Associations Between Sleep and Metabolic Outcomes in Preadolescent Children

Context

Growing evidence suggests an important role for sleep for the metabolic health of children.

Objective

We aimed to determine how sleep is related to insulin sensitivity, insulin secretion, beta-cell function, and adiposity (BMI z-scores, body fat %, waist to height ratio) using objectively measured sleep and oral glucose tolerance test (OGTT)-derived measures.

Methods

Sixty-two children aged 7-11 years, born at Kaiser Permanente Southern California, wore wrist accelerometers for 7 days to objectively measure sleep, completed an OGTT, and had anthropometric measures (height [cm], weight [kg], waist [cm], body fat [%]) collected. Using linear regression, associations between Matsuda insulin sensitivity index (ISI), insulinogenic index (IGI), disposition index (DI), BMI z-score, waist to height ratio, and body fat % with sleep parameters [total sleep time (TST; min), sleep efficiency (SE; %), time in bed (TIB; min), wake after sleep onset (WASO; min), and sleep latency (SL; min)] were assessed. Body fat % was tested as a mediator of the relationship between TST and ISI.

Results

Longer TST was associated with better insulin sensitivity (P = 0.02), but not after adjusting for body fat %. Sleep parameters were not associated with IGI or DI. Longer TST was associated with lower % body fat (P = 0.01) and lower waist-to-height-ratios (P = 0.05). Body fat % explained 62% (P = 0.01) of the relationship between TST and ISI. Longer TIB was associated with lower adiposity measures (P < 0.05). There were no associations between SE, WASO, or SL and metabolic outcomes.

Conclusion

Objectively measured sleep duration was associated with lower adiposity, and the relationship between sleep duration and ISI appeared partly through adiposity levels in preadolescent children. Longer sleep duration may be important for metabolic health.

0077 Exploring Psychological and Behavioral Factors with Sleep Health in Latinx Children

Introduction

While sleep health is comprised of multiple dimensions, extant research tends to investigate single elements of sleep, such as sleep duration or sleep quality. The current study aimed to explore whether psychological and behavioral factors were associated with a multidimensional sleep health score as well as if sleep health was related to adiposity among Latinx children.

Methods

A community sample of 100 Latinx 10-to-12-year-olds were recruited from Los Angeles and Orange Counties (California, US). Psychological (perceived stress, anxiety and depressive symptoms), sleep hygiene and chronotype (lower scores indicate more adaptive sleep hygiene and eveningness, respectively) measures were collected with surveys. Diet data (sugar, fiber) was collected by two 24-hour recalls. Adiposity (BMI percentile, percent body fat) was assessed via bioimpedance scale. Sleep actigraphy (1 week) provided objective sleep dimension data. A composite score of sleep health across 6 dimensions (regularity, satisfaction, alertness, timing, efficiency, and duration) was constructed (0=better to 6=poorer). Hierarchical linear regressions, controlling for demographics (age, gender, monthly household income), assessed associations for each set of factors.

Results

The mean sleep health score was 2.08±1.41; 31.6% of Latinx children in our sample had poor sleep health (using median cut-point of 2). Poorer sleep hygiene (std. β=-.235, p=.037) and higher income (std. β=.244, p=.022) were significantly associated with poorer sleep health, while eveningness was marginally related (std. β=-.210, p=.068). Lower fiber intake (std. β=-.235, p=.037) and higher income (std. β=-.245, p=.038) were significantly associated with poorer sleep health. Psychological and adiposity variables were not associated with sleep health after controlling for demographics.

Conclusion

This study shows the prevalence and correlates of poor sleep health in Latinx children, an understudied group at risk for several health disparities. Better sleep hygiene was related to better sleep health. Several findings diverge from the literature based on single dimensions of sleep in general samples. Higher SES was related to poorer sleep health. Psychological factors and adiposity were not related to sleep health. A novel finding was that higher fiber intake was related to better sleep health. Additional research is needed to better understand factors related to multidimensional sleep health in Latinx children.

