Physical neighborhood and social environment, beliefs about sleep, sleep hygiene behaviors, and sleep quality among African Americans

Exploring the effects of multi-dimensional geographic environment on daily sleep and physical activity based on the Actigraph data

Understanding the interplay between people's daily sleep and physical activity and how geographic environment influences them are important for developing healthy cities. However, such research has been limited. This study aims to explore the bidirectional and nonlinear relationship between daily sleep and physical activity, and further investigate the comprehensive influences of multi-dimensional geographic environment on these health behaviors. Based on the objective data on sleep and physical activity over seven consecutive days using wrist-based accelerometers in Beijing, China, we developed a series of models to analyze the mutual influences between people's daily sleep and physical activity, and employed the generalized additive model (GAM) to examine their potential nonlinear relationships and how geographic environment - including meteorological conditions, built environment, and social environment - influences them. The results show that sleep and physical activity exhibit notable bidirectional relationship. Moderate-to-vigorous physical activity (MVPA) is observed to improve sleep quality, but it decreases sleep duration. In contrast, total sleep time (TST) exhibits an inverted U-shaped pattern with both MVPA and total step counts, with the optimal sleep duration at 5 h. Furthermore, meteorological factors, built environment characteristics, and social environment have significant linear or nonlinear effects on people's daily sleep and physical activity. The outcomes of this study offer valuable insights for enhancing residents' health and developing healthy cities.

Interactions among neighborhood conditions, sleep quality, and episodic memory across the adult lifespan

OBJECTIVES

On average, adults racialized as non-Hispanic Black and Hispanic sleep more poorly than adults racialized as non-Hispanic White (hereafter, Black, Hispanic, White), but associations between factors that may moderate sleep-memory associations in these groups, such as neighborhood conditions, are unclear. Poorer neighborhood conditions (e.g. lower neighborhood cohesion) may be negatively associated with sleep quality and multiplicatively influence sleep-memory associations. We hypothesized lower ratings of neighborhood conditions would be associated with poorer sleep quality and moderate the association between sleep quality and episodic memory, especially in Black and Hispanic adults, who are disproportionately situated in poor neighborhood conditions.

DESIGN

Seven-hundred-thirty-six adults across the adult lifespan (27-89 years) were recruited from the northern Manhattan community as a part of the Offspring Study of Racial and Ethnic Disparities in Alzheimer's disease. Sleep quality was assessed using a modified version of the Pittsburgh Sleep Quality Index, and episodic memory was evaluated with the Buschke Selective Reminding Test. With multiple regression models, we measured associations between perceived neighborhood conditions and sleep quality and the interaction between sleep quality and neighborhood conditions on episodic memory stratified by racial/ethnic and gender identity groups.

RESULTS

Overall, poorer neighborhood conditions were associated with poorer sleep quality. In Black and Hispanic women, the sleep-memory association was moderated by neighborhood conditions. With more favorable neighborhood conditions, Black women showed an association between higher sleep quality and higher memory performance, and Hispanic women showed a protective effect of neighborhood (higher memory even when sleep quality was poor).

CONCLUSION

Poorer neighborhood experiences may contribute to poorer sleep quality across groups. In Black and Hispanic women, the association between sleep quality and episodic memory performance was dependent upon neighborhood conditions. These findings may inform tailored, structural level sleep interventions, aimed to improve neighborhood experiences and thereby sleep quality and episodic memory.

Sleep conditions and sleep hygiene behaviors in early pregnancy are associated with gestational diabetes mellitus: A propensity-score matched study

PURPOSE

To explore the influence of sleep conditions and sleep hygiene behaviors in early pregnancy on gestational diabetes mellitus (GDM) development.

METHODS

This 1:1 propensity-score matched study included 1,216 pregnant women divided into GDM and control groups based on diagnosis via the oral glucose tolerance test at 24-28 gestational weeks. Sleep conditions and hygiene behaviors were evaluated using structural questionnaires, including the Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale, and Sleep Hygiene Practice Scale. Univariate and multivariate logistic regression analyses and Spearman's correlation were conducted to identify the associations.

RESULTS

After adjusting for baseline clinical characteristics, women with GDM were more likely to have poor sleep quality (adjusted odds ratio [AOR] = 1.585, 95% confidence interval [CI]: 1.261-1.992) and higher scores for subjective sleep quality, latency, duration, efficiency, and sleep disturbances (all P < 0.01). Mild sleepiness (AOR = 1.311, 95% CI: 1.012-1.699) and worrying about not being able to fall asleep (AOR = 1.123, 95% CI: 1.005-1.255) were more likely to occur in the GDM group. Sleep quality and hygiene behaviors such as sleep-irrelevant activities, staying in bed after waking up, weekend catch-up sleep, and overeating before bedtime were significantly correlated with gestational diabetes variables.

CONCLUSION

Poor sleep conditions and specific sleep hygiene behaviors in early pregnancy may be independent risk factors for GDM. This suggests that sleep assessment and behavior education can be used as new approaches for the early implementation of surveillance and prevention of GDM.

Self-reported neighborhood stressors and sleep quality among Puerto Rican young adults

OBJECTIVE

To examine the association between changes in self-reported neighborhood stressors and sleep quality and determine whether this varied by sociocultural context among Puerto Rican young adults.

