Sleep Health and Serious Psychological Distress: A Nationally Representative Study of the United States among White, Black, and Hispanic/Latinx Adults

Sleep quality in relation to perceived psychological stress in patients with type 2 diabetes and in age- and sex-matched control individuals

AIM

To assess sleep quality in relation to perceived stress in patients with type 2 diabetes (T2DM) and age- and sex-matched controls.

METHODS

Perceived stress level and sleep quality assessed in 154 patients with T2DM (58 men, 96 women, age 58.3 ± 11.9 years), 154 matched controls (58 men, 96 women, age 56.8 ± 12.2 years) using Perceived Stress Scale and Pittsburgh Sleep Quality Index.

RESULTS

Patients with T2DM had worse subjective sleep quality (p < 0.001), sleep latency (p = 0.047) than controls. Patients with high stress level had worse subjective sleep quality (p = 0.027), higher use of sleeping medication (p = 0.023), daytime dysfunction (p < 0.001) than those with low stress level. No significant differences in sleep quality between controls with high and low perceived stress level. Perceived stress level in patients with T2DM correlated with subjective sleep quality (r = 0.260, p = 0.002), sleep duration (r = 0.228, p = 0.005), use of sleep medication (r = 0.245, p = 0.004), daytime dysfunction (r = 0.326, p < 0.001), in age- and sex-matched controls-to daytime dysfunction (r = 0.191, p = 0.037).

CONCLUSION

Sleep quality (subjective sleep quality, sleep latency) is worse in patients with type 2 diabetes than in age- and sex-matched controls. Patients with high perceived stress level have worse subjective sleep quality, higher use of sleeping medication, daytime dysfunction than patients with low perceived stress level; no significant differences in sleep quality between controls with high and low stress level. Perceived stress level in patients with type 2 diabetes is related to subjective sleep quality, sleep duration, use of sleep medication, daytime dysfunction, in age- and sex-matched controls-to daytime dysfunction.

Officer-Involved Killings of Unarmed Black People and Racial Disparities in Sleep Health

Importance

Racial disparities in sleep health may mediate the broader health outcomes of structural racism.

Objective

To assess changes in sleep duration in the Black population after officer-involved killings of unarmed Black people, a cardinal manifestation of structural racism.

Design, Setting, and Participants

Two distinct difference-in-differences analyses examined the changes in sleep duration for the US non-Hispanic Black (hereafter, Black) population before vs after exposure to officer-involved killings of unarmed Black people, using data from adult respondents in the US Behavioral Risk Factor Surveillance Survey (BRFSS; 2013, 2014, 2016, and 2018) and the American Time Use Survey (ATUS; 2013-2019) with data on officer-involved killings from the Mapping Police Violence database. Data analyses were conducted between September 24, 2021, and September 12, 2023.

Exposures

Occurrence of any police killing of an unarmed Black person in the state, county, or commuting zone of the survey respondent's residence in each of the four 90-day periods prior to interview, or occurence of a highly public, nationally prominent police killing of an unarmed Black person anywhere in the US during the 90 days prior to interview.

Main Outcomes and Measures

Self-reported total sleep duration (hours), short sleep (<7 hours), and very short sleep (<6 hours).

Results

Data from 181 865 Black and 1 799 757 White respondents in the BRFSS and 9858 Black and 46 532 White respondents in the ATUS were analyzed. In the larger BRFSS, the majority of Black respondents were between the ages of 35 and 64 (99 014 [weighted 51.4%]), women (115 731 [weighted 54.1%]), and college educated (100 434 [weighted 52.3%]). Black respondents in the BRFSS reported short sleep duration at a rate of 45.9%, while White respondents reported it at a rate of 32.6%; for very short sleep, the corresponding values were 18.4% vs 10.4%, respectively. Statistically significant increases in the probability of short sleep and very short sleep were found among Black respondents when officers killed an unarmed Black person in their state of residence during the first two 90-day periods prior to interview. Magnitudes were larger in models using exposure to a nationally prominent police killing occurring anywhere in the US. Estimates were equivalent to 7% to 16% of the sample disparity between Black and White individuals in short sleep and 13% to 30% of the disparity in very short sleep.

Conclusions and Relevance

Sleep health among Black adults worsened after exposure to officer-involved killings of unarmed Black individuals. These empirical findings underscore the role of structural racism in shaping racial disparities in sleep health outcomes.

