"Every shut eye, ain't sleep": The role of racism-related vigilance in racial/ethnic disparities in sleep difficulty

Student loans and racial disparities in self-reported sleep duration: evidence from a nationally representative sample of US young adults

BACKGROUND

Student loans are the second largest source of personal debt in the USA and may represent an important source of financial strain for many young adults. Little attention has been paid to whether debt is associated with sleep duration, an important health-promoting behaviour. We determine if student loans are associated with sleep duration. Since black young adults are more likely to have student debt and sleep less, we also consider whether this association varies by race.

METHODS

Data come from the US National Longitudinal Survey of Youth 1997. The main analytic sample includes 4714 respondents who were ever enrolled in college and who reported on sleep duration in 2010. Most respondents had completed their college education by 2010, when respondents were 25 to 31 years old. Multivariable linear regression models assessed the cross-sectional association between student loans accumulated over the course of college and sleep duration in 2010, as well as between student debt at age 25 and sleep duration in 2010.

RESULTS

Black young adults with greater amounts of student loans or more student debt reported shorter sleep duration, controlling for occupation, hours worked, household income, parental net worth, marital status, number of children in the household and other sociodemographic and health indicators. There was no association between student loans or debt with sleep for white or latino adults and other racial/ethnic groups.

CONCLUSIONS

Student loans may contribute to racial inequities in sleep duration. Our findings also suggest that the student debt crisis may have important implications for individuals' sleep, specifically and public health, more broadly.

Capturing the cardiac effects of racial discrimination: Do the effects "keep going"?

Racial discrimination negatively impacts cardiac functioning, but few studies examine the more distal cardiac effects of racial discrimination experiences. The present study examined the momentary and prolonged impact of lab-based intergroup and intragroup racial discrimination on heart rate variability (HRV) and heart rate (HR) in a sample (N = 42) of African American (AA) women across two days. On day one, the women were exposed to simulated racial discrimination from either a European American (EA) or AA confederate in the lab. On day two, the women returned to the lab for additional physiological recording and debriefing. Women insulted by the EA confederate exhibited lower HRV on day one and marginally lower HRV on day two. These women also exhibited marginally higher HR on day two. The HRV and HR effects on day two were not mediated by differences in perseveration about the stressor. The findings indicate that racial discrimination - particularly intergroup racial discrimination - may have both momentary and prolonged effects on cardiac activity in AAs.

Racial/ethnic disparities in midlife depressive symptoms: The role of cumulative disadvantage across the life course

This study examines the role of cumulative disadvantage mechanisms across the life course in the production of racial and ethnic disparities in depressive symptoms at midlife, including the early life exposure to health risk factors, the persistent exposure to health risk factors, and varying mental health returns to health risk factors across racial and ethnic groups. Using data from the over-40 health module of the National Longitudinal Study of Youth (NLSY) 1979 cohort, this study uses regression decomposition techniques to attend to differences in the composition of health risk factors across racial and ethnic groups, differences by race and ethnicity in the association between depressive symptoms and health risk factors, and how these differences combine within racial and ethnic groups to produce group-specific levels of--and disparities in--depressive symptoms at midlife. While the results vary depending on the groups being compared across race/ethnicity and gender, the study documents how racial and ethnic mental health disparities at midlife stem from life course processes of cumulative disadvantage through both unequal distribution and unequal associations across racial and ethnic groups.

Behavioral reactivity to acute stress among Black and White women with type 2 diabetes: The roles of income and racial discrimination

This study investigated relationships of income and self-reported racial discrimination to diabetes health behaviors following an acute stressor. A total of 77 diabetic women (51% Black, 49% White) completed a laboratory public speaking stressor. That evening, participants reported same-day eating, alcohol consumption, and medication adherence; physical activity was measured with actigraphy, and the next morning participants reported sleep quality. Measures were repeated on a counterbalanced control day. There was no mean level difference in health behaviors between stressor and control days. On stressor day, lower income predicted lower physical activity, sleep quality, and medication adherence, and higher racial discrimination predicted more eating and alcohol consumed, even after accounting confounders including race and control day behaviors.

Confronting as autonomy promotion: Speaking up against discrimination and psychological well-being in racial minorities

Few studies have considered confrontation in the context of coping with discriminatory experiences. These studies test for the first time whether confronting racial discrimination is associated with greater psychological well-being and physical health through the promotion of autonomy. In two separate samples of racial minorities who had experienced racial discrimination, confrontation was associated with greater psychological well-being, and this relationship was mediated by autonomy promotion. These findings did not extend to physical health symptoms. These studies provide preliminary evidence that confrontation may aid in the process of regaining autonomy after experiencing discrimination and therefore promote well-being.

