the child is
experiencing in their life.
Patrick Sullivan (07:53):
Yeah, thanks for thinking that through.
So I want to last ask about acouple findings that were just
sort of striking to me.
And again, I know this is anobservational study so we're not
going to attribute causalitytoo strictly, but just your
thoughts about or whether youwere surprised by these.
So one is that the participantswho had later bedtimes at age
(08:14):
three had a lower odds ofdrinking alcohol by age 15.
And, in contrast, theparticipants that had later
bedtimes at age nine had greaterodds of drinking alcohol by
that age.
So do you have any thoughtsabout why bedtimes at early
versus later ages might appearto have different associations
with the drinking alcoholoutcome?
David Reichenberger (08:37):
Yeah, this was a really counterintuitive
finding that we didn't expectwhat we think and really we're
speculating here because we werenot able to assess daytime
sleep.
The question just simply wasn'tasked at age three.
But what we suspect is thatit's perhaps that these children
are having daytime sleep.
(08:58):
They're taking naps throughoutthe day and that is pushing back
their bedtime.
So they're still gettingsufficient sleep, but the later
bedtime is potentiallyreflecting better sleep health
at that age.
Patrick Sullivan (09:14):
Interesting.
I know that was a little riskyto speculate when you have these
kinds of associations, but Ithink that's part of the process
of seeing what you learn,figuring out what the hypotheses
are for the next round and theneither designing a new study to
try and answer that, collectingadditional data elements.
So thanks for that.
So now we're going to move to asegment we call Behind the
(09:35):
Paper, which really gets to youas people as well as researchers
, and I think it's reallyinteresting to understand how
ideas for studies come about andhow people work with mentors
and work in teams.
So we want to talk a little bitabout that.
So first I wonder for either ofyou how you came to be
interested in studying sleephealth.
Akshay Krishnan (09:57):
I think my interest in sleep health started
because I myself have a lot oftrouble sleeping, so I was
really interested in learningmore about how I could both
improve my sleep and also whysleep was so important to having
a healthy lifestyle.
Patrick Sullivan (10:09):
Yeah, I think sometimes, when there are topics
that we can relate to one,there's interest in studying
them.
But you may also have insightinto asking the right questions
or how you design something, andI think we bring our own
experiences for sure to ourresearch in that way.
What was the biggest challengeyou faced in conducting the
(10:30):
analysis and how did youovercome it?
Akshay Krishnan (10:32):
One of the biggest challenges I faced while
doing this research study cameat the end, when it came time to
write the paper.
I'd never written a paper fromstart to finish before, so even
though I knew all the parts thathad to go into a paper, I
didn't really know how to get itthere on my own, and to
overcome this challenge I workeda lot with Dr.
Reichenberger and Dr.
Anne- Marie Chang, who wasDavid's mentor at the time as
(10:53):
well.
They spent a lot of timefocusing on how to structure an
abstract, how to structure theintroduction, how to do the
statistical analysis, how tostructure your figures, and they
both really spent countlesshours teaching me how to go
through this whole process, andit really shaped me into the
researcher I am today.
Patrick Sullivan (11:05):
Great, it's great to hear about that process
and can I just ask like forthose sections, was part of that
process looking at examples ofintroductions, or was it more by
example, or was it more by sortof brainstorming together what
the components of each segmentmight be?
Akshay Krishnan (11:20):
I think it was more a combination of both,
because before I started writingthe paper we did a literature
search.
So as I was doing literaturesearch I was reading a lot of
papers on similar topics.
So from there I kind of got anidea of what needed to go into
each section.
And then, as we were writingthe paper, we would go through
section by section and pick outwhat was good from each section
and what could use more work,and then we'd brainstorm ideas
on how to make it better.
Patrick Sullivan (11:40):
That sounds like a great process and
actually, even when you're laterin your career, I think writing
with colleagues is more funthan writing alone, so that's a
great habit to start.
This again might be for eitherof you, but were you surprised
by any of the findings?
We talked a little bit about acouple of the findings, but
anything else surprise you, ordid you have any associations
that you predicted that didn'tpan out?
Akshay Krishnan (12:02):
Yeah, when we first started this project I
didn't believe that there wouldbe associations between
childhood sleep and adolescentalcohol and marijuana use,
especially if we were measuringthe sleep 10 to 12 years before
the substance use.
But while we were doing theproject we found that it was
associated.
So it was really interesting tokind of like have your opinions
tested and then be able to dosome digging into why that may
have happened.
Patrick Sullivan (12:23):
And does that suggest any sort of next step
questions?
You have this association nowin observational data.
Does it prompt you to thinkabout any next step questions or
any grant ideas, dissertationideas or any of those ways we
might pursue next steps?
David Reichenberger (12:41):
Uh so, not yet for grants, certainly, but
it definitely inspires me toreally consider the
bidirectional relationshipbetween sleep and substance use,
that sleep can indeed influenceour choices, potentially, of
course, and that substance usecan affect subsequent sleep, and
(13:02):
then looking at how thatreciprocity may change over time
.
Patrick Sullivan (13:10):
Interesting.
So you've sort of alreadyalluded to this, but we're lucky
to have both of you on the calltoday.
