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

OBJECTIVE

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

METHODS

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

RESULTS AND CONCLUSIONS

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

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.

Food security status and cardiometabolic health among pregnant women in the United States

Introduction

Pregnant women and their offspring are particularly vulnerable to food insecurity and its adverse effects during critical periods of fetal development. Racially/ethnically minoritized women in the United States (US) who are pregnant are additionally burdened by food insecurity, which may exacerbate cardiovascular health (CVH) disparities. Despite heightened social vulnerability, few studies have employed an intersectional framework, including race and gender, to assess the food insecurity and CVH relationship.

Methods

We used 2012-2018 and 2020 National Health Interview Survey data among US pregnant women aged 18-49 years old (N = 1,999) to assess the prevalence of food insecurity status by race/ethnicity and to investigate household food security status in relation to ideal CVH, using a modified ideal CVH (mICVH) metric. We categorized food security status as "very low/low", "marginal", or "high". To assess mICVH, a summary score of 7 clinical characteristics and health behaviors was dichotomized as yes [(7)] vs. no [<7]. Prevalence ratios (PRs) and 95% confidence intervals (CIs) of associations between food security status and mICVH were estimated using Poisson regression with robust variance. Models were adjusted for age, household income, educational attainment, geographic region, marital status, alcohol consumption, survey year, and race/ethnicity (in overall model).

Results

The mean age ± standard error was 29.0 ± 0.2 years. Among pregnant women, 12.7% reported "very low/low", 10.6% reported "marginal", and 76.7% reported "high" food security. "Very low/low" food security prevalence was higher among NH-Black (16.2%) and Hispanic/Latina (15.2%) pregnant women compared to NH-White (10.3%) and NH-Asian (3.2%) pregnant women. The mICVH prevalence was 11.6% overall and 14.5% for NH-White, 4.1% for NH-Black, 5.0% for Hispanic/Latina, and 26.7% for NH-Asian pregnant women. Among all pregnant women, "very low/low" and "marginal" vs. "high" food security status was associated with a lower prevalence of mICVH {[PRvery low/low = 0.26 (95% CI: 0.08-0.75)]; [PRmarginal = 0.47 (95% CI: 0.23 -0.96)]}.

Conclusion

Household food insecurity was higher among pregnant women in minoritized racial/ethnic groups and was associated with lower mICVH prevalence. Given the higher burden of food insecurity among minoritized racial/ethnic groups, food security may be an important intervention target to help address disparities in poor CVH among pregnant women.

Exposure to indoor light at night in relation to multiple dimensions of sleep health: findings from the Sister Study

STUDY OBJECTIVE

To examine the association between light at night (LAN) and multiple sleep health dimensions.

METHODS

Among 47 765 Sister Study participants, indoor LAN (TV on in the room, light(s) on in room, light from outside the room, nightlight, no light) and sleep dimensions were self-reported at baseline (2003-2009). We used Poisson regression with robust variance to estimate adjusted prevalence ratios (PR) and 95% confidence intervals (CI) for the cross-sectional associations between LAN and short sleep duration (<7 hours/night), insomnia symptoms (difficulty falling or staying asleep), frequent napping (≥3 naps/week), inconsistent sleep/wake time (differed day-to-day and week-to-week), sleep debt (≥2 hours between longest and shortest duration), recent sleep medication use, and a cumulative poor sleep score (≥3 poor sleep dimensions). Population-attributable risks (PARs) were determined for any light exposure vs. none by race/ethnicity.

RESULTS

Compared to sleeping with no light in the bedroom, sleeping with a TV on was associated with a higher prevalence of most dimensions of poor sleep (e.g. short sleep duration: PR = 1.38, 95% CI: 1.32 to 1.45; inconsistent sleep/wake time: PR = 1.55, 95% CI: 1.44 to 1.66; sleep debt: PR = 1.36, 95% CI: 1.29 to 1.44; poor sleep score: PR = 1.58, 95% CI: 1.48-1.68). PARs tended to be higher for non-Hispanic black women compared to non-Hispanic white women.

CONCLUSIONS

Sleeping with a TV on was associated with poor sleep health among US women, and non-Hispanic black women may be disproportionately burdened.

The Negative Effects of Travel on Student Athletes Through Sleep and Circadian Disruption

Collegiate athletes must satisfy the academic obligations common to all undergraduates, but they have the additional structural and social stressors of extensive practice time, competition schedules, and frequent travel away from their home campus. Clearly such stressors can have negative impacts on both their academic and athletic performances as well as on their health. These concerns are made more acute by recent proposals and decisions to reorganize major collegiate athletic conferences. These rearrangements will require more multi-day travel that interferes with the academic work and personal schedules of athletes. Of particular concern is additional east-west travel that results in circadian rhythm disruptions commonly called jet lag that contribute to the loss of amount as well as quality of sleep. Circadian misalignment and sleep deprivation and/or sleep disturbances have profound effects on physical and mental health and performance. We, as concerned scientists and physicians with relevant expertise, developed this white paper to raise awareness of these challenges to the wellbeing of our student-athletes and their co-travelers. We also offer practical steps to mitigate the negative consequences of collegiate travel schedules. We discuss the importance of bedtime protocols, the availability of early afternoon naps, and adherence to scheduled lighting exposure protocols before, during, and after travel, with support from wearables and apps. We call upon departments of athletics to engage with sleep and circadian experts to advise and help design tailored implementation of these mitigating practices that could contribute to the current and long-term health and wellbeing of their students and their staff members.

Features of the Physical and Social Neighborhood Environment and Neighborhood-Level Alzheimer's Disease and Related Dementia in South Carolina

BACKGROUND

Studies are increasingly examining the relationship between the neighborhood environment and cognitive decline; yet, few have investigated associations between multiple neighborhood features and Alzheimer's disease and related dementias (ADRD).

OBJECTIVE

We investigated the relationship between neighborhood features and ADRD cumulative incidence from 2010 to 2014 in the South Carolina Alzheimer's Disease Registry (SCADR).

METHODS

Diagnosed ADRD cases ≥ 50  years of age were ascertained from the SCADR by ZIP code and census tract. Neighborhood features from multiple secondary sources included poverty, air pollution [particulate matter with a diameter of 2.5 micrometers or less (PM 2.5 )], and rurality at the census-tract level and access to healthy food, recreation facilities, and diabetes screening at the county level. In addition to using Poisson generalized linear regression to estimate ADRD incident rate ratios (IRR) with 95% confidence intervals (CIs), we applied integrated nested Laplace approximations and stochastic partial differential equations (INLA-SPDE) to address disparate spatial scales. We estimated associations between neighborhood features and ADRD cumulative incidence.

RESULTS

The average annual ADRD cumulative incidence was 690 per 100,000 people per census tract (95% CI: 660, 710). The analysis was limited to 98% of census tracts with a population ≥ 50  years old (i.e., 1,081 of 1,103). The average percent of families living below the federal poverty line per census tract was 18.8%, and ∼ 20 % of census tracts were considered rural. The average percent of households with limited access to healthy food was 6.4%. In adjusted models, every 5 μ g / m 3 ) increase of PM 2.5 was associated with 65% higher ADRD cumulative incidence (IRR = 1.65 ; 95% CI: 1.30, 2.09), where PM 2.5 at or below 12   μ g / m 3 is considered healthy. Compared to large urban census tracts, rural and small urban tracts had 10% (IRR = 1.10 ; 95% CI: 1.00, 1.23) and 5% (IRR = 1.05 ; 95% CI: 0.96, 1.16) higher ADRD, respectively. For every percent increase of the county population with limited access to healthy food, ADRD was 2% higher (IRR = 1.02 ; 95% CI: 1.01, 1.04).