METHODS

Data come from the Boricua Youth Study Health Assessment, a sample of Puerto Rican young adults from San Juan, Puerto Rico, and South Bronx, New York (n = 818; mean age=22.9years). Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI). Neighborhood social stressors (disorder, social cohesion, and safety) were parent-reported in childhood and self-reported in young adulthood and categorized into: low in childhood/young adulthood (reference group), high in childhood/low in young adulthood, low in childhood/high in young adulthood, and high in childhood/young adulthood. Sociocultural context was based on participant residence during childhood (San Juan vs. South Bronx).

RESULTS

Adjusting for sociodemographic factors, living with high neighborhood stressors in both childhood and young adulthood (prevalence ratios=1.30, 95% CI: 1.01, 1.66) was associated with overall poor sleep (PSQI score >5). Among PSQI components, living with high neighborhood stressors in young adulthood only or in both time periods was associated with worse subjective sleep quality and daytime dysfunction. Additionally, there were various associations between the neighborhood stressor measures and PSQI components. Results did not differ by sociocultural context.

CONCLUSION

Findings suggest that living with high levels of neighborhood stressors during childhood and young adulthood may have a cumulative adverse impact on sleep quality in young adulthood.

The Prevalence of Sleep Disorders in People with Type 2 Diabetes and Obesity in Saudi Arabia: A Cross-Sectional Study

Purpose

Difficulty falling or staying asleep are considered sleep disorders, and these are common among people with type 2 diabetes mellitus (T2DM) and obesity. The presence of sleep disorders may cause poor glycemic control among this population. We therefore designed this study to assess sleep disorders among patients with T2DM and obesity.

Patients and Methods

This cross-sectional study examined the prevalence of sleep disorders in 148 patients with T2DM and obesity at a hospital in Taif, Saudi Arabia using a validated questionnaire.

Results

Among those patients who have been involved in this study, we found a moderate level of sleep disorders and disturbances. The average sleep disorder assessment score for the patients with T2DM and obesity was 2.8 ± 1.4. Additionally, the average score for the sleep pattern assessment was 2.7 ± 1.3 and 2.9 ± 1.5 for symptoms of lack of sleep. Our study also revealed that those patients also had suboptimal weight and glycemic control.

Conclusion

These findings demonstrate that patients with T2DM and obesity are at a higher risk of developing sleep disorders. Therefore, these patients need to be screened for sleep disorders to avoid further diabetes-related complications and to have an early lifestyle intervention.

Race as a Potential Moderator of the Association between Dysfunctional Beliefs about Sleep and Global Sleep Health

OBJECTIVES

Dysfunctional beliefs about sleep are associated with components of sleep health, but their association with global sleep health is understudied. Beliefs about sleep may systematically vary by race, which may influence the association between dysfunctional beliefs about sleep and global sleep health. This study aimed to investigate whether race influences the association between dysfunctional beliefs about sleep and global sleep health.

METHODS

Data were collected as part of an online survey. Participants were Black (n = 181) and White (n = 179) adults who were matched on age, self-reported sex, and level of education. Global sleep health was measured using the RU-SATED and dysfunctional beliefs about sleep were measured using the DBAS-16. Moderation analyses were conducted to investigate whether race moderated the association between DBAS-16 total and subscale scores and RU-SATED total scores.

RESULTS

Race moderated the associations between DBAS-16 total score and subscale scores and RU-SATED total score (b = 0.54, p < .001). Higher DBAS-16 scores were significantly associated with lower RU-SATED scores in the white sample, while this association was not significant in the Black sample, except for the Sleep Expectations subscale, where the association was not significant in the White sample, and it was significant in the Black sample.

CONCLUSIONS

These findings highlight that the association between dysfunctional beliefs about sleep and global sleep health may systematically vary by race which may have implications for promoting sleep health equity in racial minority populations through clinical and advocacy work. Future studies are needed to investigate what specific factors may be impacting these unique associations.

Perceived Neighborhood Characteristics and Sleep in Australian Adults

BACKGROUND

Poor sleep can contribute to poorer health and socioemotional outcomes. Sleep health can be influenced by a range of individual and other socioecological factors. Perceptions of neighborhood physical and social characteristics reflect broader social-level factors that may influence sleep, which have not been well studied in the Australian context. This study examined the association between perceived neighborhood characteristics and sleep in a large sample of Australians.

METHODS

Data were from 9,792 people aged 16 years or older, from Waves 16 and 17 of the nationally representative Household, Income and Labour Dynamics in Australia Survey. Associations between perceived neighborhood characteristics (neighborly interaction and support, environmental noise, physical condition, and insecurity) and self-reported sleep duration, sleep disturbance, and napping were examined using multiple logistic regression models.

RESULTS

"Neighborhood interaction and support" and "neighborhood physical condition" were not significantly associated with any sleep outcomes after adjusting for relevant covariates. However, "environmental noise" and "neighborhood insecurity" remained significantly associated with sleep duration and sleep disturbance. None of the neighborhood characteristics were associated with napping. Furthermore, associations did not significantly vary by gender.

CONCLUSIONS

This study highlights the potential benefit of public health policies to address noise and safety in neighborhoods to improve sleep.

"What if that's your last sleep?" A qualitative exploration of the trauma of incarceration and sleep

Study Background/Objectives

Sleep is an underexplored factor in the health of people involved in the criminal legal system. This study addresses the paucity of research on how individual, social, and physical environmental factors impact sleep health during and after incarceration by highlighting the voices of people involved in the criminal legal system through a community-engaged qualitative research approach.