Well-being therapy and sleep hygiene in a non-clinical population of adults reporting poor sleep quality and distress: A remote pilot randomized controlled study

OBJECTIVES

This pilot randomized controlled study evaluates the feasibility and preliminary efficacy of a 7-week remote intervention combining well-being therapy and sleep hygiene to improve sleep and psychological outcomes among adults reporting poor sleep and distress.

METHODS

Thirty-one participants (81% women, 40.2 ± 13.0 y, 48% racial/ethnic minority) were recruited from the community during the COVID-19 pandemic through online and local advertisement, and randomized to well-being therapy+sleep hygiene or sleep hygiene-only. Study outcomes were evaluated by self-reported questionnaires administered at baseline and post-intervention and a daily sleep diary.

RESULTS

Compared to sleep hygiene-only, well-being therapy+sleep hygiene led to greater improvements in wake after sleep onset (time-by-group interaction: 3.6 ± 1.5 min, p = .017), personal growth (β -3.0, 95%CI -5.2, -0.8, p = .01), and purpose in life (β -3.5, 95%CI -6.1, -0.9, p = .009). Anxiety, perceived stress, sleep quality, and insomnia symptoms improved similarly in both groups (between-group differences, p > .05). Improvements in sleep quality, insomnia, and sleep duration were associated with reductions in multiple measures of psychological distress (all p < .05).

CONCLUSIONS

These findings suggest that, in a non-clinical setting of individuals suffering from combined poor sleep and psychological distress, the addition of well-being therapy to sleep hygiene may provide additional benefits for sleep by promoting sleep continuity and well-being.

Psychological distress and mental health care utilization among Hispanic/Latino survivors of adolescent and young adult cancer

PURPOSE

Survivors of adolescent and young adult (AYA) cancer experience psychological distress and insufficient access to mental health care. Few studies have investigated racial/ethnic disparities in psychological health outcomes in this population. This study compared psychological distress, mental health care use, and inability to afford mental health care between Hispanic/Latino survivors of AYA cancer and Hispanic/Latino controls.

METHODS

The National Health Interview Survey data (2010-2018) were analyzed to identify Hispanic/Latino survivors of AYA cancer and Hispanic/Latino age- and sex-matched non-cancer controls. Sociodemographic, chronic health, modifiable factors, and psychological outcomes were compared using chi-square tests. Logistic regression models with survey weights were used to assess the log-odds of psychological distress in relation to covariates, along with the cancer group. Interactions were evaluated between each variable and cancer group.

RESULTS

The study included 370 Hispanic/Latino survivors of AYA cancer (mean time since diagnosis = 12.34 years) and 3700 Hispanic/Latino controls. Compared to controls, survivors were more likely to report moderate/severe distress (OR = 2.23, p < 0.001), use of mental health care (OR = 2.11, p < 0.001) and inability to afford mental health care (OR = 3.05, p < 0.001). Forty-one percent of survivors reported moderate/severe distress and only 16% utilized mental health care. Among survivors, having more than two chronic health conditions and public insurance (compared to private insurance) were associated with the presence of moderate/severe distress. Among survivors experiencing moderate/severe distress, lack of insurance was associated with decreased utilization of mental health care.

CONCLUSIONS

Having cancer as an AYA may exacerbate disparities in psychological health within the Hispanic/Latino population.

The perceived neighborhood walking environment and self-reported sleep health in a nationally representative sample of the United States

Neighborhood environment can influence sleep health; yet, there is a lack of data on specific environment features in nationally representative samples. We used the 2020 National Health Interview Survey to determine associations between perceived built and social environment factors related to pedestrian access (walking paths, sidewalks), amenities (shops, transit stops, entertainment/services, places to relax), and unsafe walking conditions (traffic, crime) and self-reported sleep duration and disturbances. Places to relax and pedestrian access were associated with better sleep health while unsafe walking conditions were associated with worse sleep health. Access to amenities (shops, transit stops, entertainment venues) had null associations with sleep health.

Examination of Behavioural Patterns of Psychological Distress and Evaluation of Related Factors: A latent class regression

Objectives

This study aimed to identify the behavioural pattern of psychological distress (PD) in the population of 18 to 65 years old people in Mashhad, Iran, using latent class regression and evaluate the related factors. PD is a unique emotional state with suffering in response to a stressor or specific need that leads to temporary or permanent impacts. Due to its negative effects on several features of life like the quality of life, health, performance and productivity of individuals, PD and its consequences are considered a public health priority.

