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Thinking about getting some ink? If so, you may want to check with your current or prospective employer about the workplace policy on tattoos. While tattoos can be seen as a form of self-expression, many hiring managers don't see them as career building tools. In fact, 37 percent of HR managers cite tattoos as the third most likely physical attribute that limits career potential. Tattoos are becoming more accepted, however, with 45 million people in the United States sporting some sort of skin art.

Looking inward toward the workplace, it seems that the younger demographic finds tattoos more acceptable, with 22 percent of 18 to 25 year olds OK with them. Those 60 years and older are sticking with tradition, with 63 percent feeling that visible tattoos are inappropriate in an office environment. It may come as no surprise that the military is the job industry with the most tattooed staff, with 36 percent sporting ink.

Those in agriculture/ranching; hospitality, tourism and recreation; and arts, media and entertainment also all ranked high on the tattoo chart. The good news is that 73 percent of people claim they would hire staff that had visible tattoos; perhaps they are from San Francisco, Calif., the most tattoo-friendly city in the United States. Austin, Texas; Pittsburgh, Pa.; Philadelphia, Pa.; and Detroit, Mich. rounded out the top five cities in America that were down with inking up.

There may be bad news for those with tattoos in the south seeking employment, as 55 percent of the region perceives tattoos as inappropriate for the workplace. This is the highest region in the country by seven percent. Only three in 10 human resources managers in the country felt that bad breath and piercings were bigger red flags than visible tattoos, and zero states in the nation have laws protecting tattooed people from discrimination in company hiring practices.

Knowing this, would you cover up your tattoo to get hired? Fourteen percent of people who have tattoos regret their decision, but to remove their ink, it's going to cost a pretty penny. The U.S. national average in 2013 for tattoo removal reached $588. That number is growing and is expected to reach a total of $83.2 million 2018.

While 90,000 tattoo removals were performed in 2014, that's not the only way for a tattoo to go unnoticed. Many tattoos can be covered up, which many hiring managers deem preferable. Beware if you're thinking about a neck, head or face tattoo, as these carry the biggest negative stigma in the workforce.

If you love your ink and want to keep it, the better condition your skin is in, the better the tattoo will look and last. Be sure to moisturize daily and use sunscreen. If you decide to contribute to the tattoo removal number, Skinfo's Specialty Skincare Boutique can help whip your skin back into tip-top shape. Our epionce Essential Recovery Kit provides optimal healing and soothing benefits for post-care tattoo removal of post-procedure skin. Find out more here.

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Tattoos in the Workplace: The Good, The Bad and The Ugly

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Thinking about getting some ink? If so, you may want to check with your current or prospective employer about the workplace policy on tattoos. While tattoos can be seen as a form of self-expression, many hiring managers don't see them as career building tools. In fact, 37 percent of HR ...

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​E-cigarette could be as dangerous as normal cigarettes and users could be prone to unique health problems, a new study has revealed.

Researchers from the University of North Carolina found that vapers showed high levels of protein which are linked to potentially serious lung conditions, including COPD and Cystic Fybrosis, along with lupus and psoriasis.

An increase in mucin 5AC, a mucus secretion associated with chronic bronchitis and asthma, was also found in both e-cigarette and cigarette users.

Dr MehmetKesimer, who lead the study said: "There is confusion about whether e-cigarettes are "safer" than cigarettes because the potential adverse effects of e-cigarettes are only beginning to be studied.

"Our results suggest that e-cigarettes might be just as bad as cigarettes."

While he admitted that "comparing the harm of e-cigarettes with cigarettes is a little like comparing apples to oranges," he said: "Our data shows that e-cigarettes have a signature of harm in the lung that is both similar and unique, which challenges the concept that switching from cigarettes to e-cigarettes is a healthier alternative."

The study, published in the American Journal of Respiratory and Critical Care Medicine, examined 44 sputum samples from e-cigarette users, current cigarette smokers, and non-smokers, the authors made it clear that most of the e-cigarette smokers were formerly cigarette smokers, making it difficult to clearly identify whether these results were solely related to e-cigarette use.

The news comes after Public Health England concluded that the devices were 95 per cent less harmful than smoking normal cigarettes in 2015.

In May, users were hit by new restrictions under a new directive cracking down on all smoking products.

The legislation, which limits the potency of vaping liquids and reduces the size of refill packets, was introduced last year, but companies were given 12 months to adopt the changes.

Supporters say the new rules, which include a reduction in the size of refills and tanks and cartridges are needed to dissuade people from picking up a vaping habit, while critics argue the new laws will put smokers off switching to e-cigarettes.

Reuse content

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Vaping may cause unique health problems as dangerous as smoking cigarettes, finds study

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​E-cigarette could be as dangerous as normal cigarettes and users could be prone to unique health problems, a new study has revealed. Researchers from the University of North Carolina found that vapers showed high levels of protein which are linked to potentially serious lung conditions, including COPD and Cystic Fybrosis, along with lupus and psoriasis.

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significance for living and existence

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Sleep and College Students

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Abstract

Daytime sleepiness, sleep deprivation, and irregular sleep schedules are highly prevalent among college students, as 50% report daytime sleepiness and 70% attain insufficient sleep. The consequences of sleep deprivation and daytime sleepiness are especially problematic to college students and can result in lower grade point averages, increased risk of academic failure, compromised learning, impaired mood, and increased risk of motor vehicle accidents. This article reviews the current prevalence of sleepiness and sleep deprivation among college students, contributing factors for sleep deprivation, and the role of sleep in learning and memory. The impact of sleep and sleep disorders on academics, grade point average, driving, and mood will be examined. Most importantly, effective and viable interventions to decrease sleepiness and sleep deprivation through sleep education classes, online programs, encouragement of naps, and adjustment of class time will be reviewed. This paper highlights that addressing sleep issues, which are not often considered as a risk factor for depression and academic failure, should be encouraged. Promotion of university and college policies and class schedules that encourage healthy and adequate sleep could have a significant impact on the sleep, learning, and health of college students. Future research to investigate effective and feasible interventions, which disseminate both sleep knowledge and encouragement of healthy sleep habits to college students in a time and cost effective manner, is a priority.

Keywords: grade point average, GPA, sleep deprivation, academic performance, adolescence, sleep education programs

Introduction

The college experience is of great value in providing emerging adults with a structured environment in which they can gain the knowledge, skills, and independence to chart their own path, become successfully employed, and contribute to society. However, this experience comes at great cost given rising tuition fees and ballooning student debt, and thus, it is vital that the college years be as efficacious as possible. A potential obstacle to maximizing success in college is the high prevalence of daytime sleepiness, sleep deprivation, and irregular sleep schedules among college students.

Daytime sleepiness is a major problem, exhibited by 50% of college students compared to 36% of adolescents and adults. 1 At least 3 days a week, 60% of students report that they are dragging, tired, or sleepy. 2 Sleepiness is defined as the inability or difficulty in maintaining alertness during the major wake period of the day, resulting in unintended lapses into drowsiness or sleep. 3 It is important to note that sleepiness is often circumstance-dependent, with many aspects of the students' learning environment exacerbating sleepiness. 4 For example, a lecture that does not require active participation and may be in a dark, warm lecture hall can unmask underlying sleepiness. Sleep deprivation is defined as obtaining inadequate sleep to support adequate daytime alertness. 4 How much sleep a young adult needs is not clearly known, but is thought to be 8 hours. 5, 6 Most college students are sleep deprived, as 70.6% of students report obtaining less than 8 hours of sleep. 7 The impact of educational major on sleepiness and sleep duration is not well studied, but the effect may be substantial. As reported at an Architecture School in the Midwest, only 4% of students obtained at least 7 hours of sleep at night; the average sleep duration was 5.7 hours, with 2.7 "all-nighters" per month. 8 Eighty-two percent of college students believe that inadequate sleep and sleepiness impact their school performance. 9 Students rank sleep problems second only to stress in factors that negatively impact academic performance. 10

Sleep deprivation and sleepiness are caused by a host of reasons and have numerous negative consequences. In the literature, sleep deprivation is often termed either acute sleep deprivation or chronic partial sleep deprivation. Colloquially for students, acute sleep deprivation is termed "pulling an all-nighter", meaning that a person stays up for 24 hours or longer. More typically, sleep deprivation consists of chronic partial sleep deprivation, where a student obtains some, but not adequate sleep. Sleepiness can be an obvious consequence of sleep deprivation, but sleepiness can be caused by other circumstances, most commonly sleep disorders. To understand the consequences of sleepiness and sleep deprivation, knowledge of normal sleep and its impact on learning, memory, and performance are necessary. Equally important are potential interventions, as these may offer an opportunity to improve health and educational outcomes for this demographic. This article reviews the prevalence of sleepiness and sleep deprivation among college students, the impact of sleep on memory, contributing factors for sleep deprivation, potential consequences with a focus on those particularly applicable to college students, and available interventions to improve sleep among college students.