Methods

We conducted 20 semi-structured interviews with men recently released from prison for a study on trauma and healthcare during incarceration and after release. Interviews were coded and analyzed using reflexive thematic analysis and a critical realist framework. Our research team included people with a history of incarceration who performed central roles in the research process.

Results

Three themes emerged from participants' descriptions of sleep during and after incarceration: (1) concerns about health contributing to sleep problems, (2) lack of access to treatment for sleep disorders leading to ongoing sleep problems, and (3) issues of safety contributing to sleep problems during incarceration and after release.

Conclusions

This study identifies factors and domains influencing sleep during and after incarceration. By identifying which interpersonal, environmental, and structural factors impact sleep quality, medical and carceral staff are better equipped to ameliorate sleep health disparities within populations with a history of incarceration and those actively bound by the criminal legal system. Future research should examine other factors impacting sleep in incarcerated and recently released populations and develop multi-level interventions to improve sleep health. This paper is part of the Sleep and Circadian Health in the Justice System Collection.

Attitudes and beliefs about sleep health among a racially and ethnically diverse sample of overweight/obese adults

OBJECTIVES

To identify and compare how sleep-related attitudes and beliefs vary among racially and ethnically diverse adults with risk factors for cardio-metabolic disease.

METHODS

This exploratory qualitative study used online focus group discussions (N = 4 groups among 17 individuals) to collect information about sleep attitudes, beliefs, and practices following participation in the Mindfulness Intervention to Improve Sleep and Reduce Diabetes Risk Among a Diverse Sample in Atlanta (MINDS) study. A rapid analyses approach was used to identify shared themes related to attitudes and beliefs about sleep health and sleep practices across participants.

RESULTS

Participants on average were 31years old, 88% female, and identified as Black/African American (52.9%), White (17.7%), Asian (11.8%), and Hispanic (17.7%). Three themes related to attitudes and beliefs about sleep health were identified: prioritization of sleep to improve one's overall health, re-evaluating sleep needs, and interpersonal barriers to sleep. For Black/African American participants prioritizing sleep was coupled with a want to minimize stress as a long-term health promotion strategy, whereas individuals of other races/ethnicities were more focused on the immediate benefits of getting sufficient sleep. Individuals had reappraised their sleep needs and worked to improve their sleep hygiene accordingly, yet still experienced barriers to sleep. The most common barrier to sleep was sharing a sleep environment with someone who had conflicting sleep routines and practices.

CONCLUSION

The results of this study suggest perceived benefits of and barriers to sleep vary by race/ethnicity, thus future interventions should be culturally tailored to enhance effectiveness.

Sleep as a familial and communal matter: a qualitative study of social norms around sleep health in Israel

BACKGROUND

A growing body of research has clarified that sleep is influenced not only by biological factors but also by social factors. While studies have shown that social norms can affect sleep behavior and sleeping arrangements, including when, where, how, and with whom people sleep, researchers still know relatively little about how social norms affect sleep health, especially among adults. The current study explores the association between social norms and sleep health in the Israeli context.

METHODS

Data were drawn from semi-structured, in-depth interviews with 66 Israelis-including women and men, Arabs and Jews, and religious and non-religious persons-conducted between February 2020 and February 2022. This article focuses on responses to a set of questions about the comments people make or hear from others about their sleep. Exploring how people comment on the sleep of others highlights prevalent social norms around sleep.

RESULTS

Findings indicate that how sleep is "done" is policed by family and community members who react to norm violations by commenting on what is perceived as "inappropriate" sleep behavior. Comments were made in jest or earnest in response to breaches of social norms regarding sleep timing, duration, continuity, and alertness/sleepiness, indicating that social norms and expectations shape each of these sleep health dimensions.

CONCLUSIONS

This article expands the scholarly understanding of the social determinants of sleep health. The study concludes that since individuals may opt to conform to current social norms, which are enforced by members of the family and community, interventions aimed at promoting sleep health should target not only individuals but also the family and community.

What complex factors influence sleep quality in college students? PLS-SEM vs. fsQCA

Introduction

Sleep quality has a significant impact on the health-related quality of life, particularly among college students. This study proposes a framework for identifying factors that influence college students' sleep quality, including stress, self-control, bedtime habits, and neighborhood environment.

Methods

The study employed a cross-sectional analytical approach on a convenience sample of 255 medical students from a private university in China during the 2021/2022 academic year, of which 80.39% (205) were women. Two complementary methodologies, partial least squares-structural equation modeling (PLS-SEM), and fuzzy sets qualitative comparative analysis (fsQCA), were utilized in the study.

Results

The results of the PLS-SEM analysis suggest that Stress and Self-control act as mediating variables in the model, with Bedtime habits and Neighborhood environment influencing sleep quality through these variables. Additionally, the fsQCA analysis reveals that Bedtime habits and Neighborhood environment can combine with Stress and Self-control, respectively, to influence sleep quality.

Discussion

These findings provide insight into how multiple factors, such as Stress, Self-control, Bedtime habits, and Neighborhood environment, can impact college students' sleep quality, and can be used to develop intervention programs aimed at improving it. Moreover, the use of both methodologies enables the expansion of new methodological approaches that can be applied to different contexts.