Methods

A cross-sectional study was performed on 425,286 individuals aged 18 to 65, who were referred to health centres in Mashhad, northeastern Iran in the first half of 2018. The information required for this study, including a checklist of demographic information and the six-item Kessler Psychological Distress Scale (K-6), was obtained from the Sina System.

Results

Latent class regression identified three latent patterns of PD in answering the questions of the K-6 questionnaire, including severe PD (14%), low PD distress (40%) and no PD (46%). Statistical variables of this study due to the results are considered as the following: women, illiterate people, unemployed and divorced people, individuals aged between 50 and 59 years and people with low weight were more likely to be in the severe PD class than in the no PD class.

Conclusion

Although a small percentage of people were classified as severely disturbed, the findings showed a high rate of symptoms of distress and sadness even in the no PD class.

Geospatial Associations between Female Breast Cancer Mortality Rates and Environmental Socioeconomic Indicators for North Carolina

In North Carolina, over 6000 women will be diagnosed with breast cancer yearly, and over 1000 will die. It is well known that environmental conditions contribute greatly to health outcomes, and many of these factors include a geographic component. Using death data records from 2003-2019 extracted from North Carolina Vital Statistics Dataverse, a spatial database was developed to map and analyze female breast cancer mortality rates at the ZIP code scale in North Carolina. Thirty-nine hot spots and thirty cold spots of age-adjusted death rates were identified using the Getis-Ord analysis. Two-tailed t-tests were run between each cohort for environmental socioeconomic-related factors associated with breast cancer progression and mortality. The median age and household income of individuals who resided in ZIP codes with the highest breast cancer mortality were significantly lower than those who lived in ZIP codes with lower breast cancer mortality. The poverty rate, percentage of SNAP benefits, and the percentage of minorities were all significantly higher (p < 0.05, p < 0.001, and p < 0.001) in ZIP codes with high breast cancer rates. High-quality (ZIP code) granular cancer data were developed for which detailed analysis can be performed for future studies.

Food insecurity and sleep health by race/ethnicity in the United States

Food insecurity, poised to increase with burgeoning concerns related to climate change, may influence sleep, yet few studies examined the food security-sleep association among racially/ethnically diverse populations with multiple sleep dimensions. We determined overall and racial/ethnic-specific associations between food security and sleep health. Using National Health Interview Survey data, we categorised food security as very low, low, marginal and high. Sleep duration was categorised as very short, short, recommended and long. Sleep disturbances included trouble falling/staying asleep, insomnia symptoms, waking up feeling unrested and using sleep medication (all ≥3 d/times in the previous week). Adjusting for socio-demographic characteristics and other confounders, we used Poisson regression with robust variance to estimate prevalence ratios (PRs) and 95 % confidence intervals (95 % CIs) for sleep dimensions by food security. Among 177 435 participants, the mean age of 47⋅2 ± 0⋅1 years, 52⋅0 % were women, and 68⋅4 % were non-Hispanic (NH)-White. A higher percent of NH-Black (7⋅9 %) and Hispanic/Latinx (5⋅1 %) lived in very low food security households than NH-White (3⋅1 %) participants. Very low v. high food security was associated with a higher prevalence of very short (PR = 2⋅61 [95 % CI 2⋅44-2⋅80]) sleep duration as well as trouble falling asleep (PR = 2⋅21 [95 % CI 2⋅12-2⋅30]). Very low v. high food security was associated with a higher prevalence of very short sleep duration among Asian (PR = 3⋅64 [95 % CI 2⋅67-4⋅97]) and NH-White (PR = 2⋅73 [95 % CI 2⋅50-2⋅99]) participants compared with NH-Black (PR = 2⋅03 [95 % CI 1⋅80-2⋅31]) and Hispanic/Latinx (PR = 2⋅65 [95 % CI 2⋅30-3⋅07]) participants. Food insecurity was associated with poorer sleep in a racially/ethnically diverse US sample.

Discrimination and Health Among First-Generation Hispanic/Latinx Immigrants: the Roles of Sleep and Fatigue

INTRODUCTION

A growing literature documents the associations between discrimination and health. Emerging evidence suggests that among Hispanic/Latinx immigrants, discrimination leads to the deterioration of health outcomes over time. While sleep has been proposed as an important mediator of the relationship between discrimination and health, few studies have explicitly investigated this pathway, particularly among Hispanic/Latinx populations.