Support (If Any)

This work was supported by the National Institute of General Medical Sciences under Award Numbers UL1GM118979, TL4GM118980, and RL5GM118978 as well as the National Heart, Lung and Blood Institute Award Number 1K01HL140283.

Comprando Rico y Sano: Increasing Latino nutrition knowledge, healthful diets, and food access through a national community-based intervention

PURPOSE

Evaluation findings from "X" a culturally relevant, community-based intervention addressing nutrition knowledge and food access are presented.

DESIGN

No-control quasi-experimental intervention with pre, post, and follow-up assessments.

SETTING

"X" was promotores-led through "X" community-based partners.

SAMPLE

Low-income Latino adults (N=966) receiving services at 25 partner sites.

INTERVENTION

"X" was a six-hour intervention focused on nutrition knowledge and consumption of fruits, vegetables, and home-prepared meals. It also provided guidance for health-conscious grocery shopping, Supplemental Nutrition Assistance Program (SNAP) information, and enrollment assistance.

MEASURES

Self-report surveys assessed nutrition knowledge; intention to change; and frequency of fruit, vegetable, and home-prepared meal consumption. Sites reported monthly SNAP enrollment data.

ANALYSIS

Paired-samples t-tests and repeated-measures ANOVAs assessed changes in knowledge, intentions, and behavior from pre-to-post (n=960) and pre-to-follow-up (n=115).

RESULTS

Pre-to-follow-up increases in nutrition knowledge (p<.001) were observed. Intention to consume more vegetables (p=.027) and home-prepared meals (p<.001) also improved between pre and follow-up. Increases from pre-to-follow-up were observed for frequency of consuming fruits (p=.007), vegetables (p=.001), and home-prepared meals (p<.001). Across 16 months, 24,359 Latinos enrolled for SNAP.

CONCLUSION

Large-scale community collaborations to deliver culturally relevant nutrition education and SNAP enrollment assistance can increase food access, health literacy, and promote healthful diets for Latinos.

Hispanic/Latino heritage group disparities in sleep and the sleep-cardiovascular health relationship by housing tenure status in the United States

OBJECTIVES

The objective of this study was to investigate whether the sleep-cardiovascular health (CVH) association varies by Hispanic/Latino heritage group and housing tenure status (i.e., homeownership, unassisted housing, government-assisted housing), which is an important social determinant of health.

DESIGN

Cross-sectional analysis of pooled National Health Interview Survey (2004-2017) data.

SETTING

United States.

PARTICIPANTS

US-born/non-US-born Mexican, Puerto Rican, Cuban, Dominican, Central/South American, and US-born non-Hispanic (NH)-white adults.

MEASUREMENTS

Within each housing tenure category, Poisson regressions with robust variance estimated the adjusted prevalence ratios (PRs) and 95% confidence intervals (CIs) of (1) habitual sleep duration (<6-hours, 6-<7-hours, and >9-hours vs. 7-9 hours) and sleep quality for Hispanic/Latino heritage groups compared with NH-whites and (2) ideal CVH for Hispanic/Latino heritage groups within each sleep duration category, separately, compared with NH-whites who reported 7-9 hours sleep duration.

RESULTS

Among 283,767 NH-white and Hispanic/Latino adults (mean age=47.0±0.09 years, 50.1% female), 33% rented housing (4% government-assisted; 29% unassisted), and 67% were homeowners. Compared with their NH-white housing tenure counterparts, only Puerto Rican homeowners were more likely to report <6-hours (PR=1.70 [95% CI: 1.44-2.01]) and 6-<7-hours (PR=1.31 [1.19-1.44]) sleep duration. Overall, Hispanic/Latino heritage groups were either less likely or no more likely to report >9-hours sleep duration and poor sleep quality compared with NH-whites. Disparities in CVH were large between Puerto Rican unassisted renters and homeowners who reported >9-hours of habitual sleep compared with their NH-white housing tenure counterparts who reported 7-9 hours.

