Coffee drinking, mortality, and cancer incidence: results from a Norwegian prospective study.

Relationships between coffee consumption and occurrence of cancer as well as mortality were explored in a Norwegian study of 13,664 men and 2,891 women who in 1967-69 reported their coffee consumption. No statistically significant positive associations were found between coffee consumption and disease. A weak negative association was found with total cancer incidence even when the first 4 of the 11 1/2 years of follow-up were excluded, and strong negative associations with coffee drinking were noted for cancer of the kidney and nonmelanoma skin cancer. For cancer of the pancreas and bladder, no increase in incidence was found among those with a high coffee consumption. In subjects less than 65 years of age at start of follow-up, coffee drinking showed a significant inverse association with colon cancer.

Reproductive factors and risk of cancer of the uterine corpus: a prospective study.

Relationships between reproductive factors and risk of cancer of the uterine corpus were investigated in a prospective study of 62,079 women in Norway. A total of 420 cases were diagnosed during follow-up, from 1961 through 1980. The risk of endometrial carcinoma decreased significantly with increasing parity as well as with increasing age at first and last birth. The estimated odds ratio for women with 5 or more births versus uniparous was 0.60 in analyses with adjustment for age and residence characteristics. For first birth at age greater than or equal to 35 versus less than or equal to 19 the odds ratio was 0.48, and for last birth at age greater than or equal to 40 versus less than or equal to 24 we found an odds ratio of 0.45, in analyses with additional adjustment for parity. Significant associations were also found with age at menarche and menopause, the highest risks being observed for women with early menarche or late menopause. The different reproductive variables seemed to affect the risk of sarcomas of the uterine corpus and the risk of endometrial carcinomas in a similar way.

Prevalence of HIV-1 infection in urban, semi-urban and rural areas in Arusha region, Tanzania.

OBJECTIVE: To estimate HIV-1 prevalence among the adult population in the Arusha region, northern Tanzania. DESIGN: Cross-sectional study. METHODS: Clusters of 10 households were randomly selected from urban, semi-urban and rural areas in the Arusha region. Informed verbal consent for participation in the interview and HIV-1 test were obtained from the respondents. HIV-1 antibodies were tested using enzyme-linked immunosorbent assay (ELISA) and all ELISA-positive sera were confirmed using Western blot. Approximately 66.0% of the eligible registered adults (aged 15-54 years) participated in the interview, of whom 56.6% provided blood samples for HIV-1 testing. RESULTS: HIV-1 prevalence rates among the study population from the low and high socioeconomic status urban areas, semi-urban area and rural village were 10.7, 5.2, 2.2 and 1.6%, respectively. HIV-1 prevalence was significantly higher among women (6.5%) than men (1.7%), and infection rates were consistently higher among women than men in all areas studied except in the rural village. Divorced and separated individuals had significantly higher HIV-1 prevalence (14.8%) compared with married and cohabiting individuals (4.0%). Significantly more individuals with multiple sexual partners reported regular condom use (19.3%) than those with one sexual partner (6.4%). CONCLUSION: HIV-1 prevalence in the Arusha region was higher among the urban population than among the rural population. Women living in urban areas with low socioeconomic status appeared to be associated with increased risk of HIV-1 infection.

Coffee consumption and plasma total homocysteine: The Hordaland Homocysteine Study.

The health consequences of coffee drinking remain controversial. We report on an association between coffee consumption and the concentration of total homocysteine (tHcy) in plasma, a risk factor for cardiovascular disease and for adverse pregnancy outcome. The study population consisted of 7589 men and 8585 women 40-67 y of age and with no history of hypertension, diabetes, ischemic heart disease, or cerebrovascular disease. They were recruited from Hordaland county of western Norway in 1992-1993. Daily use of coffee was reported by 89.1% of the participants, of whom 94.9% used caffeinated filtered coffee. There was a marked positive dose-response relation between coffee consumption and plasma tHcy, which was stronger than the relation between coffee and total serum cholesterol. In 40-42-y-old men, mean tHcy was 10.1 mumol/L for nonusers and 12.0 mumol/L for drinkers of > or = 9 cups of coffee/d. Corresponding tHcy concentrations in 40-42-y-old women were 8.2 and 10.5 mumol/L, respectively. Although coffee drinking was associated with smoking and lower intake of vitamin supplements and fruit and vegetables, the coffee-tHcy association was only moderately reduced after these variables were adjusted for. The combination of cigarette smoking and high coffee intake was associated with particularly high tHcy concentrations. A strong inverse relation between tea and tHcy concentration in univariate analysis was substantially attenuated after smoking and coffee drinking were adjusted for. The results of the present report should promote future studies on tHcy as a possible mediator of adverse clinical effects related to heavy coffee consumption.