CONCLUSIONS

Neighborhood environment features, such as higher air pollution levels, were associated with higher neighborhood ADRD incidence. The INLA-SPDE method could have broad applicability to data collected across disparate spatial scales. https://doi.org/10.1289/EHP13183.

Racial/Ethnic Disparities in the Trajectories of Insomnia Symptoms from Childhood to Young Adulthood

STUDY OBJECTIVES

To examine differences in the longitudinal prevalence of childhood insomnia symptoms across Black/African American, Hispanic/Latinx, and non-Hispanic White groups.

METHODS

Participants were 519 children from the Penn State Child Cohort (baseline (V1) from 2000-2005) who were followed up 8 years later as adolescents (V2) and 15 years later as young adults (S3). Mean age at S3 was 24.1±2.7 years. Approximately, 76.5% identified as non-Hispanic White, 12.9% as Black/African American, 7.1% as Hispanic/Latinx, and 3.5% as "other" race/ethnicity. Insomnia symptoms were defined as parent-reported (childhood) or self-reported (adolescence, young adulthood) moderate-to-severe difficulties initiating/maintaining sleep. Longitudinal trajectories of insomnia symptoms were identified across three time-points and the odds of each trajectory were compared between racial/ethnic groups, adjusting for sex, age, overweight, sleep apnea, periodic limb movements, psychiatric/behavioral disorders and psychotropic medication use.

RESULTS

Black/African Americans compared to non-Hispanic Whites were at significantly higher odds to have a childhood-onset persistent trajectory through young adulthood (OR = 2.58, 95% CI [1.29, 5.14]), while Hispanics/Latinx were at non-significantly higher odds to have the same trajectory (OR = 1.81, 95% CI [0.77, 4.25]). No significant racial/ethnic differences were observed for remitted and waxing-and-waning trajectories since childhood or incident/new-onset trajectories in young adulthood.

CONCLUSIONS

The results indicate that disparities in insomnia symptoms among Black/African American and, to a lesser extent, Hispanic/Latinx groups start early in childhood and persist into young adulthood. Identifying and intervening upon upstream determinants of racial/ethnic insomnia disparities are warranted to directly address these disparities and to prevent their adverse health sequelae.

Sleep disturbances among cancer survivors

PURPOSE

We investigated sleep disturbances among cancer survivors compared to similarly aged women without cancer history.

METHODS

We identified 2067 women with a history of cancer other than breast or non-melanoma skin cancer at enrollment in the Sister Study, a US-wide cohort of women with a family history of breast cancer. Cancer survivors were matched with up to 5 cancer-free women (N = 9717) on age at enrollment. An index age (for covariate classification) was defined as the age at cancer diagnosis for survivors and the same age for their matched comparators. Sleep disturbances included duration, sleep medication usage, insomnia symptoms, long sleep-latency onset (≥30 min to fall asleep), frequent night awakenings (waking ≥3/night, ≥ 3 times/week), frequent napping (≥ 3 times/week), and a composite outcome of ≥ 1sleep disturbance. Multivariable linear regression (effect estimate, 95% confidence interval (CI)) and logistic regression (odds ratio, OR, 95% CI) were used for continuous and dichotomous outcomes, respectively.

RESULTS

At enrollment, cancer survivors were on average 13.8 years (range=0, 62) from diagnosis. After adjustment for age at enrollment and depression, diabetes, hypertension, and menopausal status prior to the index age, sleep disturbances were generally not more common among cancer survivors compared to those without cancer. However, among cancer survivors, those > 2 years from diagnosis were more likely to report ≥ 1 sleep disturbance (OR=1.44; 1.07, 1.93) compared to survivors 0-2 years from diagnosis.

CONCLUSION

Addressing sleep disturbances may improve well-being for cancer survivors.

Systematic evidence mapping informs a class-based approach to assessing personal care products and pubertal timing

BACKGROUND

Personal care products (PCPs) contain many different compounds and are a source of exposure to endocrine disrupting chemicals (EDCs), including phthalates and phenols. Early-life exposure to EDCs commonly found in PCPs has been linked to earlier onset of puberty.

OBJECTIVE

To characterize the human and animal evidence on the association between puberty-related outcomes and exposure to PCPs and their chemical constituents and, if there is sufficient evidence, identify groups of chemicals and outcomes to support a systematic review for a class-based hazard or risk assessment.

METHODS

We followed the OHAT systematic review framework to characterize the human and animal evidence on the association between puberty-related health outcomes and exposure to PCPs and their chemical constituents.

RESULTS

Ninety-eight human and 299 animal studies that evaluated a total of 96 different chemicals were identified and mapped by key concepts including chemical class, data stream, and puberty-related health outcome. Among these studies, phthalates and phenols were the most well-studied chemical classes. Most of the phthalate and phenol studies examined secondary sex characteristics and changes in estradiol and testosterone levels. Studies evaluating PCP use and other chemical classes (e.g., parabens) had less data.

CONCLUSIONS

This systematic evidence map identified and mapped the published research evaluating the association between exposure to PCPs and their chemical constituents and puberty-related health outcomes. The resulting interactive visualization allows researchers to make evidence-based decisions on the available research by enabling them to search, sort, and filter the literature base of puberty-related studies by key concepts. This map can be used by researchers and regulators to prioritize and target future research and funding to reduce uncertainties and address data gaps. It also provides information to inform a class-based hazard or risk assessment on the association between phthalate and phenol exposures and puberty-related health outcomes.

Racial and Ethnic Discrimination and Hypertension by Educational Attainment Among a Cohort of US Women

Importance

Although understudied, there are likely within-group differences among minoritized racial and ethnic groups in associations between racial and ethnic discrimination (RED) and hypertension risk, as minoritized individuals with higher educational attainment may more frequently encounter stress-inducing environments (eg, professional workplace settings, higher-income stores and neighborhoods) characterized by, for instance, exclusion and antagonism.

Objectives

To investigate educational attainment as a potential effect modifier of associations between RED and hypertension risk among US women; the study hypothesis was that the magnitude of associations would be stronger among participants with higher vs lower educational attainment.

Design, Setting, and Participants

This is a nested case-control study using Sister Study data collected at enrollment (2003-2009) and over follow-up visits until September 2019. Among eligible US Black or African American (hereafter Black), Latina, and non-Hispanic White women without prior hypertension diagnoses, incidence density sampling was performed to select self-reported hypertension cases that developed over a mean (SD) follow-up 11 (3) years. Data were analyzed August 2022 to February 2023.

Exposures

Participants reported lifetime everyday (eg, unfair treatment at a business) and major (eg, mistreatment by police) RED via a self-administered questionnaire.

Main Outcome and Measures

Adjusting for sociodemographic characteristics, conditional logistic regression was used to estimate odds ratios (ORs) and 95% CIs for associations between RED and hypertension by educational attainment category at baseline (college or higher, some college, and high school or less) within racial and ethnic groups.

Results

Among 5179 cases (338 [6.5%] Black; 200 [3.9%] Latina; and 4641 [89.6%] non-Hispanic White) and 10:1 race and ethnicity- and age-matched control participants with a mean (SD) age of 55 (9) years at enrollment, half (49.9%) of women reported attaining college or higher education, and Black women with college or greater education had the highest burden of RED (eg, 83% of case participants with college or higher education reported everyday RED compared with 64% of case participants with high school or less education). Everyday RED was associated with higher hypertension risk among Black women with college or higher education (OR, 1.56 [95% CI, 1.06-2.29]) but not among Black women with some college (OR, 0.72 [95% CI, 0.47-1.11]), with evidence of both multiplicative and additive interaction. Results for Black women with high school or less education suggested increased risk, but confidence intervals were wide, and the result was not statistically significant but may be clinically significant (OR, 1.89 [95% CI, 0.83-4.31]). Educational attainment was not a modifier among other racial and ethnic groups or for associations with major RED.