CONCLUSIONS

Hispanic/Latino-white disparities in the sleep-CVH relationship may vary by Hispanic/Latino heritage group and housing tenure.

0361 Birthplace Moderates Racial/Ethnic Disparities in Multiple Sleep Characteristics Among Non-Hispanic Whites and Hispanic/Latino Heritage Groups in the United States

Introduction

Sleep duration disparities by Hispanic/Latino heritage exist; however, few studies have additionally investigated sleep quality disparities by heritage and birthplace, nor have studies compared foreign-born to US-born Non-Hispanic Whites (NHWs).

Methods

Using pooled 2004-2017 National Health Interview Survey data, we investigated whether sleep disparities varied by birthplace among adult NHWs and Hispanic/Latino heritage groups. Adjusting for sociodemographic and behavioral/clinical characteristics, survey-weighted Poisson regressions with robust variance estimated prevalence ratios (PRs) and 95% confidence intervals (CIs) of self-reported sleep characteristics. Sleep characteristics were compared among foreign-born NHWs and Hispanic/Latino heritage groups vs. US-born NHWs. Sleep characteristics were also compared across Hispanic/Latino heritage groups vs. foreign-born NHWs.

Results

Among 254,699 participants (Meanage±SE: 47±0.9 years; 49% female), 81% self-identified as NHW (n=207,154), 12% Mexican (n=30,100), 2% Puerto Rican n=5,077), 1% Cuban(n=2,518), 1% Dominican (n=1,658), and 3% Central/South American (n=8,162). Compared to US-born NHWs, foreign-born NHWs were more likely to report &gt;9-hours sleep duration (PR=1.11[95% CI: 1.01-1.21]) and poor sleep quality (e.g., PRtrouble staying asleep=1.27[1.17-1.37]), and US-born Mexicans were no more likely to report shorter sleep duration while foreign-born Mexicans were less likely (PR&lt;6-hours=0.52[0.47-0.57], PR6-&lt;7-hours=0.72[0.68-0.76]). Although US-born and foreign-born Mexicans had lower prevalence of poor sleep quality compared to US-born NHWs, PRs were lowest for foreign-born Mexicans. Compared to foreign-born NHWs, US-born Mexicans were more likely to report shorter sleep duration, but foreign-born Mexicans were no more likely. Regardless of birthplace, Puerto Ricans were more likely (e.g., PR&lt;6-hours=1.37[1.24-1.60]) and Cubans were less likely (e.g., PR&lt;6-hours=0.81[0.68-0.96]) to report shorter sleep duration vs. US-born NHWs. Compared to US-born NHWs, Dominicans reported better sleep duration and quality. Sleep duration and quality did not differ among Dominicans vs. foreign-born NHWs.

Conclusion

Sleep disparities varied by birthplace and Hispanic/Latino heritage. Birthplace of both NHWs and racial/ethnic minority groups should be considered in disparities research.

Support

This work was funded by the Intramural Program at the National Institutes of Health (NIH), National Institute of Environmental Health Sciences (NIEHS, Z1AES103325-01) and the Division of Intramural Research, National Institute on Minority Health and Health Disparities.

Parents Report Competing Priorities Influence Snack Choice in Youth Sports

OBJECTIVE

To describe parental perceptions of team snacks, factors that motivate snack choice, and perceptions of healthy snacking guidelines in youth sports.

METHODS

Six in-depth group interviews were conducted among parents (n = 22) of children aged 4-12 years in 2 Los Angeles County Baseball Little Leagues. Interviews were audio-recorded, transcribed, and analyzed using thematic analysis.

RESULTS

Parents perceived fruit as the ideal snack; this ideal was balanced with competing priorities, including children's preferences, cost, time, and social norms regarding snacks as rewards and team bonding. Although parents were supportive of promoting healthy snacks, they believed that snacking guidelines should not be mandated.

