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Dong L, Brown RA, Palimaru AI, D’Amico EJ, Dickerson DL, Klein DJ, Johnson CL, Troxel WM. Enhancing sleep health in urban American Indian/Alaska Native adolescents: Implications for culturally tailored interventions. J Adolesc 2024; 96:1316-1327. [PMID: 38757459 PMCID: PMC11303116 DOI: 10.1002/jad.12350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 05/04/2024] [Accepted: 05/06/2024] [Indexed: 05/18/2024]
Abstract
BACKGROUND Urban American Indian/Alaska Native (AI/AN) adolescents are vulnerable to sleep and other health-related disparities due to numerous social drivers, including historical trauma and relocation to urban areas. This study aims to identify strategies to increase protective factors and culturally tailor sleep health interventions for this population. METHODS Using community-based participatory research, the NAYSHAW study conducted in-depth interviews with urban AI/AN adolescents aged 12-19 years to understand critical components needed for developing a culturally sensitive sleep health intervention. Data from two qualitative subsamples (N = 46) and parent surveys (N = 110) were analyzed, focusing on factors that affect sleep health behaviors, including parental involvement, technology, and traditional practices. RESULTS Key findings include the detrimental impact of electronics use at night and protective effects of traditional practices on sleep. Parental involvement in sleep routines varied by adolescent's age. Adolescents desired sleep health education in interactive formats, whereas parents preferred workshops and digital applications for sleep health strategies. Findings suggest that interventions need to address electronics use and should also be culturally tailored to address the unique experiences of urban AI/AN adolescents. CONCLUSIONS Results underscore the importance of utilizing community-based strategies to develop culturally tailored sleep interventions for underserved populations, specifically urban AI/AN adolescents. Integrating traditional practices with evidence-based sleep health strategies can provide a holistic approach to improving sleep and overall well-being. Parental education and involvement will be critical to the success of such interventions.
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Affiliation(s)
- Lu Dong
- RAND Corporation, Santa Monica, CA
| | | | | | | | - Daniel L. Dickerson
- UCLA Integrated Substance Abuse Programs (ISAP), Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA
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Moise R, Chery M, Wyrick M, Zizi F, Seixas A, Jean-Louis G. Photovoice for leveraging traditional, complementary, and integrative medicine amongst black adults to improve sleep health and overall health. Front Public Health 2024; 12:1359096. [PMID: 39114505 PMCID: PMC11303969 DOI: 10.3389/fpubh.2024.1359096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 06/14/2024] [Indexed: 08/10/2024] Open
Abstract
Introduction Average adults are recommended to have 7-8 h of sleep. However insufficient sleep (IS defined as <7 h/nightly) is associated with increased risk of chronic diseases such as cardiovascular disease (CVD) and type 2 diabetes mellitus (T2DM). Traditional, complementary, and integrative medicine (TCIM), a burgeoning area of research and practice, leverages both modern and traditional approaches to improve health. Despite TCIM's recognition as a tool to improve sleep and related outcomes, there is a gap in literature in addressing its impact among black individuals, who experience a disproportionate burden of IS and chronic disease. This qualitative study aimed to increase understanding of TCIM practices to overcome IS and overall health in black communities. Methods Using photovoice methodology, a qualitative tool which applies community-engaged principles to produce culturally informed results through interviews and digital media, consented participants were recruited from Miami, Florida and (1) instructed to capture images over one week that communicated their TCIM to improve sleep and overall health on their mobile device; (2) interviewed using individual, semi-structured procedures to add "voice" to the "photos" they captured for ~20 min; and (3) invited to participate in follow-up focus groups for refined discussion and data triangulation for ~1.5 h. Both individual and focus group interviews were conducted over Zoom with recordings transcribed for formal content analysis using Nvivo software. Results The sample included N = 25 diverse US black individuals (M = 37, SD = 13, range 21-57). Approximately a quarter of the sample were unemployed (N = 7) and majority were women (N = 21). Results highlighted five themes including: (1) natural wellness (sleep supplements, comfort beverages, aromatherapy, herbalism, outdoors); (2) self-care (self-maintenance, physical activity, spatial comfort); (3) leisure (pet support, play); (4) mental stimulation (mindfulness, reading); and (5) spiritual wellness (faith-based practices). Study results elucidate the heterogeneity of diverse US black individuals regarding sociocultural knowledge, beliefs, and behaviors. Conclusion Addressing IS in black communities requires a comprehensive strategy that integrates cultural sensitivity, family and community dynamics, education, mental health support, and informed policymaking. Future studies should consider how sleep health literacy, stress appraisal, and coping strategies may vary by race/ethnicity for tailored intervention.
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Affiliation(s)
- Rhoda Moise
- Department of Psychiatry, Center for Translational Sleep and Circadian Sciences, University of Miami Miller School of Medicine, Miami, FL, United States
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Maurice Chery
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Mykayla Wyrick
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Ferdinand Zizi
- Department of Psychiatry, Center for Translational Sleep and Circadian Sciences, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Azizi Seixas
- Department of Psychiatry, Center for Translational Sleep and Circadian Sciences, University of Miami Miller School of Medicine, Miami, FL, United States
- Media and Innovation Lab, Department of Informatics and Health Data Science, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Girardin Jean-Louis
- Department of Psychiatry, Center for Translational Sleep and Circadian Sciences, University of Miami Miller School of Medicine, Miami, FL, United States
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Novak JR, Miller KC, Gunn HE, Troxel WM. Yours, mine, or ours? Dyadic sleep hygiene and associations with sleep quality, emotional distress, and conflict frequency in mixed-gender, bed-sharing couples. J Sleep Res 2024; 33:e14047. [PMID: 37749792 DOI: 10.1111/jsr.14047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 07/28/2023] [Accepted: 09/11/2023] [Indexed: 09/27/2023]
Abstract
Although prior research demonstrates the interdependence of sleep quality within couples (i.e., the sleep of one partner affects the sleep of the other), little is known about the degree to which couples' sleep hygiene behaviours are concordant or discordant, and if one's own sleep hygiene or their report of their partners' sleep hygiene is related to worse relational, psychological, and sleep outcomes. In a sample of 143 mixed-gender, bed-sharing couples, each partner completed an online questionnaire consisting of the Sleep Hygiene Index (for themselves and their partner), PROMIS sleep disturbance scale, conflict frequency, PHQ-4 for anxiety and depressive symptoms, and the Perceived Stress Scale. Paired samples t-tests between partners were conducted using total and individual-item Sleep Hygiene Index scores to examine similarities and differences. Intraclass correlation coefficient (ICC) scores of dyadic reports were conducted to examine the level of agreement between each partner's sleep hygiene. Finally, we examined associations between one's own sleep hygiene and their report of their partner's sleep hygiene with both partner's sleep quality, emotional distress, and conflict frequency in a dyadic structural equation model with important covariates and alternative model tests. The results revealed a significant difference between men's (M = 14.45, SD = 7.41) and women's total score self-report sleep hygiene ([M = 17.67, SD = 8.27]; t(142) = -5.06, p < 0.001) and partners only had similar sleep hygiene for 5 out of the 13 items. Examining dyadic reports of sleep hygiene revealed that partners had moderate agreement on their partners' sleep hygiene (0.69-0.856). The results from the dyadic structural equation model revealed that poorer sleep hygiene was associated with one's own poor sleep quality, higher emotional distress, and more frequent relational conflict. For both men and women a poorer report of a partner's sleep hygiene was associated with one's own report of higher relationship conflict. Finally, men's poorer report of a partner's sleep hygiene was related better to their own sleep quality but was related to poorer sleep quality for their partners. These results have implications for sleep promotion and intervention efforts as well as for couple relationship functioning.
