Perceived school safety, perceived neighborhood safety, and insufficient sleep among adolescents

Perceived childhood neighborhood safety and sleep health during childhood and adulthood among a cohort of African American women

OBJECTIVE

To investigate associations between perceived childhood neighborhood safety and sleep over the life course.

METHODS

Among a cohort of 1693 Black/African American women aged 23-35 years at enrollment (2010-2012), participants recalled neighborhood safety (safe vs. unsafe) when they were 5, 10, and 15 years old. Participants' mothers/caregivers and participants reported sleep-related health behaviors at age 5. We used ordinal logistic regression to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for sleep-related health behaviors (i.e., rarely/never or sometimes vs. mostly/always going to bed by 8:00 p.m., bed in a quiet room, bed in a dimly lit or unlit room), separately. Adulthood sleep duration and insomnia symptoms were reported at enrollment and over three follow-up periods. We applied generalized estimating equations to log binomial regression models to estimate relative risks (RR) for adulthood sleep characteristics.

RESULTS AND CONCLUSIONS

Four percent of participants reported an unsafe neighborhood at age 5 years, only, and 12% reported an unsafe neighborhood at all ages. Participants in perceived unsafe vs. safe neighborhoods at age 5 had higher odds of poor sleep-related health behaviors (e.g., rarely/never or sometimes going to bed in a quiet room: OR = 1.73 [1.27-2.35]). Participants in perceived unsafe vs. safe neighborhoods throughout childhood had higher risk of short sleep (RR = 1.10 [1.02-1.18]) and insomnia symptoms (RR = 1.07 [1.00-1.15]) during adulthood after adjustment for life course socioeconomic characteristics and adulthood health behaviors and characteristics. Perceived unsafe childhood neighborhood was associated with poorer sleep over the life course and may serve as an early intervention target.

Neighborhood and Household Environment as Contributors to Racial Disparities in Sleep Duration among U.S. Adolescents

Objective

Racial disparities in adolescent sleep duration have been documented, but pathways driving these disparities are not well understood. This study examined whether neighborhood and household environments explained racial disparities in adolescent sleep duration.

Methods

Participants came from Waves I and II of Add Health (n=13,019). Self-reported short sleep duration was defined as less than the recommended amount for age (<9 hours for 6-12 years, <8 hours for 13-18 years, and <7 hours for 18-64 years). Neighborhood factors included neighborhood socioeconomic disadvantage, perceived safety and social cohesion. Household factors included living in a single parent household and household socioeconomic status (HSES). Structural equation modeling was used to assess mediation of the neighborhood and household environment in the association between race/ethnicity and short sleep duration.

Results

Only HSES mediated racial disparities, explaining non-Hispanic (NH) African American-NH White (11.6%), NH American Indian-NH White (9.9%), and Latinx-NH White (42.4%) differences. Unexpectedly, higher HSES was positively associated with short sleep duration.

Conclusion

Household SES may be an important pathway explaining racial disparities in adolescent sleep duration. Future studies should examine mechanisms linking household SES to sleep and identify buffers for racial/ethnic minority adolescents against the detrimental impacts that living in a higher household SES may have on sleep.

Neighborhood environment and adolescent sleep: The role of family socioeconomic status

OBJECTIVES

Socioeconomic status (SES) and neighborhood context are influential predictors of adolescent sleep, yet little is known about how they may interact to influence sleep. We examined multiple dimensions of family SES as moderators of associations between neighborhood risk and multiple sleep parameters.

METHODS

Participants were 323 adolescents (Mage = 17.4 years, SD = 0.86; 48% male; 60% White/European American, 40% Black/African American). Sleep was assessed using 7 nights of actigraphy from which sleep duration (minutes from onset to wake time), efficiency, long wake episodes, and variability in minutes over the week were derived. Youth reported on their sleep/wake problems and sleepiness, as well as their perceptions of safety and violence in their neighborhoods. Parents reported on SES indices, including income-to-needs ratio and perceived financial stability.

RESULTS

Lower SES (income-to-needs, perceived financial stability) was associated with lower sleep efficiency and more frequent long wake episodes. Lower neighborhood safety and greater community violence concerns were related to greater subjective sleep problems. Moderation effects illustrated two general patterns. For actigraphy-derived sleep variables, lower neighborhood safety was associated with poor sleep only among youth from lower-income families. For subjective sleep/wake problems and daytime sleepiness, associations between neighborhood risk and sleep difficulties were pronounced for higher SES youth, while lower SES youth had greater sleep problems regardless of neighborhood factors.

CONCLUSIONS

Findings suggest that several dimensions of SES and neighborhood risk may be consequential for adolescents' sleep. Moderation effects highlight the significance of considering multiple contextual influences towards a better understanding of adolescents' sleep.

