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Li Y, Lin S, Cheslack-Postava K, Tang H, Fan F, Hoven CW. Racial and ethnic disparities in insufficient sleep among US in infants and preschoolers. Sleep Health 2023; 9:268-276. [PMID: 36813679 DOI: 10.1016/j.sleh.2022.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 10/28/2022] [Accepted: 11/13/2022] [Indexed: 02/22/2023]
Abstract
OBJECTIVE To examine racial and ethnic disparities and associated factors of insufficient sleep among children from infancy to preschool-aged. METHODS We analyzed parent-reported data on US children ages 4 months-5 years (n = 13,975) from the 2018 and 2019 National Survey of Children's Health. Children who slept less than the age-specific minimum hours recommended by the American Academy of Sleep Medicine were classified as having insufficient sleep. Logistic regression was used to estimate unadjusted and adjusted odds ratios (AOR). RESULTS An estimated 34.3% of children from infancy to preschool-aged experienced insufficient sleep. Socioeconomic factors (poverty [AOR] = 1.5, parents' education level [AORs] from 1.3 to 1.5); parent-child interaction variables (AORs from 1.4 to 1.6); breast feeding status (AOR = 1.5); family structure (AORs from 1.5 to 4.4); and weeknight bedtime regularity (AORs from 1.3 to 3.0) were significantly associated with having insufficient sleep. Non-Hispanic Black (OR = 3.2) and Hispanic children (OR = 1.6) had significantly higher odds of insufficient sleep compared to non-Hispanic White children. Racial and ethnic disparities in insufficient sleep between non-Hispanic White children and Hispanic children were largely attenuated by adjusting for social economic factors. However, the difference in insufficient sleep between non-Hispanic Black and non-Hispanic White children remains (AOR = 1.6) after adjusting socioeconomic and other factors. CONCLUSIONS More than one-third of the sample reported insufficient sleep. After adjusting for socio-demographic variables, racial disparities in insufficient sleep decreased but persistent disparities existed. Further research is warranted to examine other factors and develop interventions to address multilevel factors and improve sleep health among racial and ethnic minority group children.
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Affiliation(s)
- Yuanyuan Li
- Department of Psychology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China; Shenshan Medical Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Shanwei, China; Division of Child and Adolescent Psychiatry, Department of Psychiatry, New York State Psychiatric Institute, Columbia University, New York, New York, USA
| | - Susan Lin
- Center for Family and Community Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Keely Cheslack-Postava
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, New York State Psychiatric Institute, Columbia University, New York, New York, USA
| | - Huilan Tang
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, New York State Psychiatric Institute, Columbia University, New York, New York, USA
| | - Fang Fan
- Key Laboratory of Brain, School of Psychology, Center for Studies of Psychological Application, and Guangdong Key Laboratory of Mental Health and Cognitive Science, South China Normal University, Guangzhou, China
| | - Christina W Hoven
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, New York State Psychiatric Institute, Columbia University, New York, New York, USA; Department of Epidemiology, Mailman School of Public Health, Columbia Univresity, USA.
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Hoyniak CP, Bates JE, McQuillan ME, Albert LE, Staples AD, Molfese VJ, Rudasill KM, Deater-Deckard K. The Family Context of Toddler Sleep: Routines, Sleep Environment, and Emotional Security Induction in the Hour before Bedtime. Behav Sleep Med 2021; 19:795-813. [PMID: 33356565 PMCID: PMC8233403 DOI: 10.1080/15402002.2020.1865356] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Family processes during the pre-bedtime period likely have a crucial influence on toddler sleep, but relatively little previous research has focused on family process in this context. The current study examined several aspects of family process during the pre-bedtime period, including the use of bedtime routines, the qualities of the child's home sleep environment, and the promotion of child emotional security, in families of 30-month-old toddlers (N= 546; 265 female) who were part of a multi-site longitudinal study of toddler development. These characteristics were quantified using a combination of parent- and observer-reports and examined in association with child sleep using correlation and multiple regression. Child sleep was assessed using actigraphy to measure sleep duration, timing, variability, activity, and latency. Bedtime routines were examined using parents' daily records. Home sleep environment and emotional security induction were quantified based on observer ratings and in-home observation notes, respectively. All three measures of pre-bedtime context (i.e., bedtime routine inconsistency, poor quality sleep environments, and emotional security induction) were correlated with various aspects of child sleep (significant correlations:.11-.22). The most robust associations occurred between the pre-bedtime context measures and sleep timing (i.e., the timing of the child's sleep schedule) and variability (i.e., night to night variability in sleep timing and duration). Pre-bedtime variables, including bedtime routine consistency, home sleep environment quality, and positive emotional security induction, also mediated the association between family socioeconomic status and child sleep. Our findings underscore the value of considering family context when examining individual differences in child sleep.