I love interviewing trainees-Hopefully we're all learners at
any age but someone in thattraining phase and a mentor.
But it sounds like there'sanother sort of colleague that's
in the mix here of your work.
So I wonder if you could talkabout that mentorship situation
either how you work together orit sounds like there may be
(13:32):
another colleague who's alsocontributing to this and how
does the structure of thatmentoring work and how do you
think that's impacted yourcareer development?
Akshay Krishnan (13:41):
Yeah.
So when I was at Penn State, Ireally had the privilege of
being mentored by both Dr.
Reichenberger, who was agraduate student when he was
mentoring me, and then also Dr.
Anne- Marie Chang, who was Dr.
Reichenberger's graduateadvisor.
They both had a lot of researchexperience which they really
imparted onto me.
So during this mentorshipprocess I worked with them
(14:01):
during different times of dayand they would help me with
different things, and we'd alsohave some time where I'll be
working together.
So when I talked to Dr.
Reichenberger, we talked a lotabout the research process
itself how to come up with agood question, how to fill out
an IRB, how to design studymethods and how to do
statistical analysis once youfinish the study.
And then, when I talked to Dr.
Chang, we talked a lot abouthow to structure a paper, what
(14:23):
type of language I should beusing and how to design figures,
and so, because I was able toget advice and mentorship from
both of these amazingresearchers, I was really able
to develop my own passion forresearch, which I've continued
now, even in medical school,when classes are a lot more busy
.
Patrick Sullivan (14:38):
It's great that you're able to keep that
research interest while you'rein medical school.
It's juggling a lot.
And, Dr.
Reichenberger, can I just askyou, in that relationship you're
sort of probably mostfrequently working with Akshay,
but you also have this otherresource, so did you get sort of
mentoring on mentoring?
Was there any sort of coachingin that relationship with Dr.
(14:59):
Chang?
David Reichenberger (14:59):
Yeah, absolutely.
There were very few times whereAkshay gave me trouble, but I
still had questions about, like,how to interact with him or how
to broach a certain topic, andso Dr.
Chang was always there for meto teach me how to mentor Akshay
.
And Dr Chang was just anamazing advisor as well, and so
(15:22):
just by working with her, I kindof already knew the kind of
mentor I wanted to be and how Iwanted to interact with Akshay
as my mentee.
Patrick Sullivan (15:32):
And I'm going to shout out Dr.
Ted McDonald, who is my majorprofessor, who I'll send this
podcast to but it really is likethat investment that Dr.
Chang made in you enables thisrelationship that you can have
with Akshay, and so I think it'sreally worth thinking about why
these relationships work wellwhen they do, and this sort of
(15:54):
tiered mentorship maybe becauseit's not intuitive always how to
be the best mentor even ifyou've had great ones being able
to go back and and beingmentored on mentor.
There's also a great curriculumin UCSF called Mentoring the
Mentors.
That is like a two or three dayprogram that you could find
online that really addresses alot of these things for earlier
(16:15):
career mentors.
So thank you both for sharingthat and I guess I'll just sort
of wrap up by saying, maybe foreach of you, what advice do you
have for aspiring students orfor earlier career researchers
who want to pursue research?
You know what steps werehelpful to you.
How did you seek and findmentorship?
What advice would you have?
Akshay Krishnan (16:35):
I think my advice for other students trying
to pursue research is to find atopic they're truly passionate
about, because if you'repassionate about the field
you're researching, the hours ittakes to do data collection and
writing won't feel like aburden and you'll be really able
to explore something you wantto learn more about.
I would also advise students tofind a good mentor, because
there's a lot that goes intohaving a successful study, not
just you going and talking tothe participants.
(16:58):
It's a lot more about the wholeprocess behind it and it's
really hard to learn that byyourself.
But if you have a strong mentor, a strong set of mentors, it
makes the process go a loteasier and really helps you take
a lot more out of the processand can really help you ignite
your passion for research andkeep doing it even later on in
your career.
David Reichenberger (17:14):
Yeah, I totally echo that sentiment.
Really having the right mentorfor you as an individual can
make or break your researchexperience or your experience in
graduate school.
Patrick Sullivan (17:27):
All right, any last thoughts that either of
you would like to share with ourlisteners?
David Reichenberger (17:30):
No, I just really want to take the time to
thank you for giving us thisopportunity to chat.
Patrick Sullivan (17:37):
Thank you.
It's our pleasure and weappreciate you bringing your
work to Annals and appreciatethe chance to you know, spread
the word a little bit more aboutyour work, but also about this
process.
So that brings us to the end ofthis episode.
I want to thank again AkshayKrishnan and Dr.
David Reichenberger for joiningus today.
It's such a pleasure to haveyou on the podcast.
David Reichenberger (17:59):
Thank you so much.
Patrick Sullivan (18:00):
Thank you.
I'm your host, Patrick Sullivan.
Thanks for tuning in to thisepisode and see you next time on
EPITalk, brought to you byAnnals of Epidemiology, the
official journal of the AmericanCollege of Epidemiology.
For a transcript of thispodcast or to read the article
featured on this episode andmore from the journal, you can
(18:21):
visit us online at www.
annalsofepidemiology.
org.
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