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Huang K, Mu C, Smith C, Lee S. From the Workroom to the Bedroom: Work-to-Home Spillover as a Mechanism Linking Work Characteristics to Sleep Health. RESEARCH SQUARE 2024:rs.3.rs-4897224. [PMID: 39184107 PMCID: PMC11343290 DOI: 10.21203/rs.3.rs-4897224/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/27/2024]
Abstract
Work may influence the home domain and subsequently impact employee sleep. Past work found that negative spillover mediated the relationship between perceived unfairness about work and insomnia symptoms across 20 years. As an extension of past work, this study investigated whether negative spillover and positive spillover mediate the relationship between job demands (perceived unfairness, job discrimination) and job resources (coworker and supervisor support) on multidimensional sleep health. Two waves of survey data from a subset of full-time workers were obtained from the Midlife in the United States Study approximately 10 years apart. A sleep health composite captured irregularity, dissatisfaction, nap frequency, inefficiency, and suboptimal sleep duration (higher=more sleep health problems). PROCESS Macro evaluated cross-sectional (T1) and sequential (T1 exposureàT1 mediatoràT2 outcome) mediation pathways, adjusting for sociodemographic characteristics, physical health, neuroticism, and work hours. Both cross-sectionally and prospectively, higher negative spillover mediated the association of higher unfairness with more sleep health problems, and the association between higher discrimination and more sleep health problems. There was no support for positive spillover as a mediator between job resources and sleep health cross-sectionally or prospectively. Findings suggest that organizations should reduce the amount of negative spillover by limiting instances of unfairness and discrimination at work to promote specific aspects of employee sleep health such as sleep irregularity, dissatisfaction, efficiency, and nap frequency.
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Arévalo SP, Nguyen-Rodriguez ST, Scott TM, Gao X, Falcón LM, Tucker KL. Longitudinal Associations Between Sleep and Cognitive Function in a Cohort of Older Puerto Rican Adults: Sex and Age Interactions. J Gerontol A Biol Sci Med Sci 2023; 78:1816-1825. [PMID: 37306295 PMCID: PMC10562885 DOI: 10.1093/gerona/glad144] [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: 08/01/2022] [Indexed: 06/13/2023] Open
Abstract
BACKGROUND Evidence on sleep duration or quality and cognitive function in diverse older adults is limited. We examined prospective associations between subjective sleep measures and cognitive function, with modifying effects of sex and age (<65 vs ≥65 years). METHODS Data are from the longitudinal Boston Puerto Rican Health Study, Waves 2 (n = 943) and 4 (n = 444), with mean follow-up of 10.5 years (range 7.2-12.8). Subjective measures of sleep duration (short <7, ref. 7, or long ≥8 hours) and insomnia symptoms (sum of difficulty falling asleep, waking up at night, and early morning awakening), were assessed at Wave 2. Linear regression models were used to assess changes in global cognition, executive function, memory, and Mini-Mental State Examination, and tested for modifying roles of sex and age. RESULTS Significant 3-way interaction (sex × age × cognition) in fully adjusted models showed greater decline in global cognitive function in older men with short (β [95% confidence interval]: -0.67 [-1.24, -0.10]) or long sleep duration (-0.92 [-1.55, -0.30]), compared to women, younger men, and older men with 7 hours of sleep. Insomnia symptoms were associated with a greater decline in memory (-0.54, [-0.85, -0.22]) among older men, compared to women and younger men. CONCLUSION Sleep duration showed a U-shaped association with cognitive decline, and insomnia symptoms were associated with memory decline in fully adjusted models. Older men, versus women and younger men, were at relatively greater risk for cognitive decline associated with sleep factors. These findings are important for personalizing sleep interventions to support cognitive health.
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Affiliation(s)
- Sandra P Arévalo
- Department of Human Development, California State University, Long Beach, California, USA
| | | | - Tammy M Scott
- Neuroscience and Aging Laboratory, Jean Mayer U.S. Department of Agriculture Human Nutrition Research Center on Aging, Boston, Massachusetts, USA
| | - Xiang Gao
- Department of Nutrition and Food Hygiene, School of Public Health, Fudan University, Shanghai, China
| | - Luis M Falcón
- College of Fine Arts, Humanities and Social Sciences, University of Massachusetts, Lowell, Massachusetts, USA
| | - Katherine L Tucker
- Department of Biomedical and Nutritional Sciences, University of MassachusettsLowell, Massachusetts, USA
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Dautovich ND, Reid MP, Ghose SM, Kim G, Tighe CA, Shoji KD, Kliewer W. A longitudinal examination of psychosocial mechanisms linking discrimination with objective and subjective sleep. Sleep Health 2023; 9:654-661. [PMID: 37482456 DOI: 10.1016/j.sleh.2023.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 04/24/2023] [Accepted: 06/18/2023] [Indexed: 07/25/2023]
Abstract
OBJECTIVE Although chronic discrimination negatively impacts sleep, the cross-sectional nature of most research limits the understanding of how changes in discrimination over time are associated with sleep health. Therefore, the aims of this study were to explore the: (1) longitudinal association between daily discrimination and subjective and objective sleep; (2) mediating roles of anxiety and social well-being; and (3) moderating role of change in discrimination over time. METHODS An archival analysis was completed using data from the Midlife in the United States study across 3 timepoints. Participants were primarily female-identifying, white, and college-educated. Measures included Pittsburgh Sleep Quality Index (N = 958), sleep diaries (N = 307), and actigraphy (N = 304). Daily discrimination, the Social Well-Being Scale, and the Mood and Anxiety Symptom Questionnaire were also administered. Moderated parallel mediations were performed using the PROCESS macro controlling for depressive symptoms. RESULTS More discrimination at time 1 was associated with worse global sleep quality (b = 0.10 and p = .001) and daily sleep quality (b = 0.03 and p = .02) and worse objective sleep-onset latency (b = 0.93 and p = .02), wake after sleep onset (b = 1.09 and p = .002), and sleep efficiency (b = -0.52 and p < .001) at time 3. Social well-being mediated the associations between discrimination and subjective global sleep quality 95% CI [0.00, 0.03] and daily sleep quality 95% CI [0.00, 0.01] and objective TST 95% CI [0.00, 0.96] when discrimination was increasing or chronic. Anxiety mediated the discrimination-global sleep quality association regardless of changes in discrimination. CONCLUSIONS Discrimination showed durable associations with a broad array of sleep outcomes across a 10-year period. Anxiety and social well-being linked discrimination to subjective sleep outcomes, illustrating the importance of psychosocial well-being for sleep health in those experiencing discrimination.
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Affiliation(s)
- Natalie D Dautovich
- Psychology Department, Virginia Commonwealth University, Richmond, Virginia, USA.
| | - Morgan P Reid
- Psychology Department, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Sarah M Ghose
- Psychology Department, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Giyeon Kim
- Department of Psychology, Chung-Ang University, Seoul, South Korea
| | - Caitlan A Tighe
- VISN 4 Mental Illness, Research, Education, and Clinical Center (MIRECC), VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA
| | - Kristy D Shoji
- Eastern Colorado Health Care System - Mental Health Service, Kerrville VA CLC, Kerrville, Texas, USA
| | - Wendy Kliewer
- Psychology Department, Virginia Commonwealth University, Richmond, Virginia, USA
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Otto MW, Lubin RE, Rosenfield D, Taylor DJ, Birk JL, Espie CA, Shechter A, Edmondson D, Shepherd JM, Zvolensky MJ. The association between race- and ethnicity-related stressors and sleep: the role of rumination and anxiety sensitivity. Sleep 2022; 45:zsac117. [PMID: 35639820 PMCID: PMC9548665 DOI: 10.1093/sleep/zsac117] [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] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 03/30/2022] [Indexed: 07/29/2023] Open
Abstract
STUDY OBJECTIVES This study was designed to investigate the association between psychosocial factors and self-reported sleep duration and two indices of sleep quality in a racially and ethnically diverse sample of adults. We investigated the relations between both rumination and anxiety sensitivity with these self-reported sleep outcomes. We also examined rumination and anxiety sensitivity as moderators of three race- and ethnicity-related stressors: discrimination, acculturative stress, and socioeconomic status. METHODS In a cross-sectional design, we assessed 1326 adults (ages 18-48 years) selected for self-reported racial and ethnic minority status. Regression analyses were used to examine the associations between demographic, social/environmental stressors, depression severity, rumination, and anxiety sensitivity and three sleep outcomes: sleep duration, sleep quality subscale, and global sleep quality. RESULTS Our findings supported the hypothesized role of rumination as an amplification factor for the influence of race- and ethnicity-related stressors on sleep duration and quality. Rumination was associated with all three sleep outcomes (sleep duration, sleep quality subscale, and global sleep quality) and was a moderator of the associations between discrimination and all 3 sleep outcomes. Anxiety sensitivity was not consistently associated with these sleep outcomes. Depression symptoms did not account for these findings. CONCLUSIONS If confirmed in longitudinal study, our findings introduce a potentially important treatment target-rumination-for addressing sleep disparities in prevention or intervention models. Rumination appears to amplify the negative sleep consequences of race- and ethnicity-related stressors and is a modifiable treatment target.