OBJECTIVE

To investigate the relationships between racial/ethnic discrimination, sleep, and physical and mental health among Hispanic/Latinx immigrants in the USA. Data and Methods Using data from a parent study of first-generation Hispanic/Latinx immigrants in the southeastern USA, we conducted sequential mediation analyses using the bootstrapping method to investigate whether self-reported sleep duration, sleep quality, and fatigue mediate the relationship(s) between self-reported discrimination, as measured by the discrimination subscale of the Riverside Acculturative Stress Inventory, and self-reported physical and mental health.

RESULTS

Nocturnal awakenings, fatigue, and sleep quality were statistically significant sequential mediators of the relationship between discrimination and physical health (b = -.001, SE = .001, CI [-.0027, -.0001]); fatigue alone also mediated this relationship (b = -.01, SE = .01, CI [-.0279, -.0003]). Nocturnal awakenings, fatigue, and sleep quality were also significant sequential mediators of the relationship between discrimination and mental health (b = -.001, SE = .001, CI [-.0031, -.0001]).

CONCLUSION

Sleep and fatigue play an important role in linking discrimination and health among first-generation Hispanic/Latinx immigrants. The development and implementation of interventions that focus on reducing fatigue among this population could mitigate the effects of unfair treatment on health outcomes.

Changes in household debt due to COVID-19 and mental health concerns among adults in Ontario, Canada

BACKGROUND

Canadian households experienced unexpected changes in their economic well-being during the COVID-19 pandemic. The extent of the impact of the pandemic on household debt and its effect on health and mental health remains unknown.

AIM

The aim of the study was to examine the associations of change in household debt due to COVID-19 with serious psychological distress (SPD) and general health measures.

METHODS

Data were from the 2020 Monitor study, a repeated cross-sectional survey of adults 18 years and older in Ontario, Canada. The 2020 cycle employed a web-based panel survey of 3,033 adults. The survey included measures of change in household debt due to the COVID-19 pandemic, mental and general health. Odds ratios (OR) were estimated from logistic regression models accounting for sociodemographic factors.

RESULTS

Overall, 17.5% of respondents reported that their household debt increased due to the COVID-19 pandemic. Such an increase in household debt was significantly associated with SPD (OR = 2.92, 95% CI, 2.05-4.16), fair/poor mental health (OR = 2.02, 95% CI, 1.59-2.56), frequent mental distress days (OR = 1.80, 95% CI, 1.31-2.48), fair/poor general health (OR = 1.93, 95% CI, 1.47-2.52), and suicidal ideation (OR = 3.71, 95% CI, 2.41-5.70) after adjusting for potential confounders including education, income and employment.

CONCLUSIONS

Household debt during the COVID-19 pandemic is an important determinant of health. Individuals who reported an increase in household debt due to COVID-19 were more likely to report serious mental health concerns including suicidal ideation. This suggests that debt-related interventions may be needed to alleviate the adverse effects of indebtedness on health.

Sleep characteristics among black cisgender sexual minority men and black transgender women during the COVID-19 pandemic: The role of multi-level COVID-19-related stressors

OBJECTIVES

To determine the association between individual, network, and structural COVID-19-related stressors and changes in sleep duration and quality among Black cisgender sexual minority men (SMM) and Black transgender women during the COVID-19 peak infectivity rate in Chicago.

METHODS

From April 20, 2020 to July 31, 2020, we conducted the N2 COVID Study in Chicago (n = 226). The survey included questions regarding multi-level COVID-19-related stressors (eg, food unavailability, partner violence, housing instability, concern about neighborhood COVID-19), sleep duration, and sleep quality.

RESULTS

About 19.5% of our sample reported a shorter duration of sleep during the initial peak COVID-19 infectivity, while 41.2% reported more sleep and 38.9% reported about the same. Compared to the prepandemic period, 16.8% reported that their sleep quality worsened in the COVID-19 pandemic, while 27.9% reported their sleep quality had improved and 55.3% reported it was about the same. In multivariable models, we found that ≥1 day of physical stress reaction, worrying about being infected with COVID-19, traveling during COVID-19 being a financial burden, not having enough medication, knowing someone who was diagnosed with COVID-19, partner violence and housing instability were associated with poor sleep health in the COVID-19 pandemic (adjusted risk ratio: 1.82-3.90, p &lt; .05).