Prevalence of insomnia in the adult Norwegian population.

A representative adult sample (18 years and above) of the Norwegian population, comprising 2001 subjects, participated in telephone interviews, focusing on the one-month point prevalence of insomnia and use of prescribed hypnotics. Employment of DSM-IV inclusion criteria of insomnia yielded a prevalence rate of 11.7%. Logistic regression analysis performed on the different insomnia symptoms revealed that somatic and psychiatric health were the strongest predictors of insomnia, whereas gender, age, and socioeconomic status showed a more inconsistent relationship. Use of prescribed hypnotic drugs was reported by 6.9% and was related to being female, elderly, and having somatic and emotional problems. Sleep onset problems and daytime impairment were more common during winter compared to summer. Use of hypnotics was more common in the southern (rather than the northern) regions of Norway. For sleep onset problems a Season x Region interaction was found, indicating that the prevalence of sleep onset problems increased in southern Norway from summer to winter, while the opposite pattern was found in the northern regions. The importance of clinically adequate criteria and seasonal variation in the evaluation of insomnia is briefly discussed.

Do reproductive factors influence colorectal cancer survival?

During 29 years follow up of 63,090 Norwegian women, 1347 women had a diagnosed cancer of the colon or rectum. Seven hundred and fifty-five of these women (56%) subsequently died of colorectal cancer. We investigated possible relationships between reproductive history and cancer survival and found little evidence that reproductive history is of prognostic value for colorectal cancer survival.

Does age at natural menopause affect mortality from ischemic heart disease?

We examined the relationship between age at natural menopause and mortality of ischemic heart disease in 19,309 Norwegian postmenopausal women. A total of 2767 fatal infarctions occurred during 29 years of follow up. Overall, a relatively weak inverse relationship was seen with approximately 10% lower ischemic heart disease mortality in women aged > or = 47 years at the menopause compared to women with an early menopause (< 44 years). Risk estimates were similar for women aged 47 and more at menopause. However, the inverse relationship was stronger and statistically significant (p = 0.01) in women aged less than 70 years. In this group of women, we observed a nearly 60% reduction in the ischemic heart disease mortality in women with a late menopause (> or = 53 years) compared to women aged < 44 years at menopause (mortality rate ratio = 0.42; 95% confidence interval 0.25-0.72). This protective effect of a late menopause is reduced with advancing age, however, and is of minor significance in the age groups where the great proportion of the ischemic heart disease deaths occur.

Survival after peptic ulcer perforation: a time trend analysis.

The survival of 1098 patients with ulcer perforation in Norway during the period 1952-1990 was compared with expected survival. Cox regression models incorporating population mortality rates, were used to analyse effects of sex, age, year of birth, and year at risk on excess mortality. Survival was lower in patients than in the general population through a follow-up period of 38 years. Relative survival was lower in women as compared to men, due to more delayed treatment. Long-term survival was lower after praepyloric perforations than after the other perforation types. Relative survival was higher in patients treated 1952-1970 than in those treated more recently. However, adjustment for year of birth revealed a decline in short-term mortality with calendar time, which is in accordance with improved management during the study period. Relative mortality, particularly long-term mortality, was higher in younger birth cohorts, suggesting a shift towards more serious etiologies.

Parity in relation to mortality and cancer incidence: a prospective study of Norwegian women.