Discrimination and sleep: a systematic review

An increasing body of literature indicates that discrimination has a negative impact on health; poor sleep may be an underlying mechanism. The primary objective of this review was to examine existing studies on the relationship between discrimination and sleep to clarify (a) the potential role of discrimination in shaping population patterns of sleep and sleep disparities, and (b) the research needed to develop interventions at individual and institutional levels. We identified articles from English-language publications in PubMed and EBSCO databases from inception through July 2014. We employed a broad definition of discrimination to include any form of unfair treatment and all self-reported and objectively assessed sleep outcomes, including duration, difficulties, and sleep architecture. Seventeen studies were identified: four prospective, 12 cross-sectional, and one that utilized a daily-diary design. Fifteen of the 17 studies evaluated interpersonal discrimination as the exposure and the majority of studies included self-reported sleep as the outcome. Only four studies incorporated objective sleep assessments. All 17 studies identified at least one association between discrimination and a measure of poorer sleep, although studies with more detailed consideration of either discrimination or sleep architecture revealed some inconsistencies. Taken together, existing studies demonstrate consistent evidence that discrimination is associated with poorer sleep outcomes. This evidence base can be strengthened with additional prospective studies that incorporate objectively measured aspects of sleep. We outline important extensions for this field of inquiry that can inform the development of interventions to improve sleep outcomes, and consequently promote well-being and reduce health inequities across the life course.

Self-reported experiences of discrimination and health: scientific advances, ongoing controversies, and emerging issues

Over the past two decades, research examining the impact of self-reported experiences of discrimination on mental and physical health has increased dramatically. Studies have found consistent associations between exposure to discrimination and a wide range of Diagnostic and Statistical Manual of Mental Disorders (DSM)-diagnosed mental disorders as well as objective physical health outcomes. Associations are seen in cross-sectional as well as longitudinal studies and persist even after adjustment for confounding variables, including personality characteristics and other threats to validity. However, controversies remain, particularly around the best approach to measuring experiences of discrimination, the significance of racial/ethnic discrimination versus overall mistreatment, the need to account for "intersectionalities," and the importance of comprehensive assessments. These issues are discussed in detail, along with emerging areas of emphasis including cyber discrimination, anticipatory stress or vigilance around discrimination, and interventions with potential to reduce the negative effects of discrimination on health. We also discuss priorities for future research and implications for interventions and policy.

Enhancing breastfeeding rates among African American women: a systematic review of current psychosocial interventions

The goals of this article are to provide a review of key interventions and strategies that impact initiation and duration of breastfeeding with particular focus on low-income African American mothers' maternal psychological vulnerabilities during the early postpartum period using a social ecological perspective as a guiding framework. Although modest gains have been achieved in breastfeeding initiation rates in the United States, a projected gap remains between infant feeding practices and national Healthy People breastfeeding goals set for 2020, particularly among African Americans. These disparities raise concerns that socially disadvantaged mothers and babies may be at increased risk for poor postnatal outcomes because of poorer mental health and increased vulnerability to chronic health conditions. Breastfeeding can be a protective factor, strengthening the relationship between mother and baby and increasing infant health and resilience. Evidence suggests that no single intervention can sufficiently address the multiple breastfeeding barriers faced by mothers. Effective intervention strategies require a multilevel approach. A social ecological perspective highlights that individual knowledge, behavior, and attitudes are shaped by interactions between the individual woman, her friends and family, and her wider historical, social, political, economic, institutional, and community contexts, and therefore effective breastfeeding interventions must reflect all these aspects. Current breastfeeding interventions are disjointed and inadequately meet all African American women's social and psychological breastfeeding needs. Poor outcomes indicate a need for an integrative approach to address the complexity of interrelated breastfeeding barriers mothers' experience across layers of the social ecological system.

Vigilance in the discrimination-stress model for Black Americans

OBJECTIVE

Daily events of discrimination are important factors in understanding health disparities. Vigilant coping, or protecting against anticipated discrimination by monitoring and modifying behaviour, is an understudied mechanism that may link discrimination and health outcomes. This study investigates how responding to everyday discrimination with anticipatory vigilance relates to the health of Black men and women.

METHODS

Black adults (N = 221) from the Detroit area completed measures of discrimination, adverse life events, vigilance coping, stress, depressive symptoms and self-reported health.