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Affiliation(s)
- Josh R Novak
- Department of Human Development and Family Science, Auburn University, Auburn, Alabama, USA
| | - Kaleigh C Miller
- Department of Human Development and Family Science, Auburn University, Auburn, Alabama, USA
| | - Heather E Gunn
- Department of Psychology, University of Alabama, Tuscaloosa, Alabama, USA
| | - Wendy M Troxel
- Department of Behavior and Policy Sciences, RAND Corporation, Pittsburgh, Pennsylvania, USA
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Chen E, Jiang T, Chen MA, Miller GE. Reflections on resilience. Dev Psychopathol 2024:1-8. [PMID: 38389301 PMCID: PMC11341778 DOI: 10.1017/s0954579424000403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2024]
Abstract
Resilience research has long sought to understand how factors at the child, family, school, community, and societal levels shape adaptation in the face of adversities such as poverty and war. In this article we reflect on three themes that may prove to be useful for future resilience research. First is the idea that mental and physical health can sometimes diverge, even in response to the same social process. A better understanding of explanations for this divergence will have both theoretical and public health implications when it comes to efforts to promote resilience. Second is that more recent models of stress suggest that stress can accelerate aging. Thus, we suggest that research on resilience may need to also consider how resilience strategies may need to be developed in an accelerated fashion to be effective. Third, we suggest that if psychological resilience interventions can be conducted in conjunction with efforts to enact system-level changes targeted at adversities, this may synergize the impact that any single intervention can have, creating a more coordinated and effective set of approaches for promoting resilience in young people who confront adversity in life.
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Affiliation(s)
- Edith Chen
- Department of Psychology and Institute for Policy Research, Northwestern University, Evanston, IL, USA
| | - Tao Jiang
- Department of Psychology and Institute for Policy Research, Northwestern University, Evanston, IL, USA
| | - Michelle A Chen
- Department of Psychology and Institute for Policy Research, Northwestern University, Evanston, IL, USA
| | - Gregory E Miller
- Department of Psychology and Institute for Policy Research, Northwestern University, Evanston, IL, USA
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5
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Johnson DA, Wallace DA, Ward L. Racial/ethnic and sex differences in the association between light at night and actigraphy-measured sleep duration in adults: NHANES 2011-2014. Sleep Health 2024; 10:S184-S190. [PMID: 37951773 PMCID: PMC11031299 DOI: 10.1016/j.sleh.2023.09.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 09/18/2023] [Accepted: 09/22/2023] [Indexed: 11/14/2023]
Abstract
OBJECTIVE Historically minoritized individuals experience greater exposure to light at night, yet it is unclear whether the association between light at night and sleep duration vary by race/ethnicity or sex. We examined the association between light at night and sleep duration by race/ethnicity and sex. METHODS Participants (N = 6089, mean age=49.5, 52% women, 13% Asian, 27% Black, 14% Mexican, 46% White) in the 2011-2014 National Health and Nutrition Examination Survey underwent 9-day of actigraphy. Light at night was defined as light exposure within the 5-hour activity nadir (L5). Sleep duration within a 24-hour period was analyzed as short (<7 hours) or long (>9 hours) compared to recommended (≥7 and <9 hours). Poisson models were fit to estimate the association between light at night and sleep duration after adjustment for covariates. RESULTS Light at night was most common among Black participants, who also had the shortest sleep duration. Overall, light at night was associated with 80% higher prevalence of short sleep duration [1.80 (1.49, 2.18)]. Compared to no-light at night, low and high light at night were associated with higher prevalence of short sleep duration, [1.61 (1.31, 1.98) and 2.01 (1.66, 2.44), respectively]. Associations varied by race/ethnicity and sex. Light at night was associated with shorter sleep duration in Black, Mexican and White females and Mexican and White males only. Black males exposed to light at night vs. no-light at night had lower prevalence of long sleep duration. There were no associations between light at night and sleep duration among Asian participants. CONCLUSION Light at night was associated with shorter sleep duration, particularly among females. Targeting light exposure may help to improve sleep duration.
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Affiliation(s)
- Dayna A Johnson
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA.
| | - Danielle A Wallace
- Department of Medicine, Division of Sleep Medicine, Harvard Medical School, Boston, Massachusetts, USA; Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Laura Ward
- Department of Biostatistics and Informatics, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
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Yeo AJ, Cohenuram A, Dunsiger S, Boergers J, Kopel SJ, Koinis-Mitchell D. The Sleep Environment, Napping, and Sleep Outcomes among Urban Children With and Without Asthma. Behav Sleep Med 2024; 22:76-86. [PMID: 36843326 PMCID: PMC10457429 DOI: 10.1080/15402002.2023.2184369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/28/2023]
Abstract
OBJECTIVES Children with asthma living in U.S. urban neighborhoods experience increased risk for asthma morbidity and poor sleep outcomes. In addition to asthma, environmental factors (e.g. noise, uncomfortable temperature, light exposure) related to urban poverty may disturb children's sleep. This study examined the association between environmental factors and sleep outcomes among urban children with and without asthma, and whether napping underlies the environment-sleep link. Additionally, the study tested whether these associations differed by health status (i.e. asthma) or race/ethnicity. METHOD Participants included urban children aged 7-9 years with (N = 251) and without (N = 130) asthma from Latino, Black, or non-Latino White (NLW) background. Caregivers reported sleep environmental factors and naps. Sleep duration, efficiency, and nightly awakenings were assessed via actigraphy. RESULTS Regardless of health status, frequent exposure to noise and light was associated with poorer sleep outcomes only among Latino children. In the full sample with and without asthma, noise exposure during nighttime sleep was related to more frequent daytime naps, which were linked to shorter nighttime sleep duration. CONCLUSIONS Exposure to noise and light may play a particularly influential role in shaping urban children's sleep outcomes. Racial/ethnic differences and the potential mediating role of napping in this environment-sleep association may inform tailored interventions.