Regulation of normal sleep: the circadian rhythm and homeostatic sleep drive

Many college students are sleep deprived because they go to sleep late and wake up for classes or employment before adequate sleep is obtained. Two primary processes govern how much sleep is obtained, the homeostatic sleep drive and the circadian rhythm. The circadian system (internal clock) helps to regulate sleep/wake cycles and hormonal secretions while the homeostatic sleep drive increases the need for sleep as the period of wakefulness lengthens. The interaction of these two systems is described by the Two-Process Model of Sleep Regulation. 11

Physiologically, adolescents and young adults tend to have a delayed circadian preference, and are "night owls". 12 This change occurs in association with puberty; more physically mature adolescents have a preference for later bedtimes and may have a lower homeostatic sleep drive, and consequently, are less sleepy at night. 13- 15 The typical adult circadian period is 24.1 hours, compared to an adolescent's circadian period of 24.27 hours; this longer period makes it easier for the bedtime to shift later. 15, 16 A cardinal sign of a delayed circadian system is an irregular sleep schedule, where students have catch-up sleep on the weekend. Both high school and college students demonstrate a 1-3 hour sleep deficit on school nights, with a much longer sleep duration and often a later wake time on the weekends. 7, 17, 18

How the circadian rhythm and homeostatic sleep drive change with puberty is not well understood, but the cumulative effect is that adolescents and young adults feel more awake in the evening, have a difficult time falling asleep until later, and consequently, have insufficient sleep during the school week and catch-up on sleep on the weekend.

Exactly when this nocturnal preference or "night owl" tendency diminishes, remains unclear. When evaluated longitudinally, weekday bedtimes continued to delay until around 19 years of age, with weekend bedtimes remaining later until the early 20s, although other studies have shown this delay persisting until the junior year. 19 The transition from high school to college also has an impact; college students go to bed 75 minutes later than high school students. 7 In this study, freshman students' bedtime was 12.22 am and 1.58 am with a rise time of 8.08 am and 10.26 am on weekdays and the weekend, respectively.

Learning, memory, and sleep cycles

Sleepiness and irregular sleep schedules have many unintended consequences, one of which is to negatively impact learning, memory, and performance. The precise details of the relationship between sleep and memory formation are not yet completely understood. The dual process theory maintains that certain types of memory are dependent on specific sleep states, such that procedural memory (knowing how) may be dependent on REM (rapid eye movement) sleep and declarative memory (knowing what) on NREM (non-REM) sleep. The sequential processing theory suggests that memories require an orderly succession of sleep stages, ie, memory formation may be prompted by slow-wave sleep and consolidated by REM sleep (see Figure 1 ). 20

Both theories may help to explain how a student's sleep pattern could impact learning. 21 In one study, REM sleep deprivation eliminated sleep-induced improvement on a visual perceptual learning (procedural) task; the same effect was not found with selective slow-wave sleep deprivation. 22 REM sleep normally occurs every 90-120 minutes, approximately 4-5 times in a typical night, with each REM sleep period growing progressively longer, with the last episode near rise time. 23 Therefore, college students with early morning classes may not attain the last 1-2 REM sleep periods, thus adversely affecting procedural memory. However, other studies suggest that NREM rather than REM sleep enhances procedural memories, while other studies correlated improvement with slow-wave sleep followed by REM sleep. 24- 26 Both of these theories support that sleep deprivation may limit the amount of REM sleep and/or slow-wave sleep that students obtain, which may compromise both learning and memory, but further research is required to clarify this.

Many studies investigating the interaction of sleep, memory, and learning use scenarios of a specific memory task and then alter subjects' sleep pattern or duration to determine the impact that sleep had on the subject's performance. These scenarios often may not directly correlate with the memory and learning that college students are expected to perform or the alterations in their sleep schedule they experience. Despite these limitations, these studies illuminate the impact of sleep on students' memory, learning, and potential academic performance.

Some students may "pull an all-nighter" (24 hours or more of sleep deprivation) before examinations in the hope of improved grades. The literature suggests that all-night study sessions are the wrong plan for improved grades and learning. Subjects were taught a visual discrimination task to identify the presence of "T" or "L" and the orientation of three diagonal bars on a screen. Subjects who were sleep deprived for 30 hours showed no improvement in performance, even after 2 days of post-recovery sleep. 26 Non-sleep-deprived subjects' performance improved for the next 4 days. In another study investigating if improvement correlated with time or time spent in sleep, subjects were taught a motor task and then tested either after a 12-hour period of wakefulness or a 12-hour period that included sleep. 24 Subjects tested at 10 am and then retested at 10 pm without sleep showed no significant change in performance. After a night of sleep, subjects' performance improved by 18%. Subjects tested at 10 pm initially, then retested after sleep, also had a significant improvement in performance. This supports the concept that sleep, and not just time, is required for learning and memory consolidation. It may be possible that there is a window for potential learning that requires sleep, and that this opportunity for learning may not be salvaged even after sleep is recovered.

Sleep before learning may also be necessary. To investigate this concept, subjects were tested on an episodic memory encoding task, which involved viewing a series of images with a recognition test 48 hours later. 27 Subjects were tested after 35 hours of sleep deprivation; memory performance was approximately two letter grades (19%; P=0.031) worse when compared to the non-sleep-deprived subjects. This difference did not seem to be due to alertness, as there was no significant difference between the two groups in terms of response rate, which has been correlated with alertness.

Looking at more global functions, total sleep deprivation showed a significant decrease of performance in cognitive tasks assessing inference, recognition of assumptions, and deduction. 28 Although this study was not carried out on college-aged students, subjects aged 10-14 years of age restricted to 5 hours of sleep, had impaired performance on verbal creativity and abstract thinking. 29 Less complex cognitive functions did not appear impaired; this has been shown in other studies and may indicate that motivation, individual response to sleep deprivation, or certain tasks may be less impacted by sleep. 20, 30

Learning may also affect the intrinsic aspects of sleep. Procedural tasks prior to sleep increased slow-wave activity in the right parietal lobe, an area that is responsible for visual-spatial skills. 31 This increased right parietal activity correlated with improvement in the task. Other studies have found an increase in spindles, a defining feature of stage 2 sleep, after procedural memory training. 32 In an intensive 6-week French language immersion course, improvement was correlated with an increase in subjects' percentage of REM sleep. 33

In summary, these finding suggest that sleep, likely before and after specific memory tasks, plays an integral part in memory consolidation. Many of these studies isolate memory into specific areas such as visual, declarative, or procedural; however, college students' learning, memory, and performance in classes rarely would have such a narrow memory domain. Further research with real-life circumstances of students would better help clarify these important issues.

Causes of sleep deprivation and sleepiness

Among college-aged students, one of the most common causes of daytime sleepiness is sleep deprivation, ie, students get inadequate sleep because they go to bed late and wake up early. This occurs for multiple reasons; some are physiologic and others behavioral. The behavioral components may be particularly problematic on college campuses. However, sleep deprivation is not the only cause of sleepiness as college students are not immune to sleep disorders, which may also cause sleepiness. This section will review common causes of sleep deprivation as well as the prevalence of sleep disorders among college students, and the influence of sleep disorders on sleepiness.