Conclusions and Relevance

In this nested case-control study of RED and hypertension risk, chronic or everyday RED-associated hypertension disproportionately affected Black women with the highest levels of educational attainment.

The need to promote sleep health in public health agendas across the globe

Healthy sleep is essential for physical and mental health, and social wellbeing; however, across the globe, and particularly in developing countries, national public health agendas rarely consider sleep health. Sleep should be promoted as an essential pillar of health, equivalent to nutrition and physical activity. To improve sleep health across the globe, a focus on education and awareness, research, and targeted public health policies are needed. We recommend developing sleep health educational programmes and awareness campaigns; increasing, standardising, and centralising data on sleep quantity and quality in every country across the globe; and developing and implementing sleep health policies across sectors of society. Efforts are needed to ensure equity and inclusivity for all people, particularly those who are most socially and economically vulnerable, and historically excluded.

Cannabis use and sleep disturbances among White, Black, and Latino adults in the United States: A cross-sectional study of National Comorbidity Survey-Replication (2001-2003) data

OBJECTIVE

Research investigating cannabis use and sleep health is limited, and results are mixed. Few studies were nationally representative with racially-ethnically diverse samples or assessed potential modifiers. Our objective was to investigate cross-sectional associations between reported cannabis use and sleep disturbances by potential modifiers among non-Hispanic White, non-Hispanic Black, and Hispanic/Latino men and women in the United States.

METHODS

We used nationally representative National Comorbidity Survey-Replication data collected from 2001 to 2003 among 3929 adults. Poisson regression with robust variance estimated prevalence ratios (PR) and 95% confidence intervals of patterns of sleep disturbances identified through latent class analysis. Models adjusted for sociodemographic, health behavior, and clinical characteristics were stratified by race-ethnicity and by race-ethnicity along with sex/gender, and age, separately.

RESULTS

Over half of adults reported cannabis use (52%-ever/lifetime vs 48%-never). We identified two latent classes: multiple sleep disturbances with daytime sleepiness and no sleep disturbances with some daytime sleepiness. Prevalence of multiple sleep disturbances with daytime sleepiness was higher among participants reporting lifetime cannabis use (23% vs 20%). Associations did not vary by race-ethnicity or sex/gender. Lifetime vs never cannabis use was marginally associated with a higher prevalence of multiple sleep disturbances with daytime sleepiness only among adults aged 25-29years (PR=1.09 [95% confidence interval: 1.00-1.18]; eg, PRage 40+ years=1.00 [0.97-1.03], pinteraction=0.03).

CONCLUSIONS

Associations between cannabis use and sleep may vary by age. Replication with more recent data and prospective studies that investigate intersectional identities among diverse populations with objective assessments are warranted.

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.

Multimodal Biomarkers That Predict the Presence of Gleason Pattern 4: Potential Impact for Active Surveillance

PURPOSE

Latent grade group ≥2 prostate cancer can impact the performance of active surveillance protocols. To date, molecular biomarkers for active surveillance have relied solely on RNA or protein. We trained and independently validated multimodal (mRNA abundance, DNA methylation, and/or DNA copy number) biomarkers that more accurately separate grade group 1 from grade group ≥2 cancers.

MATERIALS AND METHODS

Low- and intermediate-risk prostate cancer patients were assigned to training (n=333) and validation (n=202) cohorts. We profiled the abundance of 342 mRNAs, 100 DNA copy number alteration loci, and 14 hypermethylation sites at 2 locations per tumor. Using the training cohort with cross-validation, we evaluated methods for training classifiers of pathological grade group ≥2 in centrally reviewed radical prostatectomies. We trained 2 distinct classifiers, PRONTO-e and PRONTO-m, and validated them in an independent radical prostatectomy cohort.

RESULTS

PRONTO-e comprises 353 mRNA and copy number alteration features. PRONTO-m includes 94 clinical, mRNAs, copy number alterations, and methylation features at 14 and 12 loci, respectively. In independent validation, PRONTO-e and PRONTO-m predicted grade group ≥2 with respective true-positive rates of 0.81 and 0.76, and false-positive rates of 0.43 and 0.26. Both classifiers were resistant to sampling error and identified more upgrading cases than a well-validated presurgical risk calculator, CAPRA (Cancer of the Prostate Risk Assessment; P < .001).

CONCLUSIONS

Two grade group classifiers with superior accuracy were developed by incorporating RNA and DNA features and validated in an independent cohort. Upon further validation in biopsy samples, classifiers with these performance characteristics could refine selection of men for active surveillance, extending their treatment-free survival and intervals between surveillance.

Financial hardship, sleep disturbances, and their relationship among men and women in the United States during the COVID-19 pandemic

OBJECTIVE

In the United States (US), the health and financial consequences of COVID-19 have disproportionately impacted women and minoritized racial-ethnic groups. Yet, few US studies have investigated financial hardship during the COVID-19 pandemic and sleep health disparities. Our objective was to investigate associations between financial hardship and sleep disturbances during the COVID-19 pandemic by gender and race and ethnicity in the United States.

METHODS

We used the nationally representative COVID-19's Unequal Racial Burden cross-sectional survey data collected among 5339 men and women from 12/2020 to 2/2021. Participants reported financial hardship (eg, debt, employment/work loss) since the pandemic began and completed the Patient-Reported Outcomes Management Information System Short Form 4a for sleep disturbances. Prevalence ratios (PRs) and 95% confidence intervals were estimated using adjusted, weighted Poisson regression with robust variance.

RESULTS

Most (71%) participants reported financial hardship. Prevalence of moderate to severe sleep disturbances was 20% overall, higher among women (23%), and highest among American Indian/Alaska Native (29%) and multiracial adults (28%). Associations between financial hardship and moderate to severe sleep disturbances (PR = 1.52 [95% confidence interval: 1.18, 1.94]) did not differ by gender but varied by race and ethnicity: associations were strongest among Black/African American (PR = 3.52 [1.99,6.23]) adults.

CONCLUSIONS

Both financial hardship and sleep disturbances were prevalent, and their relationships were strongest among certain minoritized racial-ethnic groups, particularly Black/African American adults. Interventions that alleviate financial insecurity may reduce sleep health disparities.

Neighborhood Social Cohesion and Obesity in the United States

Low neighborhood social cohesion (nSC) has been associated with obesity. Still, few studies have assessed the nSC-obesity relationship among a large, nationally representative, and racially/ethnically diverse sample of the United States population. To address this literature gap, we examined cross-sectional associations among 154,480 adult participants of the National Health Interview Survey (NHIS) from 2013-2018. We also determined if associations varied by race/ethnicity, sex/gender, age, annual household income, and food security status. Based on a 4-item scale from the Project on Human Development in Chicago Neighborhoods Community Survey, we categorized nSC as low, medium, and high. Based on body mass index (BMI) recommendations, we categorized obesity as ≥30 kg/m². We used Poisson regression with robust variance to directly estimate prevalence ratios (PRs) and 95% confidence intervals (CIs) while adjusting for sociodemographic characteristics, such as annual household income, educational attainment, and marital status, along with other confounders. Study participants' mean age ± standard error was 47.1±0.1 years; most (69.2%) self-identified as Non-Hispanic (NH)-White, and 51.0% were women. NH-Black and Hispanic/Latinx adults comprised more of the population in neighborhoods with low nSC (14.0% NH-Black, 19.1% Hispanic/Latinx, and 61.8% NH-White) versus high nSC (7.7% NH-Black, 10.4% Hispanic/Latinx and 77.0% NH-White). Low vs. high nSC was associated with a 15% higher prevalence of obesity (PR=1.15 [95% CI: 1.12-1.18]), and the magnitude of the association was more substantial among NH-White (PR=1.21 [95% CI: 1.17-1.25]) compared to associations among Hispanic/Latinx (PR=1.04 [95% CI: 0.97-1.11]) and NH-Black (PR=1.01 [95% CI: 0.95-1.07]) adults. Low vs. high nSC was associated with a 20% higher prevalence of obesity in women (PR=1.20 [95% CI: 1.16-1.24]) compared to a 10% higher prevalence in men (PR=1.10 [95% CI: 1.06-1.14]). Low vs. high nSC was associated with a 19% higher prevalence of obesity among adults ≥50 years old (PR=1.19 [95% CI: 1.15-1.23]) compared to a 7% higher prevalence of obesity among adults <50 years old (PR=1.07 [95% CI: 1.03-1.11]). Efforts to address nSC may improve health and address health disparities.