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Affiliation(s)
- Anna J Yeo
- Bradley Hasbro Children's Research Center, Hasbro Children's Hospital, Providence, RI, USA
- The Warren Alpert Medical School of Brown University, Providence, RI, USA
- Center for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI, USA
| | - Anna Cohenuram
- Bradley Hasbro Children's Research Center, Hasbro Children's Hospital, Providence, RI, USA
| | - Shira Dunsiger
- Department of Behavioral and Social Sciences, School of Public Health, Brown University, Providence, RI, USA
| | - Julie Boergers
- Bradley Hasbro Children's Research Center, Hasbro Children's Hospital, Providence, RI, USA
- The Warren Alpert Medical School of Brown University, Providence, RI, USA
- Department of Pediatrics, Hasbro Children's Hospital/Rhode Island Hospital, Providence, RI, USA
| | - Sheryl J Kopel
- Bradley Hasbro Children's Research Center, Hasbro Children's Hospital, Providence, RI, USA
- The Warren Alpert Medical School of Brown University, Providence, RI, USA
- Department of Pediatrics, Hasbro Children's Hospital/Rhode Island Hospital, Providence, RI, USA
| | - Daphne Koinis-Mitchell
- Bradley Hasbro Children's Research Center, Hasbro Children's Hospital, Providence, RI, USA
- The Warren Alpert Medical School of Brown University, Providence, RI, USA
- Department of Pediatrics, Hasbro Children's Hospital/Rhode Island Hospital, Providence, RI, USA
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7
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Johnson LCM, Bosque L, Jagtiani A, Barber LE, Gujral UP, Johnson DA. Attitudes and beliefs about sleep health among a racially and ethnically diverse sample of overweight/obese adults. Sleep Health 2023; 9:846-851. [PMID: 37730475 PMCID: PMC10840752 DOI: 10.1016/j.sleh.2023.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 07/12/2023] [Accepted: 08/14/2023] [Indexed: 09/22/2023]
Abstract
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.
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Affiliation(s)
- Leslie C M Johnson
- Department of Family and Preventative Medicine, Emory School of Medicine, Emory University, Atlanta, Georgia, USA.
| | - Laura Bosque
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Ashna Jagtiani
- Department of Pediatrics, Emory School of Medicine, Emory University, Atlanta, Georgia, USA
| | - Lauren E Barber
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Unjali P Gujral
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Dayna A Johnson
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
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8
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Vargas I, Egeler M, Walker J, Benitez DD. Examining the barriers and recommendations for integrating more equitable insomnia treatment options in primary care. FRONTIERS IN SLEEP 2023; 2:1279903. [PMID: 39210962 PMCID: PMC11361330 DOI: 10.3389/frsle.2023.1279903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/04/2024]
Abstract
Chronic insomnia is the most common sleep disorder, occurring in ~32 million people in the United States per annum. Acute insomnia is even more prevalent, affecting nearly half of adults at some point each year. The prevalence of insomnia among primary care patients is even higher. The problem, however, is that most primary care providers do not feel adequately knowledgeable or equipped to treat sleep-related concerns. Many providers have never heard of or have not been trained in cognitive behavioral therapy for insomnia or CBT-I (the first line treatment for insomnia). The focus of the current review is to summarize the factors contributing to why sleep health and insomnia treatment have been mostly neglected, identify how this has contributed to disparities in sleep health among certain groups, particularly racial and ethnic minorities and discuss considerations or potential areas of exploration that may improve access to behavioral sleep health interventions, particularly in primary care.
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Affiliation(s)
- Ivan Vargas
- Department of Psychological Science, University of Arkansas, Fayetteville, AR, United States
| | - Mara Egeler
- Department of Psychological Science, University of Arkansas, Fayetteville, AR, United States
| | - Jamie Walker
- Department of Psychological Science, University of Arkansas, Fayetteville, AR, United States
| | - Dulce Diaz Benitez
- Department of Psychological Science, University of Arkansas, Fayetteville, AR, United States
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Eglovitch M, Parlier-Ahmad AB, Legge C, Chithranjan S, Kolli S, Violante S, Dzierzewski JM, Huhn AS, Wilkerson A, Martin CE. Patient reported preferences for sleep interventions among women receiving buprenorphine for opioid use disorder. Front Psychiatry 2023; 14:1244156. [PMID: 37779614 PMCID: PMC10537926 DOI: 10.3389/fpsyt.2023.1244156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 08/29/2023] [Indexed: 10/03/2023] Open
Abstract
Aim Among individuals receiving medication for OUD (MOUD), insomnia is highly prevalent and increases the risk for negative OUD outcomes. However, little is known about MOUD patient-reported preferences for insomnia treatments among women with OUD. This mixed-methods study explored acceptability of and patient preferences for sleep interventions among women in OUD treatment. Methods This is an analysis from an ongoing cross-sectional survey and interview study investigating the relationship between sleep and OUD recovery. The parent study is actively enrolling non-pregnant women between 18-45 years stabilized on buprenorphine from an outpatient program. Participants complete measures including the Insomnia Severity Index (ISI), with scores of ≥10 identifying clinically significant insomnia symptoms. A sub-sample who met this threshold completed semi-structured interviews. Descriptive statistics were generated for survey responses, and applied thematic analysis was used for interview data. Results Participants selected for the qualitative interview (n = 11) highlighted prior positive and negative experiences with sleep treatments, challenges with employing non-pharmacological sleep strategies, and preferences for both medical and behavioral sleep interventions while in recovery. Women emphasized the need for flexibility of sleep therapy sessions to align with ongoing social determinants (e.g., caregiving responsibilities) as well as for sleep medications without sedating effects nor risk of dependency. Conclusions Many women receiving MOUD have concomitant insomnia symptoms, and desire availability of both pharmacologic and behavioral sleep interventions within the OUD treatment setting. Qualitative findings underscore the need for evidence-based sleep interventions that account for the unique socioenvironmental factors that may impact strategy implementation in this population.
