Neighborhood environment and adolescent sleep: The role of family socioeconomic status

Comparing the Effects of Adequate and Insufficient Sleep on the Mental Health, Behavioral Outcomes, and Daily Lives of South Korean Adolescents

Background/Objectives: Adequate sleep is critical for adolescents' physical and mental health. However, academic demands and lifestyle habits lead to insufficient sleep among many adolescents. This study examined the relationship between sleep patterns and general characteristics, health behaviors, and mental health among South Korean adolescents. Methods: Data were obtained from the Korea Youth Risk Behavior Survey conducted by the Korea Disease Control and Prevention Agency, involving 21,283 students aged between 13 and 18 years. Self-reported sleep duration was categorized as adequate (8-10 h) or insufficient (less than 8 h on both weekdays and weekends), and 20 independent variables across demographic, socioeconomic, lifestyle, health-related behavioral, and psychological factors were analyzed. Multiple logistic regression analyses were conducted to evaluate the effects of insufficient sleep. Results: Insufficient sleep was more prevalent among female students (odds ratio [OR]: 2.064) and older students (OR: 16.588 for Grade 12 vs. Grade 7) and was associated with higher stress levels (OR: 4.338 for almost always vs. never), suicidal ideation (OR: 1.826), and unhealthy behaviors such as alcohol consumption (OR: 2.009), smoking (OR: 1.998), and smartphone overdependence (OR: 2.313 for severe vs. normal). In contrast, adolescents with adequate sleep reported greater happiness (OR: 4.167 for very much vs. not at all) and better academic performance (OR: 1.377 for very high vs. very low). Conclusions: The findings show that insufficient sleep significantly affects adolescent well-being, highlighting the need for tailored interventions and increased societal awareness. Future research should explore the mechanisms underlying gender differences and weekday-weekend sleep disparities to enhance sleep quality in this population.

The impact of race, ethnicity, and socioeconomic status on early adolescent sleep disturbances for youth exposed to adverse childhood experiences

BACKGROUND

Adverse childhood experiences (ACEs) may increase the risk for adolescent sleep disturbances, though the impact of race, ethnicity, and socioeconomic status (SES) remains unclear.

OBJECTIVE

We sought to determine the direct and moderating impact of race, ethnicity, family SES, and community SES on sleep disturbances across early adolescence for ACE-exposed youth.

PARTICIPANTS AND SETTING

This secondary analysis used longitudinal Adolescent Brain Cognitive Development Study® data (2016-2022) from youth who experienced ≥1 ACE by age 9-10 years.

METHODS

Clinically significant sleep disturbances were identified from the annual parent-reported Sleep Disturbances Scale for Children. Parents reported youths' race, ethnicity, family SES, and community SES at baseline. Multilevel mixed effects logistic regression modeling examined the impact of race, ethnicity, and SES on sleep disturbances over four years among ACE-exposed youth. Adjusted odds ratios with 95 % confidence intervals are presented (adj. OR [95 % CI]).

RESULTS

Among 6661 youth with ACE exposure, 2402 (36.1 %) had clinically significant sleep disturbances at baseline. Multiracial (versus White) youth were 27 % likelier to have clinically significant sleep disturbances over time (adj. OR 1.27 [95 % CI 1.01, 1.59]). Similar results were found for youth exposed to ≥2 family financial adversities (adj. OR 1.50 [95 % CI 1.19, 1.90]). There were no effects of community SES, nor interaction effects of race, ACEs, or SES on sleep disturbances.

CONCLUSION

While Multiracial youth may experience additional stressors which affect sleep disturbances, regularly assessing family environments and supporting all families to meet basic needs may positively impact adolescent sleep.

Socioeconomic status and sleep duration among a representative, cross-sectional sample of US adults

BACKGROUND

Sleep is a crucial determinant of physical and mental health outcomes, and insufficient sleep is highly prevalent among United States adults. Although some risk factors of poor sleep have been extensively studied, including substance use, age, health behaviors, and others, the associations between socioeconomic status (SES) and sleep remain inconclusive. There is limited evidence on SES and sleep duration among the US adult population. This study analyzed the relationships between three SES indicators (poverty, education, and food security), and sleep duration.

METHODS

We used responses from the 2017-March 2020 National Health and Nutrition Examination Survey (NHANES). Respondents younger than 25 years old were excluded. Sleep duration was classified using self-reported sleep time and stratified by work vs. non-workdays. SES was operationalized using three indicators: poverty-income ratio, educational attainment, and food security status. We imputed missing data for socioeconomic status and outcome variables using multiple imputation. Weighted Poisson regression models with robust standard errors were used to calculate the crude and adjusted prevalence ratios for insufficient sleep duration (< 7 h of self-reported sleep) on workdays and non-workdays separately by each of the three SES indicators.

RESULTS

We included a total of 8,457 individuals. In the adjusted model, participants with lower income, educational status, and food security had significantly higher prevalence of insufficient sleep duration on both workdays and non-workdays. For example, low-income individuals (poverty-income ratio < 1) had 1.22 (95% CI 1.04-1.44) and 2.08 (95% CI 1.61-2.67) higher prevalence of insufficient sleep as compared to high income individuals on workday and non-workdays, respectively. In general, we found larger differences by level of SES indicator for the non-workday than for the workday outcome. There were no major differences in gender-stratified analysis. We also found that lower SES was associated with higher prevalence of excessive sleep (≥ 9 h).