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.

Impact of COVID-related Discrimination on Psychological Distress and Sleep Disturbances across Race-Ethnicity

COVID-related discrimination towards historically marginalized racial-ethnic groups in the United States has been well-documented; however, its impact on psychological distress and sleep (overall and within specific racial-ethnic groups) is largely unknown. We used data from our nationally representative, online survey of 5,500 American Indian/Alaska Native, Asian, Black/African American, Native Hawaiian/Pacific Islander, Latino, White, and multiracial adults, conducted from 12/2020-2/2021. Participants were asked how often they experienced discriminatory behaviors "because they think you might have COVID-19" (modified Everyday Discrimination Scale). Psychological distress was captured as having experienced anxiety-depression symptoms (Patient Health Questionairre-4, PHQ-4), perceived stress (modified Perceived Stress Scale), or loneliness-isolation ("How often have you felt lonely and isolated?"). Sleep disturbances were measured using the Patient-Reported Outcomes Information System Short Form Sleep Disturbance scale (PROMIS-SF 4a). Overall, 22.1% reported COVID-related discriminatory behaviors (sometimes/always: 9.7%; rarely: 12.4%). 48.4% of participants reported anxiety-depression symptoms (moderate/severe: 23.7% mild: 24.8%), 62.4% reported feeling stressed (moderate/severe: 34.3%; mild: 28,1%), 61.0% reported feeling lonely-isolated (fairly often/very often: 21.3%; almost never/sometimes: 39.7%), and 35.4% reported sleep disturbances (moderate/severe:19.8%; mild: 15.6%). Discrimination was only associated with increased psychological distress among racial-ethnic minorities. For example, COVID-related discrimination was strongly associated with anxiety-depression among Black/African American adults (mild: aOR=2.12, 95% CI=1.43-5.17; moderate/severe: aOR=5.19, 95% CI=3.35-8.05), but no association was observed among White or multiracial adults. Mitigating pandemic-related discrimination could help alleviate mental and sleep health disparities occurring among minoritized racial-ethnic groups.

Racial/Ethnic Differences in Associations Between Traumatic Childhood Experiences and Both Metabolic Syndrome Prevalence and Type 2 Diabetes Risk Among a Cohort of U.S. Women

OBJECTIVE

Childhood adversity has been associated with metabolic syndrome (MetS) and type 2 diabetes risk in adulthood. However, studies have yet to investigate traumatic childhood experiences (TCEs) beyond abuse and neglect (e.g., natural disaster) while considering potential racial/ethnic differences.

RESEARCH DESIGN AND METHODS

To investigate race/ethnicity as a potential modifier of the association between TCEs, MetS, and type 2 diabetes, we used prospectively collected data from 42,173 eligible non-Hispanic White (NHW; 88%), Black/African American (BAA; 7%), and Hispanic/Latina (4%) Sister Study participants (aged 35-74 years) enrolled from 2003 to 2009. A modified Brief Betrayal Trauma Survey captured TCEs. At least three prevalent metabolic abnormalities defined MetS, and self-report of a new diagnosis during the study period defined type 2 diabetes. We used adjusted Cox proportional hazards regression to estimate hazard ratios (HRs) and 95% CIs for type 2 diabetes over a mean ± SD follow-up of 11.1 ± 2.7 years, overall and by race/ethnicity. We also tested for modification and mediation by MetS.

RESULTS

Incident cases of type 2 diabetes were reported (n = 2,479 among NHW, 461 among BAA, and 281 among Latina participants). Reporting any TCEs (50% among NHW, 53% among BAA, and 51% among Latina participants) was associated with a 13% higher risk of type 2 diabetes (HR 1.13; 95% CI 1.04-1.22). Associations were strongest among Latina participants (HR 1.64 [95% CI 1.21-2.22] vs. 1.09 for BAA and NHW). MetS was not a modifier but mediated (indirect effect, HR 1.01 [95% CI 1.00-1.01]; P = 0.02) the overall association.

CONCLUSIONS

TCE and type 2 diabetes associations varied by race/ethnicity and were partially explained by MetS.

Light at night and the risk of breast cancer: Findings from the Sister study

BACKGROUND

Light at night (LAN) may alter estrogen regulation through circadian disruption. High levels of outdoor LAN may increase breast cancer risk, but studies have largely not considered possible residual confounding from correlated environmental exposures. We evaluated the association between indoor and outdoor LAN and incident breast cancer.

METHODS

In 47,145 participants in the prospective Sister Study cohort living in the contiguous U.S., exposure to outdoor LAN was determined using satellite-measured residential data and indoor LAN was self-reported (light/TV on, light from outside the room, nightlight, no light). We used Cox proportional hazards models to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) for the associations between outdoor and indoor LAN and breast cancer risk. Models were adjusted for age, race/ethnicity, educational attainment, annual household income, neighborhood disadvantage, latitude, and population density as a proxy for urbanicity. To evaluate the potential for residual confounding of the outdoor LAN and breast cancer relationship by factors associated with urbanicity, we considered further adjustment for exposures correlated with outdoor LAN including NO2 [Spearman correlation coefficient, rho (ρ) = 0.78], PM2.5 (ρ = 0.36), green space (ρ =  - 0.41), and noise (ρ = 0.81).

RESULTS

During 11 years of follow-up, 3,734 breast cancer cases were identified. Outdoor LAN was modestly, but non-monotonically, associated with a higher risk of breast cancer (Quintile 4 vs 1: HR = 1.10, 95% CI: 0.99-1.22; Quintile 5 vs 1: HR = 1.04, 95% CI: 0.93-1.16); however, no association was evident after adjustment for correlated ambient exposures (Quintile 4 vs 1: HR = 0.99, 95% CI: 0.86-1.14; Quintile 5 vs 1: HR = 0.89, 95% CI: 0.74-1.06). Compared to those with no indoor LAN exposure, sleeping with a light or TV on was associated with a HR = 1.09 (95% CI: 0.97-1.23) in the adjusted model.

CONCLUSIONS

Outdoor LAN does not appear to increase the risk of breast cancer after adjustment for correlated environmental exposures.

Use of Straighteners and Other Hair Products and Incident Uterine Cancer

BACKGROUND

Hair products may contain hazardous chemicals with endocrine-disrupting and carcinogenic properties. Previous studies have found hair product use to be associated with a higher risk of hormone-sensitive cancers including breast and ovarian cancer; however, to our knowledge, no previous study has investigated the relationship with uterine cancer.

METHODS

We examined associations between hair product use and incident uterine cancer among 33 947 Sister Study participants aged 35-74 years who had a uterus at enrollment (2003-2009). In baseline questionnaires, participants in this large, racially and ethnically diverse prospective cohort self-reported their use of hair products in the prior 12 months, including hair dyes; straighteners, relaxers, or pressing products; and permanents or body waves. We estimated adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) to quantify associations between hair product use and uterine cancer using Cox proportional hazard models. All statistical tests were 2-sided.