Sleep mediates the effect of stressful environments on youth development of impulsivity: The moderating role of within default mode network resting-state functional connectivity

OBJECTIVES

Youth raised in stressful environments are at increased risk for developing impulsive traits, which are a robust precursor of problem behaviors. Sleep may mediate the link between stress and problem behaviors as it is both sensitive to stress and essential for neurocognitive development underlying behavioral control during adolescence. The default mode network (DMN) is a brain network implicated in stress regulation and sleep. Yet, it is poorly understood how individual differences in resting-state DMN moderate the effect of stressful environments on impulsivity via sleep problems.

METHODS

Three waves of data spanning 2 years were obtained from the Adolescent Brain and Cognitive Development Study, a national longitudinal sample of 11,878 children (Mage at baseline = 10.1; 47.8% female). Structural equation modeling was used to test (a) the mediating role of sleep at T3 in the link between stressful environments at baseline and impulsivity at T5 and (b) the moderation of this indirect association by baseline levels of within-DMN resting-state functional connectivity.

RESULTS

Sleep problems, shorter sleep duration, and longer sleep latency significantly mediated the link between stressful environments and youth impulsivity. Youth with elevated within-DMN resting-state functional connectivity showed intensified associations between stressful environments and impulsivity via shorter sleep duration.

CONCLUSION

Our findings suggest that sleep health can be a target for preventive intervention and thereby mitigate the link between stressful environments and increased levels of youth impulsivity.

Feasibility and acceptability of mobile methods to assess home and neighborhood environments related to adolescent sleep

OBJECTIVE

A growing evidence base suggests home and neighborhood environmental exposures may influence adolescent sleep, but few studies have assessed these relationships using methods that account for time-varying, location-specific exposures, or multiple neighborhood contexts. This study aimed to assess the feasibility and acceptability of using smartphone global positioning system (GPS) tracking and ecological momentary assessment (EMA) to assess time-varying home and neighborhood environmental exposures hypothesized to be associated with adolescent sleep.

METHODS

Adolescents aged 15-17 years in Philadelphia completed 7 days of continuous smartphone GPS tracking, which was used to identify daily levels of exposure to geocoded neighborhood factors (eg, crime, green space). Four daily EMA surveys assessed home sleep environment (eg, noise, light), stress, health behaviors, and neighborhood perceptions. Feasibility and acceptability of GPS tracking and EMA were assessed, and distributions of daily environmental exposures were examined.

RESULTS

Among 25 teens (mean age 16, 56% male), there was a high level of GPS location data captured (median daily follow-up: 24 hours). Seventy-eight percent of EMA surveys were completed overall. Most participants (96%) reported no privacy concerns related to GPS tracking and minimal burden from EMA surveys. Exposures differed between participants' home neighborhoods and locations visited outside the home neighborhood (eg, higher crime away from home). Sleep environment disruptions were present on 29% of nights (most common: uncomfortable temperature) and were reported by 52% of adolescents.

CONCLUSIONS

Results demonstrate the feasibility and acceptability of mobile methods for assessing time-varying home and neighborhood exposures relevant to adolescent sleep for up to 1 week.

The role of perceived threats on mental health, social, and neurocognitive youth outcomes: A multicontextual, person-centered approach

Perceived threat in youth's environments can elevate risk for mental health, social, and neurocognitive difficulties throughout the lifespan. However, few studies examine variability in youth's perceptions of threat across multiple contexts or evaluate outcomes across multiple domains, ultimately limiting our understanding of specific risks associated with perceived threats in different contexts. This study examined associations between perceived threat in youth's neighborhood, school, and family contexts at ages 9-10 and mental health, social, and neurocognitive outcomes at ages 11-12 within a large US cohort (N = 5525) enrolled in the Adolescent Brain Cognitive DevelopmentSM Study (ABCD Study®). Latent profile analysis revealed four distinct profiles: Low Threat in all contexts, Elevated Family Threat, Elevated Neighborhood Threat, and Elevated Threat in all contexts. Mixed-effect models and post hoc pairwise comparisons showed that youth in Elevated Threat profile had poorer mental health and social outcomes 2 years later. Youth in the Elevated Family Threat profile uniquely showed increased disruptive behavior symptoms, whereas youth in the Elevated Neighborhood Threat profile predominantly displayed increased sleep problems and worse neurocognitive outcomes 2 years later. Together, findings highlight the importance of considering perceptions of threat across multiple contexts to achieve a more nuanced developmental picture.