Inadequate sleep hygiene

Sleep deprivation can arise from poor sleep behaviors; sleep hygiene encourages habits conducive to restorative sleep and avoidance of substances or behaviors that are not. Good sleep hygiene includes a regular sleep-wake schedule, quiet sleep environment, and avoidance of caffeine after lunch and stimulating activities before bed. 34, 35 Substances are not the only aspect of inadequate sleep hygiene, as the ubiquitous use of technology before bed may also adversely affect sleep. Many students have inadequate sleep hygiene that, in conjunction with their delayed circadian rhythm, encourages sleep deprivation.

Alcohol

Approximately four out of five college students drink alcohol, with nearly 40% of men and women reporting "binge drinking" at least 4-5 drinks in a row within the last 14 days. 36, 37 Alcohol shortens sleep latency, but then promotes fragmented sleep in the latter half of the night. 23 One study found that 11.6% of students who drank used alcohol as a sleep aid. 7, 38 Alcohol may also increase the risk for obstructive sleep apnea. 39

Caffeine and energy drinks

Caffeine, equivalent to 2-4 cups of coffee taken at night, can increase sleep latency on average from 6.3 to 12.1 minutes, reduce sleepiness, and improve the ability to sustain wakefulness. 40 In this study, the effects of caffeine lasted 5.5-7.5 hours, suggesting that caffeine consumed even in the afternoon could impair the ability to fall asleep. Caffeine is an adenosine receptor antagonist and can increase arousal. Caffeine also may act on gamma-aminobutyric acid neurons of the posterior hypothalamus to suppress sleep-promoting pathways. 23 The net effect is that caffeine increases vigilance, alertness, and decreases sleepiness.

Energy drinks are becoming increasingly popular and 34% of 18-24-year-olds consume them regularly. In 2006, Americans spent more than $3.2 billion on energy drinks. 41 The majority (67%) of users consumed energy drinks to help compensate for insufficient sleep. 42 The contents of energy drinks are variable and depend on the individual product, but usually contain caffeine, herbal products, and sometimes vitamins and other supplements. Caffeine is the primary constituent responsible for the effect of increased energy. The amount of caffeine varies widely from 45-500 mg. Use of energy drinks is associated with higher use of alcohol and possibly other drugs, including stimulants. 43

Stimulants

Use of either prescribed or nonprescribed stimulants is a growing problem in young adults. The most commonly reported reason is to "stay awake to study" or increase concentration. 44 Students may utilize these drugs more than age-matched non-students. 45 A survey at 119 colleges and universities across the US found a 6.9% lifetime prevalence for the use of stimulants. 46 Other studies show prevalence as high as 14%. 44, 47 Men are more likely than women to use stimulants, as well as caffeine and energy drinks. Nonprescribed use of stimulants is associated with increased use of alcohol, cocaine, and marijuana. 46 Not all stimulant use is illicit, as between 2%-8% of college students' self-reported symptoms are consistent with attention deficit hyperactivity disorder (ADHD). 48 However, when parents of college students were asked to report such symptoms in their children, the prevalence of ADHD decreased to around 1%. Stimulants increase sleep latency and suppress REM sleep; subjects who use stimulant medications report worse sleep quality. 23, 47

Technology

Inadequate sleep hygiene also encompasses the use of technology prior to bed. Relevant data often must be extrapolated from literature on adolescents, as few studies have focused on college students. The 2011 Sleep in America Poll addressed technology available in the bedroom. "Generation Y'ers" (adults aged 19-29 years old) are heavy users of technology prior to bed: 67% use cell phones, 43% music devices, 60% computers, and 18% video games. The majority (51%) report rarely getting a good night's sleep and often wake unrefreshed. Computer use in the hour before bed is associated with less restful sleep, higher Epworth Sleepiness Scales, and drowsy driving. 49 Frequent use of cell phones around bedtime is associated with difficulties falling asleep, repeated awakenings, or waking up too early. 50 Most young adults (57%) leave their phone on during sleep, with only 33% turning it to silent or vibrate modes ( Table 1 ). Playing video games before bed can increase sleep latency, an average of 21.6 minutes. 51 Functional magnetic resonance imaging (fMRI) shows that video game playing heightens cognitive alertness, especially during violent scenes ( Table 1 ). 52

Table 1

Use of cell phone in the bedroom was associated with a higher frequency of

* Daytime sleepiness

* Poor quality sleep

* Waking unrefreshed

* More difficulties falling asleep and staying asleep

* Repeated awakenings

Use of the computer before bed was associated with a higher frequency of

* Drowsy driving

* Daytime sleepiness

* Less restful sleep

Use of video games before bed was associated with a higher frequency of

* Increased sleep latency

Light exposure from various sources, including computers, tablet computers (eg, iPads; Apple Inc., Cupertino, CA, USA), and cell phones may also impact sleep. Melatonin, secreted by the pineal gland, helps regulate the circadian rhythm to the environment. 15 Normally, it is low or absent during the day and starts to rise about 2 hours before the habitual bedtime. Melatonin is suppressed by light, and light sources as low 200-300 lux (room lights) can cause suppression. 53 The amount of light from technologic devices is variable; for example, a tablet computer generated 50 lux suppressed melatonin in a cohort of college students after 2 hours of use. 54 A case report describes a student in Brazil who had a 40-minute delay in sleep on the weekends when electric lights were installed. 55 Bright light (8,000 lux) given at 7 pm or at 9 pm reduced nighttime sleepiness in students who had an evening preference and those with a later onset of melatonin. 56 One of the effects of technology may be to suppress melatonin, resulting in a delay in sleep onset.

In summary, many students engage in behaviors, such as those described above, which increase stimulation and alertness prior to bed. This, in conjunction with their delayed circadian rhythm, encourages late bedtimes and insufficient sleep. To combat sleepiness, students often drink caffeine and energy drinks, compromising sleep and ensuring a vicious cycle of sleep deprivation ( Table 2 ).

Table 2

Technology

TV, computer, or video games before bed

Cell phones on overnight

Frequent exposure to light before bed

Substances

Caffeine and energy drinks

Alcohol use

Stimulant use

College scheduling and activities

Variable class schedules from day to day

Late night socializing

Early or late obligations

Sleep disorders

Sleep deprivation is not the only cause of sleepiness on campus, as sleep disorders may also play a role. A survey of 1,845 students in introductory psychology labs suggested that 27% were at risk for at least one sleep disorder or sleep-related problem, including obstructive sleep apnea (4%), insomnia (12%), restless legs disorder and periodic limb movement disorder (8%), circadian rhythm sleep disorders (7%), and hypersomnia (4%). 57

Obstructive sleep apnea can be associated with significant sleepiness. 58 The prevalence of snoring may be more common than expected, as 30% of non-overweight students in a California school reported snoring. Men more commonly reported snoring (42%) than women (25%). 59 Asian students (37%) more often reported snoring than African-American (24%) or Caucasian (27%) students. Although such observations of snoring frequency do not reveal the prevalence of obstructive sleep apnea among college students, they do suggest that this disorder may not be as infrequent among young, otherwise healthy college students as is sometimes assumed.

Consequences of sleep deprivation and sleepiness

College is a time of intellectual growth and development as young adults' transition from adolescence to adulthood. Although the worth of college in terms of increased productivity and higher earning potential is rarely debated, there is a significant personal and societal cost of college both in terms of time and money. For optimal return on the investment of time, effort, and money, students need to maximize their learning, academic, and personal growth. Sleepiness from any cause can compromise these goals, through impact on learning, memory, grades, perception of effort, driving performance, and mood. Although sleep deprivation has effects on many aspects of health, this article will focus on areas that may be particularly problematic for college students.

Grade point average (GPA) and academic performance

Despite growing evidence of the relationships between sleep, learning, and memory, a direct connection between learning and GPA has not yet been established. 60 A student's GPA is not just an indication of learning, but instead involves a complex interaction between the student and their environment. 61 Intelligence, motivation, work ethic, personality, socioeconomic status, health problems, current and past school systems, course load, academic program, and test-taking abilities all may influence GPA.

Existing evidence does suggest an association between sleep and GPA. Students who obtained more sleep (long sleepers, ≥9 hours) had higher GPAs than short sleepers (≤6 hours): GPAs were 3.24 vs 2.74 on average, respectively. 62 More evidence exists to support an influence of sleep patterns rather than sleep duration on GPA. Students at a community college near Washington DC showed no difference in total sleep time (TST), sleepiness, or morning preference between high (GPA >3.5) and low (GPA <2.7) academic performers. 63 High academic performers instead showed earlier bed and rise times, though with similar overall TST. No difference was present between the two groups with regards to a morning preference, but a validated questionnaire was not used.