RESULTS

Over an average of 10.9 years of follow-up, 378 uterine cancer cases were identified. Ever vs never use of straightening products in the previous 12 months was associated with higher incident uterine cancer rates (HR = 1.80, 95% CI = 1.12 to 2.88). The association was stronger when comparing frequent use (>4 times in the past 12 months) vs never use (HR = 2.55, 95% CI = 1.46 to 4.45; Ptrend = .002). Use of other hair products, including dyes and permanents or body waves, was not associated with incident uterine cancer.

CONCLUSION

These findings are the first epidemiologic evidence of association between use of straightening products and uterine cancer. More research is warranted to replicate our findings in other settings and to identify specific chemicals driving this observed association.

Associations of circadian rest/activity rhythms with cognition in middle-aged and older adults: Demographic and genetic interactions

Objectives

Wrist actigraphs (accelerometers) can record motor activity over multiple days and nights. The resulting data can be used to quantify 24-h activity profiles, known as circadian rest-activity rhythms (CRARs). Actigraphic CRARs have been tied to cognitive performance and decline in older adults; however, little is known about links between CRARs and performance or change in specific cognitive domains, or how individual differences may influence these associations. We investigated associations of actigraphic CRARs with cognitive performance and change in middle-aged and older adults, and explored whether age, sex/gender, race, and apolipoprotein E (APOE) e4 carrier status moderated these associations.

Materials and methods

Participants (N = 422; 47% male) were cognitively healthy adults (i.e., without mild cognitive impairment or dementia) at baseline aged ≥ 50 years from the Baltimore Longitudinal Study of Aging who completed 5.6 ± 0.89 nights of wrist actigraphy and tests of memory, executive function, attention, language, and visuospatial ability at the same visit the actigraph was issued; 292 participants had repeat cognitive testing 3.12 (1.58) years later. Predictors included indices of rhythm strength [i.e., amplitude; relative amplitude (RA); interdaily stability (IS); mesor], delayed timing of the rhythm peak [i.e., later acrophase; midpoint of an individual's least active 5 h (L5 time); midpoint of an individual's most active 10 h (M10 time)], and fragmentation [i.e., intradaily variability (IV)].

Results

In main effects, later L5 time was cross sectionally associated with poorer memory, and greater IS predicted slower longitudinal memory decline. Associations of CRARs with cognition differed as a function of age, sex/gender, race, and APOE e4 carrier status.

Conclusion

Among middle-aged and older adults, delayed circadian phase is associated with poorer memory performance, and greater day-to-day rhythm stability is associated with slower declines in memory. Significant interactions suggest that CRARs are generally more strongly associated with cognitive performance and rate of cognitive decline among women, Black adults, older individuals, and APOE e4 carriers. Replication in independent samples is needed.

Insomnia during pregnancy and severe maternal morbidity in the united states: nationally representative data from 2006 to 2017

STUDY OBJECTIVES

Using a large, nationally representative database, we aimed to estimate the prevalence and trends of insomnia among pregnant women over a 12-year period. In addition, we aimed to examine the interplay among insomnia, maternal comorbidities, and severe maternal morbidity (SMM).

METHODS

We conducted a serial cross-sectional analysis of pregnancy-related hospitalizations in the United States from the 2006 to 2017 National Inpatient Sample (NIS). ICD-9 and ICD-10 codes were used to capture diagnoses of insomnia and obstetric comorbidities during delivery and non-delivery hospitalizations. The primary outcome was the diagnosis of SMM at delivery. We used logistic regression to assess the association between insomnia and SMM. Joinpoint regression was used to estimate trends in insomnia and SMM.

RESULTS

Of nearly 47 million delivery hospitalizations, 24 625 women had a diagnosis of insomnia, or 5.2 per 10 000 deliveries. The annual incidence increased from 1.8 to 8.6 per 10 000 over the study period. The crude rate of insomnia was 6.3 times higher for non-delivery hospitalizations. Patients with insomnia had more comorbidities, particularly neuromuscular disease, mental health disorders, asthma, and substance use disorder. Prevalence of non-blood transfusion SMM was 3.6 times higher for patients with insomnia (2.4% vs. 0.7%). SMM increased annually by 11% (95% CI = 3.0% to 19.7%) in patients with insomnia. After adjusting for comorbidities, there remained a 24% increased likelihood of SMM for patients with insomnia.

CONCLUSIONS

Coded diagnosis of insomnia during pregnancy has increased over time, and this burden disparately affects women of low socioeconomic status. Diagnosis of insomnia is an independent predictor of SMM.

Neighborhood characteristics and dementia symptomology among community-dwelling older adults with Alzheimer's disease

Background

Neuropsychiatric symptoms (NPSs) lead to myriad poor health outcomes among individuals with Alzheimer's disease (AD). Prior studies have observed associations between the various aspects of the home environment and NPSs, but macro-level environmental stressors (e.g., neighborhood income) may also disrupt the neuronal microenvironment and exacerbate NPSs. Yet, to our knowledge, no studies have investigated the relationship between the neighborhood environment and NPSs.

Methods

Using 2010 data among older adults with AD collected from a sample of the South Carolina Alzheimer's Disease Registry, we estimated cross-sectional associations between neighborhood characteristics and NPSs in the overall population and by race/ethnicity. Neighborhood measures (within a 1/2-mile radius of residence) came from the American Community Survey and Rural Urban Commuting Area Code. We categorized median household income into tertiles: < $30,500, $30,500-40,000, and > $40,000, and rurality as: rural, small urban, and large urban. Residential instability was defined as the percent of residents who moved within the past year. NPSs were defined using the Neuropsychiatric Inventory Questionnaire that included the composite measure of all 12 domains. Adjusting for age, sex/gender, race/ethnicity, and caregiver educational attainment, we used negative binomial regression to estimate prevalence ratios (PR) and 95% confidence intervals (CI) for NPSs by neighborhood characteristics.

Results

Among 212 eligible participants, mean age was 82 ± 8.7 years, 72% were women, and 55% non-Hispanic (NH)-Black. Individuals with AD living in < $30,500 vs. > $40,000 income neighborhoods had a 53% (PR = 1.53; 95% CI = 1.06-2.23) higher prevalence of NPSs while individuals living in rural vs. large urban neighborhoods had a 36% lower prevalence of NPSs (PR = 0.64; 95% CI = 0.45-0.90), after adjustment. We did not observe an association between residential instability and NPSs (PR = 0.92; 95% CI = 0.86-1.00); however, our estimates suggested differences by race/ethnicity where NH-White older adults living in residential instable areas had lower NPSs (PR = 0.89; 95% CI = 0.82-0.96) compared to NH-Black older adults (PR = 0.96; 95% CI = 0.86-1.07).

Discussion

Across racial/ethnic groups, individuals with AD had more symptomology when living in lower income areas. Pending replication, intervention efforts should consider resource allocation to high-need neighborhoods (e.g., lower income), and studies should investigate underlying mechanisms for this relationship.

Latent Class Models of Early-life Trauma and Incident Breast Cancer

BACKGROUND

Psychosocial trauma has been hypothesized to influence breast cancer risk, but little is known about how co-occurring traumas-particularly during early life-may impact incidence. We examine the relationship between multiple measures of early-life trauma and incident breast cancer.

METHODS

The Sister Study is a prospective cohort study of US women (n = 50,884; enrollment 2003-2009; ages 35-74). Of 45,961 eligible participants, 3,070 developed invasive breast cancer or ductal carcinoma in situ through 2017. We assessed trauma before age 18 using previously studied measures (cumulative score, individual trauma type, and substantive domain) and a six-class latent variable to evaluate co-occurring traumas. We accounted for missing data using multiple imputation and estimated hazard ratios (HRs) and 95% confidence intervals (CIs) using Cox proportional-hazards models.