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Affiliation(s)
- Michael W Otto
- Corresponding author. Michael W. Otto, Department of Psychological and Brain Sciences, Boston University, 900E Commonwealth Ave., Boston, MA, 02215. E-mail:
| | - Rebecca E Lubin
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA
| | - David Rosenfield
- Department of Psychology, Southern Methodist University, Dallas, TX, USA
| | - Daniel J Taylor
- Department of Psychology, University of Arizona, Tucson, AZ, USA
| | - Jeffrey L Birk
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Colin A Espie
- Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Ari Shechter
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
- Sleep Center of Excellence, Columbia University Irving Medical Center, New York, NY, USA
| | - Donald Edmondson
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | | | - Michael J Zvolensky
- Department of Psychology, University of Houston, Houston, TX,USA
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX,USA
- HEALTH Institute, University of Houston, Houston, TX,USA
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5
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Danyluck C, Blair IV, Manson SM, Laudenslager ML, Daugherty SL, Brondolo E. Discrimination and Sleep Impairment in American Indians and Alaska Natives. Ann Behav Med 2022; 56:969-976. [PMID: 34864832 DOI: 10.1093/abm/kaab097] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Sleep impairment may be a key pathway through which discrimination undermines health. Links between discrimination and sleep in American Indians and Alaska Natives (AI/AN) have not been established. Further, it is unclear if such links might depend on the timing of discrimination or if socioeconomic status (SES) might buffer the impact of discrimination. PURPOSE To investigate associations between interpersonal discrimination and sleep impairment in urban AI/AN, for both lifetime and recent discrimination, and controlling for other life stressors. Education and income, indices of SES, were tested as potential moderators. METHODS A community sample of urban AI/AN (N = 303, 18-78 years old, 63% female) completed self-report measures of sleep impairment, lifetime and recent discrimination, depressive symptoms, perceived stress, other life stressors (childhood adversity and past year major events), and socio-demographic characteristics. RESULTS Lifetime discrimination was associated with impaired sleep in AI/AN after adjustment for socio-demographic characteristics, recent depressive symptoms, perceived stress, and other life stressors. Past-week discrimination was associated with sleep in unadjusted but not adjusted models. Education, but not income, was found to buffer the effects of both lifetime and past-week discrimination on sleep in adjusted models. CONCLUSION Lifetime discrimination uniquely accounts for sleep impairment and may be especially harmful in those with less education. These findings suggest targeting interventions to those most in need. Limitations include the cross-sectional nature of the data. Longitudinal and qualitative work is needed to understand how education may buffer the effects of discrimination on sleep and perhaps other health problems in AI/AN.
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Affiliation(s)
| | | | - Spero M Manson
- University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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Nwanaji-Enwerem U, Condon EM, Conley S, Wang K, Iheanacho T, Redeker NS. Adapting the Health Stigma and Discrimination Framework to understand the association between stigma and sleep deficiency: A systematic review. Sleep Health 2022; 8:334-345. [PMID: 35504839 PMCID: PMC9233012 DOI: 10.1016/j.sleh.2022.03.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 02/11/2022] [Accepted: 03/08/2022] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Sleep deficiency and sleep disorders disproportionally affect socially disadvantaged and marginalized individuals and groups. Recent evidence suggests that stigma, a social process characterized by labeling, stereotyping, and prejudice, is associated with sleep characteristics. PURPOSE Guided by the Health Stigma and Discrimination Framework, the purpose of this systematic review is to describe associations between dimensions of stigma and sleep deficiency and to identify future directions for research. METHODS We searched the OVIDPsycINFO, OVIDEMASE, OVIDMEDLINE, and CINAHL databases for empirical research studies that reported relationships between the 3 dimensions of stigma-internalized, perceived, and anticipated-and characteristics of sleep deficiency-duration, continuity/efficiency, timing, alertness/sleepiness, quality, and disorders. RESULTS Of 1717 articles, 15 met our inclusion criteria. The most frequently assessed dimensions of stigma were internalized and perceived stigma. Characteristics of sleep deficiency were measured by self-report and included sleep quality, duration, trouble sleeping, and insomnia symptoms. We found consistent evidence that stigma, whether internalized, perceived, or anticipated, is associated with self-reported characteristics of sleep deficiency. CONCLUSIONS This evidence base can be further strengthened with prospective studies that incorporate both multidimensional measures of stigma and objective measures of sleep characteristics. We outline research implications that can clarify underlying mechanisms and more precisely define the relationships between stigma and sleep and inform interventions to address stigma, improve sleep, and reduce the health inequities that disproportionately affect individuals from socially disadvantaged and marginalized groups.
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Affiliation(s)
| | - Eileen M Condon
- University of Connecticut School of Nursing, Storrs, Connecticut, USA
| | | | - Katie Wang
- Yale School of Public Health, New Haven, Connecticut, USA
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Zhan C, Nagy GA, Wu JQ, McCabe B, Stafford AM, Gonzalez-Guarda RM. Acculturation Stress, Age at Immigration, and Employment Status as Predictors of Sleep Among Latinx Immigrants. J Immigr Minor Health 2022; 24:1408-1420. [PMID: 35291029 DOI: 10.1007/s10903-022-01342-8] [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] [Accepted: 02/03/2022] [Indexed: 11/25/2022]
Abstract
Sleep is important for physical and mental health. Latinx individuals are thought to experience worse sleep and associated health outcomes, resulting in health disparities. There is a dearth of research on the factors (e.g., employment status, age at immigration) that predict poor sleep among Latinx immigrants. The present study aimed to (1) examine the link between demographic factors, immigration-related factors, and acculturation stress, and sleep, and (2) identify factors that either attenuate or intensify the link between acculturation stress and sleep among Latinx immigrants in the US South, an immigrant-hostile area that is home to an increasing Latinx population that remains understudied. Hierarchical regressions were used to analyze data from 391 Latinx adult immigrants, examining the link between demographic factors, immigration-related factors, acculturation stress, and two sleep variables (sleep quality, difficulty falling asleep). Employment status and age at immigration were examined as moderators of the link between acculturation stress and sleep. Data were collected through in-person surveys. Regressions showed that acculturation stress was significantly linked to worse sleep quality (β = 0.30, p = 0.001) and more difficulty falling asleep (β = 0.41, p < 0.001), while controlling for participant characteristics. Younger age at immigration (β = - 0.14, p = 0.005) and being unemployed (β = - 0.13, p = 0.006) were associated with more difficulty falling asleep. Age at immigration intensified the relationship between acculturation stress and sleep quality (β = 0.14, p = 0.005), difficulty falling asleep (β = 0.15, p = 0.002). Reducing acculturation stress is a meaningful intervention focus, with important implications for sleep health, particularly for recent Latinx immigrants. Age at immigration and employment status are also important factors to consider when designing targeted interventions.