Among first-year university students, sleep patterns also influenced GPA; each hour delay in weekday or weekend rise time decreased the GPA by 0.132/4.0 and 0.115/4.0, respectively. 60 Bedtimes were also influential, with later bedtimes associated with lower GPAs. TST or circadian factors were not evaluated. These results do not explain why an earlier rise time was associated with better grades; it could arise from the sleep schedule itself, but many potential confounders exist. For example, early risers may also be more motivated or organized. Another possibility is that negative influences arise when students who have a nocturnal preference are unable to wake up earlier. In a study of medical students, subjects with an evening preference on the Horne-Ostberg Questionnaire had a more irregular sleep pattern than students with a morning or indifferent-type preference. Sleep duration was not different between the groups, but subjects with a more irregular sleep pattern had lower academic performance. 64 This suggests that sleep patterns influence academic performance more than sleep duration, with the caveat that students who have an evening preference may have a more irregular sleep schedule.

Extreme forms of irregular sleep schedules include all-night study sessions. No literature appears to address the association between all-nighter study sessions and GPA, but the absence of sleep is known to affect learning and performance improvement. Subjects taught a visual discrimination task who were then sleep deprived for 30 hours showed no improvement in the task, even after 2 days of post-recovery sleep. 26 Non-sleep-deprived subjects' performance improved for the next 4 days. Similar results were demonstrated with a finger-tapping motor task; without sleep, no significant improvement occurred. 24 All-nighter study sessions may also alter motivation and perceived effort. Students' self-perceived effort and performance were evaluated following two sleep scenarios: 24 hours of sleep deprivation or 8 hours of sleep. 28 Despite performing worse, sleep-deprived subjects felt they had better concentration, effort, and performance than did non-sleep-deprived subjects. Why sleep-deprived subjects rated their effort as higher is not known, and could be due to sleep deprivation itself, or relate to other unknown factors. This perception of improved performance following sleep deprivation may in part explain why it can be challenging to get students to change their sleep behavior. If students perceive no impairment in performance due to lack of sleep, they have little motivation to change.

Sleep disorders and academic performance

Students with sleep disorders probably do not achieve optimal academic performance, and up to 27% of students may be at risk for at least one sleep disorder. 57 Students at risk for academic failure (GPA <2.0) were at a disproportionately high risk for sleep disorders. Among those who screened positive for obstructive sleep apnea, 30% were at risk for academic failure. Medical students classified as frequent snorers more frequently failed their Internal Medicine examination (47%) than did occasional snorers (22.2%) or non-snorers (12.8%). After adjustment for age, BMI, and sex, the relative risk for snorers to fail the examination was 1.26 (95% confidence interval: 1.01-1.57). 65 Obstructive sleep apnea is suspected to have cognitive effects in both children and adults. 66 A higher percentage of students at risk for academic failure screened positive for other sleep disorders including: periodic limb movement disorder/restless legs syndrome (21%), 67 insomnia (22%), circadian rhythm sleep disorders (26%), and hypersomnia (21%). 57 As nearly one in four students is at risk for a sleep disorder, screening for sleep disorders among students with poor academic performance may well be advisable.

Although many students have a nocturnal preference, this preference can progress to delayed sleep-phase disorder (DSPD), a circadian rhythm disorder characterized by sleep-onset insomnia and difficulty waking at the desired time. 3 Consequences of DSPD may include missed morning classes, increased sleepiness, and decreased concentration, especially in morning classes. Students with DSPD have lower grades. 68 The prevalence of DSPD in the US college population may be as high as 6.7%-17%. 68, 69

Driving

One of the most concerning consequences of sleep deprivation and sleepiness is drowsy driving. In the 2011 Sleep in America Poll, 66% of young adults reported drowsy driving. 49 However, few studies have evaluated drowsy driving specifically in college students. Among 1,039 undergraduate students, 16% reported falling asleep while driving and 2% had had a motor vehicle accident due to sleepiness. Men were more likely to fall asleep while driving than women. 38 A school in Utah had 86 student deaths due to motor vehicle accidents over a 15-year period; dozing/sleepiness was thought to be causative in 44%-72% of the cases. In a retrospective review of students' "closest calls" for a motor vehicle accident due to sleepiness, most near accidents occurred between 11 pm and 1 am and often (39%) during the first hour of driving. Nearly half (48%) of students had a less intense dozing episode earlier in the same drive, with 68% of students continuing their drive despite feeling sleepy. 70 The findings overall suggest that drowsy driving accidents or near accidents are too frequent and that students may minimize the warning signs of drowsiness.

Driving, sleep deprivation, and alcohol

The impact of sustained wakefulness on driving performance has been compared to the impairment of performance that is produced by specific blood alcohol levels. In adults, sustained wakefulness of 17 hours was equivalent to a blood alcohol concentration (BAC) of 0.05%, and 24 hours was equivalent to 0.1%, above the legal level for intoxication in the US and most countries worldwide. 71, 72 Similar findings were found in males aged 19-35 years of age, in whom 18.5 and 21 hours of wakefulness produced changes in driving performance mimicking a 0.08% BAC. 73 Sleep deprivation in combination with alcohol has a synergistic detrimental effect on driving performance. To evaluate these effects, young male college students were sleep restricted to 4 hours in bed; they then consumed alcohol until they attained BACs of 0.025 g/dL or 0.035 g/dL, equivalent to about 1-2 drinks. 74 A simulated driving task at 2 pm monitored crashes, speed variability, and lane deviations. Crashes occurred in 23% and 33% of the subjects (BAC 0.025 g/dL and 0.035 g/dL, respectively), compared to only 4.7% in the controls and 19% in sleep-restricted subjects who had no alcohol.

Driving after drinking is commonplace during college, as up to 34% of students reported driving after drinking within the last 30 days. 75 The combination of sleep deprivation and drinking may be especially common at the end of the semester, when sleep-deprived students celebrate the end of exams with drinks before driving home for the holiday break. The dangerous combination of sleep loss and alcohol could impair driving performance even in students who are not legally intoxicated.

Mood effects

Depression and sleep are interrelated. A cardinal feature of depression is disturbed sleep. 76, 77 Depression is common during the college years: 14.8% of students report a diagnosis of depression and an estimated 11% have suicidal ideation. 78 Insufficient sleep can increase depressive symptoms. In a study of female college students, sleep debt of 2 hours per night and/or a bedtime after 2 am was associated with greater depressive symptoms. 79 Irregular sleep schedules have been associated with greater depressive symptoms. Prolonged sleep latency was associated with loss of pleasure, punishment feelings, and self-dislike. 80 Differences between sex were apparent, as women went to bed earlier, slept longer, had more nocturnal awakenings, and reported more depressive symptoms. However, when the sleep variable was removed by deleting the question, "Have you experienced changes in sleep?", no significant difference in sex persisted, suggesting the greater incidence of depression in college-aged women may be due in part to the greater number of reported sleep difficulties. 80, 81

Improving sleep may improve depressive symptoms. Cognitive behavioral therapy for insomnia (CBT-I) administered via email to college students with poor sleep quality produced greater improvement in depressive symptoms than did an intervention focused on mood and stress reduction. 67 A study on college students without reported sleepiness or depression found that sleep extension significantly improved scores on the Profile of Mood States. 82 Increased total sleep in teenagers has also been shown to improve mood. When school start time was delayed by 30 minutes, fewer students rated themselves as "at least somewhat unhappy or depressed". 83 As sleep may be a modifiable risk factor for depression, further research is needed on ways to improve sleep and sleep quality in depressed subjects.