RESULTS

Approximately 49% of participants reported early-life trauma. Using the latent class variable approach, breast cancer hazard was higher among participants who had sexual trauma or household dysfunction (HR = 1.1; CI = 0.93, 1.3) or moderate (HR = 1.2; CI = 0.99, 1.4) but not high trauma (HR = 0.66; CI = 0.44, 0.99) compared to low trauma. Breast cancer HRs associated with sexual early-life trauma or household dysfunction were elevated for pre- and postmenopausal breast cancer and by estrogen receptor status. We found no effect modification by race-ethnicity. Estimated effects were attenuated with report of constant childhood social support.

CONCLUSIONS

Breast cancer incidence varied by latent patterns of co-occurring early-life trauma. Models capturing childhood social support and trauma patterning, rather than cumulative or discrete indicators, may be more meaningful in breast cancer risk assessment.

Sleep-Disordered Breathing and Cardiac Arrhythmias in Adults: Mechanistic Insights and Clinical Implications: A Scientific Statement From the American Heart Association

Sleep-disordered breathing (SDB), characterized by specific underlying physiological mechanisms, comprises obstructive and central pathophysiology, affects nearly 1 billion individuals worldwide, and is associated with excessive cardiopulmonary morbidity. Strong evidence implicates SDB in cardiac arrhythmogenesis. Immediate consequences of SDB include autonomic nervous system fluctuations, recurrent hypoxia, alterations in carbon dioxide/acid-base status, disrupted sleep architecture, and accompanying increases in negative intrathoracic pressures directly affecting cardiac function. Day-night patterning and circadian biology of SDB-induced pathophysiological sequelae collectively influence the structural and electrophysiological cardiac substrate, thereby creating an ideal milieu for arrhythmogenic propensity. Cohort studies support strong associations of SDB and cardiac arrhythmia, with evidence that discrete respiratory events trigger atrial and ventricular arrhythmic events. Observational studies suggest that SDB treatment reduces atrial fibrillation recurrence after rhythm control interventions. However, high-level evidence from clinical trials that supports a role for SDB intervention on rhythm control is not available. The goals of this scientific statement are to increase knowledge and awareness of the existing science relating SDB to cardiac arrhythmias (atrial fibrillation, ventricular tachyarrhythmias, sudden cardiac death, and bradyarrhythmias), synthesizing data relevant for clinical practice and identifying current knowledge gaps, presenting best practice consensus statements, and prioritizing future scientific directions. Key opportunities identified that are specific to cardiac arrhythmia include optimizing SDB screening, characterizing SDB predictive metrics and underlying pathophysiology, elucidating sex-specific and background-related influences in SDB, assessing the role of mobile health innovations, and prioritizing the conduct of rigorous and adequately powered clinical trials.

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.

The Need for Social and Environmental Determinants of Health Research to Understand and Intervene on Racial/Ethnic Disparities in Obstructive Sleep Apnea

Obstructive sleep apnea (OSA), a sleep-disordered breathing (SDB) disorder, affects at least 25 million adults in the United States and is associated with increased risk for hypertension, diabetes, and cardiovascular disease (CVD). Racial/ethnic minorities have a disproportionate burden of OSA along with the health sequelae associated with this condition. Despite supporting evidence of racial/ethnic disparities, few studies have investigated SDB including OSA among minoritized racial/ethnic groups. In this scoping review of the literature, the authors summarize current findings related to racial/ethnic disparities in OSA, identified social and environmental determinants of health, treatment inequities, and promising evidence-based interventions and conclude with future research directions.

Vitamin D concentrations and breast cancer incidence among Black/African American and non-Black Hispanic/Latina women

BACKGROUND

Vitamin D may protect against breast cancer. Although Black/African American women and Hispanic/Latina women have lower circulating vitamin D levels than non-Hispanic White women, few studies have examined the association between vitamin D and breast cancer within these racial/ethnic groups.

METHODS

The vitamin D-breast cancer association was evaluated using a case-cohort sample of self-identified Black/African American and non-Black Hispanic/Latina women participating in the US-wide Sister Study cohort. Circulating 25-hydroxyvitamin D (25(OH)D) and 24,25-dihydroxyvitamin D (24,25(OH)2D) were measured using liquid chromatography-tandem mass spectrometry in blood samples collected at the baseline from 415 women (290 Black/African American women and 125 non-Black Hispanic/Latina women) who developed breast cancer. These were compared to concentrations in 1545 women (1084 Black/African American women and 461 Hispanic/Latina women) randomly selected from the cohort. Multivariable-adjusted Cox regression was used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs).

RESULTS

Over a mean follow-up of 9.2 years, women with circulating 25(OH)D concentrations above the clinical cut point for deficiency (20.0 ng/mL) had lower breast cancer rates than women with concentrations ≤ 20 ng/mL (HR, 0.79; 95% CI, 0.61-1.02). The inverse association was strongest among Hispanic/Latina women (HR, 0.52; 95% CI, 0.29-0.93), with a weaker association observed among Black/African American women (HR, 0.89; 95% CI, 0.68-1.18; P for heterogeneity = 0.13). There were no clear differences by menopausal status, follow-up time, estrogen receptor status, or invasiveness. Neither 24,25(OH)₂ D nor the 24,25(OH)₂ D to 25(OH)D ratio were independently associated with breast cancer risk.

CONCLUSIONS

This prospective study supports the hypothesis that vitamin D may be protective against breast cancer incidence in women, including non-Black Hispanic/Latina and Black/African American women.; LAY SUMMARY: Vitamin D may protect against breast cancer. Although women of color have lower average vitamin D levels than non-Hispanic White women, few studies have considered the role of race/ethnicity. In a sample of self-identified Black/African American and Hispanic/Latina women, we observed that vitamin D concentrations measured in blood were inversely associated with breast cancer, particularly among Latinas. These findings indicate that vitamin D may protect women against breast cancer, including those in racial/ethnic groups with low average circulating levels.

Knowledge Gaps, Challenges, and Opportunities in Health and Prevention Research for Asian Americans, Native Hawaiians, and Pacific Islanders: A Report From the 2021 National Institutes of Health Workshop

Asian Americans (AsA), Native Hawaiians, and Pacific Islanders (NHPI) comprise 7.7% of the U.S. population, and AsA have had the fastest growth rate since 2010. Yet the National Institutes of Health (NIH) has invested only 0.17% of its budget on AsA and NHPI research between 1992 and 2018. More than 40 ethnic subgroups are included within AsA and NHPI (with no majority subpopulation), which are highly diverse culturally, demographically, linguistically, and socioeconomically. However, data for these groups are often aggregated, masking critical health disparities and their drivers. To address these issues, in March 2021, the National Heart, Lung, and Blood Institute, in partnership with 8 other NIH institutes, convened a multidisciplinary workshop to review current research, knowledge gaps, opportunities, barriers, and approaches for prevention research for AsA and NHPI populations. The workshop covered 5 domains: 1) sociocultural, environmental, psychological health, and lifestyle dimensions; 2) metabolic disorders; 3) cardiovascular and lung diseases; 4) cancer; and 5) cognitive function and healthy aging. Two recurring themes emerged: Very limited data on the epidemiology, risk factors, and outcomes for most conditions are available, and most existing data are not disaggregated by subgroup, masking variation in risk factors, disease occurrence, and trajectories. Leveraging the vast phenotypic differences among AsA and NHPI groups was identified as a key opportunity to yield novel clues into etiologic and prognostic factors to inform prevention efforts and intervention strategies. Promising approaches for future research include developing collaborations with community partners, investing in infrastructure support for cohort studies, enhancing existing data sources to enable data disaggregation, and incorporating novel technology for objective measurement. Research on AsA and NHPI subgroups is urgently needed to eliminate disparities and promote health equity in these populations.