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Affiliation(s)
- Chanel Zhan
- Duke University School of Medicine, Durham, NC, USA.
| | - Gabriela A Nagy
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
- Duke University School of Nursing, 307 Trent Drive, DUMC 3322, Durham, NC, 27710, USA
| | - Jade Q Wu
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Brian McCabe
- Department of Special Education, Rehabilitation, and Counseling, Auburn University, Auburn, AL, USA
| | - Allison M Stafford
- Duke University School of Nursing, 307 Trent Drive, DUMC 3322, Durham, NC, 27710, USA
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8
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Yang Y, Cuffee YL, Aumiller BB, Schmitz K, Almeida DM, Chinchilli VM. Serial Mediation Roles of Perceived Stress and Depressive Symptoms in the Association Between Sleep Quality and Life Satisfaction Among Middle-Aged American Adults. Front Psychol 2022; 13:822564. [PMID: 35265017 PMCID: PMC8899090 DOI: 10.3389/fpsyg.2022.822564] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 01/26/2022] [Indexed: 01/26/2023] Open
Abstract
In this study, we used data from the second wave of Midlife in the United States (MIDUS) Study, MIDUS Biomarkers and MIDUS 3. We applied the serial mediation model to explore the serial mediating effects of perceived stress and depressive symptoms on the relationship between sleep quality and life satisfaction. A total of 945 participants were included in our study. The total indirect effect of sleep quality on life satisfaction through perceived stress, depressive symptoms and the combination of perceived stress and depressive symptoms accounted for within the overall model was 45.5%. At the intervention level, programs designed to improve the level of life satisfaction among adults should focus on perceived stress and depressive symptoms. The prevention of perceived stress and depression contributes to improving life satisfaction and wellbeing. The serial mediation results should be confirmed by further longitudinal study.
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Affiliation(s)
- Yanxu Yang
- Department of Public Health Sciences, Penn State College of Medicine and Milton S. Hershey Medical Center, Hershey, PA, United States,*Correspondence: Yanxu Yang
| | - Yendelela L. Cuffee
- College of Health Sciences, University of Delaware, Newark, DE, United States
| | - Betsy B. Aumiller
- Department of Public Health Sciences, Penn State College of Medicine and Milton S. Hershey Medical Center, Hershey, PA, United States
| | - Kathryn Schmitz
- Department of Public Health Sciences, Penn State College of Medicine and Milton S. Hershey Medical Center, Hershey, PA, United States
| | - David M. Almeida
- Department of Human Development and Family Studies, Pennsylvania State University, University Park, PA, United States
| | - Vernon M. Chinchilli
- Department of Public Health Sciences, Penn State College of Medicine and Milton S. Hershey Medical Center, Hershey, PA, United States
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Johnson DA, Lewis TT, Guo N, Jackson CL, Sims M, Wilson JG, Diez Roux AV, Williams DR, Redline S. Associations between everyday discrimination and sleep quality and duration among African-Americans over time in the Jackson Heart Study. Sleep 2021; 44:zsab162. [PMID: 34197610 PMCID: PMC8664593 DOI: 10.1093/sleep/zsab162] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 05/14/2021] [Indexed: 11/14/2022] Open
Abstract
STUDY OBJECTIVES African-Americans have a high burden of poor sleep, yet, psychosocial determinants (e.g. discrimination) are understudied. We investigated longitudinal associations between everyday discrimination and sleep quality and duration among African-Americans (N = 3404) in the Jackson Heart Study. METHODS At Exam 1 (2000-2004) and Exam 3 (2008-2013), participants completed the Everyday Discrimination Scale, rated their sleep quality (1 = poor to 5 = excellent), and self-reported hours of sleep. A subset of participants (N = 762) underwent 7-day actigraphy to objectively measure sleep duration and sleep quality (Sleep Exam 2012-2016). Changes in discrimination were defined as low stable (reference), increasing, decreasing, and high stable. Within-person changes in sleep from Exam 1 to Exam 3 were regressed on change in discrimination from Exam 1 to Exam 3 while adjusting for age, sex, education, income, employment, physical activity, smoking, body mass index, social support, and stress. RESULTS At Exam 1, the mean age was 54.1 (12.0) years; 64% were female, mean sleep quality was 3.0 (1.1) and 54% were short sleepers. The distribution of the discrimination change trajectories were 54.1% low stable, 13.5% increasing, 14.6% decreasing, and 17.7% were high stable. Participants who were in the increasing (vs. low stable) discrimination group had greater decrease in sleep quality. There was no association between change in discrimination and change in sleep duration. Among Sleep Exam participants, higher discrimination was cross-sectionally associated with shorter self-reported sleep duration, independent of stress. CONCLUSION Discrimination is a unique stressor for African-Americans; thus, future research should identify interventions to reduce the burden of discrimination on sleep quality.
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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
| | - Tené T Lewis
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Na Guo
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Boston, MA, USA
| | - Chandra L Jackson
- Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Services, Research Triangle Park, NC, USA
- Division of Intramural Program, Department of Health and Human Services, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, USA
| | - Mario Sims
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS, USA
| | - James G Wilson
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS, USA
| | - Ana V Diez Roux
- Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - David R Williams
- T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Susan Redline
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Boston, MA, USA
- T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
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Chan KKS, Fung WTW. Differential Impact of Experienced and Anticipated Discrimination on Sleep and Health Among Sexual Minorities. ARCHIVES OF SEXUAL BEHAVIOR 2021; 50:3053-3063. [PMID: 34617190 DOI: 10.1007/s10508-021-01981-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 02/16/2021] [Accepted: 03/06/2021] [Indexed: 06/13/2023]
Abstract
For many lesbian, gay, and bisexual (LGB) individuals, stigma may represent a psychosocial stressor that can disrupt sleep and impair health. The present study tested a stigma model of sleep health to examine whether experienced and anticipated discrimination, as well as associated primal threat, would affect sleep quality and, in turn, physical and mental health among LGB individuals. A total of 401 LGB individuals (201 women and 200 men; mean age = 27.48 years) from Hong Kong, China, provided cross-sectional questionnaire data on experienced and anticipated discrimination, primal threat, sleep disturbance, and self-rated physical and mental health. Path analyses showed that experienced and anticipated discrimination were associated with higher primal threat, which was, in turn, associated with greater sleep disturbance and then poorer physical and mental health. Bootstrap analyses further revealed that experienced and anticipated discrimination had significant indirect effects on sleep disturbance via primal threat and on physical and mental health via primal threat and sleep disturbance. In addition, multi-group analyses demonstrated that the mediation model held across women and men and across lesbian/gay and bisexual individuals. Theoretically, our findings highlighted the importance of considering the differential effects of experienced and anticipated discrimination, as well as the contributive role of primal threat, on the sleep quality and health status of LGB individuals. Practically, our findings pointed to the necessity of developing community-based stigma reduction programs and individual-oriented stigma coping interventions in order to facilitate LGB individuals to reduce discrimination-related primal threat and thereby improve sleep and health.
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Affiliation(s)
- Kevin Ka Shing Chan
- Department of Psychology, The Education University of Hong Kong, Tai Po, Hong Kong.
- Centre for Psychosocial Health, The Education University of Hong Kong, Tai Po, Hong Kong.
| | - Winnie Tsz Wa Fung
- Department of Psychology, The Education University of Hong Kong, Tai Po, Hong Kong
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Ahn S, Lobo JM, Logan JG, Kang H, Kwon Y, Sohn MW. A scoping review of racial/ethnic disparities in sleep. Sleep Med 2021; 81:169-179. [PMID: 33713923 DOI: 10.1016/j.sleep.2021.02.027] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 02/08/2021] [Accepted: 02/11/2021] [Indexed: 01/01/2023]
Abstract
BACKGROUND Despite remarkable achievements in ensuring health equity, racial/ethnic disparities in sleep still persist and are emerging as a major area of concern. Accumulating evidence has not yet been well characterized from a broad perspective. We conducted a scoping review of studies on sleep disparities by race/ethnicity to summarize characteristics of existing studies and identify evidence gaps. METHODS We searched PubMed, CINAHL, PsycINFO, and Web of Science databases for studies of racial/ethnic disparities in sleep. Studies that met inclusion criteria were retrieved and organized in a data charting form by study design, sleep measuring methods, sleep features, and racial/ethnic comparisons. RESULTS One hundred sixteen studies were included in this review. Most studies focused on disparities between Whites and Blacks. Disproportionately fewer studies examined disparities for Hispanic, Asian, and other racial/ethnic groups. Self-reported sleep was most frequently used. Sleep duration, overall sleep quality, and sleep disordered breathing were frequently studied, whereas other features including sleep efficiency, latency, continuity, and architecture were understudied, particularly in racial minority groups in the US. Current study findings on racial/ethnic disparities in most of sleep features is mixed and inconclusive. CONCLUSIONS This review identified significant evidence gaps in racial/ethnic disparities research on sleep. Our results suggest a need for more studies examining diverse sleep features using standardized and robust measuring methods for more valid comparisons of sleep health in diverse race/ethnicity groups.