Complex relationships exist between suicide, mood disorders, and sleep. Insomnia may be a risk factor for suicidal ideation, suicide attempts, and death by suicide. 84 Conflicting results have been reported on whether both insomnia and nightmares increase the risk of suicidal ideation. 85, 86 A confounder is that post-traumatic stress disorder (PTSD) may account for these associations. A study among college students found that insomnia and nightmares were independently associated with suicidal ideation. However, after depression, anxiety, and PTSD were taken into account, nightmares, but not insomnia, retained an association with suicidal ideation. The presence of nightmares in a student with depression may be a warning sign of increased risk for suicidal ideation that warrants further evaluation. 87

Potential interventions

While sleep deprivation, irregular sleep schedules and sleepiness are highly prevalent among college students, little information is available on effective ways for schools to successfully disseminate information on the importance of sleep and to potentially improve the sleep of their students. In general, the few programs that have been tried are expensive, time consuming, and available for only a limited number of students. A recent review of sleep education programs for children and adolescents found only twelve studies, of which four were available only as abstracts. 81

Educational programs

Improved sleep hygiene, which is widely believed to be beneficial, has been the focus of most educational programs on sleep, although there is little published support. An American Academy of Sleep Medicine Practice Parameter concluded in 1999 that insufficient evidence exists to recommend sleep hygiene as a single therapy or in combination with other treatments. 88 A study evaluating sleep hygiene awareness and sleep hygiene practice found only a weak association between knowledge and practice. However, good sleep hygiene practice was strongly correlated with good sleep quality. 35 Adequate sleep knowledge does not necessarily translate into practice. Many sleep hygiene recommendations, such as a quiet environment and use of the bedroom only for sleep, may be challenging in college dormitories.

One educational campaign with a focus on sleep hygiene included a "Go to Bed" poster, a 2-page "Snooze letter", and sleep educational information in the school newspaper. An earlier bedtime, shorter sleep latency, longer sleep duration, and improved sleep quality, as measured by the Pittsburg Sleep Quality Index, was noted in 9% of students. 89 Although this intervention did not affect a large percentage of the student population, it was relatively inexpensive and did produce a measurable benefit ( Table 3 ).

Table 3

"Snooze Letter"

"Go to Bed" poster

Sleep education information in school newspaper

Two-credit course with discussion, lecture, self-assessment

30-minute oral presentation

8 weeks of emailed PDF addressing sleep schedule, relaxation, etc

An extra credit online pre-test and self-education program

Sleep courses

In another study, a two-credit, 18-week course included group discussion, lectures, and self-evaluation. Topics included circadian rhythms, sleep hygiene, muscle relaxation, and public sleep education. 90 Participants had improved sleep quality over the semester and women reported decreased nap time. However, despite this intensive intervention, only a limited effect on sleep patterns was observed.

The Sleep Treatment and Education Program (STEPS) consisted of a 30-minute oral presentation and handouts on various aspects of sleep, provided to students attending introductory psychology classes. 91 Six weeks later, participants showed improved sleep quality and sleep hygiene. These results may be more robust than suggested, as sleep quality and sleep behaviors typically worsen as the semester progresses; therefore, this intervention not only halted this deterioration, but resulted in improvement. 92 Four supplementary sleep-learning modules, offered as extra credit, improved sleep knowledge and encouraged some sleep-related behavior changes, as 55% reported a change in their sleep hygiene as compared to 45% of control students ( P<0.01). 93 Students in the intervention reported specific behavior changes such as having a more "consistent wake time" versus a more general "trying to get more sleep" as indicated by the control students. However, all of these interventions are time consuming, involve only a select number of students, and may not be practicable on a large university scale.

Electronic cognitive behavioral therapy

More feasible options are under development. A modified form of cognitive behavioral therapy for insomnia (CBT-I) was emailed to students over an 8-week period. 67 Each weekly email contained an attachment to address several aspects of sleep, such as stabilizing the circadian rhythm by anchoring wake time, relaxation techniques, and a protocol for self-administered sleep restriction. This was compared to an alternative program (Breathe), which was created to reduce depressive symptoms and improve coping skills for stress. Participants in the sleep program (Refresh) had improvement in sleep quality and a decrease in depressive symptoms. Although the study involved only a small number (19 and 15, respectively), results showed promise as an effective electronic program that could be widely accessible and economically feasible for colleges and universities.

Class scheduling

The amount of sleep that students obtain is often dictated by the first obligation of the day, typically their first class. This is one reason why students often sleep longer and later on a vacation or summer schedule. 15 Therefore, class start times are an opportunity for intervention, but available information must be extrapolated from adolescent literature. A study at an independent college preparatory school showed increased sleep duration after a delay in school start time. The majority of students were boarders (81.5%) with structured lights-out schedules ranging from 10.30-11.30 pm. 83 When school was started at 8.30 am, 30 minutes later than usual, sleep duration was increased by 45 minutes on school days. An unexpected effect was that bedtime shifted earlier by 15 minutes. Following the time change, fewer students reported daytime sleepiness (49.1% to 20.0%), sleepiness in class (85.1% to 60.5%), and falling asleep in class (38% to 18%). A positive effect on mood was found, with a decrease in the Depressed Mood Scale. 83 Students continued to have significant "oversleeping" on the weekend, by nearly 3 hours. A study of eighth graders (mean age 13.7 years) who had 1 hour of sleep extension for 5 days through delays in the school start time, documented improved attention and performance. 94 This growing evidence from adolescents suggests that later school start times do increase total sleep duration, attention, and performance, but the data needs to be replicated in college students ( Table 4 ).

Table 4

Extracurricular educational programs

Sleep courses

Scheduling classes at a later start time, eg, 10 am classes

Encouraging naps via educational programs or availability of "nap rooms"

Public health outreach programs to students

Adequate evaluation and screening for sleep disorders

Naps

Although not often considered as an intervention for sleep deprivation, daytime naps may offer a potential remedy that may also help academic performance. Interestingly, in light of how napping may improve certain memory tasks, high academic performers were more likely to nap than low academic performers (52% vs 29%, respectively). 63 In a study of non-sleep-deprived subjects, deterioration in the performance of a visual perception task occurred during the day. 95 Intervening naps of 60 or 90 minutes halted this deterioration, but only naps with both REM and slow-wave sleep resulted in improvement compared to baseline. Sustained wakefulness can impair performance. In an episodic memory-encoding task (face and name recognition), significant deterioration at 6 pm occurred in all subjects, except those who had had a 100-minute nap. In the nap group, not only was performance deterioration abated, but improvement was noted. 27 Following training to recognize phonetically similar words, subjects showed an increase in accuracy, but 12 hours of sustained wakefulness reduced improvements by half. A nap prevented this decrement in performance. 96, 97 In short, naps may enhance certain cognitive and performance tasks, but further research is still needed in this important area.

Conclusion

The college years are a time of critical transition from adolescence to adulthood. For many individuals, this transition is associated with inadequate sleep and daytime sleepiness. Many factors contribute to this, including the students' own circadian physiology. Class times are often scheduled without consideration of young adults' circadian patterns. Inadequate sleep hygiene is common, as students often use technology and substances that compromise sleep quality and quantity. This chronic sleep deprivation may impair academic performance, mood regulation, and driving safety. Students who attain sufficient sleep may still struggle with sleepiness due to sleep disorders.

Further research is needed to not only determine how to best educate students about the importance of sleep and the consequences of sleep deprivation, but also how to translate this knowledge into practice. Electronic or web-based interventions may be economically feasible and attractive to an electronically savvy demographic. Universities and colleges need to understand, acknowledge, and publicize that policies and class schedules may have substantial impacts on the sleep, learning, and health of their students. Investigation of new approaches to promote good sleep and sleep habits could have significant public health impact and should be prioritized.

Footnotes

Disclosure
The authors report no conflicts of interest in this work.