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.

Integrating Environment and Aging Research: Opportunities for Synergy and Acceleration

Despite significant overlaps in mission, the fields of environmental health sciences and aging biology are just beginning to intersect. It is increasingly clear that genetics alone does not predict an individual’s neurological aging and sensitivity to disease. Accordingly, aging neuroscience is a growing area of mutual interest within environmental health sciences. The impetus for this review came from a workshop hosted by the National Academies of Sciences, Engineering, and Medicine in June of 2020, which focused on integrating the science of aging and environmental health research. It is critical to bridge disciplines with multidisciplinary collaborations across toxicology, comparative biology, epidemiology to understand the impacts of environmental toxicant exposures and age-related outcomes. This scoping review aims to highlight overlaps and gaps in existing knowledge and identify essential research initiatives. It begins with an overview of aging biology and biomarkers, followed by examples of synergy with environmental health sciences. New areas for synergistic research and policy development are also discussed. Technological advances including next-generation sequencing and other-omics tools now offer new opportunities, including exposomic research, to integrate aging biomarkers into environmental health assessments and bridge disciplinary gaps. This is necessary to advance a more complete mechanistic understanding of how life-time exposures to toxicants and other physical and social stressors alter biological aging. New cumulative risk frameworks in environmental health sciences acknowledge that exposures and other external stressors can accumulate across the life course and the advancement of new biomarkers of exposure and response grounded in aging biology can support increased understanding of population vulnerability. Identifying the role of environmental stressors, broadly defined, on aging biology and neuroscience can similarly advance opportunities for intervention and translational research. Several areas of growing research interest include expanding exposomics and use of multi-omics, the microbiome as a mediator of environmental stressors, toxicant mixtures and neurobiology, and the role of structural and historical marginalization and racism in shaping persistent disparities in population aging and outcomes. Integrated foundational and translational aging biology research in environmental health sciences is needed to improve policy, reduce disparities, and enhance the quality of life for older individuals.

Invited Commentary: The Need for Repeated Measures and Other Methodological Considerations When Investigating Discrimination as a Contributor to Health

To determine potential measurement error related to the assessment of lifetime discrimination, Van Dyke et al. (Am J Epidemiol. 2022;191(3):370-378) investigated inconsistencies in reporting of racial, socioeconomic status, and sex discrimination over time among Black and White adults enrolled in the Coronary Artery Risk Development in Young Adults (CARDIA) Study. The authors found that "ever" reports of discrimination (as assessed by the Experiences of Discrimination Scale) decreased over time and that populations who most experience discrimination (i.e., Black/African-American people, younger persons, persons of low socioeconomic status, and women) were often also the most likely to inconsistently report discrimination over the course of the study period (from 1992 to 2010). The authors have raised an important issue related to the potential underestimation of lifetime discrimination that may depend on when discrimination is assessed, as well as the social identity of individuals surveyed. With implications for health inequities, these findings highlight study design and methodological issues that should be addressed to accurately estimate the true burden discrimination places on health. In this commentary, we further illuminate potential methodological challenges and opportunities to consider when investigating the impact of discrimination on health.

Vitamin D Supplement Use and Risk of Breast Cancer by Race-Ethnicity

BACKGROUND

Vitamin D has anticarcinogenic properties, but a relationship between vitamin D supplement use and breast cancer is not established. Few studies have accounted for changes in supplement use over time or evaluated racial-ethnic differences.

METHODS

The Sister Study is a prospective cohort of 50,884 women with 35-74 years of age who had a sister with breast cancer, but no breast cancer themselves at enrollment (2003-2009). We used Cox proportional hazards models to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for the association between vitamin D supplement use and incident breast cancer (3,502 cases; median follow-up 10.5 years).

RESULTS

Vitamin D supplement use was common, with 64% reporting ever use (at least once per month) in the year before enrollment. Considering supplement use over time, ever use of vitamin D supplements was not meaningfully associated with breast cancer (HR = 0.96, 95% CI = 0.88, 1.0), relative to never use. However, after adjusting for prior use, recent use of vitamin D supplements ≥1/month was inversely associated with breast cancer (HR = 0.88, 95% CI = 0.78, 1.0), relative to nonrecent use. The inverse association was stronger for ductal carcinoma in situ (HR = 0.67, 95% CI = 0.52, 0.87) than invasive breast cancer (HR = 0.94, 95% CI = 0.72, 1.1, p-for-heterogeneity = 0.02). Supplement use was less common among African American/Black (56%) and non-Black Hispanic/Latina (50%) women than non-Hispanic White women (66%), but there was limited evidence of racial-ethnic differences in HRs (p-for-heterogeneity = 0.16 for ever use, P = 0.55 for recent).

CONCLUSIONS

Our findings are consistent with the hypothesis that recent vitamin D use is inversely associated with breast cancer risk.

Experiences With Everyday and Major Forms of Racial/Ethnic Discrimination and Type 2 Diabetes Risk Among White, Black, and Hispanic/Latina Women: Findings From the Sister Study

Racial/ethnic discrimination may contribute to the risk of type 2 diabetes mellitus (T2DM), but few studies have prospectively examined this relationship among racially/ethnically diverse populations. We analyzed prospective data from 33,833 eligible Sister Study participants enrolled from 2003 to 2009. In a follow-up questionnaire (2008-2012), participants reported their lifetime experiences of everyday and major forms of racial/ethnic discrimination. Self-reported physician diagnoses of T2DM were ascertained through September 2017. Hazard ratios and 95% confidence intervals were estimated using Cox proportional hazards models, overall and by race/ethnicity. Mean age at enrollment was 54.9 (standard deviation, 8.8) years; 90% of participants self-identified as non-Hispanic (NH) White, 7% as NH Black, and 3% as Hispanic/Latina. Over an average of 7 years of follow-up, there were 1,167 incident cases of T2DM. NH Black women most frequently reported everyday (75%) and major (51%) racial/ethnic discrimination (vs. 4% and 2% of NH White women, respectively, and 32% and 16% of Hispanic/Latina women, respectively). While everyday discrimination was not associated with T2DM risk, experiencing major discrimination was marginally associated with higher T2DM risk overall (hazard ratio = 1.26, 95% confidence interval: 0.99, 1.61) after adjustment for sociodemographic characteristics and body mass index. Associations were similar across racial/ethnic groups; however, racial/ethnic discrimination was more frequently reported among racial/ethnic minority women. Antidiscrimination efforts may help mitigate racial/ethnic disparities in T2DM risk.

Association between neighbourhood deprivation and hypertension in a US-wide Cohort

Background

Socioeconomic status (SES) at the individual level is associated with hypertension risk. Less is known about neighbourhood level SES or how neighbourhood and individual level SES may jointly affect hypertension risk.

Methods

The Area Deprivation Index (ADI) includes 17 census-based measures reflecting neighbourhood SES. The ADI was linked to enrolment addresses of 47 329 women in the Sister Study cohort and categorised as ≤10% (low deprivation), 11%–20%, 21%–35%, 36%–55% and >55% (high deprivation). Hypertension was defined as either high systolic (≥140 mm Hg) or diastolic (≥90 mm Hg) blood pressure or taking antihypertensive medication. We used log binomial regression to investigate the cross-sectional association between ADI and hypertension and evaluated interactions between ADI and race/ethnicity and between ADI and individual SES.