CONCLUSIONS AND IMPLICATIONS

Developing messages that align with parents' motivations when choosing snacks could promote healthier snacking in youth sports. Future studies are warranted to explore drivers of snacking with a broader sample and to examine how to promote healthy snacks effectively.

Academic-Related Factors and Emotional Eating in Adolescents

BACKGROUND

Existing literature indicates a relationship between stress and emotional eating in adults, yet limited research has examined the impact of school-related stress on emotional eating in adolescents. This study investigated the influence of academic factors on emotional eating among minority adolescents.

METHODS

A survey was implemented among a sample of minority adolescents (N = 666) to investigate the relationship between emotional eating and 3 academic factors: academic self-esteem, grade point average (GPA), and academic worries. Forced-entry multiple linear regressions were used to test for relationships.

RESULTS

Findings indicate that GPA, academic self-esteem, and academic worries were related to emotional eating scores in adolescents. There were no significant differences in academic factors between emotional eaters and nonemotional eaters.

CONCLUSIONS

Additional research is needed to further elucidate the complex interaction between emotional eating behavior and academics.

Mujer Sana, Familia Fuerte: The Effects of a Culturally-Relevant, Community-Based, <i>Promotores</i> Program to Increase Cervical Cancer Screening among Latinas

OBJECTIVE

Although cervical cancer can be prevented through screening and follow-up, Latinas' rate of Pap tests remains low due to knowledge gaps and cultural and attitudinal factors.

METHODS

This study used a single-group pre-/post-test design to evaluate the effectiveness of Mujer Sana, Familia Fuerte (Healthy Woman, Strong Family), an intervention intended to improve Latinas' cervical cancer prevention knowledge, attitudes, self-efficacy to obtain a Pap test, and intention to get tested. The intervention is delivered through a single session by promotores de salud, who use a culturally competent, linguistically appropriate toolkit. A total of 5,211 Latinas participated in the study.

RESULTS

The evaluation indicated that participants had increases in knowledge, positive attitudes, self-efficacy, and intention to test.

CONCLUSION

Latinas have a low rate of cervical cancer screening but a high rate of cervical cancer, and Mujer Sana, Familia Fuerte shows promise as a public health practice for use with this population.

Using path analysis to examine the relationship between sexual abuse in childhood and diabetes in adulthood in a sample of US adults

To understand mechanisms underlying the relationship between adverse childhood experiences (ACE) and diabetes the study evaluated mediators of the relationship between childhood sexual abuse and diabetes in adulthood. This study used cross-sectional data from the 2011 Behavioral Risk Factor Surveillance Survey (BRFSS). Participants totaled 48, 526 who completed the ACE module. Based on theoretical relationships, path analysis was used to investigate depression and obesity as pathways between childhood sexual abuse, and diabetes in adulthood. Among adults with diabetes, 11.6% experienced sexual abuse. In the unadjusted model without mediation, sexual abuse was significantly associated with depression (OR=4.48, CI 4.18-4.81), obesity (OR=1.28, CI 1.19-1.38), and diabetes (OR=1.39, CI 1.25-1.53). In the unadjusted model with mediation, depression and obesity were significantly associated with diabetes (OR=1.59, CI 1.48-1.72, and OR=3.77, CI 3.45-4.11, respectively), and sexual abuse and diabetes was no longer significant (OR=1.10, CI 0.98-1.23), suggesting full mediation. After adjusting for covariates in the mediation model, significance remained between sexual abuse and depression (OR=3.04, CI 2.80-3.29); sexual abuse and obesity (OR=1.41, CI 1.29-1.53), depression and diabetes (OR=1.35, CI 1.23-1.47); and obesity and diabetes (OR=3.53, CI 3.20-3.90). The relationship between sexual abuse and diabetes remained insignificant (OR=1.09, CI 0.96-1.24). This study demonstrates that depression and obesity are significant pathways through which childhood sexual abuse may be linked to diabetes in adulthood. These results can guide intervention development, including multifaceted approaches to treat depression and increase physical activity in patients with a history of sexual abuse to prevent diabetes.