CONCLUSIONS

These data suggest that COVID-19-related stressors impacted poor sleep duration and quality during the pandemic among this cohort. Multi-level interventions to reduce COVID-19-related stressors (eg, meditation, intimate partner violence prevention and housing programs) may be useful for improving sleep health among Black cisgender sexual minority men and Black transgender women.

Systematic review: sleep health in the US Latinx population

Sleep disturbances are a common and unmet health problem in Latinx. While Latinx report similar sleep disturbances as non-Hispanic Whites [NHW], Latinx suffer from these disturbances to a greater degree than their NHW counterparts. Sleep disturbances are associated with increased risk of chronic health conditions, which Latinx experience at high rates. Research also points to significant sleep differences within Latinx. Given that Latinx are a rapidly growing population in the United States, sleep disparities between Latinx and NHWs and sleep differences within Latinx warrant further investigation. While research on Latinx sleep is growing, the last narrative review on US Latinx sleep health was published by Loredo and colleagues in 2010. Our narrative review expands on Loredo et al.'s work, adding the literature on Latinx sleep published since 2010 (N = 70). A total of 78 peer-reviewed articles related to young to middle-aged (i.e., 18-65 years) healthy Latinx adult sleep were identified in three databases-PsycInfo, PubMed/Medline, and Web of Science. With the socioecological model as framework, this review (1) summarizes current evidence pertaining to sleep health in healthy, community dwelling, urban Latinx adults; (2) discusses measurement challenges related to investigating Latinx sleep disparities and differences; and (3) discusses potential contributors to Latinx sleep. The prevalence of short sleep duration, long sleep duration, and poor sleep quality is high among Latinx; there are differences by Latinx subgroup. Our review identifies several multi-level influences associated with poor sleep: SES, sexual minority status, racial discrimination, access to care, neighborhood environment, and shift work. N = 250/250.

Employment Industry and Occupational Class in Relation to Serious Psychological Distress in the United States

Occupational characteristics may influence serious psychological distress (SPD) and contribute to health inequities; yet, few studies have examined multiple employment industries and occupational classes in a large, racially diverse sample of the United States. Using data from the National Health Interview Survey, we investigated employment industry and occupational class in relation to SPD in the overall population and by race/ethnicity, gender, age, household income, and health status. We created eight employment industry categories: professional/administrative/management, agricultural/manufacturing/construction, retail trade, finance/information/real estate, educational services, health care/social assistance, accommodation/food services, and public administration/arts/other services. We also created three occupational class categories: professional/management, support services, and laborers. SPD was measured using the Kessler Psychological Distress Scale and scores ≥13 indicated SPD. We adjusted for confounders and used Poisson regression to estimate prevalence ratios (PRs) and 95% confidence intervals (CIs). Among the 245,038 participants, the mean age was 41.7 ± 0.1 years, 73% were Non-Hispanic (NH)-White, and 1.5% were categorized as having SPD. Compared to the professional/administrative/management industry, working in other industries (e.g., manufacturing/construction (PR = 0.82 [95% CI: 0.70–0.95]) and educational services (PR = 0.79 [95% CI: 0.66–0.94])) was associated with lower SPD. Working in support services and laborer versus professional/management positions were both associated with 19% higher prevalence of SPD (95% CI: 1.04–1.35; 95% CI: 1.04–1.38, respectively). Furthermore, working in a support services or laborer versus professional/management position was associated with higher SPD in most employment industries. Industry-specific workplace interventions to equitably improve mental health are warranted.

Neighborhood social cohesion and serious psychological distress among Asian, Black, Hispanic/Latinx, and White adults in the United States: a cross-sectional study

BACKGROUND

Serious psychological distress (SPD) is common and more prevalent in women, older adults, and individuals with a low-income. Prior studies have highlighted the role of low neighborhood social cohesion (nSC) in potentially contributing to SPD; however, few have investigated this association in a large, nationally representative sample of the United States. Therefore, our objective was to investigate the overall and racial/ethnic-, sex/gender-, self-rated health status-, age-, and household income-specific relationships between nSC and SPD.