Neighborhood Social Cohesion and Obesity in the United States

Low neighborhood social cohesion (nSC) has been associated with obesity. Still, few studies have assessed the nSC-obesity relationship among a large, nationally representative, and racially/ethnically diverse sample of the United States population. To address this literature gap, we examined cross-sectional associations among 154,480 adult participants of the National Health Interview Survey (NHIS) from 2013-2018. We also determined if associations varied by race/ethnicity, sex/gender, age, annual household income, and food security status. Based on a 4-item scale from the Project on Human Development in Chicago Neighborhoods Community Survey, we categorized nSC as low, medium, and high. Based on body mass index (BMI) recommendations, we categorized obesity as ≥30 kg/m2. We used Poisson regression with robust variance to directly estimate prevalence ratios (PRs) and 95% confidence intervals (CIs) while adjusting for sociodemographic characteristics, such as annual household income, educational attainment, and marital status, along with other confounders. Study participants' mean age ± standard error was 47.1±0.1 years; most (69.2%) self-identified as Non-Hispanic (NH)-White, and 51.0% were women. NH-Black and Hispanic/Latinx adults comprised more of the population in neighborhoods with low nSC (14.0% NH-Black, 19.1% Hispanic/Latinx, and 61.8% NH-White) versus high nSC (7.7% NH-Black, 10.4% Hispanic/Latinx and 77.0% NH-White). Low vs. high nSC was associated with a 15% higher prevalence of obesity (PR=1.15 [95% CI: 1.12-1.18]), and the magnitude of the association was more substantial among NH-White (PR=1.21 [95% CI: 1.17-1.25]) compared to associations among Hispanic/Latinx (PR=1.04 [95% CI: 0.97-1.11]) and NH-Black (PR=1.01 [95% CI: 0.95-1.07]) adults. Low vs. high nSC was associated with a 20% higher prevalence of obesity in women (PR=1.20 [95% CI: 1.16-1.24]) compared to a 10% higher prevalence in men (PR=1.10 [95% CI: 1.06-1.14]). Low vs. high nSC was associated with a 19% higher prevalence of obesity among adults ≥50 years old (PR=1.19 [95% CI: 1.15-1.23]) compared to a 7% higher prevalence of obesity among adults <50 years old (PR=1.07 [95% CI: 1.03-1.11]). Efforts to address nSC may improve health and address health disparities.

Neighborhood Built Environment and Sleep Health: A Longitudinal Study in Low-Income and Predominantly African-American Neighborhoods

In the present study, we examined the associations between physical characteristics of neighborhoods and sleep health outcomes and assessed the mediating role of physical activity in these associations. A longitudinal study (the Pittsburgh Hill/Homewood Research on Eating, Shopping, and Health (PHRESH) Zzz Study; n = 1,051) was conducted in 2 low-income, predominately African-American neighborhoods in Pittsburgh, Pennsylvania, with repeated measures of neighborhood characteristics and sleep health outcomes from 2013 to 2018. Built environment measures of walkability, urban design, and neighborhood disorder were captured from systematic field observations. Sleep health outcomes included insufficient sleep, sleep duration, wakefulness after sleep onset, and sleep efficiency measured from 7-day actigraphy data. G-computations based on structural nested mean models were used to examine the total effects of each built environment feature, and causal mediation analyses were used to evaluate direct and indirect effects operating through physical activity. Urban design features were associated with decreased wakefulness after sleep onset (risk difference (RD) = -1.26, 95% confidence interval (CI): -4.31, -0.33). Neighborhood disorder (RD = -0.46, 95% CI: -0.86, -0.07) and crime rate (RD = -0.54, 95% CI: -0.93, -0.08) were negatively associated with sleep efficiency. Neighborhood walkability was not associated with sleep outcomes. We did not find a strong and consistent mediating role of physical activity. Interventions to improve sleep should target modifiable factors, including urban design and neighborhood disorder.

Observation of covid-19 safety protocols by persons with chronic health conditions in Ghana: The influence of health belief model

Covid-19 has brought distortion to health delivery globally and made it challenging to seek healthcare, but persons with chronic health conditions who require continuous medical attention have suffered the most as all attention at the medical front was directed to covid-19 related issues. The study explores how the five primary constructs of the health belief model were used to drive adherence to covid-19 preventive protocols among persons with chronic health conditions in Ghana. A quantitative technique was used for data collection and analyses. SPSS version 21 and AMOS version 21 were used to analyze data. Hierarchical regression from SPSS were used to examine the influences of health belief model constructs on chronic patients' adherence to covid-19 preventive protocols. The study's finding indicates that perceived susceptibility, severity, and self-efficacy influence adherence to covid-19 protocols among persons with chronic conditions. While perceived benefits and perceived barriers though they have negative and positive influences on adherence, they were not statistically significant. Perceived self-efficacy has a negative influence on the perceived barrier and a positive influence on perceived benefit. Gender has positive influence on Perceived susceptibility. The study's outcome indicated that persons with chronic health conditions need special arrangements to ease their access to healthcare during outbreaks. Hence, public health professionals need to educate chronic patients on how to practice the covid-19 preventive protocols and support them with covid-19 preventive materials to increase their self-efficacy to adhere to covid-19 protocols.