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Affiliation(s)
- Soojung Ahn
- School of Nursing, University of Virginia, Charlottesville, VA, USA
| | - Jennifer M Lobo
- Department of Public Health Sciences, University of Virginia, Charlottesville, VA, USA
| | - Jeongok G Logan
- School of Nursing, University of Virginia, Charlottesville, VA, USA
| | - Hyojung Kang
- College of Applied Health Sciences, University of Illinois at Urbana-Champaign, Champaign, IL, USA
| | - Younghoon Kwon
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Min-Woong Sohn
- Department of Health Management and Policy, College of Public Health, University of Kentucky, Lexington, KY, USA.
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12
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Ogbenna BT, Ryu S, Lee S, Slopen N. Discrimination and Sleep among Asians and Pacific Islanders Adults. Sleep 2021; 44:6257851. [PMID: 33912974 DOI: 10.1093/sleep/zsab109] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 03/13/2021] [Indexed: 11/14/2022] Open
Abstract
STUDY OBJECTIVES To examine the association between discrimination and sleep duration and difficulty among Asians and Pacific Islanders (APIs) in the United States, and to test nativity and ethnic identity (EI) as effect modifiers. METHODS This cross-sectional study of 1,765 adults from the National Epidemiology Study of Alcohol and Related Conditions III, assessed discrimination using the Experiences of Discrimination scale. Discrimimation was classified as low, moderate, and high. Regression models were used to examine self-reported sleep duration and difficulty. RESULTS In bivariate analyses, individuals with high discrimination had the shortest sleep and reported sleep difficulty most often. Using linear models adjusted for sociodemographic and health characteristics, moderate and high discrimination were associated with 9 minutes (standard error [SE]: 4.8, p <0.10) and 14.4 minutes (SE: 6.0, p <0.05) less sleep, respectively, relative to low discrimination. Individuals with moderate and high discrimination had higher prevalence of sleep difficulty compared to those with low discrimination (prevalence ratio [PR]: 1.51, 95% confidence interval [CI]: 1.14-1.99 and PR: 1.73, 95% CI: 1.33-2.24, respectively). Interaction effect was observed in sleep difficulty by nativity and EI, but not duration. The association between discrimination and sleep difficulty was stronger among US-born relative to foreign-born participants. Among participants with low EI, moderate and high discrimination were associated with sleep difficulty, whereas among those with high EI, only high discrimination displayed this association. CONCLUSIONS Discrimination is associated with sleep duration and difficulty, and varies by nativity and EI. Research is needed to improve sleep among APIs that experience discrimination.[.
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Affiliation(s)
- Bethany Townsend Ogbenna
- University of Maryland School of Public Health, Department of Epidemiology and Biostatistics, USA
| | - Soomin Ryu
- University of Maryland, College Park, School of Public Policy, USA
| | - Sunmin Lee
- University of California, Irvine, School of Medicine, Department of Medicine, USA
| | - Natalie Slopen
- Harvard T. H. Chan School of Public Health, Department of Social and Behavioral Sciences, USA
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Beyond single sleep measures: A composite measure of sleep health and its associations with psychological and physical well-being in adulthood. Soc Sci Med 2021; 274:113800. [PMID: 33652324 DOI: 10.1016/j.socscimed.2021.113800] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 01/05/2021] [Accepted: 02/19/2021] [Indexed: 12/23/2022]
Abstract
RATIONALE Sleep is important for many functions including body and mind restoration. Studies report the association of sleep with stress and physical deterioration, often focusing only on sleep duration; yet, sleep health needs to be understood by multiple dimensions to comprehensively capture its impact on well-being. OBJECTIVE This study examined cross-sectional and longitudinal associations of multidimensional sleep health with perceived stress and chronic physical conditions. METHODS We used a sample of 441 adults (M age = 57 years) who participated in the biomarker project of the Midlife in the United States Study. Participants provided self-report and actigraphy sleep data in 2004-2009 (T1). We created a composite score of sleep health (Range = 0-6; higher indicating more sleep problems) encompassing: actigraphy-measured regularity, timing, efficiency, duration, and self-reported satisfaction and alertness. Participants responded to the perceived stress scale and chronic physical conditions checklist at T1; chronic physical conditions were reassessed in 2013-2015 (T2). RESULTS Cross-sectionally, a composite score of sleep health problems was uniquely associated with higher perceived stress and more chronic conditions, explaining additional variance that each individual sleep variable did not explain. Sleep duration - one of the most commonly researched dimensions of sleep - was not associated with either perceived stress or chronic conditions. Longitudinally, for individuals who had fewer chronic conditions at T1, having more sleep health problems was associated with an increase in chronic conditions at T2. Among the multiple dimensions, sleep satisfaction was most consistently and strongly associated with the outcomes. CONCLUSION Findings suggest the importance of considering multiple sleep dimensions concerning psychological and physical well-being in adulthood.
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Yip T, Chen M, Wang Y, Slopen N, Chae D, Priest N, Williams D. Linking discrimination and sleep with biomarker profiles: An investigation in the MIDUS study. COMPREHENSIVE PSYCHONEUROENDOCRINOLOGY 2021; 5:100021. [PMID: 34337570 PMCID: PMC8321117 DOI: 10.1016/j.cpnec.2020.100021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 12/08/2020] [Indexed: 12/29/2022] Open
Abstract
Self-reported experiences of discrimination and sleep dysfunction have both been shown to adversely impact biological functioning; however, few studies have examined how they are jointly associated with health. The current study draws from two samples of the Midlife in the United States (MIDUS) data (n = 617 participants; 59.8% female; 72.3% White and 27.7% African American; Age: Mean = 52.6, SD = 12.22) to identify profiles of sleep (duration, variability, onset latency, wake after sleep onset, naps) and discrimination (everyday, lifetime, impact). Associations with latent profiles of biomarkers of inflammation (CRP, fibrinogen, IL-6) and endocrine stress (cortisol, epinephrine, norepinephrine) were examined. Three profiles were identified for sleep/discrimination (good, fair, poor) and for biomarkers (average, high inflammation, high neuroendocrine). Chi-square analyses indicated that adults in the good sleep/low discrimination profile were more likely to be in the average biomarker profile but less likely to be in the high inflammation profile. Adults in the fair sleep/moderate discrimination risk profile were more likely to be in the high inflammation profile. Adults in the poor sleep/high discrimination risk profile were less likely to be in the average biomarker profile but more likely to be in the high inflammation profile. The current study identified configurations of sleep and discrimination among midlife adults which were associated with profiles of biological risk. The findings provide implications for identifying individuals who may be at increased risk of developing stress-related tertiary outcomes of morbidity and disease.