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Affiliation(s)
- Michelle Eglovitch
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, United States
| | | | - Catherine Legge
- School of Medicine, Virginia Commonwealth University, Richmond, VA, United States
| | - Sajanee Chithranjan
- School of Medicine, Virginia Commonwealth University, Richmond, VA, United States
| | - Saisriya Kolli
- School of Medicine, Virginia Commonwealth University, Richmond, VA, United States
| | - Stephanie Violante
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, United States
| | | | | | - Allison Wilkerson
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, United States
| | - Caitlin Eileen Martin
- Institute for Drug and Alcohol Studies, Virginia Commonwealth University, Richmond, VA, United States
- Department of Obstetrics and Gynecology, School of Medicine, Virginia Commonwealth University, Richmond, VA, United States
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10
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Johnson LCM, Aiello JJ, Jagtiani A, Moore KN, Barber L, Gujral UP, Johnson DA. Feasibility, appropriateness, and acceptability of a mobile mindfulness meditation intervention to improve sleep quality among a racially/ethnically diverse population. Sleep Health 2023; 9:196-202. [PMID: 36371380 PMCID: PMC10122694 DOI: 10.1016/j.sleh.2022.09.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 09/14/2022] [Accepted: 09/28/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVES To evaluate the acceptability, appropriateness, and feasibility of using a mindfulness meditation mobile application to improve sleep quality among a diverse group of adults. METHODS This explanatory qualitative study used online focus group discussions (N = 4 groups with 17 individuals) to collect information about user experiences with a mindfulness meditation mobile application (Headspace) among participants enrolled in the MINDS study. A rapid analyses approach was used to descriptively compare motivators of app use, barriers and facilitators to app use, and perceived tailoring needs across participants. RESULTS Participants on average were 30 years old, 88% female, and identified as Black/African American (52.9%), White (29.4%), Asian (11.8%), and Hispanic (17.6%). All participants felt the app was acceptable and appreciated the ability to personalize their app experience. Individuals with ≥50% intervention adherence (daily use for 30 days) reported being motivated to use the app because it helped them to fall asleep faster, while the remainder of participants used the app to relax throughout the day and faced external barriers to app use (eg, lack of time) and difficulty with app navigation. Only those participants who used the app exclusively in the evenings reported falling asleep faster and staying asleep. Suggestions for tailoring the app differed by race and age. Only Black/African American participants preferred using an instructor based on their race and gender. CONCLUSION Using a mobile meditation app to enhance sleep quality is acceptable and feasible, but additional tailoring for Black/African American individuals may improve uptake in this population.
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Affiliation(s)
- Leslie C M Johnson
- Family and Preventative Medicine, Emory School of Medicine, Emory University, Atlanta, Georgia, USA.
| | - Jacob J Aiello
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Ashna Jagtiani
- Department of Epidemiology Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Kyler N Moore
- Department of Epidemiology Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Lauren Barber
- Department of Epidemiology Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Unjali P Gujral
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Dayna A Johnson
- Department of Epidemiology Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
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11
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Adams EL, Edgar A, Mosher P, Armstrong B, Burkart S, Weaver RG, Beets MW, Siceloff ER, Prinz RJ. Barriers to Optimal Child Sleep among Families with Low Income: A Mixed-Methods Study to Inform Intervention Development. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:862. [PMID: 36613199 PMCID: PMC9820071 DOI: 10.3390/ijerph20010862] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 12/20/2022] [Accepted: 12/27/2022] [Indexed: 06/17/2023]
Abstract
This study gathered formative data on barriers to optimal child sleep to inform the development of a sleep intervention for parents of preschool-aged children in low-income households. Parents (n = 15, age: 34 ± 8 years, household income: $30,000 ± 17,845/year) reporting difficulties with their child's sleep participated in this study. Mixed methods included an online survey and semi-structured phone interview. Items assessed barriers/facilitators to optimal child sleep and intervention preferences. Interview transcripts were coded using inductive analyses and constant-comparison methods to generate themes. Derived themes were then mapped onto the Theoretical Domains Framework to contextualize barriers and inform future intervention strategies. Themes that emerged included: stimulating bedtime activities, child behavior challenges, variability in children's structure, parent work responsibilities, sleep-hindering environment, and parent's emotional capacity. Parent's intervention preferences included virtual delivery (preferred by 60% of parents) to reduce barriers and provide flexibility. Mixed preferences were observed for the group (47%) vs. individual (53%) intervention sessions. Parents felt motivated to try new intervention strategies given current frustrations, the potential for tangible results, and knowing others were in a similar situation. Future work will map perceived barriers to behavior change strategies using the Behavior Change Wheel framework to develop a parenting sleep intervention.
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Affiliation(s)
- Elizabeth L. Adams
- Department of Exercise Science, University of South Carolina, 921 Assembly Street, Columbia, SC 29208, USA
- Research Center for Child Well-Being, University of South Carolina, 1400 Pickens Street, Suite 400, Columbia, SC 29201, USA
| | - Amanda Edgar
- Research Center for Child Well-Being, University of South Carolina, 1400 Pickens Street, Suite 400, Columbia, SC 29201, USA
| | - Peyton Mosher
- Department of Exercise Science, University of South Carolina, 921 Assembly Street, Columbia, SC 29208, USA
| | - Bridget Armstrong
- Department of Exercise Science, University of South Carolina, 921 Assembly Street, Columbia, SC 29208, USA
- Research Center for Child Well-Being, University of South Carolina, 1400 Pickens Street, Suite 400, Columbia, SC 29201, USA
| | - Sarah Burkart
- Department of Exercise Science, University of South Carolina, 921 Assembly Street, Columbia, SC 29208, USA
- Research Center for Child Well-Being, University of South Carolina, 1400 Pickens Street, Suite 400, Columbia, SC 29201, USA
| | - R. Glenn Weaver
- Department of Exercise Science, University of South Carolina, 921 Assembly Street, Columbia, SC 29208, USA
- Research Center for Child Well-Being, University of South Carolina, 1400 Pickens Street, Suite 400, Columbia, SC 29201, USA
| | - Michael W. Beets
- Department of Exercise Science, University of South Carolina, 921 Assembly Street, Columbia, SC 29208, USA
- Research Center for Child Well-Being, University of South Carolina, 1400 Pickens Street, Suite 400, Columbia, SC 29201, USA
| | - E. Rebekah Siceloff
- Research Center for Child Well-Being, University of South Carolina, 1400 Pickens Street, Suite 400, Columbia, SC 29201, USA
| | - Ronald J. Prinz
- Research Center for Child Well-Being, University of South Carolina, 1400 Pickens Street, Suite 400, Columbia, SC 29201, USA
- Department of Psychology, Barnwell College, University of South Carolina, 1512 Pendleton Street, Columbia, SC 29208, USA
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12
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Johnson DA, Cheng P, FarrHenderson M, Knutson K. Understanding the determinants of circadian health disparities and cardiovascular disease. Chronobiol Int 2023; 40:83-90. [PMID: 34547974 PMCID: PMC8934749 DOI: 10.1080/07420528.2021.1966026] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 08/03/2021] [Accepted: 08/04/2021] [Indexed: 10/20/2022]
Abstract
Emerging research suggests that sleep contributes to racial disparities in cardiovascular disease (CVD). Racial/ethnic minorities are disproportionately affected by poor cardiovascular outcomes including obesity, hypertension and diabetes. Although circadian rhythms affect sleep patterns, few studies have examined disparities in circadian health or the contribution of circadian disparities to CVD. In this paper, we provide an overview of the relation between circadian health and CVD in the context of health disparities. We discuss (1) the current knowledge on racial disparities in circadian health; (2) social and environmental determinants of circadian health disparities; (3) the cardiovascular consequences of circadian disparities; and (4) future opportunities to advance the field of circadian disparities. In brief, our findings demonstrated that among a small literature, racial minorities (mainly African American) were more likely to have a shorter circadian period, delayed phase shifts, and were more likely to be shift workers, which are associated with CVD risk factors. Given racial minorities are disproportionately affected by CVD and CVD risk factors, it is important to further understand circadian health as an intervention target and support more research among racial minorities to understand circadian health in these populations.
