Graduation Year

2025

Document Type

Dissertation

Degree

Ph.D.

Degree Name

Doctor of Philosophy (Ph.D.)

Degree Granting Department

Educational and Psychological Studies

Major Professor

Kathy Bradley-Klug, Ph.D.

Co-Major Professor

Marilyn Stern, Ph.D.

Committee Member

Emily Shaffer, Ph.D.

Committee Member

Robert Dedrick, Ph.D.

Keywords

family factors, health psychology, leukemia, pediatric school psychology, survivorship

Abstract

Advances in cancer treatment have improved survival rates among pediatric cancer survivors (PCS), shifting the focus toward long-term quality of life. Despite this progress, PCS remain at elevated risks of chronic health issues, including disrupted sleep and obesity. The purpose of this study was to characterize the sleep of PCS with overweight/obesity and to identify predictors of sleep quality. Guided by Merz and Tomfohr-Madsen’s (2018) conceptual framework for sleep disruption in children impacted by cancer, this secondary analysis of data examined disease parameters, family and environmental factors, and physical activity as potential predictors of sleep quality. Participants were enrolled between December 2020 and May 2025 as part of the NOURISH-T+ health-promotion study (Stern et al., 2021). Sleep was measured using the Pittsburgh Sleep Quality Index (PSQI; Buysse et al., 1989). Results indicated that 41% of PCS and 43% of caregivers reported poor sleep quality (PSQI > 5). Children averaged 8.5 hours of sleep per night (range = 2–14), with 44% failing to meet age-based recommendations, while caregivers averaged 7.2 hours (range = 3–14), with 37% obtaining insufficient sleep. Child and caregiver sleep quality were strongly correlated (r = .54, p < .001). A multiple regression model explained 37.6% of the variance in child sleep quality. Caregiver sleep quality, household income, number of children in the home, and physical activity frequency identified as significant predictors. Findings highlight the prevalence of sleep difficulties among PCS with overweight/obesity, the interdependence of family sleep, and the importance of contextual factors such as socioeconomic status. Implications for school psychology practice include screening, family engagement, and advocacy for policies that promote healthy sleep. Future research should develop family-centered interventions to improve sleep among PCS with overweight/obesity.

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