References

3. American Academcy of Sleep Medicine Diagnostic and Coding Manual. International Classification of Sleep Disorders. 2nd ed. Westchester, IL: American Academy of Sleep Medicine; 2005. [ Google Scholar]

4. Kryger MH, Roth T, Dement WC, editors. Principles and Practice of Sleep Medicine. St Louis, MO: Elsevier BV; 2005. [ Google Scholar]

23. Amlander CJ, Fuller PM, editors. Basics of Sleep Guide. 2nd ed. Westchester, IL: Sleep Research Society; 2005. [ Google Scholar]

37. O'Malley PM, Johnston LD. Epidemiology of alcohol and other drug use among American college students. J Stud Alcohol Suppl. 2002;(14):23-39. [[ PubMed] Google Scholar]

45. Johnston LD, O'Malley PM, Bachman JG. Volume II: College Students and Adults Ages 19-40. Washington, DC: US Department of Health and Human Services; 2002. Monitoring the Future: National Survey Results on Drug Use, 1975-2002. [ Google Scholar]

Articles from Nature and Science of Sleep are provided here courtesy of Dove Press

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Causes and consequences of sleepiness among college students

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Daytime sleepiness, sleep deprivation, and irregular sleep schedules are highly prevalent among college students, as 50% report daytime sleepiness and 70% attain insufficient sleep. The consequences of sleep deprivation and daytime sleepiness are especially ...

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According to the American Academy of Dermatology, almost 70 percent of people who use tanning salons are Caucasian girls and young women. Because of that, rates of melanoma is increasing faster in women between the ages of 15 through 29 than in their male peers. It is estimated that the 400,000 cases of skin cancer in the U.S. each year are caused by tanning beds. Despite this, 7.8 million women still tan indoors. I spoke with a 27-year-old woman in New York City who is Caucasian and has a naturally tan complexion, yet still visits tanning salons once every two to three weeks. She wishes to remain anonymous. Here's what she had to say about why she tans.
The first time I used a tanning bed was in high school. I was probably 17 or 18. I wanted a tan before prom or some kind of dance. I remember my mom took my sister and me to the tanning salon, and since she was tanning with us, I didn't think it was bad. There wasn't as much information back then about how bad tanning beds are for you, so I didn't think much of it.

When I was away at college, I didn't really go tanning because there wasn't a salon on my campus, and I would never go out of my way to get a tan. I only tan when it's convenient for me. If I got pale, I would just wear a lot more makeup. That's what I like about tanning. I feel like I don't need to wear as much makeup when I'm tan, and I don't have to use as much bronzer or cover-up because it's like having cover-up on already.

I like the way I look when I'm tan, and I feel more attractive. I also think it makes my skin look better. I've noticed it clears up any acne that I have since it dries out your skin, and my pimples start to clear up after I've been to a tanning bed. I don't know if that's accurate or has any scientific proof to back that up; I've just noticed it on my own.

My body also looks more toned when I'm tan, so I'll go tanning more often right before I go on vacation to the beach or somewhere I'll be wearing less clothing. Normally, I'll go to the salon once every two or three weeks, but right before a special occasion, like a vacation or a big event, I'll go two times the week before.

I use tanning beds that you lie down in called S Class. They're super strong and I only use them for 12 minutes at a time. Well, it's 12 minutes and then an additional 3 minutes just on your face. I prefer that bed because it's one of the strongest, so you don't have to go to the salon as frequently. Even if you go one time, your tan will last a week or two versus the lower-level beds where you barely see a difference. I don't burn that easily, but usually when I leave, my face is red. I think it's because of the heat because it's so hot in that bed. It goes away after a day or so.

Being pale makes me feel ugly. I look sickly and ghostly. My skin gets a yellow tone when I'm pale, so if I get to that point, I'll make an effort to go to the salon every two weeks instead of every three.

When I'm tan, I feel more confident. I get compliments from my friends, guys and girls. They'll say things like, "How are you always so tan?" or, "I'm so jealous," or, "Are you naturally that skin color?" I'll tell my close friends I use tanning salons if they ask (they usually yell at me for it) but if it's someone I hardly know, I don't admit to tanning because I don't want them to judge me. Especially if it's my boss or someone superior to me, or if I've heard them talk badly about people using tanning beds in the past.

My coworker once told me that I look too tan for winter, or at least in comparison to how everyone else looks in the winter. I told her I didn't really care because I don't really care that she thinks I look too tan. I'd rather look good than be pale and look the same color as everyone else. I also use tanning beds consistently, so I feel like it's not noticeable that I go to tanning salons. The way I look in the winter isn't too different from how I look in the summer.

I'm familiar with the dangers of using tanning beds. I know it can cause skin cancer, wrinkles, and eye problems, but it doesn't really interest me to read more about it. If I scroll through Facebook and see an article about it, I won't click on it and read more because it doesn't really matter. I'm still going to go anyway. I haven't noticed a change in the way my skin looks. I haven't noticed wrinkles yet, knock on wood. And I feel like if it's still legal, then it can't be that bad for you. A lot of things are bad for you. A lot of things cause cancer. But lying in the sun is just as bad for you. If I'm still going to lie on the beach in the summer, what's the difference between that and tanning beds? It pisses me off when people tell me it's bad for me because obviously I know that. It's just an annoying buzz in my ear at this point. That's why I avoid telling people.

I have naturally dark skin. I know people with pale skin have a higher chance of getting skin cancer, so that's another thing that comforts me. My mom doesn't use tanning beds anymore and lectures me for still going. But my mom used to lay out with foil and baby oil to attract the sun, and she doesn't have any wrinkles.

I have no family history of skin cancer. I think that's another reason why I'm not too concerned. When you get old, you're going to look worse anyway, so you might as well try to look as good as you can while you're young. And to me, that means being tan.

I quit going to salons for a month and a half last winter because I was trying to be better about it (and I probably just didn't like making the trek in the cold), but I started going again because I had a vacation coming up and wanted to look good in a bathing suit. I tried spray tanning one time, but it turned out orange and only lasted, like, two showers. It was also expensive. It cost $75 for one time, and I can get seven tanning bed session for $150.
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I've only recently started noticing sun spots on my chest, but I think that's from getting burned in the real sun, not tanning beds. I've never been to the dermatologist, so I haven't gotten them checked out. Maybe one day if I go to the dermatologist, and she or he tells me I have a cancerous spot, I'll stop going to tanning salons. Until then, I'm gonna keep doing my thing.

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According to the American Academy of Dermatology, almost 70 percent of people who use tanning salons are Caucasian girls and young women. Because of that, rates of melanoma is increasing faster in women between the ages of 15 through 29 than in their male peers.

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Pew Research Center's Social & Demographic Trends Project

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Perceived inequities are especially common among women in science, technology, engineering and math jobs who work mostly with men

For women working in science, technology, engineering or math (STEM) jobs, the workplace is a different, sometimes more hostile environment than the one their male coworkers experience. Discrimination and sexual harassment are seen as more frequent, and gender is perceived as more of an impediment than an advantage to career success. Three groups of women in STEM jobs stand out as more likely to see workplace inequities: women employed in STEM settings where men outnumber women, women working in computer jobs (only some of whom work in the technology industry), and women in STEM who hold postgraduate degrees. Indeed, a majority of each of these groups of STEM women have experienced gender discrimination at work, according to a nationally representative Pew Research Center survey with an oversample of people working in STEM jobs.

These findings come amid heightened public debate about underrepresentation and treatment of women - as well as racial and ethnic minorities - in the fast-growing technology industry and decades of concern about how best to promote diversity and inclusion in the STEM workforce. Conducted in the summer of 2017, prior to the recent outcry about sexual harassment by men in positions of public prominence, the Center's new survey findings also speak to the broader issues facing women in the workplace across occupations and industries.

Compared with those in non-STEM jobs, women in STEM are more likely to say they have experienced discrimination in the workplace (50% vs. 41%). But in other respects, the challenges women in STEM face in the workplace echo those of all working women. Women in STEM and non-STEM jobs are equally likely to say they have experienced sexual harassment at work, and both groups of women are less inclined than men to think that women are "usually treated fairly" when it comes to promotions where they work.

Pew Research Center analysis of U.S. Census Bureau data since 1990 shows that while jobs in STEM have grown substantially, particularly in computer occupations, the share of women working in STEM jobs has remained at about half over time. But the share of women varies widely across the 74 standard occupations classified as STEM in this study - from under one-in-ten for sales engineers (7%) and mechanical engineers (8%) to 96% of speech language pathologists and 95% of dental hygienists. Women are a majority of those working in health-related occupations but just 14%, on average, of those in engineering jobs. In computer occupations, a job cluster which includes computer scientists, systems analysts, software developers, information systems managers and programmers - the STEM job cluster that has seen the most growth in recent decades - women's representation has actually decreased from 32% in 1990 to 25% today.