Short sleep duration and interest in sleep improvement in a multi-ethnic cohort of diverse women participating in a community-based wellness intervention: an unmet need for improvement

BACKGROUND

Disparities in sleep duration are a modifiable contributor to increased risk for cardiometabolic disorders in communities of color. We examined the prevalence of short sleep duration and interest in improving sleep among a multi-ethnic sample of women participating in a culturally tailored wellness coaching program and discussed steps to engage communities in sleep health interventions.

METHODS

Secondary analysis of data from a randomized trial were used. The wellness coaching trial utilized a Community-Based Participatory Research (CBPR) approach. Data were from the baseline survey and baseline wellness coaching notes. Short sleep duration was defined as < 7 h of self-reported sleep. Participants were prompted to set a goal related to healthy eating/physical activity and had the opportunity to set another goal on any topic of interest. Those who set a goal related to improving sleep or who discussed a desire to improve sleep during coaching were classified as having an interest in sleep improvement. Analyses utilized multivariable models to evaluate factors contributing to short sleep and interest in sleep improvement. We present our process of discussing results with community leaders and health workers.

RESULTS

A total of 485 women of color participated in the study. Among these, 199 (41%) reported short sleep duration. In adjusted models, Blacks/African Americans and Native Hawaiians/Pacific Islanders had higher odds of reporting < 7 h of sleep than Hispanics/Latinas. Depression symptoms and self-reported stress management scores were significantly associated with short sleep duration. Interest in sleep improvement was noted in the wellness coaching notes of 52 women (10.7%); sleep was the most common focus of goals not related to healthy eating/physical activity. African Immigrants/Refugees and African Americans were less likely to report interest in sleep improvement. Community leaders and health workers reported lack of awareness of the role of sleep in health and discussed challenges to obtaining adequate sleep in their communities.

CONCLUSION

Despite the high prevalence of short sleep duration, interest in sleep improvement was generally low. This study highlights a discrepancy between need and interest, and our process of community engagement, which can inform intervention development for addressing sleep duration among diverse women.

Discrimination and Education Quality Moderate the Association of Sleep With Cognitive Function in Older Black Adults: Results From the Einstein Aging Study

OBJECTIVES

Heterogeneity among Black adults' experiences of discrimination and education quality independently influence cognitive function and sleep, and may also influence the extent to which sleep is related to cognitive function. We investigated the effect of discrimination on the relationship between objective sleep characteristics and cognitive function in older Black adults with varying education quality.

METHOD

Cross-sectional analyses include Black participants in the Einstein Aging Study (N = 104, mean age = 77.2 years, 21% males). Sleep measures were calculated from wrist actigraphy (15.4 ± 1.3 days). Mean ambulatory cognitive function (i.e., spatial working memory, processing speed/visual attention, and short-term memory binding) was assessed with validated smartphone-based cognitive tests (6 daily). A modified Williams Everyday Discrimination Scale measured discriminatory experiences. Linear regression, stratified by reading literacy (an indicator of education quality), was conducted to investigate whether discrimination moderated associations between sleep and ambulatory cognitive function for individuals with varying reading literacy levels. Models controlled for age, income, sleep-disordered breathing, and sex assigned at birth.

RESULTS

Higher reading literacy was associated with better cognitive performance. For participants with both lower reading literacy and more discriminatory experiences, longer mean sleep time was associated with slower processing speed, and lower sleep quality was associated with worse working memory. Later sleep midpoint and longer nighttime sleep were associated with worse spatial working memory for participants with low reading literacy, independent of their discriminatory experiences.

DISCUSSION

Sociocultural factors (i.e., discrimination and education quality) can further explain the association between sleep and cognitive functioning and cognitive impairment risk among older Black adults.

Sleep - the guarantee of health! Does the environmental perception characteristics of urban residential areas affect residents' sleep quality?

A complex urban living environment and residents' sleep quality are intrinsically linked. Nonetheless, there is little evidence that the residential environment affects sleep quality. Based on the results of subjective questionnaires, this study uses the multiple regression combined with mediation analysis to construct a mechanical model of the impact of urban residential environmental perception characteristics on residents' sleep quality. Moreover, the differences among the influence intensities of the significant factors are compared and the results show that (1) in low-density environments (FAR < 2) and lower floors (4-6), residents sleep longer and have better sleep quality; (2) the environmental quality and service facilities of the physical environment and the sense of safety in the social environment have a significant impact on residents' sleep quality; and (3) the mental health of residents play a significant intermediary role in the relationship between social environment and sleep quality, with the highest effect accounting for 33.88%. The influence mechanisms of various environmental factors in a residential area on sleep quality were revealed and a more refined design basis for a healthy urban living environment, community renewal, and renovation was provided.

Factors that protect against poor sleep quality in an adult lifespan sample of non-Hispanic Black and non-Hispanic White adults during COVID-19: A cross-sectional study

Introduction

Stress in relation to the Coronavirus disease 19 pandemic (i.e., COVID-19, COVID stress) may be linked with poor sleep quality. The association between stress that is specific to the COVID-19 pandemic and sleep quality has been understudied, particularly in racially diverse people across the adult lifespan. Here, we investigated self-reported sleep quality in relation to COVID stress and factors that may protect against experiencing poor sleep quality from high COVID stress, including social support and religiosity.