Relationship between individual categories of adverse childhood experience and diabetes in adulthood in a sample of US adults: Does it differ by gender?

AIMS

ACEs are known to increase risk for diabetes in adulthood. However, little is known about the differential impact of individual ACE categories on diabetes risk, and whether this relationship is gender specific.

METHODS

Data from the 2011 BRFSS was used in this study. Participants included 48,526 adults who completed the ACE module across 5 states. Using logistic regression, we examined the odds of diabetes in adulthood related to eight individual categories of ACEs: sexual abuse, physical abuse, verbal abuse, mental illness, substance abuse, incarceration, separation/divorce, and violence. A gender interaction term was included to test if this relationship varied between men and women.

RESULTS

In adjusted analyses, sexual abuse (OR 1.57, CI 1.240; 1.995) had the strongest positive association followed by verbal (OR 1.29, CI 1.117; 1.484) and physical abuse (OR 1.26, CI 1.040; 1.516). Having a parent with mental illness was also significantly associated with increased odds of diabetes (OR 1.19, CI 0.996; 1.416). No interaction between ACEs and diabetes status by gender in any of the eight categories was found.

CONCLUSIONS

Overall, this study found that four ACE categories were significantly associated with increased odds of diabetes in adulthood with sexual abuse being the strongest predictor.

Evaluation of a Community Health Worker Intervention to Reduce HIV/AIDS Stigma and Increase HIV Testing Among Underserved Latinos in the Southwestern U.S

OBJECTIVES

Latinos are at an elevated risk for HIV infection. Continued HIV/AIDS stigma presents barriers to HIV testing and affects the quality of life of HIV-positive individuals, yet few interventions addressing HIV/AIDS stigma have been developed for Latinos.

METHODS

An intervention led by community health workers (promotores de salud, or promotores) targeting underserved Latinos in three southwestern U.S. communities was developed to decrease HIV/AIDS stigma and increase HIV knowledge and perception of risk. The intervention was led by HIV-positive and HIV-affected (i.e., those who have, or have had, a close family member or friend with HIV/AIDS) promotores, who delivered interactive group-based educational sessions to groups of Latinos in Spanish and English. To decrease stigma and motivate behavioral and attitudinal change, the educational sessions emphasized positive Latino cultural values and community assets. The participant pool comprised 579 Latino adults recruited in El Paso, Texas (n=204); San Ysidro, California (n=175); and Los Angeles, California (n=200).

RESULTS

From pretest to posttest, HIV/AIDS stigma scores decreased significantly (p<0.001). Significant increases were observed in HIV/AIDS knowledge (p<0.001), willingness to discuss HIV/AIDS with one's sexual partner (p<0.001), and HIV risk perception (p=0.006). Willingness to test for HIV in the three months following the intervention did not increase. Women demonstrated a greater reduction in HIV/AIDS stigma scores when compared with their male counterparts, which may have been related to a greater increase in HIV/AIDS knowledge scores (p=0.016 and p=0.007, respectively).

CONCLUSION

Promotores interventions to reduce HIV/AIDS stigma and increase HIV-related knowledge, perception of risk, and willingness to discuss sexual risk with partners show promise in reaching underserved Latino communities.

Temporal relationship between insulin sensitivity and the pubertal decline in physical activity in peripubertal Hispanic and African American females

OBJECTIVE

Little attention has been paid to possible intrinsic biological mechanisms for the decline in physical activity that occurs during puberty. This longitudinal observational study examined the association between baseline insulin sensitivity (SI) and declines in physical activity and increases in sedentary behavior in peripubertal minority females over a year.