Blacks and Hispanics are underrepresented in STEM occupations relative to their share in the U.S. workforce. The share of blacks working in STEM jobs has gone from 7% in 1990 to 9% today (blacks make up 11% of the total U.S. workforce today). And that for Hispanics has gone up from 4% to 7%, while their share of the U.S. workforce has grown from 7% in 1990 to 16% today.

The survey finds a higher share of blacks in STEM jobs report experiencing any of eight types of racial/ethnic discrimination (62%) than do others in STEM positions (44% of Asians, 42% of Hispanics and just 13% of whites in STEM jobs say this). They also tend to do so more than blacks in non-STEM jobs (50%), with many saying they have been treated as if they were not competent because of their race or ethnicity. Blacks in STEM jobs are particularly likely to say there is too little attention to racial and ethnic diversity where they work (57%). And, when it comes to the way opportunities for advancement and promotion are handled in their own workplace, 37% of blacks in STEM jobs believe that blacks are usually treated fairly, while a similar share (36%) says this sometimes occurs and 24% believe that blacks are usually treated unfairly where they work. Among Hispanics, those in STEM and non-STEM jobs are equally likely to say they have experienced racial/ethnic workplace discrimination.

These are some of the findings from a Pew Research Center survey with a nationally representative sample of 4,914 adults (including 2,344 STEM workers), ages 18 and older, conducted July 11-Aug. 10, 2017 and a Pew Research Center analysis of U.S. Census Bureau data. The survey, conducted online in English and in Spanish, included an oversample of employed adults working in science, technology, engineering and math fields. See Methodology for details.

Most women in STEM jobs who work in majority-male workplaces, in computer jobs or who have a postgraduate degree have experienced gender discrimination at work

On average, women working in STEM jobs are more likely than men to say they have experienced workplace discrimination due to their gender. Half (50%) of women in STEM jobs say they have experienced any of eight forms of discrimination in the workplace because of their gender - more than women in non-STEM jobs (41%) and far more than men in STEM occupations (19%). The most common forms of gender discrimination experienced by women in STEM jobs include earning less than a man doing the same job (29%), having someone treat them as if they were not competent (29%), experiencing repeated, small slights in their workplace (20%) and receiving less support from senior leaders than a man who was doing the same job (18%).

In workplaces where most employees are men, about half of women in STEM say their gender has been an impediment to success on the job

Pioneering work from business school professor Rosabeth Moss Kanter in the late 1970s drew attention to how the structure of organizations - particularly the balance of minority and majority groups - can influence experiences in the workplace.

The majority of women in STEM positions work in majority-female workplaces (55%) or work with an even mix of both genders (25%). But the 19% of women in STEM who work in settings with mostly men stand out from others. Fully 78% of these women say they have experienced gender discrimination in the workplace - compared with 44% of STEM women in other settings.

About half (48%) of women in STEM jobs who work with mostly men say their gender has made it harder for them to succeed in their job, compared with just 14% of other women in STEM.

One respondent explained it this way:

"People automatically assume I am the secretary, or in a less technical role because I am female. This makes it difficult for me to build a technical network to get my work done. People will call on my male co-workers, but not call on me." - White woman, technical consultant, 36

Gender balance in the workplace also tends to matter for women in non-STEM positions but those in STEM stand out especially when it comes to experiences with workplace discrimination, the feeling that they need to prove themselves in order to be respected by coworkers, and their belief that, overall, their gender has made it harder for them to succeed at work. By contrast, for male STEM workers, the gender balance in their workplace is largely unrelated to views about gender equity.

There are similar differences, though less pronounced, among women in STEM jobs by their level of education. Women with a postgraduate degree who work in STEM jobs are more likely than other women in STEM to have experienced gender discrimination at work (62%, compared with 41% of women with some college or less education). Roughly a third (35%) of women in STEM with a postgraduate degree believe their gender has made it harder to succeed on the job, compared with just 10% of women in STEM with some college or less education. And, women in STEM with more education are more skeptical that women where they work are usually treated fairly when it comes to opportunities for promotion (52% of those with a postgraduate degree say women are usually treated fairly vs. 76% of women with some college or less working in a STEM job).

Roughly three-quarters of women in computer jobs say they have experienced gender-related workplace discrimination

Some 74% of women in computer jobs, such as software development or data science, say they have experienced discrimination because of their gender, compared with 16% of men in these jobs. (This group includes some who work in the tech industry and some who work in other sectors.)

Women in computer jobs are less likely than men in such jobs to believe that women are "usually" given a fair shake where they work when it comes to opportunities for promotion and advancement (43% of women in computer jobs say this usually occurs, compared with 77% of men).

About one-in-five women in STEM and non-STEM jobs say they have experienced sexual harassment at work

In the Pew Research Center survey - conducted before the string of prominent sexual harassment allegations and public discussion of these issues on social media outlets and elsewhere - some 22% of working women in the U.S. say they have experienced sexual harassment at work, compared with 7% of working men. The share of women who say they have experienced sexual harassment at work is the same among those in STEM and non-STEM jobs.

Women working in STEM are more likely than their male counterparts to regard sexual harassment as at least a small problem in their workplace (36% vs. 28%). As with experience with discrimination, women in STEM jobs who work in majority-male settings and women in computer jobs are particularly likely to say that sexual harassment is at least a small problem where they work. Nearly half (48%) of female STEM workers in majority-male workplaces say that sexual harassment is a problem where they work. About four-in-ten (42%) women in computer jobs consider workplace sexual harassment a problem where they work, compared with three-in-ten (30%) men in computer jobs.

Among those in non-STEM occupations, men and women are equally likely to consider sexual harassment a problem where they work.

About six-in-ten blacks working in STEM say they have experienced workplace discrimination because of their race

Concerns about the underrepresentation of blacks and other racial minorities - and particularly women of color - in the STEM workforce have been ongoing for at least four decades. The Pew Research Center survey finds that, today, black STEM workers are especially likely to say they have experienced discrimination at work because of their race or ethnicity; 62% of blacks in STEM say this, compared with 44% of Asians, 42% of Hispanics and just 13% of whites in STEM jobs.

Blacks in STEM jobs tend to report experiences of workplace discrimination due to race more than blacks in non-STEM jobs (62% vs. 50%). Hispanics in STEM and non-STEM jobs are equally likely to say they have experienced workplace discrimination because of their race or ethnicity (42% each).

And, blacks working in STEM jobs are less convinced than white STEM workers that black employees where they work are treated fairly when it comes to hiring and promotions. In all, 43% of blacks in STEM jobs believe that blacks where they work are usually treated fairly during recruitment; 37% say this is the case during promotion and advancement opportunities. By contrast most white STEM workers believe that blacks are usually treated fairly in these processes where they work (78% say this about hiring, 75% about advancement processes).

Other Pew Research Center analyses found that black Americans with at least some college experience are more likely to say they have experienced discrimination or been treated unfairly across a range of experiences because of their race or ethnicity, compared with those without any college experience. (There are not enough blacks in STEM jobs in this survey for analysis by levels of education.)

While the majority of STEM workers believe their race or ethnicity has made no difference in their ability to succeed in their job, blacks (40%) and Asians (31%) in STEM jobs, followed by Hispanics (19%), are more likely than white STEM workers (5%) to say it has been harder to find success in their job because of their race or ethnicity.

STEM workers who believe their race or ethnicity has made it harder to succeed provide a number of explanations, including concerns about the hiring process, promotions and pay equity, and stereotypical beliefs among their coworkers. Some respondents put it this way:

"People have preconceived ideas of what I am capable of doing." - Black man, physical scientist, 39

"This 'other-ness' exists intentionally or unintentionally between those of a minority and those of a majority from lacking of common cultural background. Relationships at work appear polite on surface but reluctant tendency in willing to share limited opportunities the same way, which I felt in a previous job where whites and males were overwhelmingly a majority." - Asian woman, engineer, 56

The STEM workforce has grown, especially among computer occupations

Analysis of the U.S. Census Bureau's American Community Survey shows that employment in STEM occupations has grown 79% since 1990 (from 9.7 million to 17.3 million) with the largest growth occurring in computer occupations (338% growth since 1990).