METHODS

We used data from survey years 2013 to 2018 of the National Health Interview Survey to investigate nSC and SPD among Asian, Non-Hispanic (NH)-Black, Hispanic/Latinx, and NH-White men as well as women in the United States (N = 168,573) and to determine modification by race/ethnicity, sex/gender, self-rated health status, age, and annual household income. nSC was measured by asking participants four questions related to the trustworthiness and dependability of their neighbors. nSC scores were trichotomized into low (< 12), medium (12-14), and high (15-16). SPD was measured using the Kessler 6 psychological distress scale with scores ≥ 13 indicating SPD. After adjusting for sociodemographic, health behavior, and clinical confounders, we used Poisson regression with robust variance to estimate prevalence ratios (PRs) and 95% confidence intervals (CIs).

RESULTS

Among 168,573 participants, most were Non-Hispanic (NH)-White (69%), and mean age was 47 ± 0.01 years. After adjustment, low vs. high nSC was associated with a 75% higher prevalence of SPD overall (PR = 1.75 [1.59-1.92]), 4 times the prevalence of SPD among Asian men (PR = 4.06 [1.57-10.50]), 2 times the prevalence of SPD among participants in at least good health (PR = 2.02 [95% CI: 1.74-2.35]), 92% higher prevalence of SPD among participants ≥ 50 years old (PR = 1.92 [1.70-2.18]), and approximately 3 times the prevalence of SPD among Hispanic/Latinx participants with household incomes ≥ $75,000 (PR = 2.97 [1.45-6.08]).

CONCLUSIONS

Low nSC was associated with higher SPD in the overall population and the magnitude of the association was higher in Asian men, participants who reported good health, older participants, and Hispanic/Latinx adults with higher household incomes. Future research should continue to examine how neighborhood contexts can affect health across various sociodemographic groups, especially among groups with multiple marginalized social identities.

Evaluation of Temporal Trends in Racial and Ethnic Disparities in Sleep Duration Among US Adults, 2004-2018

IMPORTANCE

Historically marginalized racial and ethnic groups are generally more likely to experience sleep deficiencies. It is unclear how these sleep duration disparities have changed during recent years.

OBJECTIVE

To evaluate 15-year trends in racial and ethnic differences in self-reported sleep duration among adults in the US.

DESIGN, SETTING, AND PARTICIPANTS

This serial cross-sectional study used US population-based National Health Interview Survey data collected from 2004 to 2018. A total of 429 195 noninstitutionalized adults were included in the analysis, which was performed from July 26, 2021, to February 10, 2022.

EXPOSURES

Self-reported race, ethnicity, household income, and sex.

MAIN OUTCOMES AND MEASURES

Temporal trends and racial and ethnic differences in short (<7 hours in 24 hours) and long (>9 hours in 24 hours) sleep duration and racial and ethnic differences in the association between sleep duration and age.

RESULTS

The study sample consisted of 429 195 individuals (median [IQR] age, 46 [31-60] years; 51.7% women), of whom 5.1% identified as Asian, 11.8% identified as Black, 14.7% identified as Hispanic or Latino, and 68.5% identified as White. In 2004, the adjusted estimated prevalence of short and long sleep duration were 31.4% and 2.5%, respectively, among Asian individuals; 35.3% and 6.4%, respectively, among Black individuals; 27.0% and 4.6%, respectively, among Hispanic or Latino individuals; and 27.8% and 3.5%, respectively, among White individuals. During the study period, there was a significant increase in short sleep prevalence among Black (6.39 [95% CI, 3.32-9.46] percentage points), Hispanic or Latino (6.61 [95% CI, 4.03-9.20] percentage points), and White (3.22 [95% CI, 2.06-4.38] percentage points) individuals (P < .001 for each), whereas prevalence of long sleep changed significantly only among Hispanic or Latino individuals (-1.42 [95% CI, -2.52 to -0.32] percentage points; P = .01). In 2018, compared with White individuals, short sleep prevalence among Black and Hispanic or Latino individuals was higher by 10.68 (95% CI, 8.12-13.24; P < .001) and 2.44 (95% CI, 0.23-4.65; P = .03) percentage points, respectively, and long sleep prevalence was higher only among Black individuals (1.44 [95% CI, 0.39-2.48] percentage points; P = .007). The short sleep disparities were greatest among women and among those with middle or high household income. In addition, across age groups, Black individuals had a higher short and long sleep duration prevalence compared with White individuals of the same age.