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Affiliation(s)
- Caroline P. Hoyniak
- Department of Psychiatry, Washington University in St. Louis School of Medicine, St. Louis, USA
| | - John E. Bates
- Department of Psychological and Brain Sciences, Indiana University, Bloomington, USA
| | - Maureen E. McQuillan
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, USA
| | - Lauren E. Albert
- Department of Psychological and Brain Sciences, Indiana University, Bloomington, USA
| | | | - Victoria J. Molfese
- Department of Child, Youth, and Family Studies, University of Nebraska, Lincoln, USA
| | | | - Kirby Deater-Deckard
- Department of Psychological and Brain Sciences, University of Massachusetts, Amherst, USA
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Billings ME, Cohen RT, Baldwin CM, Johnson DA, Palen BN, Parthasarathy S, Patel SR, Russell M, Tapia IE, Williamson AA, Sharma S. Disparities in Sleep Health and Potential Intervention Models: A Focused Review. Chest 2020; 159:1232-1240. [PMID: 33007324 PMCID: PMC7525655 DOI: 10.1016/j.chest.2020.09.249] [Citation(s) in RCA: 108] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Revised: 08/25/2020] [Accepted: 09/24/2020] [Indexed: 12/14/2022] Open
Abstract
Disparities in sleep health are important but underrecognized contributors to health disparities. Understanding the factors contributing to sleep heath disparities and developing effective interventions are critical to improving all aspects of heath. Sleep heath disparities are impacted by socioeconomic status, racism, discrimination, neighborhood segregation, geography, social patterns, and access to health care as well as by cultural beliefs, necessitating a cultural appropriateness component in any intervention devised for reducing sleep health disparities. Pediatric sleep disparities require innovative and urgent intervention to establish a foundation of lifelong healthy sleep. Tapping the vast potential of technology in improving sleep health access may be an underutilized tool to reduce sleep heath disparities. Identifying, implementing, replicating, and disseminating successful interventions to address sleep disparities have the potential to reduce overall disparities in health and quality of life.
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Affiliation(s)
- Martha E Billings
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington School of Medicine, Seattle, WA
| | - Robyn T Cohen
- Department of Pediatrics, Boston Medical Center, Boston University School of Medicine, Boston, MA
| | - Carol M Baldwin
- Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ
| | - Dayna A Johnson
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Brian N Palen
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington School of Medicine, Seattle, WA; Veterans Affairs Puget Sound Health Care System, Seattle, WA
| | | | - Sanjay R Patel
- Center for Sleep and Cardiovascular Outcomes Research, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Maureen Russell
- Northern Arizona University, Institute for Human Development, Flagstaff, AZ
| | - Ignacio E Tapia
- Sleep Center, Division of Pulmonary Medicine, Children's Hospital of Philadelphia, Philadelphia, PA; University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Ariel A Williamson
- Sleep Center, Division of Pulmonary Medicine, Children's Hospital of Philadelphia, Philadelphia, PA; University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Sunil Sharma
- Division of Pulmonary, Critical Care, and Sleep Medicine, West Virginia University, WV.