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Affiliation(s)
- Dayna A. Johnson
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Boston, MA, USA
| | - Philip Cheng
- Thomas Roth Sleep Disorders and Research Center, Henry Ford Health System, 39450 W 12 Mile Road, Detroit MI 48197 USA
| | - Maya FarrHenderson
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Kristen Knutson
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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13
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Baiden P, Spoor SP, Nicholas JK, Brown FA, LaBrenz CA, Spadola C. Association between use of electronic vaping products and insufficient sleep among adolescents: Findings from the 2017 and 2019 YRBS. Sleep Med 2023; 101:19-27. [PMID: 36334497 DOI: 10.1016/j.sleep.2022.10.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 09/13/2022] [Accepted: 10/10/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND OBJECTIVE Although studies have investigated the association between cigarette smoking and sleep outcomes among adolescents in the United States, few studies have examined the association between electronic vaping products (EVPs) use and insufficient sleep among adolescents. The objective of this study was to investigate the cross-sectional association between the use of EVPs and insufficient sleep among adolescents. METHODS Data were pooled from the 2017 and 2019 Youth Risk Behavior Survey. An analytic sample of 28,135 adolescents (51.2% female) was analyzed using binary logistic regression. The dependent variable investigated was insufficient sleep, and the main independent variable was the use of EVPs. RESULTS Of the 28,135 adolescents, 22.6%, 19.2%, and 58.2% were current, former, and never users of EVPs, respectively. More than three in four adolescents (76.5%) did not obtain the recommended 8 h of sleep on an average school night. Controlling for demographic factors and other covariates, adolescents who currently used EVPs had 1.33 times higher odds of having insufficient sleep (AOR = 1.33, p < .001, 95% CI = 1.16-1.52), and adolescents who previously used EVPs had 1.29 times higher odds of having insufficient sleep (AOR = 1.29, p < .001, 95% CI = 1.15-1.44) when compared to adolescents who had never used EVPs. Adolescents were more likely to get insufficient sleep if they were older, non-Hispanic Black, had symptoms of depression, experienced suicidal ideation, engaged in excessive screen-time behaviors, or currently used alcohol. Physical activity had a protective effect on insufficient sleep. CONCLUSION This study found that EVPs use was associated with insufficient sleep among adolescents over and above demographic and other covariates. As EVP use increases among adolescents, it is important to consider the potential impact on multiple domains, including sleep. Future studies that employ longitudinal designs may offer additional insight into the mechanisms underlying the association between EVPs use and insufficient sleep.
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Affiliation(s)
- Philip Baiden
- The University of Texas at Arlington, School of Social Work, 211 S. Cooper St, Box 19129, Arlington, TX, 76019, USA.
| | - Samantha P Spoor
- University of Wyoming, Department of Psychology, 1000 E. University Ave, Laramie, WY, 82071, USA
| | - Julia K Nicholas
- University of Louisville, Department of Psychological and Brain Sciences, Room 307 Life Sciences Building, Louisville, KY, 40292, USA
| | - Fawn A Brown
- The University of Texas at Arlington, Department of Psychology, 501 Nedderman Dr, Box 19528, Arlington, TX, 76019, USA
| | - Catherine A LaBrenz
- The University of Texas at Arlington, School of Social Work, 211 S. Cooper St, Box 19129, Arlington, TX, 76019, USA
| | - Christine Spadola
- The University of Texas at Arlington, School of Social Work, 211 S. Cooper St, Box 19129, Arlington, TX, 76019, USA
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14
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Lucchini M, Ordway MR, Kyle MH, Pini N, Barbosa JR, Sania A, Shuffrey LC, Firestein MR, Fernández CR, Fifer WP, Alcántara C, Monk C, Dumitriu D. Racial/ethnic disparities in infant sleep in the COVID-19 Mother Baby Outcomes (COMBO) study. Sleep Health 2022; 8:429-439. [PMID: 36038499 PMCID: PMC9411732 DOI: 10.1016/j.sleh.2022.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 06/13/2022] [Accepted: 06/20/2022] [Indexed: 01/21/2023]
Abstract
OBJECTIVE Investigate racial and ethnic differences in infant sleep and examine associations with insurance status and parent-infant bedtime behavioral factors (PIBBF). METHODS Participants are part of the COVID-19 Mother Baby Outcomes (COMBO) Initiative, Columbia University. Data on infant sleep (night, day and overall sleep duration, night awakenings, latency, infant's sleep as a problem) were collected at 4 months postpartum. Regressions estimated associations between race/ethnicity, insurance status, PIBBF and infants' sleep. RESULTS A total of 296 infants were eligible (34.4% non-Hispanic White [NHW], 10.1% Black/African American [B/AA], 55.4% Hispanic). B/AA and Hispanic mothers were more likely to have Medicaid, bed/room-share, and report later infant bedtime compared to NHW mothers. Infants of B/AA mothers had longer sleep latency compared to NHW. Infants of Hispanic mothers slept less at night (∼70 ± 12 minutes) and more during the day (∼41 ± 12 minutes) and Hispanic mothers were less likely to consider infants' sleep as a problem compared to NHW (odds ratio 0.4; 95% confidence interval: 0.2-0.7). After adjustment for insurance status and PIBBF, differences by race/ethnicity for night and day sleep duration and perception of infant's sleep as a problem persisted (∼32 ± 14 minutes, 35 ± 15 minutes, and odds ratio 0.4; 95% confidence interval: 0.2-0.8 respectively). Later bedtime was associated with less sleep at night (∼21 ± 4 minutes) and overall (∼17 ± 5 minutes), and longer latency. Infants who did not fall asleep independently had longer sleep latency, and co-sleeping infants had more night awakenings. CONCLUSIONS Results show racial/ethnic differences in sleep in 4-month-old infants across sleep domains. The findings of our study suggest that PIBBF have an essential role in healthy infant sleep, but they may not be equitably experienced across racial/ethnic groups.
