Material hardship and sleep: results from the Michigan Recession and Recovery Study

Financial Strain and Psychological Distress Among Middle-Aged and Older Adults: A Moderated Mediation Model

This study investigates the association between financial strain and psychological distress among middle-aged and older adults, exploring how this association is mediated by sleep problems and moderated by marital status. A subsample of 12,095 adults aged 50 and older was selected from the 2018 National Health Interview Survey. Results showed that financial strain was associated with higher psychological distress, and sleep problems partially mediated this association. Marital status moderated the association between sleep problems and psychological distress, and between financial strain and psychological distress, but not between financial strain and sleep problems. These findings partially support the stress-buffering role of marriage. The study offers valuable insights into the complex relationship between financial strain, sleep problems, marital status, and psychological distress among middle-aged and older adults in the United States, highlighting the need for interventions targeting financial stressors and sleep problems, especially for unmarried individuals, to improve mental health outcomes in this population.

The sleep justice study - a prospective cohort study assessing sleep as a cardiometabolic risk factor after incarceration: a protocol paper

BACKGROUND

An estimated 11 million individuals are released from U.S. jails and prisons each year. Individuals with a history of incarceration have higher rates of cardiovascular disease (CVD) events and mortality compared to the general population, especially in the weeks following release from carceral facilities. Healthy sleep, associated with cardiovascular health, is an underexplored factor in the epidemiology of CVD in this population. Incarcerated people may have unique individual, environmental, and institutional policy-level reasons for being sleep deficient. The social and physical environment within carceral facilities and post-release housing may synergistically affect sleep, creating disparities in sleep and cardiovascular health. Since carceral facilities disproportionately house poor and minoritized groups, population-specific risk factors that impact sleep may also contribute to inequities in cardiovascular outcomes.

METHODS

This study is ancillary to an ongoing prospective cohort recruiting 500 individuals with known cardiovascular risk factors within three months of release from incarceration, the Justice-Involved Individuals Cardiovascular Disease Epidemiology (JUSTICE) study. The Sleep Justice study will measure sleep health among participants at baseline and six months using three validated surveys: the Pittsburgh Sleep Quality Index (PSQI), the STOP-Bang, and the Brief Index of Sleep Control. In a subsample of 100 individuals, we will assess sleep over the course of one week using wrist actigraphy, a validated objective measure of sleep that collects data on rest-activity patterns, sleep, and ambient light levels. Using this data, we will estimate and compare sleep health and its association with CVD risk factor control in individuals recently released from carceral facilities.

DISCUSSION

The incarceration of millions of poor and minoritized groups presents an urgent need to understand how incarceration affects CVD epidemiology. This study will improve our understanding of sleep health among people released from carceral facilities and its potential relationship to CVD risk factor control. Using subjective and objective measures of sleep will allow us to identify unique targets to improve sleep health and mitigate cardiovascular risk in an otherwise understudied population.

Associations among social needs, health and healthcare utilization, and desire for navigation services among US Medicaid beneficiaries with type 2 diabetes

The purpose of this study was to better understand the number and types of social needs experienced by Medicaid beneficiaries with type 2 diabetes, and how their social needs are associated with key health indicators. Also examined were factors that influence patients' interest in navigation services for health and social needs to inform future interventions and service delivery. The study expands upon prior research, much of which has focused on only one social need (e.g., food insecurity) or one health outcome. The hypothesis was that among individuals with type 2 diabetes, those with a greater number of social needs would report more health-related problems and be more interested in receiving social needs navigation services. Participants completed a cross-sectional survey by phone (n = 95) or online (n = 14). Most (85%) reported having at least one social need (M = 2.5, SD = 2.2), most commonly not having enough money for unexpected expenses (68%) or necessities like food, shelter and clothing (31%), medical costs (24%), and utilities (23%). Results supported our comprehensive conceptual model. Having more social needs was associated with greater perceived stress, diabetes distress, problems with sleep and executive and cognitive functioning, less frequent diabetes self-care activities, more days of poor mental health and activity limitations, worse self-reported health and more hospitalisations. Number of social needs also was positively associated with interest in having a social needs navigator. Social needs were not associated with days of poor physical health, BMI, self-reported A1C or smoking status. Social needs were associated with a wide range of indicators of poor health and well-being. Participants with the greatest social need burden were most open to intervention.