BACKGROUND: Few prospective studies relating childbearing to total and cause-specific mortality and cancer incidence have been published. The purpose of this paper was to examine these relations in a large cohort of Norwegian women. METHODS: Information on reproductive factors was obtained through interviews with 63,090 women. All deaths and cancer cases during follow-up, 1961-1980, were obtained by linkage to the files at the Central Bureau of Statistics and the Cancer Registry of Norway, respectively. Associations with parity were assessed by stratified logistic regression. RESULTS: For cerebrovascular and ischaemic heart disease, moderate but highly significant positive trends of increasing mortality with increasing parity were observed in the older part of the cohort. Deaths from diseases of the respiratory system and suicide were most common among nulliparous women. Inverse associations with parity were observed for cancers of the breast, corpus uteri and ovaries as well as for melanoma and non-melanoma skin cancers. Positive associations were observed for cancer of the cervix uteri in all age groups, for cancer of the respiratory system among older women and for pancreatic cancer and multiple myelomas in the younger part of the cohort. The results gave no support to previous reports of positive associations with cancer of the liver or gallbladder. CONCLUSIONS: The study supports evidence of an increased risk of ischaemic heart disease in multiparous women, which had been observed previously in three smaller prospective studies. It confirms earlier observations of low risks of cancer of the breast, corpus uteri and ovaries in women with high parity.

Determinants of night blindness in Bangladesh.

A cross-sectional study was conducted to evaluate the effect of a community-based health education intervention programme and to study the determinants of night blindness in Bangladesh. The intervention programme was implemented to reduce the morbidity of nutritional blindness (night blindness) in the northern part of Bangladesh (Ranjpure district) during 1986-1989. A baseline study in 1986 covered 2010 households with a total population of 11,600, and the evaluation study in 1989 covered 2011 households with a total population of 10,456. Prevalence of night blindness was studied among children aged < 9 years in these households. The prevalence of night blindness per 1000 children was reduced significantly during the intervention period from 50.7 in 1986 to 26.7 in 1989. However, the post-intervention prevalence varied significantly between areas. Multivariate analyses showed that consumption of fish, meat, milk or eggs, dark green leaf vegetables, yellow fruits and vitamin A capsules were significant predictors of night blindness. In addition, family income, mother's literacy, family size and area of residence exhibited strong and statistically significant associations with night blindness in the 1989 cross-sectional study. The prevalence of night blindness was highest among 4-6 year old girls and 7-8 year old boys. The sex difference was, however, not statistically significant.

PIP: A community-based health education intervention program was implemented over the period 1986-89 in the northern Bangladesh district of Ranjpure in hopes of reducing the level of morbidity due to nutritional blindness. This cross-sectional study reports findings from an evaluation of the effects of the program and the determinants of night blindness in the country. The baseline study in 1986 assessed the prevalence of night blindness among children under 9 years old in 2010 households with a total population of 11,600. The evaluation study of 1989 covered comparably aged individuals in 2011 households with a total population of 10,456. The data indicate that the prevalence of night blindness was reduced from 50.7% to 26.7% over the period, but post-intervention prevalences varied significantly between areas. Where fish, meat, milk or eggs, dark green leaf vegetables, yellow fruits, and vitamin A capsules were consumed in comparatively larger quantities, the prevalence of night blindness was significantly lower. Likewise, higher family income, higher mother's literacy, and smaller family size were associated with lower prevalence of night blindness in the 1989 cross-sectional study. Area of residence was strong and statistically significant as a determinant factor. Finally, the prevalence of night blindness was highest among 4-6 year old girls and 7-8 year old boys, yet the sex difference was not statistically significant.

Environmental conditions, health behavior, and mortality in siblings as risk indicators of night blindness.

The purpose of the study was to estimate the association of environmental factors (water and sanitation), health behavior (breast feeding practice and vaccination), and mortality among siblings with night blindness. A total of 5,420 children were enrolled in a cross-sectional study from 2,101 households in the northern part of Bangladesh, a high risk area for night blindness. One hundred twenty-four children were reported by parents to have night blindness. Our results indicated that environmental factors, health behavior, and the death of siblings were significantly associated with the occurrence of night blindness in crude analyses, as well as in analyses with adjustment for a number of potential confounding variables. The strongest association was noted for sibling death. The findings support the notion that night blindness should not be viewed as an isolated health problem and that approaches aimed at improving vitamin A status should also include interventions directed to environmental and health-associated behavioral factors.

PIP: The northern part of Bangladesh is a high-risk area for night blindness. 5420 children from 2101 households in that part of the country were enrolled in a cross-sectional study conducted to determine the association of water and sanitation, breast feeding practice and vaccination, and mortality among siblings with night blindness. 124 children were reported by parents to have night blindness. The study found environmental factors, health behavior, and the death of siblings to be significantly associated with the occurrence of night blindness in crude analyses, as well as in analyses adjusted for a number of potential confounding variables. The strongest association was noted for sibling death. These findings support the rationale for not regarding night blindness as an isolated health problem. Moreover, approaches followed to improve vitamin A status should include interventions directed to environmental and health-associated behavioral factors.