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Affiliation(s)
- Maristella Lucchini
- Division of Developmental Neuroscience, Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, USA.
| | | | - Margaret H Kyle
- Division of Developmental Neuroscience, Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, USA
| | - Nicolò Pini
- Division of Developmental Neuroscience, Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, USA
| | - Jennifer R Barbosa
- Division of Developmental Neuroscience, Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, USA
| | - Ayesha Sania
- Division of Developmental Neuroscience, Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, USA
| | - Lauren C Shuffrey
- Division of Developmental Neuroscience, Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, USA
| | - Morgan R Firestein
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
| | - Cristina R Fernández
- New York-Presbyterian Hospital, New York, New York, USA; Division of Child and Adolescent Health, Department of Pediatrics, Columbia University Irving Medical Center, New York, New York, USA
| | - William P Fifer
- Division of Developmental Neuroscience, Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, USA; New York State Psychiatric Institute, New York, New York, USA
| | | | - Catherine Monk
- Division of Developmental Neuroscience, Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, USA; New York State Psychiatric Institute, New York, New York, USA; Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, New York, USA
| | - Dani Dumitriu
- Division of Developmental Neuroscience, Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, USA; Division of Child and Adolescent Health, Department of Pediatrics, Columbia University Irving Medical Center, New York, New York, USA; Sackler Institute, Zuckerman Institute, and the Columbia Population Research Center, Columbia University, New York, New York, USA.
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15
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Cohen MF, Corwin E, Dunlop AL, Brennan PA. Psychological Distress Prospectively Predicts Later Sleep Quality in a Sample of Black American Postpartum Mothers. Behav Sleep Med 2022; 20:442-459. [PMID: 34120540 PMCID: PMC8665932 DOI: 10.1080/15402002.2021.1932499] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Objective: Previous longitudinal studies have demonstrated prospective relationships between maternal sleep quality and subsequent psychological distress in the postpartum period. Despite evidence for prospective relationships between mood and subsequent sleep quality in adult populations, this direction has not been examined in postpartum women. We aimed to test prospective relationships between sleep quality and subsequent psychological distress, as well as the plausible reverse possibility, in a sample of Black American postpartum mothers (n = 146).Participants: Mothers were recruited prenatally from two hospitals in a Southeastern city of the United States. Eligible and interested mothers enrolled in a follow-up study on infant development. Data from the current study were obtained during the follow-up study.Method: Mothers reported on their psychological distress (i.e., anxiety, depression, stress) and sleep quality at 3- and 6-months postpartum. We performed hierarchical linear regressions to explore whether 1) maternal sleep quality at 3-months postpartum would predict maternal psychological distress at 6-months postpartum, after adjustment for mothers' earlier psychological distress, and 2) whether psychological distress at 3-months postpartum would predict maternal sleep quality at 6-months postpartum, after adjustment for mothers' earlier sleep quality.Results: Maternal sleep quality at 3-months postpartum was not a significant predictor of psychological distress at 6-months postpartum. However, maternal psychological distress at 3-months postpartum was a significant predictor of sleep quality at 6-months postpartum.Conclusions: Mothers' psychological distress earlier in the postpartum was a significant predictor of their later sleep quality. Replication is needed in large, prospective studies, with results stratified by race/ethnicity.
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Affiliation(s)
- Madeleine F. Cohen
- Emory University Department of Psychology, 36 Eagle Row, Atlanta, GA 30322, United States of America
| | - Elizabeth Corwin
- Emory University Neil Hodgson Woodruff School of Nursing, 1520 Clifton Road, Atlanta, GA 30322, United States of America
| | - Anne L. Dunlop
- Emory University Neil Hodgson Woodruff School of Nursing, 1520 Clifton Road, Atlanta, GA 30322, United States of America
| | - Patricia A. Brennan
- Emory University Department of Psychology, 36 Eagle Row, Atlanta, GA 30322, United States of America
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16
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Zhou ES, Ritterband LM, Bethea TN, Robles YP, Heeren TC, Rosenberg L. Effect of Culturally Tailored, Internet-Delivered Cognitive Behavioral Therapy for Insomnia in Black Women: A Randomized Clinical Trial. JAMA Psychiatry 2022; 79:538-549. [PMID: 35442432 PMCID: PMC9021979 DOI: 10.1001/jamapsychiatry.2022.0653] [Citation(s) in RCA: 47] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Black women are at risk for insomnia disorder. Despite interest in addressing sleep health disparities, there is limited research investigating the efficacy of criterion-standard treatment (cognitive behavioral therapy for insomnia [CBT-I]) among this racial minority population. OBJECTIVE To compare the efficacy of a standard version of an internet-delivered CBT-I program, a culturally tailored version, and a sleep education control at improving insomnia symptoms. DESIGN, SETTING, AND PARTICIPANTS In this single-blind, 3-arm randomized clinical trial, participants in a national, longitudinal cohort (Black Women's Health Study [BWHS]) were recruited between October 2019 and June 2020. BWHS participants with elevated insomnia symptoms were enrolled and randomized in the current study. INTERVENTIONS Participants were randomized to receive (1) an automated internet-delivered treatment called Sleep Healthy Using the Internet (SHUTi); (2) a stakeholder-informed, tailored version of SHUTi for Black women (SHUTi-BWHS); or (3) patient education (PE) about sleep. MAIN OUTCOMES AND MEASURES The primary outcome was insomnia severity (Insomnia Severity Index [ISI]). Index score ranged from 0 to 28 points, with those scoring less than 8 points considered to not have clinically significant insomnia symptoms and a score of 15 points or higher suggesting insomnia disorder. An ISI score reduction of more than 7 points was considered a clinically significant improvement in insomnia symptoms. The SHUTi-BWHS program was hypothesized to be more effective at significantly decreasing insomnia severity compared with the SHUTi program and PE. RESULTS A total of 333 Black women were included in this trial, and their mean (SD) age was 59.5 (8.0) years. Those randomized to receive either SHUTi or SHUTi-BWHS reported significantly greater reductions in ISI score at 6-month follow-up (SHUTi: -10.0 points; 95% CI, -11.2 to -8.7; SHUTi-BWHS: -9.3 points; 95% CI, -10.4 to -8.2) than those randomized to receive PE (-3.6 points; 95% CI, -4.5 to -2.1) (P < .001). Significantly more participants randomized to SHUTi-BWHS completed the intervention compared with those randomized to SHUTi (86 of 110 [78.2%] vs 70 of 108 [64.8%]; P = .008). Participants who completed either intervention showed greater reductions in insomnia severity compared with noncompleters (-10.4 points [95% CI, -11.4 to -9.4] vs -6.2 points [95% CI, -8.6 to -3.7]). CONCLUSIONS AND RELEVANCE In this randomized clinical trial, both the SHUTi and SHUTi-BWHS programs decreased insomnia severity and improved sleep outcomes more than PE. The culturally tailored SHUTi-BWHS program was more effective at engaging participants with the program, as a greater proportion completed the full intervention. Program completion was associated with greater improvements in sleep. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03613519.