Supporting student learning and development through trauma-informed campuses

Many students come to higher education with a history of trauma. College life may also expose students to traumatizing events. While the past decade has witnessed greater discussion of trauma-informed frameworks, it has not regularly been applied to the college environment. We advance the concept of a trauma-informed campus, where administrators, faculty, staff, and students from diverse disciplines create an environment that recognizes the widespread nature of trauma, integrates knowledge about trauma into practices and procedures, and minimizes further re-traumatization for all community members. A trauma-informed campus is prepared for students' past or future traumatic experiences, while also recognizing and responding to structural and historical harms. In addition, it recognizes the role of the surrounding community challenges, particularly how violence, substance use, hunger, poverty, and housing insecurity may contribute to further trauma or negatively impact healing. We use an ecological model to frame and shape the construct of trauma-informed campuses.

Sleep duration, depressive symptoms, and digital self-harm among adolescents

BACKGROUND

This study examines the relationship between sleep duration, depression, and engagement in a novel cyber behavior, digital self-harm, among adolescents.

METHOD

Logistic regression analyses were conducted using cross-sectional data from the 2019 Florida Youth Substance Abuse Survey (N = 9,819; 48% male; avg. grade level = 9th grade [SD = 1.9]) to analyze the association between sleep duration and digital self-harm. A Karlson-Holm-Breen (KHB) analysis was used to assess whether depressive symptoms attenuate this association.

RESULTS

Bivariate results indicated that longer sleep duration was associated with lower incidence of digital self-harm. Multivariate results showed that sleep duration was inversely associated with engaging in digital self-harm, net of all covariates. Depressive symptoms attenuated the influence of sleep duration on digital self-harm by 50.72%.

CONCLUSIONS

Both insufficient sleep and depressive symptoms were associated with engagement in digital self-harm among adolescents. Prospective research is needed, however, to confirm this pathway. Practitioners and clinicians should consider discussing digital self-harm with adolescents and parents, especially if adolescents are experiencing poor sleep and depressive symptoms.

A quasi-experimental study of parent and child well-being in families of color in the context of COVID-19 related school closure

Families of color living in historically disinvested neighborhoods face a multitude of health disparities which have been exacerbated by COVID-19 and the resulting strategies to mitigate its transmission. School closure, which occurred with little warning and few, if any, resources for preparation, disrupted multiple aspects of families' lives; these disruptions are anticipated to adversely impact mental health and well-being. The current study aims to advance understanding of the experiences of families of young children of color during the pandemic by utilizing a natural experiment design to test impact on child and parent mental health and sleep in the context of COVID-19 related school closure among families in historically disinvested neighborhoods. Data from this study come from an ongoing study of 281 families of color enrolled in 41 pre-kindergarten (pre-K) programs in neighborhoods across New York City (NYC). In NYC, school closure occurred on March 16, 2020, during a data collection period involving phone surveys with parents; the quasi-experimental design allows for comparison of the 198 families who had completed the survey prior to March 16, and the 83 families who completed the survey after March 16, using identical protocols and procedures. Results demonstrate poorer mental health among parents surveyed after school closure as compared to before school closure. No differences were found for parent sleep, child mental health, or child sleep. Implications of this work highlight the need for structural and systemic supports for families faced with compounding stressors as a result of the COVID-19 pandemic and related school closure.

Neighborhood Disadvantage Is Associated with Lower Quality Sleep and More Variability in Sleep Duration among Urban Adolescents

Differential social and contextual environments may contribute to adolescent sleep disparities, yet most prior studies are limited to self-reported sleep data and have not been conducted at a national level, limiting the variation in neighborhood contexts. This study examined the association between neighborhood disadvantage and objective measures of adolescent sleep. A racially and geographically diverse sample of American adolescents (N = 682) wore wrist-worn accelerometers, "actigraphs," for ≥ 5 nights. Neighborhood disadvantage was calculated using a standardized index of neighborhood characteristics (proportion of female-headed households, public assistance recipients, households in poverty, adults without high school degrees, and unemployed). Adolescents in more disadvantaged neighborhoods spent more time awake after falling asleep (4.0 min/night, p < .05), a greater percentage of nighttime sleep intervals awake (1%, p < .01), and had less consistent sleep duration (11.6% higher standard deviation, p < .05). Sleep duration and timing did not differ across neighborhood groups. These findings demonstrate that adolescents who live in more disadvantaged neighborhoods have lower quality, less consistent sleep.

Sleep, Classroom Behavior, and Achievement Among Children of Color in Historically Disinvested Neighborhoods

Children of color are more likely to have poor sleep health than White children, placing them at risk for behavioral problems in the classroom and lower academic performance. Few studies, however, have utilized standardized measures of both classroom behavior and achievement. This study examined whether children's sleep (parent and teacher report) in first grade concurrently related to independent observations of classroom behavior and longitudinally predicted achievement test scores in second grade in a sample of primarily Black (86%) children (n = 572; age = 6.8) living in historically disinvested neighborhoods. Higher teacher-reported child sleepiness was associated with lower adaptive behaviors and higher problem behaviors in the classroom, and predicted lower achievement. Parent-reported bedtime resistance and disordered breathing also predicted lower achievement.