Lactation and cancer risk: is there a relation specific to breast cancer?

Relations between previous lactation experience and risks of cancer of the breast and other sites were investigated after follow-up of 50,274 parous women from 1961 through 1980. Among women with complete information on lactation, 5102 developed cancer and, of these, 1136 were diagnosed with breast cancer. Analyses of associations with mean duration of lactation per birth and duration for each of the three first births suggested a nonlinear relation to breast cancer. The highest risk was observed for those with intermediate duration of breast feeding, whereas lower risks were found among those with very short or very long duration. For all nongenital cancers combined, decreased risks were observed among those with the longest duration of breast feeding. However, among cancers of specific sites, a significant inverse association was found for pancreatic cancer only. The overall impression given by our data is that breast feeding is not strongly related to risks of breast cancer or any other common cancer.

Childbearing and use of oral contraceptives: impact of educational level. The Nordland Health Study.

STUDY OBJECTIVE: The aim was to correlate the level of education to childbearing pattern and previous use of oral contraceptives in middle aged women. DESIGN AND SETTING: The study was a cross sectional survey of 3608 women aged 40-42 years in a county in northern Norway and involved 72% of all women in the age bracket living in the county. Information about childbearing and use of oral contraceptives was obtained from a self administered questionnaire. MAIN RESULTS: Level of education was inversely associated with parity and positively related to age at first and last birth, to the use of oral contraceptives at any time, and particularly to the use of oral contraceptives before the first birth. CONCLUSIONS: Women with high level of education have relatively low parity and postpone childbearing by using oral contraceptives.

Reproductive factors and fatal hip fractures. A Norwegian prospective study of 63,000 women.

STUDY OBJECTIVE: The aim of the study was to investigate the impact of reproductive variables (age at menarche, menopause, first and last birth as well as parity, lactation, and abortions) on hip fracture mortality. DESIGN AND SETTING: A prospective study in Norway with more than 60,000 women followed up for 29 years. A total of 465 deaths as a result of hip fracture were recorded. MAIN RESULTS: Statistically significant linear relations (p < or = 0.02) were found between both age at menarche and length of reproductive period (defined as age at menopause to age at menarche) and the mortality of hip fractures in women aged less than 80. The death rate for women with a late menarche (> or = 17 years) was twice that of the women with relatively early menarche (< or = 13 years). Compared with women with less than 30 years between menopause and menarche, the mortality rate ratio in women with more than 38 reproductive years was 0.5. We also found an inverse relation with age at first birth. CONCLUSIONS: This study supports by hypothesis that an early menarche and a long reproductive period protect against hip fracture mortality. High age at first birth may also be protective.

Anticipatory nausea and vomiting in cancer patients.

The present study reports on a mediating mechanism for anticipatory nausea and vomiting (ANV) in cancer chemotherapy. ANV is usually explained as a classically conditioned response. However, conditioning models have failed to explain individual variation in ANV susceptibility. On the basis of the positive correlation between degree of autonomic reactivity (AR) and conditionability, it is proposed that individual AR is predictive of ANV development. Of the 31 patients who participated in the study, 74% experienced postinfusion nausea and vomiting (PNV). Of the 23 patients who experienced PNV, 52% developed ANV. AR was recorded in a habituation paradigm before chemotherapy treatment was initiated. The patients in the ANV group showed significantly increased sympathetic reactivity as compared with the no-ANV group, implying that AR is a mediator of ANV development.

Homocysteine and methylmalonic acid levels in pregnant Nepali women. Should cobalamin supplementation be considered?