Results

The highest ADI level of >55% was associated with increased prevalence of hypertension, compared with the lowest level of ADI≤10%, in a model adjusted for age, race/ethnicity, educational attainment and annual household income (prevalence ratio=1.26, 95% CI 1.21 to 1.32). We observed interaction between race/ethnicity and ADI (interaction contrast ratio (ICR)=1.9; 95% CI 0.94 to 2.8 comparing non-Hispanic Black women with ADI >55% to non-Hispanic White women with ADI≤10%) and between household income and ADI (ICR 0.38; 95% CI 0.12 to 0.65 comparing participants with household income ≤US$49 999 and ADI>55% to those with household income >US$100 000 and ADI≤10%).

Conclusions

These findings suggest that neighbourhood deprivation measured by ADI may be a risk factor for hypertension and that ADI may act synergistically with race/ethnicity and individual household income to contribute to hypertension.

A prospective study of multiple sleep dimensions and hypertension risk among white, black and Hispanic/Latina women: findings from the Sister Study

BACKGROUND

Poor sleep is associated with increased hypertension risk, but few studies have evaluated multiple sleep dimensions or investigated racial/ethnic disparities in this association among women.

METHOD

We investigated multiple sleep dimensions (sleep duration, inconsistent weekly sleep patterns, sleep debt, frequent napping and difficulty falling or staying asleep) and hypertension risk among women, and determined modification by age, race/ethnicity and menopausal status. We used data from the Sister Study, a national cohort of 50 884 women who had sisters diagnosed with breast cancer in the United States enrolled in 2003-2009 and followed through September 2018.

RESULTS

Of 33 497 women without diagnosed hypertension at baseline (mean age ± standard deviation: 53.9 ± 8.8 years; 88.7% White, 6.4% Black and 4.9% Hispanic/Latina), 23% (n = 7686) developed hypertension over a median follow-up of 10.1 years [interquartile range: 8.2-11.9 years]. Very short, short or long sleep duration, inconsistent weekly sleep patterns, sleep debt, frequent napping, insomnia, insomnia symptoms as well as short sleep and exploratory cumulative poor sleep score were associated with incident hypertension after adjustment for demographics factors. After additional adjustment for lifestyle and clinical factors, insomnia [hazard ratio = 1.09, 95% confidence interval (95% CI): 1.03-1.15] and insomnia symptoms plus short sleep (hazard ratio = 1.13, 95% CI: 1.05-1.21) remained associated with incident hypertension. These associations were stronger in younger (age<54 vs. ≥54 years) and premenopausal vs. postmenopausal women (all P-interaction < 0.05). Associations did not differ by race/ethnicity (all P-interaction > 0.05).

CONCLUSION

Thus, screening for multiple sleep dimensions and prioritizing younger and premenopausal women may help identify individuals at high risk for hypertension.

Use of hair products in relation to ovarian cancer risk

We evaluated whether hair products, which may contain carcinogens and endocrine disruptors that can be absorbed into the bloodstream, are related to ovarian cancer incidence in a prospective cohort. After excluding women with a history of ovarian cancer or bilateral oophorectomy, 40 559 Sister Study participants ages 35-74 at enrollment (2003-2009) were included. Participants completed questionnaires on hair product use, including hair dyes, straighteners/relaxers and permanents/body waves, in the past 12 months. Cox regression was used to estimate adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for the association between hair products and incident ovarian cancer. We assessed associations stratified by tumor type (serous, non-serous). Over a mean follow-up of 10 years, 241 women were diagnosed with ovarian cancer. Ever use of any of the examined hair products during the past year was not associated with ovarian cancer risk. However, frequent use (>4 times/year) of straighteners/relaxers or pressing products in the past year was associated with an increased risk of ovarian cancer (HR = 2.19, 95% CI: 1.12-4.27). Ever use of permanent hair dye was positively associated with non-serous (HR = 1.94, 95% CI 1.12-3.37), but inversely associated with serous (HR = 0.65, 95% CI: 0.43-0.99) tumors (p-for-heterogeneity = 0.002). Our novel findings suggest that frequent use of hair straighteners/relaxers or pressing products, which are primarily used by African American/Black women, and possibly permanent hair dye, may be associated with the occurrence of ovarian cancers.

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.

A Systematic Review of Workplace-Based Employee Health Interventions and Their Impact on Sleep Duration Among Shift Workers

BACKGROUND

Shift work is associated with long-term health risks. Workplace-based health interventions hold promise for improving or maintaining the health of shift workers; yet, the impact of workplace-based interventions on shift worker sleep duration has not been assessed. We conducted a systematic review of workplace interventions on shift worker sleep.

METHODS

We conducted searches in PubMed, Web of Knowledge, EMBASE, Scopus, and PsycINFO (n = 6,868 records) of all studies published through May 15, 2019. Eligibility criteria included the following: (a) individuals aged ≥18 years; (b) a workplace-based employee intervention; (c) an employee population comprised predominantly of shift workers (>50%); and (d) sleep duration as a study outcome.

FINDINGS

Twenty workplace interventions met eligibility criteria. Mean intervention duration was 125 (SD = 187) days and mean sample size was 116 employees (SD = 256) with a mean age of 36.4 years (SD = 6.5). Interventions most commonly focused on light exposure (25%) or shift timing (25%), followed by sleep hygiene (20%). Most interventions were conducted in the health care and social assistance sector (60%). Study quality on average was 64% (SD = 7%). A majority of the studies found that a workplace-based health intervention was associated with a desirable increase in 24-hour total sleep duration (55%). The overall average increase in daily employee sleep duration achieved by interventions ranged for RCT studies from 0.34 to 0.99 hours and for non-RCT studies from 0.02 to 1.15 hours.

CONCLUSIONS/APPLICATIONS TO PRACTICE

More than half of the employee health interventions, especially yoga or mindfulness interventions, resulted in a desirable increase in sleep duration. Workplaces hold promise as an avenue? for delivering programs and policies that aim to improve sleep duration among shift workers.

Perceived Home Sleep Environment: Associations of Household-level Factors and In-bed Behaviors with Actigraphy-based Sleep Duration and Continuity in the Jackson Heart Sleep Study

STUDY OBJECTIVES

In an older African-American sample (n=231) we tested associations of the household environment and in-bed behaviors with sleep duration, efficiency, and wakefulness after sleep onset (WASO).

METHODS

Older adult participants completed a household-level sleep environment questionnaire, a sleep questionnaire, and underwent 7-day wrist actigraphy for objective measures of sleep. Perceived household environment (self-reported) was evaluated using questions regarding safety, physical comfort, temperature, noise, and light disturbances. In-bed behaviors included: watching television, listening to radio/music, use of computer/tablet/phone, playing video games, reading books, and eating. To estimate the combined effect of the components in each domain (perceived household environment and in-bed behaviors), we calculated and standardized a weighted score per sleep outcome (e.g., duration, efficiency, WASO), with a higher score indicating worse conditions. The weights were derived from the coefficients of each component estimated from linear regression models predicting each sleep outcome while adjusting for covariates.

RESULTS

A standard deviation increase in an adverse household environment score was associated with lower self-reported sleep duration (β=-13.9 minutes, 95% confidence interval: -21.6, -1.7) and actigraphy-based sleep efficiency (β=-0.7%, -1.4, 0.0). A standard deviation increase in the in-bed behaviors score was associated with lower actigraphy-based sleep duration (β=-9.7 minutes, -18.0, -1.3), sleep efficiency (β=-1.2%, -0.9, -0.6), and higher WASO (5.3 minutes, 2.1, 8.6).

CONCLUSION

Intervening on the sleep environment, including healthy sleep practices, may improve sleep duration and continuity among African-Americans.

Associations between everyday discrimination and sleep quality and duration among African Americans over time in the Jackson Heart Study

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 assess sleep duration (Sleep Exam 2012-2016). Changes in discrimination were defined as low stable (reference), increasing, decreasing, and stable high. Within-person changes in sleep from Exam 1-to-3 were regressed on change in discrimination from Exam 1-to-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. stable low) 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.