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Affiliation(s)
- Eric S. Zhou
- Division of Sleep Medicine, Harvard Medical School, Boston, Massachusetts,Perini Family Survivors’ Center, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Lee M. Ritterband
- Center for Behavioral Health and Technology, Department of Psychiatry and Neurobehavioral Sciences, University of Virginia Health System, Charlottesville
| | - Traci N. Bethea
- Cancer Prevention and Control Program, Georgetown Lombardi Comprehensive Cancer Center, Washington, DC
| | - Yvonne P. Robles
- Slone Epidemiology Center at Boston University, Boston, Massachusetts
| | | | - Lynn Rosenberg
- Slone Epidemiology Center at Boston University, Boston, Massachusetts
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17
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Johnson DA, Jackson CL, Guo N, Sofer T, Laden F, Redline S. Perceived home sleep environment: associations of household-level factors and in-bed behaviors with actigraphy-based sleep duration and continuity in the Jackson Heart Sleep Study. Sleep 2021; 44:zsab163. [PMID: 34283244 PMCID: PMC8678916 DOI: 10.1093/sleep/zsab163] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 06/09/2021] [Indexed: 11/13/2022] Open
Abstract
STUDY OBJECTIVES In an older African-American sample (n = 231) we tested associations of the household environment and in-bed behaviors with sleep duration, efficiency, and wakefulness after sleep onset (WASO). METHODS Older adult participants completed a household-level sleep environment questionnaire, a sleep questionnaire, and underwent 7-day wrist actigraphy for objective measures of sleep. Perceived household environment (self-reported) was evaluated using questions regarding safety, physical comfort, temperature, noise, and light disturbances. In-bed behaviors included watching television, listening to radio/music, use of computer/tablet/phone, playing video games, reading books, and eating. To estimate the combined effect of the components in each domain (perceived household environment and in-bed behaviors), we calculated and standardized a weighted score per sleep outcome (e.g. duration, efficiency, WASO), with a higher score indicating worse conditions. The weights were derived from the coefficients of each component estimated from linear regression models predicting each sleep outcome while adjusting for covariates. RESULTS A standard deviation increase in an adverse household environment score was associated with lower self-reported sleep duration (β = -13.9 min, 95% confidence interval: -26.1, -1.7) and actigraphy-based sleep efficiency (β = -0.7%, -1.4, 0.0). A standard deviation increase in the in-bed behaviors score was associated with lower actigraphy-based sleep duration (β = -9.7 min, -18.0, -1.3), sleep efficiency (β = -1.2%, -1.9, -0.6), and higher WASO (5.3 min, 2.1, 8.6). CONCLUSION Intervening on the sleep environment, including healthy sleep practices, may improve sleep duration and continuity among African-Americans.
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Affiliation(s)
- Dayna A Johnson
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Boston, MA, USA
| | - Chandra L Jackson
- Department of Health and Human Services, Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Triangle Park, NC, USA
- Intramural Program, Department of Health and Human Services, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, USA
| | - Na Guo
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Boston, MA, USA
| | - Tamar Sofer
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Boston, MA, USA
- Division of Sleep Medicine, Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Francine Laden
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
- Exposure, Epidemiology and Risk Program, Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Susan Redline
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Boston, MA, USA
- Division of Sleep Medicine, Department of Medicine, Harvard Medical School, Boston, MA, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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18
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Chung J, Goodman M, Huang T, Wallace ML, Johnson DA, Bertisch S, Redline S. Racial-ethnic Differences in Actigraphy, Questionnaire, and Polysomnography Indicators of Healthy Sleep: The Multi-Ethnic Study of Atherosclerosis. Am J Epidemiol 2021; 193:kwab232. [PMID: 34498675 DOI: 10.1093/aje/kwab232] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 08/11/2021] [Accepted: 09/02/2021] [Indexed: 11/14/2022] Open
Abstract
A paradigm shift in sleep science argues for a systematic, multidimensional approach to investigate sleep's association with disease and mortality and to address sleep disparities. We utilized the comprehensive sleep assessment of the Multi-Ethnic Study of Atherosclerosis (2010- 2013), a cohort of U.S. White, Black, Chinese, and Hispanic adults and older adults (n=1,736; mean age=68.3), to draw 13 sleep dimensions and create composite Sleep Health Scores to quantify multidimensional sleep health disparities. After age and sex adjustment in linear regression, compared to White participants, Black participants showed the greatest global sleep disparity, then Hispanic and Chinese participants. We estimated relative 'risk' of obtaining favorable sleep compared to White adults at the component level by race/ethnicity (lower is worse). The largest disparities were in objectively-measured sleep timing regularity (RRBlack [95% CI]: 0.37 [0.29,0.47], RRHispanic: 0.64 [0.52,0.78], RRChinese: 0.70 [0.54,0.90]) and duration regularity (RRBlack: 0.55 [0.47,0.65], RRHispanic: 0.76 [0.66,0.88], RRChinese: 0.74 [0.61,0.90]), after sex and age adjustment. Disparities in duration and continuity were also apparent, and Black adults were additionally disadvantaged in %N3 (slow wave sleep), sleepiness, and sleep timing (24-hour placement). Sleep timing regularity, duration regularity, duration, and continuity may comprise a multidimensional cluster of targets to reduce racial-ethnic sleep disparities.
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Affiliation(s)
- Joon Chung
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - Matthew Goodman
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - Tianyi Huang
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - Meredith L Wallace
- Department of Psychiatry, University of Pittsburgh, PA
- Department of Biostatistics, University of Pittsburgh, PA
| | - Dayna A Johnson
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Suzanne Bertisch
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - Susan Redline
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA
- Harvard Medical School, Boston, MA
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19
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Insomnia disorder and its reciprocal relation with psychopathology. Curr Opin Psychol 2021; 41:34-39. [PMID: 33691218 DOI: 10.1016/j.copsyc.2021.02.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 01/06/2021] [Accepted: 02/03/2021] [Indexed: 01/07/2023]
Abstract
Sleep is crucial for daytime functioning. In populations with psychiatric conditions, many people suffer from insomnia symptoms or an insomnia disorder. Emerging evidence suggests a bidirectional relationship between insomnia and various psychopathologies, implying that insomnia not only may be a consequence of mental disorders but also may contribute to new development, symptom severity, and reoccurrence of diverse mental disorders. Research on potential mechanisms underlying the insomnia psychopathology association is important, both from the preventive and treatment perspective. Most hypotheses concern the influence of insomnia on emotion regulation and on shared pathophysiological pathways, ranging from gut microbiome composition to genetic and specific neurotransmitter system aberrations.