Sleep in times of crises: A scoping review in the early days of the COVID-19 crisis

During the early days of the pandemic and in the context of a seemingly unknown global threat, several potential major sleep disruptors were identified by sleep researchers and practitioners across the globe. The COVID-19 pandemic combined several features that, individually, had been shown to negatively affect sleep health in the general population. Those features included state of crisis, restrictions on in-person social interactions, as well as financial adversity. To address the lack of a comprehensive summary of sleep research across these three distinctive domains, we undertook three parallel systematic reviews based on the following themes: 1) Sleep in times of crises; 2) Sleep and social isolation; and 3) Sleep and economic uncertainty. Using a scoping review framework, we systematically identified and summarized findings from these three separated bodies of works. Potential moderating factors such as age, sex, ethnicity, socioeconomic status, psychological predisposition, occupation and other personal circumstances are also discussed. To conclude, we propose novel lines of research necessary to alleviate the short- and long-term impacts of the COVID-19 crises and highlight the need to prepare the deployment of sleep solutions in future crises.

COVID-19 and behaviors in children with autism spectrum disorder: Disparities by income and food security status

BACKGROUND

Research on the impact of the COVID-19 pandemic on behaviors of children with autism spectrum disorder (ASD) is lacking.

AIMS

This study investigates the relationship between COVID-19 and behaviors of children with ASD living in the United States.

METHODS AND PROCEDURES

Parents and caregivers (n = 200) across the United States, as proxies for children 2-17 years of age with ASD, participated in an online survey querying changes in overall behavior and 15 specific behaviors during the COVID-19 pandemic. Logistic regression was used to assess the association of a moderate-to-large impact on the child's overall behavior with household income level and food security status.

OUTCOMES AND RESULTS

A majority of respondents reported a moderate-to-large impact on the child's overall behavior (74 %) due to COVID-19. Several specific behaviors were also affected. Stratifying by income level and food security status revealed disparities in the impact on overall behavior and most specific behaviors. Compared to a household income ≥$100 K, an income <$50 K was associated with an increased risk of moderate-to-large impact on the child's overall behavior (odds ratio (OR): 4.07, 95 % CI: 1.60, 10.38). Food insecurity also significantly impacted this risk, even after adjusting for potential confounding factors (OR: 3.31, 95 % CI: 1.13, 9.66).

CONCLUSIONS AND IMPLICATIONS

Our findings show a large proportion of caregivers reporting moderate-to-large changes post-COVID-19 in the behaviors of U.S. children with ASD, particularly in families with low income and/or food insecurity. This study highlights the effects of existing disparities on children with ASD and their families during this unprecedented time.

Social Needs, Chronic Conditions, and Health Care Utilization among Medicaid Beneficiaries

Health care organizations are increasingly assessing patients' social needs (eg, food, utilities, transportation) using various measures and methods. Prior studies have assessed social needs at the point of care and many studies have focused on correlates of 1 specific need (eg, food). This comprehensive study examined multiple social needs and medical and pharmacy claims data. Medicaid beneficiaries in Louisiana (n = 10,275) completed a self-report assessment of 10 social needs during July 2018 to June 2019. Chronic health conditions, unique medications, and health care utilization were coded from claims data. The sample was predominantly female (72%), Black (45%) or White (32%), had a mean age of 42 years, and at least 1 social need (55%). In bivariate analyses, having greater social needs was associated with greater comorbidity across conditions, and each social need was consistently associated with mental health and substance use disorders. In multivariable logistic analyses, having ≥2 social needs was positively associated with emergency department (ED) visits (OR = 1.39, CI = 1.23 - 1.57) and negatively associated with wellness visits (OR = 0.87, CI = 0.77 - 0.98), inpatient visits (OR = 0.87, CI = 0.76 - 0.99), and 30-day rehospitalization (OR = 0.66, CI = 0.50 - 0.87). Findings highlight the greater concomitant risk of social needs, mental health, and substance use. Admission policies may reduce the impact of social needs on hospitalization. Chronic disease management programs offered by health plans may benefit from systematically assessing and addressing social needs outside point-of-care interactions to impact health outcomes and ED utilization. Behavioral health care management programs would benefit from integrating interventions for multiple social needs.