The share of women working in such jobs varies widely both within and across job types (or clusters). Women account for a majority of healthcare practitioners and technicians but are underrepresented in other jobs, particularly computer and engineering positions. While there has been significant progress for women in the life and physical sciences since 1990, the share of women has been roughly stable in other STEM occupational clusters and has gone down 7 percentage points in computer occupations.

What's a STEM job?

This analysis relies on a broad-based definition of the science, technology, engineering and math (STEM) workforce. STEM jobs are defined solely based on occupation and include: life sciences, physical and Earth sciences, engineering and architecture, computer and math occupations as well as health-related occupations including healthcare providers and technicians.

Educators specializing in STEM subjects could not be identified in the analysis of the American Community Survey, though they are included as holding STEM jobs in the analysis of the Pew Research Center survey.

While there is often considerable overlap across definitions, there is no commonly agreed definition of the STEM workforce. Thus, caution is warranted in any direct comparisons with other studies.

Gains in women's representation in STEM jobs have been concentrated among women holding advanced degrees, although women still tend to be underrepresented among such workers. Women are roughly four-in-ten (41%) of all STEM workers with a professional or doctoral degree such as an M.D., D.D.S., or Ph.D.

Black and Hispanic workers continue to be underrepresented in the STEM workforce. Blacks make up 11% of the U.S. workforce overall but represent 9% of STEM workers, while Hispanics comprise 16% of the U.S. workforce but only 7% of all STEM workers.

Asians are overrepresented in the STEM workforce, relative to their overall share of the workforce, especially among college-educated workers: 17% of college-educated STEM workers are Asian, while 10% of all workers with a college degree are Asian.

The representation of women, blacks and Hispanics in STEM has implications for the average earnings of workers in these groups. STEM workers earn more, on average, than workers in non-STEM jobs, even when controlling for educational attainment.

One potential barrier for those wishing to enter the STEM workforce is the generally higher level of educational attainment required for many such positions. Among college-educated workers, one-in-three (33%) majored in a STEM field. But only about half (52%) of those with college training in a STEM field are currently employed in a STEM job. The rest are working in other fields, with many benefiting from the financial bump in earnings that comes with a STEM degree.

The reasons why half of college-educated workers with STEM-related training turn to jobs elsewhere are likely complicated. Among college-educated workers, those who majored in a health professions field are more likely than those who majored in other STEM fields to be working in a job directly related to their degree. About seven-in-ten (69%) women who majored in a health professions field (such as nursing or pharmacy) are working in a health-related occupation, as are 61% of men who majored in health professions.

But among those who majored in computers or computer science, women are less likely than men to be working in a computer occupation (38% vs 53%). Similarly, women who majored in engineering during their undergraduate studies are less likely than men to be working in engineering jobs (24% vs. 30%). Thus, in two occupational areas with particularly low shares of women, retention of those who meet a key barrier for job entry appears to be lower for women than for men.

Other notable findings include the following:
The public image of STEM jobs includes higher pay and an advantage in attracting young talent compared with other industry sectors
In some ways, the public has a very positive view of STEM jobs, as they compare with jobs in other sectors. About seven-in-ten Americans (71%) see jobs in STEM as offering better compensation than jobs in other industries. And, a majority of Americans (58%) consider STEM jobs to attract more of the brightest, most qualified young people.

The public is closely divided over whether jobs in STEM make a more meaningful contribution to society or do so to about the same extent as other jobs (45% to 48%). But only a minority think of STEM jobs as being more focused on helping others (28%) than jobs in other industries.

About one-in-five Americans (18%) say STEM jobs have more flexibility to balance work and family needs than other jobs in other sectors, while about half (52%) say the flexibility in this regard is about the same as it is in other sectors and 28% say there is less flexibility in STEM jobs than there is elsewhere.
Men and women working in STEM say flexibility to balance work and family needs is important to them
Men and women in STEM jobs - and indeed those in non-STEM jobs as well - say that having the flexibility to balance their work and family obligations is an important factor to them in choosing a job. But men and women in STEM tend to diverge when it comes to other job characteristics. A somewhat higher share of men than women say that having higher pay and opportunities for promotion is important to them in choosing a job. Women in STEM jobs are more inclined to consider a job that focuses on helping others (59%) as important to them compared with men in STEM jobs (31%).

Americans see a range of explanations for the underrepresentation of women, blacks and Hispanics in STEM jobs

Many Americans attribute the limited diversity of the STEM workforce to a lack of encouragement for girls and blacks and Hispanics to pursue STEM from an early age; 39% of Americans consider this a major reason there are not more women in some STEM areas, and 41% say this is a major reason there are not more blacks and Hispanics in the STEM workforce.

In addition, 42% of Americans say limited access to quality education to prepare them for these fields is a major reason blacks and Hispanics are underrepresented in the STEM workforce; this view is held by a majority of those working in STEM who are black (73%) and about half of Hispanics (53%), Asians (52%) and whites (50%) in STEM jobs.

There are wide differences among STEM workers on the role of racial/ethnic discrimination in underrepresentation. Among blacks in STEM jobs, 72% say discrimination in recruitment, hiring and promotions is a major reason behind the underrepresentation of blacks and Hispanics in these jobs. By contrast, 27% of whites and 28% of Asians say this, while 43% of Hispanics think discrimination is a major reason behind the underrepresentation.

Similarly, there are wide differences between men and women working in STEM jobs on the role of gender discrimination. About half of women in STEM jobs (48%) say gender discrimination in recruitment, hiring and promotions is a major reason there are not more women in STEM jobs, compared with 29% of men in STEM jobs.

When women and those in racial and ethnic minority groups working in STEM were asked to say, in their own words, the best ways to attract more people like themselves to STEM, many emphasized the importance of quality schooling and an early start to encouraging people into the field with repeated support over time. A few examples:

"You must introduce those fields early in the elementary school years. Then continue to build on that by establishing STEM clubs and activities. Provide information to parents about local/community STEM events for continued interests. Most of all, make sure that any STEM student has the rigorous preparation that will be needed to get them accepted into college and able to handle the nature of the college level classes." - Black woman, nurse, 49

"K-8 teaching needs to be designed to make these subjects more interesting and accessible to girls. Teachers need to be explicit about the need for more women in STEM jobs, and help girls feel that they have a reason to pursue these fields in spite of the somewhat intimidating gender breakdown of higher level classes." - White woman, math teacher, 42

"Providing opportunities such as putting upgraded computers and/or science labs in inner-city schools, libraries and community centers. Black men currently in the STEM industries must be visible to the younger generation in order to show the value of those skills and the career implications." - Black man, systems engineer, 30
Most Americans rate K-12 STEM education as average or worse compared with other developed nations, so, too, do those with an advanced degree in STEM
Americans are generally critical of the quality of STEM education in the nation's K-12 schools. A quarter of Americans (25%) consider K-12 STEM education in the U.S. to be at least above average compared with other developed countries, while 30% say the U.S. is below average in this regard, and 43% say it is average. Parents with children in public schools give similar ratings of the nation's K-12 STEM education.

Americans tend to see higher education in STEM more favorably, by comparison, but there too, fewer than half consider undergraduate education (35%) or graduate education (38%) in STEM as at least above average compared with other nations.

People who, themselves, have a postgraduate degree in a STEM field give positive ratings to the quality of postsecondary education in the U.S., but just 13% of this group considers K-12 STEM education to be at least above average.

Nonetheless, as Americans look back on their own K-12 experiences, three-quarters (75%) report that they generally liked science classes. Science labs and hands-on learning experiences stand out as a key appeal among those who liked science classes. Some 46% of those who disliked science classes in their youth say a reason for their view is that these classes were hard, while another 36% of this group found it hard to see how science classes would be useful to them in the future.

Terminology

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Women and Men in STEM Often at Odds Over Workplace Equity

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Perceived inequities are especially common among women in science, technology, engineering and math jobs who work mostly with men For women working in science, technology, engineering or math (STEM) jobs, the workplace is a different, sometimes more hostile environment than the one their male coworkers experience.

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Although coffee and caffeine have essentially no nutritional value, drinking coffee can be beneficial for some teens.