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20
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Lee S, Bonnar D, Kim Y, Lee Y, Lee S, Gradisar M, Suh S. Sleep Characteristics and Risk Factors of Korean Esports Athletes: An Exploratory Study. SLEEP MEDICINE RESEARCH 2020. [DOI: 10.17241/smr.2020.00773] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
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21
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Davenport MA, Landor AM, Zeiders KH, Sarsar ED, Flores M. Within-person associations between racial microaggressions and sleep among African American and Latinx young adults. J Sleep Res 2020; 30:e13226. [PMID: 33219603 DOI: 10.1111/jsr.13226] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 09/22/2020] [Accepted: 10/09/2020] [Indexed: 11/30/2022]
Abstract
Emerging work suggests that experiences of racial discrimination may impact overall sleep health; however, there is limited work on the link between racial microaggressions and sleep. Using weekly diary data, the current study examined young adults' weekly reports of racial microaggressions across 4 weeks, and their relation to weekly reports of sleep-onset latency, reduced total sleep time and poorer sleep quality. This design allowed us to examine how within-person fluctuations in racial microaggressions corresponded with young adults' sleep. Data were collected among 140 African American (62.1%) and Latinx (37.9%) college students attending a Midwestern University. Students were randomly selected to participate; they were, on average, 20.70 years old (SD = 1.22) and the majority were female (69.3%). Participants self-reported their racial microaggressions and sleep behaviours (i.e. sleep-onset latency, total sleep time and sleep quality) each week (across 4 weeks). Multilevel modelling showed significant within-person effects of racial microaggressions for sleep onset and sleep quality, but not for total sleep duration. Specifically, on weeks that individuals reported increases in racial microaggressions, they reported greater sleep-onset duration and poorer sleep quality. The current findings provide preliminary evidence that racial microaggressions are associated with sleep-onset durations and sleep quality among African American and Latinx young adults. Although racial microaggressions are often considered subtle, they may impact the sleep health of young adults in marginalized groups.
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Affiliation(s)
| | - Antoinette M Landor
- Department of Human Development and Family Science, University of Missouri, Columbia, MO, USA
| | - Katharine H Zeiders
- Norton School of Family and Consumer Sciences, University of Arizona, Tucson, AZ, USA
| | - Evelyn D Sarsar
- Norton School of Family and Consumer Sciences, University of Arizona, Tucson, AZ, USA
| | - Melissa Flores
- The Center on Border Health Disparities, University of Arizona, Tucson, AZ, USA
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22
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Billings ME, Cohen RT, Baldwin CM, Johnson DA, Palen BN, Parthasarathy S, Patel SR, Russell M, Tapia IE, Williamson AA, Sharma S. Disparities in Sleep Health and Potential Intervention Models: A Focused Review. Chest 2020; 159:1232-1240. [PMID: 33007324 PMCID: PMC7525655 DOI: 10.1016/j.chest.2020.09.249] [Citation(s) in RCA: 122] [Impact Index Per Article: 30.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Revised: 08/25/2020] [Accepted: 09/24/2020] [Indexed: 12/14/2022] Open
Abstract
Disparities in sleep health are important but underrecognized contributors to health disparities. Understanding the factors contributing to sleep heath disparities and developing effective interventions are critical to improving all aspects of heath. Sleep heath disparities are impacted by socioeconomic status, racism, discrimination, neighborhood segregation, geography, social patterns, and access to health care as well as by cultural beliefs, necessitating a cultural appropriateness component in any intervention devised for reducing sleep health disparities. Pediatric sleep disparities require innovative and urgent intervention to establish a foundation of lifelong healthy sleep. Tapping the vast potential of technology in improving sleep health access may be an underutilized tool to reduce sleep heath disparities. Identifying, implementing, replicating, and disseminating successful interventions to address sleep disparities have the potential to reduce overall disparities in health and quality of life.
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Affiliation(s)
- Martha E Billings
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington School of Medicine, Seattle, WA
| | - Robyn T Cohen
- Department of Pediatrics, Boston Medical Center, Boston University School of Medicine, Boston, MA
| | - Carol M Baldwin
- Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ
| | - Dayna A Johnson
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Brian N Palen
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington School of Medicine, Seattle, WA; Veterans Affairs Puget Sound Health Care System, Seattle, WA
| | | | - Sanjay R Patel
- Center for Sleep and Cardiovascular Outcomes Research, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Maureen Russell
- Northern Arizona University, Institute for Human Development, Flagstaff, AZ
| | - Ignacio E Tapia
- Sleep Center, Division of Pulmonary Medicine, Children's Hospital of Philadelphia, Philadelphia, PA; University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Ariel A Williamson
- Sleep Center, Division of Pulmonary Medicine, Children's Hospital of Philadelphia, Philadelphia, PA; University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Sunil Sharma
- Division of Pulmonary, Critical Care, and Sleep Medicine, West Virginia University, WV.
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23
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Spadola CE, Rottapel RE, Zhou ES, Chen JT, Guo N, Khalsa SBS, Redline S, Bertisch SM. A sleep hygiene and yoga intervention conducted in affordable housing communities: Pilot study results and lessons for a future trial. Complement Ther Clin Pract 2020; 39:101121. [PMID: 32379660 DOI: 10.1016/j.ctcp.2020.101121] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 02/19/2020] [Accepted: 02/19/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND and purpose: Inadequate sleep is highly prevalent among socioeconomically disadvantaged and racial/ethnic minority communities and is often related to maladaptive sleep behaviors and stress. There is scant research investigating the delivery of these interventions in underserved communities. The purpose of this study was to develop and test the feasibility and acceptability of a sleep education and yoga intervention for socioeconomically disadvantaged and racial/ethnic diverse adults. MATERIALS AND METHODS We present quantitative and qualitative data from a single-arm sleep education and yoga pilot study (n = 17) conducted in two affordable housing communities, and the multi-modal process we employed to refine the intervention for a future trial. RESULTS Participants were age 43.6 years on average (±19.3 years) and 88.2% were female. Nearly 56% identified as non-Hispanic Black and 19% as Hispanic/Latino. Results showed significant pre/post-intervention improvements in sleep duration (5.4 ± 1.2 h/night vs 6.9 ± 1.7 h/night; p < 0.01), sleep-related impairment (-8.15; p < 0.01), sleep disturbance (-5.95; p < 0.01), and sleep hygiene behaviors (-5.50; p < 0.01). CONCLUSION This study indicates intervention acceptability and improvements in sleep and sleep hygiene. Future randomized controlled trials are needed to assess efficacy.
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Affiliation(s)
- Christine E Spadola
- Sandler School of Social Work, Florida Atlantic University, Boca Raton, FL, USA.
| | - Rebecca E Rottapel
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA, USA
| | - Eric S Zhou
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA, USA; Division of Sleep Medicine Harvard Medical School, Boston, MA, USA
| | - Jarvis T Chen
- Harvard T.H. Chan School of Public Health, Department of Social and Behavioral Sciences, Boston, MA, USA
| | - Na Guo
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA, USA
| | - Sat Bir S Khalsa
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA, USA; Division of Sleep Medicine Harvard Medical School, Boston, MA, USA
| | - Susan Redline
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA, USA; Division of Sleep Medicine Harvard Medical School, Boston, MA, USA
| | - Suzanne M Bertisch
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA, USA; Division of Sleep Medicine Harvard Medical School, Boston, MA, USA
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