OBJECTIVE: The aim of this study was to investigate homocysteine and methylmalonic acid levels as markers of functional cobalamin and folate status in pregnant Nepali women. DESIGN: Cross-sectional study. SETTING: Patan Hospital, Kathmandu, Nepal. SUBJECTS: A sub-sample (n=382) of all pregnant women (n=2856) coming for their first antenatal visit in a 12 month period, 1994-1995. The selection of the sub-sample was based on maternal haematocrit values, categorised into three groups: severely, moderately and non-anaemic women. As serum levels of total homocysteine (s-tHcy) and methylmalonic acid (s-MMA) were similar in the three groups, pooled data are presented. Women who had already received micronutrient supplementation (n=54) were excluded. The remaining women (n=328) were included in the statistical analysis. RESULTS: Overall mean values (+/-s.d.) of s-tHcy and s-MMA were 9.5 (+/-4.2) micromol/l and 0.39 (+/-0.32) micromol/l, respectively. Elevated s-tHcy (>7.5 micromol/l) was found in 68% of the women, while 61% had elevated s-MMA (>0.26 micromol/l). Low s-cobalamin values (<150 pmol/l) were observed in 49% of the women, while only 7% had low s-folate values (< or =4.5 nmol/l). s-tHcy was significantly correlated with s-MMA (r=0.28, P<0.001), s-cobalamin (r=-0.30, P<0.001) and s-folate (r=-0.24, P<0.001). s-MMA was significantly associated with s-cobalamin (r=-0.40, P<0.001), but not with s-folate. CONCLUSIONS: Functional cobalamin deficiency was very common in the study population, while functional folate deficiency was rather uncommon. We suggest considering cobalamin supplementation to pregnant Nepali women. SPONSORSHIP: The Norwegian Research Council and the Norwegian Universities Committee for Development, Research and Education.

Anaemia in pregnancy: possible causes and risk factors in Nepali women.

OBJECTIVE: The aim of this study was to investigate the importance of nutritional deficiencies and infections in the development of anaemia in pregnant Nepali women. DESIGN: Case-control study. SETTING: Patan Hospital, Kathmandu, Nepal. SUBJECTS: A sub-sample (n=479) of all pregnant women (n=2856) coming for their first antenatal visit in a 12 month period, 1994-1995. Women who had already received any micronutrient supplementation (n=82), and those whose serum samples showed macroscopic haemolysis (n=7) were excluded. The remaining women (n=390) were included in the statistical analysis. They were divided into three groups; a non-anaemic control group, haematocrit (Hct)>33% (n=82), and two case-groups: moderately anaemic, Hct 25-33% (n=254), and severely anaemic, Hct<25% (n=54). RESULTS: We found high prevalences of nutritional deficiencies and intestinal infections, both among cases and controls. The prevalence of low s-ferritin was high, especially among the severely anaemic women (55.6%). In a multiple logistic regression model, the presence of low s-vitamin A, elevated s-C-reactive protein or hookworm infection was associated with a significantly increased risk of severe anaemia. The adjusted odds ratios (95% CI) were 8.38 (1.99, 35.30), 4.91 (1.22, 19.67) and 5.43 (1.20, 24.61), respectively. CONCLUSIONS: In addition to the present routine iron and folate supplementation to pregnant Nepali women, vitamin A supplementation needs to be considered. Prevention and treatment of infections should, together with dietary advice, be emphasized more strongly in the antenatal care. SPONSORSHIP: The Norwegian Research Council and the Norwegian Universities Committee for Development, Research and Education. European Journal of Clinical Nutrition (2000) 54, 3-8

Anemia in pregnancy in rural Tanzania: associations with micronutrients status and infections.

OBJECTIVE: We studied the association between anemia in pregnancy and characteristics related to nutrition and infections. DESIGN: Cross-sectional study. SETTING: Four antenatal clinics in rural northern Tanzania. SUBJECTS/METHODS: A total of 2547 women were screened for hemoglobin (Hb) and malaria plasmodia in capillary blood and for infections in urine. According to their Hb, they were assigned to one of five groups and selected accordingly, Hb<70 g/l (n=10), Hb=70-89 g/l (n=61), Hb=90-109 g/l (n=86), Hb=110-149 g/l (n=105) and Hb> or =150 g/l (n=50). The 312 selected subjects had venous blood drawn, were interviewed, and their arm circumference was measured. The sera were analyzed for ferritin, iron, total iron binding capacity (TIBC), cobalamin, folate, vitamin A, C-reactive protein (CRP), and lactate dehydrogenase (LD). Transferrin saturation (TFsat) was calculated. Urine was examined by dipsticks for nitrite. MAIN OUTCOME MEASURES: Unadjusted and adjusted odds ratio (OR and AOR) of anemia with Hb<90 g/l. RESULTS: Anemia (Hb<90 g/l) was associated with iron deficiency (low s-ferritin; AOR 3.4). The association with vitamin deficiencies were significant in unadjusted analysis (low s-folate; OR 3.1, low s-vitamin A; OR 2.6). Anemia was also associated with markers of infections (elevated s-CRP; AOR 3.5, urine nitrite positive; AOR 2.4) and hemolysis (elevated s-LD; AOR 10.1). A malaria positive blood slide was associated with anemia in unadjusted analysis (OR 2.7). An arm circumference less than 25 cm was associated with anemia (AOR 4.0). The associations with less severe anemia (Hb 90-109 g/l) were similar, but weaker. CONCLUSIONS: Anemia in pregnancy was associated with markers of infections and nutritional deficiencies. This should be taken into account in the management of anemia at antenatal clinics. SPONSORSHIP: The study was supported by the Norwegian Research Council (NFR) and the Centre for International Health, University of Bergen.