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Affiliation(s)
- Tiffany Yip
- Fordham University, Department of Psychology, 441 E. Fordham Road, 226 Dealy Hall, Bronx, NY, 10458, USA
| | - Mingzhang Chen
- Michigan State University, Human Development and Family Studies, 552 West Circle Drive, East Lansing, MI, 48824, USA
| | - Yijie Wang
- Michigan State University, Human Development and Family Studies, 552 West Circle Drive, East Lansing, MI, 48824, USA
| | - Natalie Slopen
- University of Maryland, School of Public Health, 4200 Valley Drive, Suite 2242, College Park, MD, 20742-2611, USA
| | - David Chae
- Tulane University, School of Public Health and Tropical Medicine, 1440 Canal Street, Suite 2210, New Orleans, LA, 70112, USA
| | - Naomi Priest
- Australian National University, Centre for Social Research and Methods, Caberra, ACT 0200, Australia
| | - David Williams
- Harvard University, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA
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Peltzer K, Pengpid S. Prevalence and correlates of insomnia symptoms among older adults in India: Results of a national survey in 2017-2018. ARCHIVES OF MENTAL HEALTH 2021. [DOI: 10.4103/amh.amh_19_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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16
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Lee KM, Hunger JM, Tomiyama AJ. Weight stigma and health behaviors: evidence from the Eating in America Study. Int J Obes (Lond) 2021; 45:1499-1509. [PMID: 33934109 PMCID: PMC8236399 DOI: 10.1038/s41366-021-00814-5] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 02/18/2021] [Accepted: 04/09/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Weight stigma is pervasive across the U.S. and is associated with poor health outcomes including all-cause mortality. One potential reason that weight stigma may be detrimental to health is that it begets poorer health behaviors. Therefore, the present study tested for associations between weight stigma and four health behaviors (i.e., eating behavior, alcohol use, sleep disturbance, and physical activity), while controlling for BMI and other potential confounds. SUBJECTS/METHODS Participants (N = 2022) in the U.S. were recruited for the Eating in America Study using a Qualtrics panel between December 2019 and January 2020 and were census-matched according to national quotas for age, gender, income, race/ethnicity, and census region. Participants completed questionnaires about weight stigma, health behaviors, demographics, and anthropometric measurements. The current study employed a two-stage investigation: exploratory analyses were first performed on a random sample of the dataset (n = 438), then the remaining unexamined data were used to conduct confirmatory analyses that were preregistered on the Open Science Framework. RESULTS Controlling for BMI, weight stigma was significantly associated with greater disordered eating (b = 0.34, 95% CI [0.31, 0.38], p < 0.001), comfort eating (b = 0.32, 95% CI [0.25, 0.39], p < 0.001), sleep disturbance (b = 0.27, 95% CI [0.20, 0.33], p < 0.001), and alcohol use (b = 0.30, 95% CI [0.11, 0.49], p = 0.002), but not lower physical activity (b = -0.04, 95% CI [-0.13, 0.05], p = 0.402) for individuals across the weight spectrum. BMI and perceived weight status significantly moderated the effects of weight stigma on disordered eating and alcohol use. No gender differences were found. These confirmatory analyses partially replicated the exploratory stage 1 findings. CONCLUSIONS This study provides preliminary evidence that weight stigma is linked to several poor health behaviors, which may impact physical health.
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Affiliation(s)
- Kristen M. Lee
- grid.19006.3e0000 0000 9632 6718Department of Psychology, University of California, Los Angeles, CA USA
| | - Jeffrey M. Hunger
- grid.259956.40000 0001 2195 6763Department of Psychology, Miami University, Oxford, OH USA
| | - A. Janet Tomiyama
- grid.19006.3e0000 0000 9632 6718Department of Psychology, University of California, Los Angeles, CA USA
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Yang YT, Chang HY, Hsu CY, Zeitzer JM. Translation and Validation of a Chinese Version of the Cleveland Adolescent Sleepiness Questionnaire. Nat Sci Sleep 2021; 13:695-702. [PMID: 34104022 PMCID: PMC8179797 DOI: 10.2147/nss.s262572] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 08/11/2020] [Indexed: 11/23/2022] Open
Abstract
PURPOSE The Cleveland Adolescent Sleepiness Questionnaire was originally developed and published in English and has served as a valid and effective tool for the assessment of adolescents' experiences with sleepiness in a variety of situations. To allow for comparisons between sleepiness in adolescents from different cultures, and with different linguistic backgrounds, reliable and valid measurement tools are necessary. The purpose of this study was to translate and validate a Chinese version of the Cleveland Adolescent Sleepiness Questionnaire (C-CASQ). MATERIALS AND METHODS Sensitivity, specificity, internal consistency, and criterion validity data for the C-CASQ were tested using 458 adolescents in Taiwan. Data from 191 participants were used to establish internal consistency reliability and conduct exploratory factor analysis (EFA), while data from 267 participants were used to establish criterion validity and conduct confirmatory factor analysis (CFA). Initial criterion validity was established through a comparison of the C-CASQ with scores from the Chinese version of the Morningness-Eveningness Scale for Children, a measure of chronotype. RESULTS EFA resulted in four factors, consistent with the original English version of the CASQ, while CFA established goodness of fit. The scale demonstrated acceptable to good internal consistency (α = 0.77~0.86). Initial criterion validity was evident as the total score and each of the subscale scores on the C-CASQ was significantly higher (greater sleepiness) in evening-types. CONCLUSION The C-CASQ appears to be a psychometrically sound measure to evaluate sleepiness in Chinese-speaking adolescents.
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Affiliation(s)
- Ya-Ting Yang
- Institute of Education, National Cheng Kung University, Tainan City, Taiwan.,Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
| | - Han-Yun Chang
- Institute of Education, National Cheng Kung University, Tainan City, Taiwan
| | - Chung-Yao Hsu
- Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Jamie M Zeitzer
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA.,Mental Illness Research Education and Clinical Center, VA Palo Alto Health Care System, Palo Alto, CA, USA
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Jackson CL, Walker JR, Brown MK, Das R, Jones NL. A workshop report on the causes and consequences of sleep health disparities. Sleep 2020; 43:zsaa037. [PMID: 32154560 PMCID: PMC7420527 DOI: 10.1093/sleep/zsaa037] [Citation(s) in RCA: 120] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 01/16/2020] [Indexed: 01/10/2023] Open
Abstract
Sleep deficiencies, which include insufficient or long sleep duration, poor sleep quality, and irregular timing of sleep, are disproportionately distributed among populations that experience health disparities in the United States. Sleep deficiencies are associated with a wide range of suboptimal health outcomes, high-risk health behaviors, and poorer overall functioning and well-being. This report focuses on sleep health disparities (SHDs), which is a term defined as differences in one or more dimensions of sleep health on a consistent basis that adversely affect designated disadvantaged populations. SHDs appear to share many of the same determinants and causal pathways observed for health outcomes with well-known disparities. There also appears to be common behavioral and biological mechanisms that connect sleep with poorer health outcomes, suggesting a link between SHDs and other health disparities observed within these designated populations. In 2018, the National Institute on Minority Health and Health Disparities, the National Heart, Lung, and Blood Institute, and the Office of Behavioral and Social Sciences Research convened a workshop with experts in sleep, circadian rhythms, and health disparities to identify research gaps, challenges, and opportunities to better understand and advance research to address SHDs. The major strategy to address SHDs is to promote integration between health disparity causal pathways and sleep and circadian-related mechanisms in research approaches and study designs. Additional strategies include developing a comprehensive, integrative conceptual model, building transdisciplinary training and research infrastructure, and designing as well as testing multilevel, multifactorial interventions to address SHDs.
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Affiliation(s)
- Chandra L Jackson
- Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, NC
- Intramural Program, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD
| | - Jenelle R Walker
- Center for Translation Research and Implementation Science, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD
| | - Marishka K Brown
- Division of Lung Diseases, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD
| | - Rina Das
- Division of Extramural Scientific Programs, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD
| | - Nancy L Jones
- Division of Extramural Scientific Programs, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD
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Yip T, Cheon YM. Sleep, psychopathology and cultural diversity. Curr Opin Psychol 2020; 34:123-127. [PMID: 32203913 PMCID: PMC7308190 DOI: 10.1016/j.copsyc.2020.02.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 02/10/2020] [Accepted: 02/11/2020] [Indexed: 11/30/2022]
Abstract
Research on ethnic/racial disparities in sleep in the United States finds minorities to have shorter self-reported and actigraphy-recorded sleep duration and poorer sleep quality. Disparities in mental health mirror disparities in sleep with ethnic/racial minorities reporting higher prevalence and more severe struggles. This review focuses on recent research in sleep and mental health disparities and considers ethnic/racial discrimination as an important third variable that may link these two domains of disparities research. For example, research has found discrimination to mediate ethnic/racial disparities in sleep; at the same time, sleep has been observed to mediate the link between discrimination and mental health. The review concludes with the importance of considering ethnicity/race and accompanying sociodemographic, environmental, and behavioral influences on sleep and mental health research.