Method

We recruited non-Hispanic Black (n = 73) and non-Hispanic White (n = 178) participants across the adult lifespan (18-76 years) using an online, cross-sectional design during the COVID-19 pandemic (March 2021-June 2021). We asked participants to report information regarding demographics (age, race/ethnicity, years of education), sleep (sleep quality, sleep habits), and positive (social support, religious activities) and negative (events of discrimination, depression, general stress, COVID stress) psychosocial factors.

Results

Across age and racial groups, better sleep habits were associated with better sleep quality, and higher COVID stress was linked to poorer sleep quality. Black participants reported higher quality sleep than White participants (p = 0.006). They also endorsed greater private and internal religiosity (p's < 0.001). Across racial groups, moderation analyses revealed a protective effect of religiosity against poor sleep (p's < 0.006). Specifically, individuals with high religious activity and high COVID stress did not experience poor sleep quality, but individuals with low religious activity and high COVID stress demonstrated poor sleep quality. These results remained significant when controlling for general stress.

Discussion

Protective factors, such as religiosity, may mitigate the negative associations between high COVID stress and poor sleep quality.

The association of 1-year weight loss from bariatric surgery and self-reported sleep: a prospective cohort

OBJECTIVE

This study examined the association of weight loss following bariatric surgery with self-reported sleep quality after accounting for other sleep-related factors.

METHODS

Participants were from the Bariatric Experience Long Term (BELONG) study. Participants completed a survey up to 6 months before surgery and approximately 1 year after surgery. The Pittsburgh Sleep Quality Index (PSQI) was used to measure sleep quality. One-year percentage total weight loss (%TWL) was determined from electronic medical records. Covariates included demographics, Charlson Comorbidity Index, geocoded variables to assess neighborhood quality, and physical activity. The authors assessed the association between %TWL at 1 year and PSQI component scores with separate cumulative logit models.

RESULTS

There were 997 participants in the analytic cohort. Participants were 86.2% women, 37.0% Hispanic, and 13.7% Black adults. Mean one-year %TWL was 26.3 (SD 8.7). Each 1% increase in %TWL was associated with a 3% better daytime dysfunction score (odds ratio = 1.03; 95% CI: 1.02-1.05) and a 2% better sleep quality score (odds ratio = 1.02; 95% CI: 1.00-1.03). No significant differences were found for the other PSQI components.

CONCLUSIONS

Weight loss from bariatric surgery was associated with better self-reported sleep at 1 year. For people undergoing bariatric surgery, there may be an added benefit of better sleep.

Sleep Disturbance is Associated with Missing PrEP Doses Among Young Black Sexual Minority Men in The N2 study

PrEP uptake and adherence among young Black sexual minority men (YBSMM), has been sub-optimal. Multiple studies identified sleep as an important determinant of medication adherence, although it has not been examined with regard to PrEP among YBSMM. This study utilized data collected from HIV-negative cisgender YBSMM in the Neighborhoods and Networks (N2) study in Chicago using PrEP (N = 70). Sleep quality was measured using the PHQ-9 and PrEP adherence questions were adapted from Reynolds et al., 2004. Bivariate and multivariable regression analyses were used to estimate associations between sleep and missing PrEP doses, controlling for relevant demographic and behavioral factors. YBSMM who reported sleep disturbance a moderate amount of time (aOR 7.59 [1.05 to 54.57]) were more likely to miss taking PrEP because they had too many pills to take. Sleep quality is an overlooked determinant of medication adherence, and may negatively impact YBSMM's ability to consistently take PrEP.

Maternal sleep deprivation induces gut microbial dysbiosis and neuroinflammation in offspring rats

Maternal sleep deprivation (MSD) is a global public health problem that affects the physical and mental development of pregnant women and their newborns. The latest research suggests that sleep deprivation (SD) disrupts the gut microbiota, leading to neuroinflammation and psychological disturbances. However, it is unclear whether MSD affects the establishment of gut microbiota and neuroinflammation in the newborns. In the present study, MSD was performed on pregnant Sprague-Dawley rats in the third trimester of pregnancy (gestational days 15-21), after which intestinal contents and brain tissues were collected from offspring at different postnatal days (P1, P7, P14, and P56). Based on microbial profiling, microbial diversity and richness increased in pregnant rats subjected to MSD, as reflected by the significant increase in the phylum Firmicutes. In addition, microbial dysbiosis marked by abundant Firmicutes bacteria was observed in the MSD offspring. Furthermore, quantitative real-time polymerase chain reaction (qRT-PCR) and enzyme-linked immunosorbent assay (ELISA) showed that the expression levels of proinflammatory cytokines interleukin 1β (IL-1β) and tumor necrosis factor α (TNF-α) were significantly higher in the MSD offspring at adulthood (P56) than in the control group. Through Spearman correlation analysis, IL-1β and TNF-α were also shown to be positively correlated with Ruminococcus_1 and Ruminococcaceae_UCG-005 at P56, which may determine the microbiota-host interactions in MSD-related neuroinflammation. Collectively, these results indicate that MSD changes maternal gut microbiota and affects the establishment of neonatal gut microbiota, leading to neuroinflammation in MSD offspring. Therefore, understanding the role of gut microbiota during physiological development may provide potential interventions for cognitive dysfunction in MSD-impacted offspring.