RESEARCH DESIGN AND METHODS

Participants were Hispanic and African American girls (n = 55; 76% Hispanic; mean age 9.4 years; 36% obese). SI and other insulin indices were measured at baseline using the frequently sampled intravenous glucose tolerance test. Physical activity was measured on a quarterly basis by accelerometry and self-report.

RESULTS

Physical activity declined by 25% and time spent in sedentary behaviors increased by ∼13% over 1 year. Lower baseline SI predicted the decline in physical activity measured by accelerometry, whereas higher baseline acute insulin response to glucose predicted the decline in physical activity measured by self-report. Time spent in sedentary behavior increased by ~13% over 1 year, and this was predicted by lower baseline SI. All models controlled for adiposity, age, pubertal stage, and ethnicity.

CONCLUSIONS

When evaluated using a longitudinal design with strong outcome measures, this study suggests that lower baseline SI predicts a greater decline in physical activity in peripubertal minority females.

Physical inactivity, but not sedentary behavior or energy intake, is associated with higher fat mass in Latina and African American girls

BACKGROUND

Minority girls are disproportionately affected by overweight and obesity. The independent effects of physical activity (PA), sedentary behavior (SB), and diet are not well understood.

OBJECTIVE

This study examined the individual influences of PA, SB and diet on fat mass in Latina and African American (AA) girls, aged 8-11.

METHODS

Baseline data from a longitudinal cohort study in minority girls is presented. Multiple linear regression analysis assessed the effects of PA, SB, and energy intake on fat mass, adjusting for lean mass, age, Tanner stage and ethnicity.

RESULTS

Participants were 53 Latina and AA girls (77% Latina; M age=9.8 +/- .9; M(BMI%)=80.8 +/- 23.1). Moderate-to-vigorous physical activity (MVPA) by accelerometry (beta= -.13, P<.01) and lean mass (beta=.69, P<.001) were associated with fat mass (Model R2=.63; P<.0001). MVPA by 3-day-physical-activity-recall (beta=-.04, P=.01) and lean mass (beta=.75, P<.001) were associated with fat mass (Model R2=.61; P<.0001). SB and energy intake were not associated with fat mass in any model.

CONCLUSION

Using both objective and subjective measures of PA, MVPA, but not SB or diet, was associated with higher fat mass in Latina and AA girls, independent of lean mass, age, Tanner stage, and ethnicity. Prospective studies are needed to clarify the differential impact of diet and activity levels on adiposity in this population.

Acute effects of stress-reduction Interactive Guided Imagery(SM) on salivary cortisol in overweight Latino adolescents

OBJECTIVES

Chronic stress with relative hypercortisolism has been associated with metabolic disease risk. Stress-reduction interventions may therefore hold promise for reducing such chronic disease risk in obese youth. The purpose of this study was to conduct a 4-week pilot intervention to determine whether stress-reduction Interactive Guided Imagery(SM) (IGI) could serve as an acceptable and effective stress-reduction modality in overweight Latino adolescents.

DESIGN

Subjects (6 male/6 female, ages 14-17, body-mass index >95th percentile) were randomly assigned to the experimental guided imagery group (IGI, n = 6), or the nonintervention control group (C, n = 6). IGI subjects received four weekly 45-minute stress-reduction IGI sessions. Salivary cortisol was assessed immediately before and after each session. Acceptability was assessed by compliance and qualitative interviews.

RESULTS

Subjects attended all sessions and expressed acceptance of the IGI intervention. There were significant within-group reductions in salivary cortisol in the IGI group in three of the four sessions, and no reductions in cortisol in the control group. For all four sessions combined, there was a significant between-group effect for the change in salivary cortisol in IGI versus C (p = 0.007). Effect sizes of cortisol change in IGI group were moderate to very high in the four sessions.

CONCLUSIONS

We conclude that IGI may be feasible and effective in acutely reducing salivary cortisol levels in overweight Latino adolescents. Future studies will need to determine whether stress-reduction IGI can result in longer-term reductions in chronic stress and measures of HPA activity.