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Bonuck K, Collins-Anderson A, Ashkinaze J, Karasz A, Schwartz A. Environmental Scan of Sleep Health in Early Childhood Programs. Behav Sleep Med 2020; 18:598-610. [PMID: 31318273 PMCID: PMC6980449 DOI: 10.1080/15402002.2019.1640222] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To ascertain how sleep health knowledge is translated to early care and education (ECE) programs, using a multi-component environmental scan. METHODS A website scan identified organizations' sleep content re: recommended practices, developmental effects, and "actionable" ratings (0-2). ECE staff surveys assessed preparedness, practices, and beliefs about addressing sleep health and sleep problems in ECE programs. Semi-structured interviews with stakeholders from the ECE, pediatric and sleep communities assessed awareness, priorities, and practices at their organizations. RESULTS Of 15 websites scanned, half lacked sleep content on links to development, optimal duration, or scientific background. ECE staff (n = 31) were comfortable speaking to parents about healthy sleep, and with incorporating sleep education and guidance into ECE. Stakeholders (n = 15) rated healthy sleep as a high relevance, but lower priority issue. Within ECE settings stakeholders reported that knowledge about specific links to health and development was poor and that sleep health was often obscured by "safe sleep" issues. Their recommendations included: linking sleep health to "hot topics" such as obesity or preschool suspensions and expulsions, integrating it with the teaching of routines, and raising public awareness. CONCLUSION Despite understanding that healthy sleep promotes school readiness, there is insufficiently specific, actionable information in ECE training, programs, or policies. Findings suggest a need for an awareness campaign with clear, actionable messaging, dissemination of turnkey materials, and integration with policy and professional training systems. TRIAL REGISTRATION - ClinicalTrials.Gov: NCT03556462.
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Affiliation(s)
- Karen Bonuck
- Family and Social Medicine, Albert Einstein College of Medicine , Bronx, NY, USA
| | | | | | - Alison Karasz
- Department of Family and Social Medicine, Albert Einstein College of Medicine , Bronx, NY
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Body Mass Index, Physical Activity, Sedentary Behavior, Sleep, and Gross Motor Skill Proficiency in Preschool Children From a Low- to Middle-Income Urban Setting. J Phys Act Health 2020; 16:525-532. [PMID: 31154894 DOI: 10.1123/jpah.2018-0133] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 12/27/2018] [Accepted: 02/24/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND Limited research reports on the relationship between body mass index (BMI) and physical activity (PA), sedentary behavior (SB), sleep, and gross motor skills (GMS) in low- and middle-income countries. The aim of this study was to (1) describe BMI, PA, SB, sleep duration, and GMS proficiency in South African preschool children and (2) identify relationships between variables. METHODS BMI, including z scores for height, weight, and BMI were determined. Seven-day PA, SB, and sleep were measured using accelerometry. GMS were assessed using the Test of Gross Motor Development (second edition). Associations were explored by comparing sleep, PA, SB, and GMS between BMI tertiles using the Kruskal-Wallis test. RESULTS Most (86%) children (n = 78, 50% boys) had a healthy BMI (15.7 [1.3] kg/m2). Children spent 560.5 (52.9) minutes per day in light- to vigorous-intensity PA and 90.9 (30.0) minutes per day in moderate- to vigorous-intensity PA; most (83%) met the current PA guideline. Nocturnal sleep duration was low (9.28 [0.80] h/d). Although daytime naps increased 24-hour sleep duration (10.17 [0.71] h/d), 38% were classified as short sleepers. Around half (54.9%) of participants complied with both PA and sleep guidelines. No associations between variables were found. CONCLUSION Despite being lean, sufficiently active, and having adequate GMS, many children were short sleepers, highlighting a possible area for intervention.
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Norm-referenced scoring system for the Brief Infant Sleep Questionnaire – Revised (BISQ-R). Sleep Med 2019; 63:106-114. [DOI: 10.1016/j.sleep.2019.05.010] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 05/24/2019] [Accepted: 05/26/2019] [Indexed: 11/18/2022]
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