RESULTS

Vigilance coping strategies mediated the relationship between discrimination and stress. Multi-group path analysis revealed that stress in turn was associated with increased depression in men and women. Self-reported health consequences of stress differed between men and women.

CONCLUSIONS

Vigilance coping mediates the link between discrimination and stress, and stress has consequences for health outcomes resulting from discrimination. More research is needed to understand other underlying contributors to discrimination, stress and poor health outcomes as well as to create potential interventions to ameliorate health outcomes in the face of discrimination-related stress.

Racial/ethnic disparities in short sleep duration by occupation: the contribution of immigrant status

Sleep duration, associated with increased morbidity/mortality, has been shown to vary by race and occupation. Few studies have examined the additional influence of immigrant status. Using a nationally-representative sample of 175,244 US adults from the National Health Interview Survey from 2004 to 2011, we estimated prevalence ratios (PRs) for short sleep duration (<7 h/per day) among US- and non-US born Blacks and Latinos by occupation compared to their White counterparts using adjusted Poisson regression models with robust variance. Non-US born participants' mean age was 46 years, 55% were men, 58% were Latino, and 65% lived in the US ≥ 15 years. Short sleep prevalence was highest among US- and non-US born Blacks in all occupations, and the prevalence generally increased with increasing professional/management roles in Blacks and Latinos while it decreased among Whites. Adjusted short sleep was more prevalent in US-born Blacks compared to Whites in professional/management (PR = 1.52 [95% confidence interval (CI): 1.42-1.63]), support services (PR = 1.31 [95% CI: 1.26-1.37]), and laborers (PR = 1.11 [95% CI: 1.06-1.16]). The Black-White comparison was even higher for non-US born Black laborers (PR = 1.50 [95% CI: 1.24-1.80]). Similar for non-US born Latinos, Latinos born in the US had a higher short sleep prevalence in professional/management (PR = 1.14 [95% CI: 1.04-1.24]) and support services (PR = 1.06 [95% CI: 1.01-1.11]), but a lower prevalence among laborers (PR = 0.77 [95% CI: 0.74-0.81]) compared to Whites. Short sleep varied within and between immigrant status for some ethnicities in particular occupations, further illuminating the need for tailored interventions to address sleep disparities among US workers.

Self-Reported Experiences of Discrimination and Cardiovascular Disease

Researchers have long speculated that exposure to discrimination may increase cardiovascular disease (CVD) risk but compared to other psychosocial risk factors, large-scale epidemiologic and community based studies examining associations between reports of discrimination and CVD risk have only emerged fairly recently. This review summarizes findings from studies of self-reported experiences of discrimination and CVD risk published between 2011-2013. We document the innovative advances in recent work, the notable heterogeneity in these studies, and the considerable need for additional work with objective clinical endpoints other than blood pressure. Implications for the study of racial disparities in CVD and clinical practice are also discussed.

Association of race consciousness with the patient-physician relationship, medication adherence, and blood pressure in urban primary care patients

BACKGROUND

Race consciousness (the frequency with which one thinks about his or her own race) is a measure that may be useful in assessing whether racial discrimination negatively impacts blood pressure (BP). However, the relation between race consciousness and BP has yet to be empirically tested, especially within the context of the patient-physician relationship and medication adherence.

METHODS

Race-stratified generalized estimating equations were used to assess the relationship of race consciousness on BP, measures of the patient-physician relationship, and self-reported medication adherence, controlling for patients being nested within physicians and for patient age and sex.

RESULTS

The mean age of the patients was 61.3 years, 62% were black, and 65% were women. Black patients were more likely to ever think about race than were white patients (49% vs. 21%; P < 0.001). Race-conscious blacks had significantly higher diastolic BP (79.4 vs. 74.5 mm Hg; P = 0.004) and somewhat higher systolic BP (138.8 vs. 134.7 mm Hg; P = 0.13) than blacks who were not race conscious. Race-conscious whites were more likely to perceive respect from their physician (57.1% vs. 25.8%; P = 0.01) but had lower medication adherence (62.4% vs. 82.9%; P = 0.05) than whites who were not race-conscious.

CONCLUSIONS

Among blacks, race consciousness was associated with higher diastolic BP. In contrast, among whites, there was no association between race consciousness and BP, but race consciousness was associated with poor ratings of adherence, despite more favorable ratings of the patient-physician relationship. Future work should explore disparities in race consciousness and its impact on health and health-care disparities.