Acculturation Stress, Age at Immigration, and Employment Status as Predictors of Sleep Among Latinx Immigrants

Sleep is important for physical and mental health. Latinx individuals are thought to experience worse sleep and associated health outcomes, resulting in health disparities. There is a dearth of research on the factors (e.g., employment status, age at immigration) that predict poor sleep among Latinx immigrants. The present study aimed to (1) examine the link between demographic factors, immigration-related factors, and acculturation stress, and sleep, and (2) identify factors that either attenuate or intensify the link between acculturation stress and sleep among Latinx immigrants in the US South, an immigrant-hostile area that is home to an increasing Latinx population that remains understudied. Hierarchical regressions were used to analyze data from 391 Latinx adult immigrants, examining the link between demographic factors, immigration-related factors, acculturation stress, and two sleep variables (sleep quality, difficulty falling asleep). Employment status and age at immigration were examined as moderators of the link between acculturation stress and sleep. Data were collected through in-person surveys. Regressions showed that acculturation stress was significantly linked to worse sleep quality (β = 0.30, p = 0.001) and more difficulty falling asleep (β = 0.41, p < 0.001), while controlling for participant characteristics. Younger age at immigration (β = - 0.14, p = 0.005) and being unemployed (β = - 0.13, p = 0.006) were associated with more difficulty falling asleep. Age at immigration intensified the relationship between acculturation stress and sleep quality (β = 0.14, p = 0.005), difficulty falling asleep (β = 0.15, p = 0.002). Reducing acculturation stress is a meaningful intervention focus, with important implications for sleep health, particularly for recent Latinx immigrants. Age at immigration and employment status are also important factors to consider when designing targeted interventions.

Investigating Sleep Disturbance and Its Correlates Among Formerly Homeless Adults in Permanent Supportive Housing

BACKGROUND

Adults experiencing homelessness have a high burden of sleep disturbance, which may be reduced by accessing permanent supportive housing.

OBJECTIVES

To assess sleep disturbances and their correlates, including demographics, activity level, health status, age-related health issues (eg, functionality and cognitive impairment), substance use, and homelessness history in a sample of permanent supportive housing (PSH) tenants.

RESEARCH DESIGN

Cross-sectional survey design.

SUBJECTS

A total of 237 formerly homeless adults between 45 and 80 years old.

MEASURES

The Patient-Reported Outcomes Measurement Information System (PROMIS) Sleep Disturbance short form was used to measure sleep disturbance.

RESULTS

Twenty-eight percent of our sample had PROMIS scores indicative of a moderate or severe sleep disturbance. Functional impairment, pain, and mental health comorbidities were associated with increased sleep disturbance in multivariable linear regression analyses. The number of years a person experienced homelessness was inversely associated with sleep disturbance.

CONCLUSIONS

This study supports the need to screen for sleep disturbances among PSH tenants. The findings suggest that supportive services in PSH may need to include integrated physical and behavioral health care, pain management, and interventions designed to address activities of daily livings to improve tenant sleep. They also suggest that improved sleep may help reduce PSH tenant pain, impairment, and mental health symptoms among PSH tenants.

Neighborhood Social Cohesion and Sleep Health by Age, Sex/Gender, and Race/Ethnicity in the United States

Although low neighborhood social cohesion (nSC) has been linked with poor sleep, studies of racially/ethnically diverse participants using multiple sleep dimensions remain sparse. Using National Health Interview Survey data, we examined overall, age, sex/gender, and racial/ethnic-specific associations between nSC and sleep health among 167,153 adults. Self-reported nSC was categorized into low, medium, and high. Very short sleep duration was defined as <6 h; short as <7 h, recommended as 7–9 h, and long as ≥9 h. Sleep disturbances were assessed based on trouble falling and staying asleep, waking up feeling unrested, and using sleep medication (all ≥3 days/times in the previous week). Adjusting for sociodemographics and other confounders, we used Poisson regression with robust variance to estimate prevalence ratios (PRs) and 95% confidence intervals (CIs) for sleep dimensions by low and medium vs. high nSC. The mean age of the sample was 47 ± 0.1 years, 52% of those included were women, and 69% were Non-Hispanic (NH)-White. Low vs. high nSC was associated with a higher prevalence of very short sleep (PR = 1.29; (95% CI = 1.23–1.36)). After adjustment, low vs. high nSC was associated with very short sleep duration among NH-White (PR = 1.34 (95% CI = 1.26–1.43)) and NH-Black (PR = 1.14 (95% CI = 1.02–1.28)) adults. Low nSC was associated with shorter sleep duration and sleep disturbances.

Sociodemographic and environmental factors associated with childhood sleep duration

OBJECTIVES

This study investigates sociodemographic and environmental correlates of sleep duration among school-aged children.

DESIGN & SETTING

The New York City 2009 Child Community Health Survey was analyzed using weighted regression analyses.

PARTICIPANTS

1293 Asian, Black, Latino and White children ages 6-12 years, 999 children in Pre-K - 5th grade and 294 children in the 6th-8th grades.

MEASUREMENTS

Parents/guardians completed a survey about the target child's sleep duration on a typical school night/day, and sociodemographic and household characteristics.

RESULTS

Most children (89.3%) met the National Sleep Foundation's (NSF) recommendation of 9-11 h of sleep per night. Pre-K-5th grade children who were born in the United States were less likely than children born outside of the United States to sleep 9-11 h. When sleep duration was examined continuously, children slept an average of 9 h 44 min. On average, with each additional year of age, children slept 7.2 min less than children who were one year younger. Although there were no differences among ethnic/racial groups in sleeping the recommended 9-11 h/night, when sleep duration was measured as a continuous variable, Asian, Latino, and Black children slept an average of 23, 14, and 17 min fewer, respectively, than White children, adjusting for sociodemographic and environmental factors.