Opportunities to improve sleep of children exposed to interpersonal violence: A social-ecological perspective

Over 25% of U.S. children are witness to traumatic intrafamilial or community violence each year, and sleep medicine and developmental research jointly suggest that trauma-exposed youth experience more sleep disturbance than their non-exposed counterparts. Sleep medicine literature emphasizes physical and social environmental factors affecting sleep, and trauma literature underscores children's seeking out physically and emotionally safe and predictable environments during trauma recovery. This study employed a hermeneutic phenomenological framing to explore the lived experiences of 65 violence-exposed children and families, and to examine how youths' social and physical sleep environments facilitated or impeded sleep in the aftermath of trauma. Children's sleep experiences following violence exposure shared two primary essences of experience: a) navigating external threats that agitated sleep after trauma; and b) exercising agency over sleep and related environments to restabilize emotional security. Clinicians and social services coordinators working with children and families are uniquely positioned to indicate sleep assessments as part of treatment following trauma, and to also facilitate identification of tangible, sleep-supportive and changeable factors in sleep environments.

Neighborhood environments and sleep among children and adolescents: A systematic review

Understanding salient environmental determinants of pediatric sleep is essential for informing interventions and public health initiatives. Emerging evidence suggests that the neighborhood environment can impact pediatric sleep, but this evidence has not yet been systematically reviewed. We conducted a systematic review of the scientific literature on associations between neighborhood environments and sleep in young children (0-5 y), school-aged children (6-12 y) and adolescents (13-18 y). We reviewed 85 articles published between 2003 and 2020. The most commonly examined neighborhood exposure was low socioeconomic status (40 studies), which was associated with sleep outcomes in 58% of studies (primarily shorter sleep duration, later sleep timing, or obstructive sleep apnea). Evidence was stronger for neighborhood safety/crime/violence (21 studies), with 86% of studies reporting associations with sleep outcomes (primarily self- or caregiver-reported sleep problems). Fewer studies examined associations of neighborhood physical environment exposures, including noise (15 studies), the built environment (seven studies), and air pollution (six studies). Limitations of the current body of evidence include 1) limited examination of neighborhood exposures other than socioeconomic status or safety, 2) use of primarily cross-sectional observational study designs, 3) lack of objective sleep outcome assessment, and 4) limits of current exposure assessment methods.

Feeling Unsafe at School and Associated Mental Health Difficulties among Children and Adolescents: A Systematic Review

This study systematically reviewed the literature on perceived school safety. We investigated the prevalence, factors and associated mental health difficulties, as well as cross-cultural findings. Five databases were searched up to 9 February 2021 for peer-reviewed papers published in English. We included quantitative studies that explored the perception of school safety among children and adolescents. The reference lists of the selected papers were also searched. We conducted a narrative synthesis of the included studies. The review included 43 papers. The mean prevalence of the students who felt unsafe at school was 19.4% and ranged from 6.1% to 69.1%. Their perceived safety was associated with a wide range of personal, school, and social factors. Not feeling safe at school was related to being victimized and mental health difficulties, including depressive symptoms and suicidal behavior. Higher perceived school safety was associated with measures such as the presence of a security officer and fair school rule enforcement. The results showed the lack of cross-cultural studies on perceived school safety. Empirical studies are needed that examine the mechanisms of school safety, using valid measures. A clear definition of school safety should be considered a key aspect of future studies.

The association between excessive screen-time behaviors and insufficient sleep among adolescents: Findings from the 2017 youth risk behavior surveillance system

Although studies have examined the association between television viewing and poor sleep quality, few studies have considered the association between excessive screen-time behaviors and insufficient sleep among adolescents drawing on a large nationally representative sample. The objective of this study was to examine the association between excessive screen-time behaviors and insufficient sleep among adolescents. Data for this study came from the 2017 Youth Risk Behavior Survey. A sample of 14,603 adolescents aged 14-18 years (51.5% female) was analyzed using logistic regression with insufficient sleep as the outcome variable and excessive screen-time behaviors as the main explanatory variable. Of the 14,603 adolescents, almost three out of four (74.8%) had less than 8 h of sleep on an average school night, and about 43% engaged in excessive screen-time behaviors on an average school day. Controlling for all other predictors, odds were 1.34 times higher for adolescents who engaged in excessive screen-time behaviors to have insufficient sleep when compared to adolescents who did not engage in excessive screen-time behaviors (AOR = 1.34, p < .001, 95% CI = 1.22-1.48). School-based behavior interventions that focus on reduction in excessive screen-time and sedentary behaviors might be beneficial in reducing excessive screen-time behaviors and consequently improve sleep quality among adolescents.