CONCLUSION

Socioeconomic status indicators are significantly associated with sleep duration in the US adult population. Lower SES correlates with increased prevalence of insufficient sleep duration, which has implications for the overall wellbeing of US adults with lower SES. Targeted interventions and further research are needed to reduce this disparity.

Understanding the Association Between Neighborhoods and Adolescent Sleep: Evidence from Add Health

Introduction

Research suggests that perceived neighborhood social environments (PNSE) may contribute to gender and race/ethnicity-based sleep disparities. Our study aimed to examine associations between PNSE factors and adolescents' sleep patterns. As a secondary aim, we examined how gender and race/ethnic groups might moderate these associations.

Method

Data came from the National Longitudinal Study of Adolescent to Adult Health (n=5158; mean age=15.34 years). Four self-reported sleep outcomes were created: 1) sleep duration (hours/night), 2) short sleep (≥8 hours [reference] vs <8 hours), 3) parental set bedtime (10:00 PM/earlier [reference] among girls vs by 11:00PM vs by/after 12:00AM), and 4) sleep satisfaction (enough sleep [reference] vs not enough sleep). PNSE included total scores for contentedness, social cohesion, and safety. Weighted linear and generalized logistic regressions were used to examine the relationship between each PNSE factor and sleep outcomes, adjusting for covariates. Associations were stratified by gender and race/ethnicity, separately.

Results

Neighborhood contentedness was associated with longer sleep duration and lower odds of short sleep, parental set bedtime by/after 12:00 AM, and not enough sleep. Neighborhood social cohesion was related to lower odds of a parental set bedtime by/after 12:00 AM. Neighborhood safety was related to lower odds of short sleep and not enough sleep. Gender and race/ethnic-specific results were mixed.

Conclusion

Positive perceptions of neighborhood social environments served as a protective factor against adverse sleep outcomes among adolescents. Efforts to improve adolescent sleep should consider the role of the neighborhood social context, gender, and racial and ethnic groups.

Using the Person-Based Approach to Co-Create and Optimize an App-Based Intervention to Support Better Sleep for Adolescents in the United Kingdom: Mixed Methods Study

BACKGROUND

Poor sleep is a common problem in adolescents aged 14 to 18 years. Difficulties with sleep have been found to have a bidirectional link to mental health problems.

OBJECTIVE

This new research sought to involve young people in the co-creation of a new app, particularly those from underserved communities. The Sleep Solved app uses science-based advice to improve sleep-related behaviors and well-being. The app was developed using the person-based approach, underpinned by the social cognitive theory and the social-ecological model of sleep health.

METHODS

Young people (aged 14-18 y) were recruited from across the United Kingdom to contribute to patient and public involvement (PPI) activities. In partnership with our peer researcher (MHJ), we used a multitude of methods to engage with PPI contributors, including web-based workshops, surveys, think-aloud interviews, focus groups, and app beta testing.

RESULTS

A total of 85 young people provided PPI feedback: 54 (64%) young women, 27 (32%) young men, 2 (2%) genderfluid people, 1 (1%) nonbinary person, and 1 (1%) who reported "prefer not to say." Their levels of deprivation ranged from among the 40% most deprived to the 20% least deprived areas. Most had self-identified sleep problems, ranging from 2 to 3 times per week to >4 times per week. Attitudes toward the app were positive, with praise for its usability and use of science-based yet accessible information. Think-aloud interviews and a focus group identified a range of elements that may influence the use of the app, including the need to pay attention to language choices and readability. User experiences in the form of narrated audio clips were used to normalize sleep problems and provide examples of how the app had helped these users.

CONCLUSIONS

Young people were interested in using an app to better support their sleep and mental health. The app was co-created with strong links to theory- and evidence-based sleep hygiene behaviors. Future work to establish the effectiveness of the intervention, perhaps in a randomized controlled trial, would provide support for potential UK-wide rollout.

Do Sleep Problems Exacerbate the Mental Health Consequences of Discrimination Among Adults?

OBJECTIVE

An emerging literature suggests that sleep may play an important role in moderating the association between discrimination and mental health problems among adolescents. However, few if any studies have considered this topic among adults. Addressing this knowledge gap, the current study examined multiple sleep parameters as moderating variables in the association between discrimination and mental health problems among adults.

METHODS

Participants were 874 adults residing in small towns and semirural contexts within the Southeastern region of the United States ( Mage = 41 years, SD = 7; 57% female; 31% Black, 69% White; 52% income-to-needs < 2). Sleep duration and night-to-night variability in duration were assessed using wrist actigraphy. Established self-report measures were used to assess global sleep problems, experiences of discrimination, and mental health problems (anxiety, depression, and externalizing symptoms).

RESULTS

Experiences of discrimination were associated with more depression, anxiety, and externalizing problems. Two out of three sleep parameters were found to moderate the effects of discrimination on mental health. The association between discrimination and externalizing problems (but not anxiety or depression) was attenuated among those with less night-to-night variability in sleep duration. The associations between discrimination and anxiety and externalizing problems (but not depression) were attenuated among those with fewer global sleep problems. Less variability in sleep duration and fewer global sleep problems were also directly associated with lower levels of depression, anxiety, and externalizing problems.

CONCLUSIONS

Greater consistency in sleep duration from night-to-night, and fewer overall sleep problems appear to mitigate risk of mental health problems among adults, particularly in contexts where discrimination is prevalent.

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.