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20
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Dzierzewski JM, Ravyts SG, Dautovich ND, Perez E, Schreiber D, Rybarczyk BD. Mental health and sleep disparities in an urban college sample: A longitudinal examination of White and Black students. J Clin Psychol 2020; 76:1972-1983. [PMID: 32410237 DOI: 10.1002/jclp.22974] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 04/29/2020] [Accepted: 05/01/2020] [Indexed: 01/17/2023]
Abstract
OBJECTIVE Racial disparities in sleep may be consequential among college students given high rates of dysfunctional sleep among this population. The present study sought to investigate whether disparities in sleep explain existing mental health disparities. METHOD Data included secondary analysis of a college risk behaviors and health study (n = 1242, mean age = 18.5). Race was dichotomized as White or Black, excluding all others, with participants completing measures of sleep at baseline and measures of depression and anxiety at follow-up 1 to 2 years later. RESULTS Compared to White students, Black students were more likely to report lower rates of depression and anxiety, but poorer sleep outcomes. Mediation analyses revealed that sleep partially mediated (suppressed) the association between race and depressive and anxiety symptoms. CONCLUSIONS Results indicate that disparities in sleep may play an important role in the association between race and mental health symptoms among college students. Future health disparity research would benefit from exploring the potentially bidirectional relationship between sleep and mental health symptoms among college students.
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Affiliation(s)
| | - Scott G Ravyts
- Department of Psychology, Virginia Commonwealth University, Richmond, Virginia
| | - Natalie D Dautovich
- Department of Psychology, Virginia Commonwealth University, Richmond, Virginia
| | - Elliottnell Perez
- Department of Psychology, Virginia Commonwealth University, Richmond, Virginia
| | - Dana Schreiber
- Department of Psychology, Virginia Commonwealth University, Richmond, Virginia
| | - Bruce D Rybarczyk
- Department of Psychology, Virginia Commonwealth University, Richmond, Virginia
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Abstract
OBJECTIVE This study aimed to examine associations among race, the accumulation of multiple forms of discriminatory experiences (i.e., "pervasive discrimination"), and allostatic load (AL) in African Americans and whites in midlife. METHODS Using data collected in 2004 to 2006 from 226 African American and 978 white adults (57% female; mean [SD] age = 54.7 [0.11] years) in the Midlife in the United States II Biomarker Project, a pervasive discrimination score was created by combining three discrimination scales, and an AL score was created based on 24 biomarkers representing seven physiological systems. Linear regression models were conducted to examine the association between pervasive discrimination and AL, adjusting for demographics and medical, behavioral, and personality covariates. A race by pervasive discrimination interaction was also examined to determine whether associations varied by race. RESULTS African Americans had higher pervasive discrimination and AL scores than did whites. In models adjusted for demographics, socioeconomic status, medications, health behaviors, neuroticism, and negative affect, a pervasive discrimination score of 2 versus 0 was associated with a greater AL score (b = 0.30, SE = 0.07, p < .001). Although associations seemed to be stronger among African Americans as compared with whites, associations did not statistically differ by race. CONCLUSIONS More pervasive discrimination was related to greater multisystemic physiological dysregulation in a cohort of African American and white adults. Measuring discrimination by combining multiple forms of discriminatory experiences may be important for studying the health effects of discrimination.
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Becerra MB, Bol BS, Granados R, Hassija C. Sleepless in school: The role of social determinants of sleep health among college students. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2020; 68:185-191. [PMID: 30489219 DOI: 10.1080/07448481.2018.1538148] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Revised: 10/03/2018] [Accepted: 10/15/2018] [Indexed: 06/09/2023]
Abstract
Sleep health is a public health concern and has been linked to an increased risk of number of deleterious health outcomes. Poor sleep health has been documented among college student populations; however, few studies have examined the social determinants of deficient sleep. The present study aims to address this gap, with emphasis on food insecurity, psychological distress, everyday discrimination, and academic performance. Participants (n = 282) completed self-report measures online assessing the variables of interest for the present study. Results revealed that the majority of college students in our sample reported feeling tired, fatigue, or daytime sleepiness and sleeping less than eight hours per night during the school week. Poor sleep health was significantly associated with being food insecurity, serious psychological distress, and poorer self-rated mental and physical health. Results have important implications for the development of targeted evidence-based interventions to improve sleep health among college populations.
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Affiliation(s)
- Monideepa B Becerra
- Department of Health Science and Human Ecology, California State University, San Bernardino, CA, USA
| | - Brittny S Bol
- Department of Health Science and Human Ecology, California State University, San Bernardino, CA, USA
| | - Rochelle Granados
- Department of Health Science and Human Ecology, California State University, San Bernardino, CA, USA
| | - Christina Hassija
- Department of Psychology, California State University, San Bernardino, CA, USA
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Bethea TN, Zhou ES, Schernhammer ES, Castro-Webb N, Cozier YC, Rosenberg L. Perceived racial discrimination and risk of insomnia among middle-aged and elderly Black women. Sleep 2020; 43:zsz208. [PMID: 31555803 PMCID: PMC6955644 DOI: 10.1093/sleep/zsz208] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 06/26/2019] [Indexed: 12/17/2022] Open
Abstract
STUDY OBJECTIVE To assess whether perceived racial discrimination is associated with insomnia among Black women. METHODS Data on everyday and lifetime racism and insomnia symptoms were collected from questionnaires administered in the Black Women's Health Study, an ongoing prospective cohort of Black women recruited in 1995 from across the United States. In 2009, participants completed five questions on the frequency of discriminatory practices in daily life (everyday racism) and six questions on ever experiencing unfair treatment in key institutional contexts (lifetime racism). In 2015, the Insomnia Severity Index was used to assess insomnia symptoms. We estimated odds ratios and 95% confidence intervals for associations of racism with insomnia, using multivariable logistic regression models adjusted for potential confounders. RESULTS The 26 139 participants in the analytic sample were 40-90 years old (median = 57 years, SD = 9.6 years). Higher levels of everyday racism and lifetime racism were positively associated with subthreshold (ptrend < .01) and clinical insomnia (ptrend < .01). Results remained unchanged after further adjustment for sleep duration and shift work. CONCLUSIONS Higher levels of perceived racism were associated with increased odds of insomnia among middle-aged and elderly Black women. Thus, perceived racism may contribute to multiple racial health disparities resulting from insomnia. Helping minority populations cope with their experiences of discrimination may decrease the significant public health impact of sleep disruption and subsequent diagnoses.
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Affiliation(s)
- Traci N Bethea
- Slone Epidemiology Center, Boston University, Boston, MA
- Department of Medicine, Boston University School of Medicine, Boston, MA
| | - Eric S Zhou
- Dana-Farber Cancer Institute, Boston, MA
- Division of Sleep Medicine, Harvard Medical School, Boston, MA
| | - Eva S Schernhammer
- Department of Medicine, Channing Division of Network Medicine, Brigham and Women’s Hospital, Boston, MA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
- Department of Epidemiology, Medical University of Vienna, Vienna, Austria
| | | | - Yvette C Cozier
- Slone Epidemiology Center, Boston University, Boston, MA
- Department of Epidemiology, Boston University School of Public Health, Boston, MA
| | - Lynn Rosenberg
- Slone Epidemiology Center, Boston University, Boston, MA
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Abstract
OBJECTIVE This set of studies examines the bidirectional links between social rejection and poor sleep, a ubiquitous and increasingly problematic health behavior. METHODS In study 1, a multiday field experiment, 43 participants completed a neutral task just before sleep on night 1 and a social rejection task on night 2. Objective and subjective sleep, postrejection affect, and physiological responses were measured. In study 2, 338 participants reported typical sleep quality before coming to the laboratory where they received social rejection or social acceptance feedback from a stranger. Physiological and affective responses were measured throughout the session. RESULTS In study 1, after social rejection, participants took longer going to bed (M [SD] = 38.06 [48.56] versus 11.18 [15.52], t(42) = 3.86, p < .001) and had shorter sleep durations (6:46 [1:27] versus 7:19 [1:38], t(41) = 2.92, p = .006) compared with the baseline night. Trait rumination moderated these effects, with high ruminators taking the longest to go to bed postrejection (t(38) = 2.90, p = .006). In both studies, there was (inconsistent) evidence that sleep influences reactions to rejection: some sleep measures predicted physiological reactivity during the rejection task in study 1 and greater negative affect after social rejection in study 2. CONCLUSIONS These studies provide evidence that social rejection may affect sleep outcomes, particularly for trait ruminators, and poor sleep in turn may exacerbate affective responses to social rejection. Given the mixed findings, small sample size, and no active control condition, more work is needed to confirm and build on these findings.