CONCLUSIONS

Sleep duration varied across sociodemographic groups of children in New York City in 2009. Future studies should determine causal influences and whether these differences persist.

Psychometric properties of sleep hygiene index in Indonesian adolescents

Background: Sleep is associated with some behavioral factors such as maladaptive, which tend to disrupt its normal mechanism, therefore, a tool is needed to measure maladaptive sleep hygiene. This study aims to assess the psychometric properties of sleep hygiene index (SHI), translation, factor structure, validity, and reliability. Design and Methods: Data were collected from 101 Indonesia adolescents in junior high school, with SHI-Indonesia translated based on WHO guideline. The obtained data were analyzed using varimax rotation, while the convergent validity was evaluated by calculating the correlation between the item and total score. In addition, the Cronbach's alpha was computed to investigate internal consistency, and two-week interval test-retest was conducted to assess reliability. Results: SHI is a unidimensional factor structure with an excellent test-retest reliability of P<0.001 at 0.618, and a positive convergent validity correlation between each item and the total score. Conclusions: The SHI Bahasa translation is a reliable and valid tool to assess maladaptive sleep hygiene among Indonesia Adolescents.

Mental health and sleep disparities in an urban college sample: A longitudinal examination of White and Black students

OBJECTIVE

Racial disparities in sleep may be consequential among college students given high rates of dysfunctional sleep among this population. The present study sought to investigate whether disparities in sleep explain existing mental health disparities.

METHOD

Data included secondary analysis of a college risk behaviors and health study (n = 1242, mean age = 18.5). Race was dichotomized as White or Black, excluding all others, with participants completing measures of sleep at baseline and measures of depression and anxiety at follow-up 1 to 2 years later.

RESULTS

Compared to White students, Black students were more likely to report lower rates of depression and anxiety, but poorer sleep outcomes. Mediation analyses revealed that sleep partially mediated (suppressed) the association between race and depressive and anxiety symptoms.

CONCLUSIONS

Results indicate that disparities in sleep may play an important role in the association between race and mental health symptoms among college students. Future health disparity research would benefit from exploring the potentially bidirectional relationship between sleep and mental health symptoms among college students.

Sleep Health in Women of Childbearing Age

The concept of sleep health (adequate sleep duration and continuity, regular timing, satisfaction with sleep, and ability to maintain wakefulness during the day) is consistent with a definition of health as more than the absence of disease. Yet past research on women's sleep focused primarily on biological influences (e.g., hormonal fluctuations) or specific sleep disorders. We reviewed the literature on sleep health in women of childbearing age from the perspectives of health promotion and the social ecological model and identified needs for future research and intervention. At least 40% of women of childbearing age report inadequate sleep, and sleep is associated with short- and long-term health and performance outcomes. Numerous sociodemographic, psychosocial, role, familial, and community factors contribute to sleep, but few studies have addressed the contributions of these factors to sleep health in women of childbearing age, aside from those who are pregnant. Understanding these factors may assist in identifying women at particular risk for sleep difficulty; some may be modifiable, and other may signal the need for sleep interventions tailored to specific circumstances. Low-income women and those in ethnic and racial minority groups are at particular risk for disparities in sleep health. There is a need for research that addresses these factors and the development of interventions at the individual, family, and community levels to promote sleep health. Screening and intervention to promote health sleep and decrease sleep difficulty should be a standard of care in clinical, community, and workplace settings frequented by women.

Sleep-related attitudes, beliefs, and practices among an urban-dwelling African American community: a qualitative study

OBJECTIVES

Short sleep duration and poor sleep quality are more prevalent among African Americans (AAs) and may be a modifiable risk factor for cardiometabolic disorders. However, research is limited about sleep-related attitudes, beliefs, and practices among AAs. Our objective was to evaluate these practices and beliefs surrounding sleep among urban-dwelling AAs.

DESIGN

Qualitative study comprised of five 90-minute focus groups using a semistructured interview guide.

SETTING

Five churches located on the west side of Chicago.

PARTICIPANTS

Adults (N = 43) ages 25-75 years.

MEASUREMENTS

Transcripts were voice recorded, transcribed, and then coded for content analysis using NVivo 12 Pro to capture themes in the discussions.

RESULTS

Most participants (86%) reported sleeping less than the recommended 7 or more hours. The discrepancy between actual and desired sleep duration was nearly 3 hours per night. Participants reported that sleep is essential for mental and physical health. Napping and consuming caffeine were frequently reported techniques for coping with lack of sleep. Noise, physical discomfort, and stress were reported as barriers to sleep, and participants reported using TV and other electronics to cope with racing thoughts or worry. Many participants were diagnosed with or knew someone with obstructive sleep apnea, but few participants had been diagnosed with insomnia or were aware of nonpharmacologic insomnia treatments.

CONCLUSION

A cycle of stress/disruptive environment, stress, rumination at night, and coping by use of electronics and daytime napping may perpetuate sleep disparities in this community. Results suggest that sleep-related interventions should include stress reduction and environmental improvements in addition to the typical sleep hygiene-related behavioral recommendations.