CONCLUSIONS AND RELEVANCE

The findings of this cross-sectional study suggest that from 2004 to 2018, the prevalence of short and long sleep duration was persistently higher among Black individuals in the US. The disparities in short sleep duration appear to be highest among women, individuals who had middle or high income, and young or middle-aged adults, which may be associated with health disparities.

Prenatal and early childhood exposure to tetrachloroethylene (PCE)-contaminated drinking water and sleep quality in adulthood: a retrospective cohort study

BACKGROUND

Communities in Cape Cod, Massachusetts were exposed to tetrachloroethylene (PCE) through contaminated drinking water from 1969 to 1983. PCE exposure during adulthood has well-established neurotoxic effects; however, long-term impacts stemming from early life exposure, especially adverse effects on sleep quality, are not well understood.

METHODS

The present analysis was based on data from the Cape Cod Health Study, a retrospective cohort study of the long-term neurotoxic impacts of early-life exposure to PCE-contaminated drinking water. Exposure to PCE-contaminated water was estimated using a validated leaching and transport model. Measures of sleep quality were obtained from self-administered questionnaires. Generalized estimating equations were used to generate risk ratios and 95% confidence intervals to estimate the association between early-life PCE exposure and sleep quality among 604 participants.

RESULTS

Compared to unexposed participants, any PCE exposure during early life was associated with 1.57 times the risk of reporting breathing pauses during sleep (95% CI 0.92-2.68). Low-level exposure to PCE was associated with 1.50 times the risk of reporting sleep apnea or other sleep disorders (95% CI 0.78-2.89), while high levels of exposure had comparable risk compared to no exposure (RR = 0.94, 95% CI 0.50-1.79). Weak or no associations were observed for other sleep quality outcomes. In stratified analyses participants with mental illness and/or substance use disorder had increased risk ratios for short sleep duration associated with PCE exposure.

CONCLUSION

These findings suggest that early-life exposure to PCE may be associated with a moderate increase in the risk of reporting breathing pauses during sleep in adulthood and that a history of mental illness and/or substance use disorder may exacerbate the risk of short sleep duration.

Are Sleep Problems Related to Psychological Distress in Healthy Aging during the COVID-19 Pandemic? A Review

The SARS-CoV-2 pandemic, characterized by home confinement and other restrictive measures to reduce the spread of the infection, led to significant changes in people's habits and lifestyle. One of the most common problems is the worsening of sleep quality or quantity, which could have negative effects on psychological wellbeing, particularly in older adults. The purposes of the present literature review considering healthy aging subjects are (a) to examine the existing research on sleep alterations during the current pandemic and (b) to highlight possible relationships between sleep problems and psychological distress. A systematic search strategy was implemented according to PRISMA guidelines in the international literature online databases, up to 1 July 2021. After identification and screening phases, 11 articles were included in this review. The studies found possible associations between sleep problems and mood changes-particularly in terms of depression and anxiety. In addition, altered sleep patterns seemed to be related to changes in individual aspects, lifestyle, and attitudes adopted by older adults during the COVID-19 lockdown. Thus, the pandemic could affect the sleep and psychological wellbeing of the older population, even in healthy aging.

Disparities in multiple sleep characteristics among non-Hispanic White and Hispanic/Latino adults by birthplace and language preference: cross-sectional results from the US National Health Interview Survey

OBJECTIVE

To investigate whether sleep disparities vary by birthplace among non-Hispanic White (NHW) and Hispanic/Latino adults in the USA and to investigate language preference as an effect modifier.

DESIGN

Cross-sectional.

SETTING

USA.

PARTICIPANTS

254 699 men and women.

METHODS

We used pooled 2004-2017 National Health Interview Survey data. Adjusting for sociodemographic and behavioural/clinical characteristics, survey-weighted Poisson regressions with robust variance estimated prevalence ratios (PRs) and 95% CIs of self-reported sleep characteristics (eg, sleep duration, trouble staying asleep) among (1) foreign-born NHW adults and Hispanic/Latino heritage groups versus US-born NHW adults and (2) Hispanic/Latino heritage groups versus foreign-born NHW adults. We further stratified by language preference in comparisons of Hispanic/Latino heritage groups with the US-born NHW group.