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Abstract
OBJECTIVE Several researchers have argued that racism-related stressors play an important role in adverse cardiovascular outcomes among African American women. However, studies have primarily focused on experiences of racism; thus, the role of expectations of racism is insufficiently understood. The current proof-of-concept study was designed to examine associations among expectations of racism, self-reported experiences of racism, and carotid intima-media thickness (IMT), a marker of cardiovascular risk, in African American women. METHODS Participants were 52 healthy African American women, aged 30 to 50 years (M (SD) = 40.8 (4.3)). Expectations of racism were assessed with a modified version of the Race-Based Rejection Sensitivity Questionnaire, experiences of racism were assessed with the Schedule of Racist Events, and carotid IMT was measured using B-mode ultrasound. RESULTS In linear regression analyses adjusted for age, expectations of racism were associated with higher levels of carotid IMT (b = .04, SE = .014, p = .013), after adjusting for experiences of racism. Findings remained significant after additional adjustments for cardiovascular risk factors (b = .03, SE = .014, p = .032). Associations were not confounded by additional stressors, hostility, or negative affect (depressive symptoms). CONCLUSIONS Independent of actual reports of racism, "expectations" of racism may be associated with increased cardiovascular risk in African American women. In addition, although experiences of discrimination were associated with depressive symptoms, expectations of racism were not, suggesting that other negative emotions likely play a role. Future studies are needed to replicate these results in larger samples and to explore the psychological and physiological pathways through which expectations of racism might affect cardiovascular disease risk across a range of populations.
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Johnson DA, Jackson CL, Williams NJ, Alcántara C. Are sleep patterns influenced by race/ethnicity - a marker of relative advantage or disadvantage? Evidence to date. Nat Sci Sleep 2019; 11:79-95. [PMID: 31440109 PMCID: PMC6664254 DOI: 10.2147/nss.s169312] [Citation(s) in RCA: 214] [Impact Index Per Article: 42.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Accepted: 05/09/2019] [Indexed: 12/25/2022] Open
Abstract
Sleep is a fundamental necessity of life. However, sleep health and sleep disorders are not equitably distributed across racial/ethnic groups. In fact, growing research consistently demonstrates that racial/ethnic minorities are more likely to experience, for instance, shorter sleep durations, less deep sleep, inconsistent sleep timing, and lower sleep continuity in comparison to Whites. However, racial/ethnic disparities in reports of sleepiness and sleep complaints are inconsistent. Racial/ethnic groups have significant heterogeneity, yet within-group analyses are limited. Among the few published within-group analyses, there are differences in sleep between non-US-born and US-born racial/ethnic groups, but the group with the more favorable sleep profile is consistent for non-US-born Latinos compared to US-born Latinos and Whites but unclear for other racial/ethnic minority groups. These sleep health disparities are a significant public health problem that should garner support for more observational, experimental, intervention, and policy/implementation research. In this review, we 1) summarize current evidence related to racial/ethnic disparities in sleep health and within-group differences, focusing on the sleep of the following racial/ethnic minority categories that are defined by the United States Office of Management and Budget as: American Indian/Alaska Native, Asian, African American/Black, Hispanic/Latino, and Native Hawaiian/Pacific Islander; 2) discuss measurement challenges related to investigating sleep health disparities; 3) discuss potential contributors to sleep health disparities; 4) present promising interventions to address sleep health disparities; and 5) discuss future research directions on intersectionality and sleep health.
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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 on Environmental Health Sciences, National Institutes of Health, Research Triangle Park, NC, USA
- Department of Health and Human Services, Intramural Program, National Institute of Minority Health and Health Disparities, Bethesda, MD, USA
| | - Natasha J Williams
- Department of Population Health, New York University School of Medicine, Center for Healthful Behavior Change, New York, NY, USA
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Matthews KA, Hall MH, Lee L, Kravitz HM, Chang Y, Appelhans BM, Swanson LM, Neal-Perry GS, Joffe H. Racial/ethnic disparities in women's sleep duration, continuity, and quality, and their statistical mediators: Study of Women's Health Across the Nation. Sleep 2019; 42:zsz042. [PMID: 30778560 PMCID: PMC6519910 DOI: 10.1093/sleep/zsz042] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 01/09/2019] [Accepted: 02/08/2019] [Indexed: 11/15/2022] Open
Abstract
STUDY OBJECTIVES To describe racial/ethnic differences in sleep duration, continuity, and perceived sleep quality in postmenopausal women and to identify statistical mediators of differences in sleep characteristics. METHODS Recruited from the observational Study of Women's Health Across the Nation (SWAN), 1,203 (548 white, 303 black, 147 Chinese, 132 Japanese, and 73 Hispanic; mean age 65 years, 97% postmenopausal) women participated in a week-long actigraphy and daily diary study in 2013-2015. Actigraphic measures of sleep duration and wake after sleep onset (WASO), and diary-rated sleep quality were averaged across the week. Candidate mediators included health-related variables; stress; and emotional well-being assessed up to 13 times across 18 years from baseline to sleep study. RESULTS Whites slept longer than other groups; the significant mediators were concurrent financial hardship and increasing number of stressors for Hispanics or Japanese versus whites. Whites had less WASO than blacks and Hispanics; significant mediators were concurrent number of health problems, physical inactivity, waist circumference, vasomotor symptoms, number of life stressors, and financial hardship, and increasing number of health problems from baseline to sleep study. Whites reported better sleep quality than blacks, Chinese, and Japanese; significant mediators were concurrent physical inactivity, vasomotor symptoms, positive affect, and depressive symptoms. CONCLUSIONS Sleep differences between blacks or Hispanics versus whites were mediated by health problems, number of stressors, and financial hardship, whereas sleep differences between Chinese or Japanese versus whites were mediated by emotional well-being. This is the first study using formal mediational approaches.