Condom awareness and use in the Arusha and Kilimanjaro regions, Tanzania: a population-based study.

A cross-sectional study of condom awareness, perceived availability, and use was conducted using a questionnaire in the Arusha and Kilimanjaro regions in northern Tanzania. The questionnaire was administered to a random sample (n = 1,081) of males and females (15-54 years of age) from four localities in the Arusha, Babati, Moshi, and Same districts. Of the 1,081 respondents, 69.9% knew what condoms are and, of these, 31.7% reported having ever used a condom, while 20.7% stated that they used condoms regularly. Furthermore, of the 756 respondents who knew what condoms are, 62.2% stated that condoms were available in their localities and, of these, 44.1% reported having used condoms regularly. The results suggested that, while the majority of the respondents knew about condoms and stated that condoms were available in their localities, reported regular condom use was low. Age, gender, marital status, occupation, and place of residence appeared to be significant determinants of condom awareness and use, while educational status was not. Although barmaids and professional drivers have been shown to practice high-risk sexual behavior, reported condom use among them was low.

PIP: A cross-sectional study of condom awareness, perceived availability, and use was conducted using a questionnaire in the Arusha and Kilimanjaro regions in northern Tanzania. The questionnaire was administered to a random sample (n = 1081) of males and females (15-54 years old) from 4 localities in the Arusha, Babati, Moshi, and Same districts. Of the 1081 respondents 507 were males and 574 females. Overall, 52.3% of the respondents were married and 34.0% were single. The mean age of the population was 29.3 years. 756 (69.9%) knew what condoms were; of these, only 343 (31.7%) reported having ever used a condom, and 224 (20.7%) stated that they used condoms regularly. Respondents in the 25-34 year age group had the highest level of condom awareness and use. Men were significantly more aware of condoms than women (81.9% vs. 59.4%, p 0.0001) and reported more regular condom use than women (27.6% vs. 14.6%, p 0.0001). Unmarried individuals had a significantly higher proportion of reported regular condom use (28.6% vs. 16.1%) compared with married individuals (p 0.001). Furthermore, of the 756 respondents who knew what condoms were, 470 (62.2%) stated that condoms were available in their localities and, of these, 44.1% reported having used condoms regularly. 196 (25.9%) said that they had condoms at home. Significantly more men (80.7%) than women (71.6%) knew where to get condoms (p 0.01). Awareness of condom availability was significantly associated with occupation (p 0.0001), but having condoms at home was significantly lower among farmers and housewives than among people in other occupations (p 0.0001). The results suggested that, while the majority of the respondents knew about condoms and stated that condoms were available in their localities, reported regular condom use was low. Age, gender, marital status, occupation, and place of residence appeared to be significant determinants of condom awareness and use, while educational status was not. Although barmaids and professional drivers have been shown to practice high-risk sexual behavior, reported condom use among them was low.

Behavioral treatment of insomnia in older adults: an open clinical trial comparing two interventions.

Fifty-five insomniacs, 60 years or above, participated in a behavioral treatment program, comparing two interventions (sleep hygiene+stimulus control vs sleep hygiene+relaxation tape). Half of the subjects were randomized to a waiting-list condition prior to treatment. No significant changes were observed during the waiting-list period. During the treatment period however, the subjects improved on several sleep parameters, and treatment gains were maintained at a 6-month follow-up. The effects of treatment were greater for nocturnal measures (e.g. sleep onset latency and total sleep time) as compared to daytime measures (e.g. life satisfaction, daytime alertness) and not-targeted behavior (medication use). There were no differences in treatment effects for the two interventions.