RESULTS

Among 254 699 participants with a mean age±SE 47±0.9 years, 81% self-identified their race/ethnicity as NHW, 12% Mexican, 2% Puerto Rican, 1% Cuban, 1% Dominican and 3% Central/South American. Compared with US-born NHW adults, foreign-born NHW adults were more likely to report poor sleep quality (eg, PR_{trouble staying asleep}=1.27 (95% CI: 1.17 to 1.37)), and US-born Mexican adults were no more likely to report non-recommended sleep duration while foreign-born Mexican adults were less likely (eg, PR_≤5-hours=0.52 (0.47 to 0.57)). Overall, Mexican adults had lower prevalence of poor sleep quality versus US-born NHW adults, and PRs were lowest for foreign-born Mexican adults. US-born Mexican adults were more likely than foreign-born NHW adults to report shorter sleep duration. Regardless of birthplace, Puerto Rican adults were more likely to report shorter sleep duration versus NHW adults. Generally, sleep duration and quality were better among Cuban and Dominican adults versus US-born NHW adults but were similar versus foreign-born NHW adults. Despite imprecision in certain estimates, Spanish language preference was generally associated with increasingly better sleep among Hispanic/Latino heritage groups compared with US-born NHW adults.

CONCLUSION

Sleep disparities varied by birthplace, Hispanic/Latino heritage and language preference, and each characteristic should be considered in sleep disparities research.

The Effects of Exposure to Domestic Violence on Sleep Among Urban Adults

PURPOSE

Domestic violence contributes to poor health including sleep disruptions, which has been associated with risk for chronic conditions and ultimately, premature mortality. The present study examined the effects of ever witnessing domestic violence on sleep among urban neighborhoods of color.

DESIGN

Cross-sectional.

SETTING

Ten of Chicago's 77 community areas.

PARTICIPANTS

Adults, aged 18 years and older (N = 1,543, Response Rate = 28.4%). Over 49% of participants reported a Hispanic ethnicity, 34.8 percent reported being non-Hispanic Black and 14.2 percent reported being White.

MEASURES

We used the Sinai Community Health Survey, 2.0, to examine: average hours of sleep in a 24-hour period, ever witnessing domestic violence, ever being emotionally or physically abused, frequent stress in the past 12 months, and other key covariates (race and ethnicity, annual household income, sex, and health status).

ANALYSIS

Multivariate logistic regression.

RESULTS

In the full model, participants who reported witnessing domestic violence were significantly less likely to report meeting sleep recommendations even after controlling for ever being emotionally or physically abused, frequently feeling stress, demographic factors, and health status. Non-Hispanic Blacks were most likely to report not meeting sleep recommendations (OR = .54, 95% CI = .30-.96, P = .036).

CONCLUSION

Witnessing domestic violence contributes to not meeting sleep recommendations and this appears to be most salient for Non-Hispanic Blacks. These point-in-time findings document an important potential contributor to racial health disparities.

Sleep Education for Elders Program (SLEEP): Promising Pilot Results of a Virtual, Health Educator-Led, Community-Delivered Sleep Behavior Change Intervention

PURPOSE

Sleep problems pose serious public health concerns, and evidence suggests that the problem is worsening. Both sufficient sleep quantity and quality are needed for optimal health, particularly among older adults, but access to sleep care can be difficult. This study examined the efficacy of a six-week sleep behavior change program designed for older adults that was delivered virtually by health educators.

PARTICIPANTS AND METHODS

This quasi-experimental pilot study (intervention n = 22; control n = 31) explored the effects of the Sleep Education for Elders Program (SLEEP) on sleep outcomes, which included: 1) sleep quality, measured by the Pittsburgh Sleep Quality Index (PSQI); 2) sleep duration, extracted from the PSQI; 3) insomnia symptoms, measured by the Insomnia Severity Index; 4) sleep hygiene behaviors, obtained from the Sleep Hygiene Index; and 5) excessive daytime sleepiness, measured by the Epworth Sleepiness Scale.

RESULTS

After SLEEP, the intervention group experienced significantly improved sleep quality (p < 0.001), a reduction in maladaptive sleep hygiene behaviors (p = 0.007), and reduced daytime sleepiness (p < 0.027) compared to the control group. Effect sizes for all five sleep measures were medium or large. In the intervention group, all changes were judged to be clinically meaningful (≥ 0.5 SD) except for improvements in daytime sleepiness.

CONCLUSION

These data support the efficacy of a group-based, virtual behavior change intervention in improving sleep outcomes among older adults.