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Affiliation(s)
- Karen A Matthews
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA
| | - Martica H Hall
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA
| | - Laisze Lee
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA
| | - Howard M Kravitz
- Department of Psychiatry, Rush University Medical Center, Chicago, IL
- Department of Preventive Medicine, Rush University Medical Center, Chicago, IL
| | - Yuefang Chang
- Department of Neurosurgery, University of Pittsburgh, Pittsburgh, PA
| | | | | | | | - Hadine Joffe
- Connors Center for Women’s Health and Department of Psychiatry, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
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Chan KKS, Fung WTW. The impact of experienced discrimination and self-stigma on sleep and health-related quality of life among individuals with mental disorders in Hong Kong. Qual Life Res 2019; 28:2171-2182. [DOI: 10.1007/s11136-019-02181-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/09/2019] [Indexed: 01/12/2023]
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Hisler GC, Brenner RE. Does sleep partially mediate the effect of everyday discrimination on future mental and physical health? Soc Sci Med 2019; 221:115-123. [DOI: 10.1016/j.socscimed.2018.12.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2018] [Revised: 09/27/2018] [Accepted: 12/02/2018] [Indexed: 01/17/2023]
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Ong AD, Williams DR. Lifetime discrimination, global sleep quality, and inflammation burden in a multiethnic sample of middle-aged adults. CULTURAL DIVERSITY & ETHNIC MINORITY PSYCHOLOGY 2019; 25:82-90. [PMID: 30714770 PMCID: PMC6369702 DOI: 10.1037/cdp0000233] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVE Despite considerable evidence that greater exposure to discrimination over the life course increases risk for systemic inflammation, little is known about the mechanisms responsible for this association. Here we examine the role of global sleep quality as a potential pathway by which self-reported experiences of discrimination contribute to inflammatory dysfunction in a multiethnic sample of middle-aged adults. METHOD Participants were 300 adults (36-85 years; 65% women) from Milwaukee, Wisconsin, a subset of the Midlife in the United States Study 2 (2004-2006). Racial/ethnic representation included African American (77.7%), Hispanic (12.7%), Asian/Pacific Islander (5.6%), and Native American (4.0%). Global sleep quality and perceptions of lifetime and daily discrimination were measured by questionnaire. A composite score of inflammation burden was computed as the sum of five markers including C-reactive protein (CRP), interleukin-6 (IL-6), fibrinogen, E-selectin, and intracellular adhesion molecule-1 (ICAM-1). RESULTS Greater lifetime exposure to discrimination was associated with higher inflammation burden. This relationship remained significant after adjustments for potential confounding factors, including demographics, medication use, health behaviors, psychological distress, and daily discrimination. Mediation analyses suggested that poor global sleep quality was a key mechanism underlying the link between lifetime discrimination and inflammation burden. CONCLUSION These results add to a growing literature on the effects of bias and unfair treatment experienced by people of color and other marginalized groups by demonstrating how such experiences may be particularly consequential for sleep and physiological functioning in midlife. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Affiliation(s)
- Anthony D. Ong
- Department of Human Development, Cornell University
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medical College
| | - David R. Williams
- Harvard T. H. Chan School of Public Health
- Department of Social and Behavioral Sciences, Harvard University
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Everyday Discrimination and Metabolic Syndrome Incidence in a Racially/Ethnically Diverse Sample: Study of Women's Health Across the Nation. Psychosom Med 2018; 80:114-121. [PMID: 28787363 PMCID: PMC5741524 DOI: 10.1097/psy.0000000000000516] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE Everyday discrimination may contribute to incident metabolic syndrome (MetS) in the United States and related racial/ethnic differences in MetS. The study investigated whether everyday discrimination predicted MetS in a diverse sample. METHODS A longitudinal, cohort study of 2132 women (mean [standard deviation] = 45.8 [2.7] years) who self-reported as black (n = 523), white (n = 1065), Chinese (n = 194), Japanese (n = 227), or Hispanic (n = 123) at baseline drawn from seven cities across the United States was conducted. MetS was defined in accordance with the National Cholesterol Education Program Adult Treatment Panel III criteria. The Everyday Discrimination scale was used to assess exposure to and level of everyday discrimination. RESULTS Everyday discrimination exposure at baseline predicted a 33% greater incidence of MetS during the 13.89-year (standard deviation = 3.83, hazard ratio (HR) = 1.33, 95% confidence interval [CI] = 1.11-1.64, p = .001) follow-up in the full sample and was most pronounced in black, Hispanic, and Japanese women. Each 1-point increase in the continuous everyday discrimination score (HR = 1.03, 95% CI =1.01-1.05, p = .001) predicted a 3% greater incidence of MetS and, specifically, blood pressure (HR = 1.01, 95% CI = 1.00-1.03, p = .04), waist circumference (HR = 1.05, 95% CI =1.03-1.06, p < .001), and triglyceride level (HR = 1.02, 95% CI =1.00-1.04, p = .01). These associations were independent of risk factors including physical activity, socioeconomic status, smoking, and alcohol consumption. CONCLUSIONS Everyday discrimination contributes to poorer metabolic health in midlife women in the United States. These findings have clinical implications for the development of MetS and, ultimately, cardiovascular disease and diabetes, and intervention strategies to reduce these outcomes.
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Alcántara C, Patel SR, Carnethon M, Castañeda S, Isasi CR, Davis S, Ramos A, Arredondo E, Redline S, Zee PC, Gallo LC. Stress and Sleep: Results from the Hispanic Community Health Study/Study of Latinos Sociocultural Ancillary Study. SSM Popul Health 2017; 3:713-721. [PMID: 29104908 PMCID: PMC5663240 DOI: 10.1016/j.ssmph.2017.08.004] [Citation(s) in RCA: 83] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Hispanics/Latinos face specific sociocultural stressors associated with their marginalized status in the United States. While stress is known to cause poor sleep, the differential effects of the specific stressors faced by Hispanics/Latinos have not been evaluated. Using cross-sectional data from the Hispanic Community Health Study/Study of Latinos Sociocultural Ancillary Study, we conducted weighted generalized linear models to evaluate the associations of acculturation stress, ethnic discrimination, and chronic moderate/severe stress with self-reported sleep outcomes (insomnia symptoms, daytime sleepiness, sleep duration) in individual and aggregate models adjusted for site, socio-demographics, behavioral, and medical conditions. Participants included 5313 Hispanic/Latino adults; 43.5% ≥ age 45, 54.8% female, and 22.0% US-born. Chronic moderate/severe stress, ethnic discrimination, and acculturation stress were each positively associated with sleep. In the adjusted aggregate model, only chronic moderate/severe stress was associated with insomnia symptoms (exp(b) = 1.07 for each additional stressor, 95% CI = 1.05, 1.09). Both acculturation stress (exp(b) = 1.05 for each additional SD, 95% CI = 1.02, 1.10) and ethnic discrimination (exp(b) = 1.05 for each additional SD, 95% CI = 1.01, 1.08) were associated with daytime sleepiness. Each SD increase in ethnic discrimination related to a 16% and 13% increased prevalence of short (< 7 h) (RRR = 1.16, 95% CI = 1.02, 1.31) and long sleep duration (> 9 h) (RRR = 1.13, 95% CI = 1.00, 1.27), respectively. These associations were consistent across sex. Acculturation stress and ethnic discrimination are associated with poor sleep in Hispanics/Latinos. Future research should explore whether behavioral sleep interventions minimize the impact of sociocultural stressors on sleep. Latina/os face unique stressors associated with their marginalized status in the USA. We explored the association of sociocultural stressors with Latina/o sleep. Acculturation stress and ethnic discrimination were associated with daytime sleepiness. Only chronic psychosocial stress was associated with insomnia symptoms. Ethnic discrimination was associated with both short and long sleep duration.
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Affiliation(s)
| | - Sanjay R Patel
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Mercedes Carnethon
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Sheila Castañeda
- School of Public Health, San Diego State University, San Diego, CA
| | | | - Sonia Davis
- Department of Biostatistics, University of North Carolina at Chapel Hill-Gillins School of Global Public Health, Chapel Hill, NC
| | - Alberto Ramos
- University of Miami Miller School of Medicine, Miami, FL
| | - Elva Arredondo
- School of Public Health, San Diego State University, San Diego, CA
| | - Susan Redline
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Phyllis C Zee
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Linda C Gallo
- Department of Psychology, San Diego State University, San Diego, CA
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Abstract
OBJECTIVE Perceived discrimination has been associated with psychosocial distress and adverse health outcomes. We examined associations of perceived discrimination measures with changes in kidney function in a prospective cohort study, the Healthy Aging in Neighborhoods of Diversity across the Life Span. METHODS Our study included 1620 participants with preserved baseline kidney function (estimated glomerular filtration rate [eGFR] ≥ 60 mL/min/1.73 m) (662 whites and 958 African Americans, aged 30-64 years). Self-reported perceived racial discrimination and perceived gender discrimination (PGD) and a general measure of experience of discrimination (EOD) ("medium versus low," "high versus low") were examined in relation to baseline, follow-up, and annual rate of change in eGFR using multiple mixed-effects regression (γbase, γrate) and ordinary least square models (γfollow). RESULTS Perceived gender discrimination "high versus low PGD" was associated with a lower baseline eGFR in all models (γbase = -3.51 (1.34), p = .009 for total sample). Among white women, high EOD was associated with lower baseline eGFR, an effect that was strengthened in the full model (γbase = -5.86 [2.52], p = .020). Overall, "high versus low" PGD was associated with lower follow-up eGFR (γfollow = -3.03 [1.45], p = .036). Among African American women, both perceived racial discrimination and PGD were linked to lower follow-up kidney function, an effect that was attenuated with covariate adjustment, indicating mediation through health-related, psychosocial, and lifestyle factors. In contrast, EOD was not linked to follow-up eGFR in any of the sex by race groups. CONCLUSIONS Perceived racial and gender discrimination are associated with lower kidney function assessed by glomerular filtration rate and the strength of associations differ by sex and race groups. Perceived discrimination deserves further investigation as a psychosocial risk factors for kidney disease.
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