Why Have Sleep Problems in Later-Midlife Grown Following the Great Recession? A Comparative Cohort Analysis

OBJECTIVES

This research compares three cohorts of individuals in their fifth decade of life and examines whether sleep problems are greater in cohorts following the Great Recession. We argue that these differences will occur because postrecession cohorts are exposed to more economic burdens that harm sleep. We also suggest that postrecession exposure to economic burdens will be amplified among women, leading to greater cross-cohort differences in sleep problems.

METHOD

Data were derived from the Health and Retirement Study, focusing on cohort surveys starting in 2004, 2010, and 2016 (N = 12,129). Structural equation models compared cohorts in latent levels of sleep problems and also examined whether economic burdens mediated cohort differences. Interactions tested whether cohort differences varied between men and women.

RESULTS

The 2010 and 2016 cohorts had higher mean levels of sleep problems than the 2004 cohort. Greater postrecession exposure to economic burdens largely explained inter-cohort change in sleep problems, with this pattern stronger among women.

DISCUSSION

Americans are approaching their senior years increasingly burdened by economic stressors that incur sleep problems. Practitioners and aging researchers should be prepared to address deleterious health consequences created by heightened sleep impairments.

Do managers sleep well? The role of gender, gender empowerment and economic development

Work demands often disrupt sleep. The stress of higher status theory posits that workers with greater resources often experience greater stress. We extend this theory to sleep and ask: do managers report more disrupted sleep and does this vary by gender and country context? Data come from the 2012 European Social Survey Programme and our sample comprised those currently employed in their prime working age (n = 27,616; age 25–64) in 29 countries. We include country level measures of the Gender Development Index (GDI) and gross domestic product (GDP). We find that workers sleep better, regardless of gender, in countries where women are empowered. For managers, women sleep better as GDI increases and men as GDP increases. Our results suggest that men experience a sleep premium from economic development and women from gender empowerment.

Accumulation of economic hardship and health during the COVID-19 pandemic: Social causation or selection?

This study examines whether economic hardship during the COVID-19 pandemic is deleteriously associated with psychological distress and self-rated health. A social causation perspective suggests that exposure to economic hardship will harm well-being, but a social selection perspective suggests that the appearance of health effects of hardship during the pandemic are attributable to the increased risk of exposure to hardship associated with poor well-being at the start of the pandemic. We also propose a third perspective, economic selection, which suggests that economic hardship prior to the pandemic negatively affects health and increases risk of exposure to hardship during the pandemic; consequently, an association between health and economic hardship during the pandemic may be spurious, and entirely due to pre-existing levels of hardship. To test these competing perspectives, we use a longitudinal study based in Canada that began in late March of 2020 and followed respondents monthly in April, May, and June. Baseline psychological distress and self-rated health, as well as economic hardship prior to the pandemic, independently predict the accumulation of monthly periods of hardship from April to June. The accumulation of periods of hardship from April to June is deleteriously associated with psychological distress and self-rated health in June. Controls for prior economic hardship and baseline health weaken the association between accumulation of periods of hardship and psychological distress, while also eliminating the association between accumulation of hardship and self-rated health. These findings favor a social causation perspective for psychological distress and a social selection perspective for self-rated health, with less evidence found in support of economic selection. This study took place during the first months of the COVID-19 pandemic, though, and associations with self-rated health may have become more evident as hardship further wore on individual well-being over a longer period of time.

Sleep Predicts Collegiate Academic Performance: Implications for Equity in Student Retention and Success

College students show high levels of insufficient sleep, excessive daytime sleepiness, sleep schedule irregularity, poor sleep quality, and inadequate sleep hygiene. This article describes the evidence linking poor sleep with impaired academic performance; discusses mediating environmental, behavioral, and demographic factors that correlate with sleep; and highlights examples of successful health promotion initiatives on college campuses. Given that students who are traditionally minoritized on college campuses tend to have worse sleep, improving sleep health emerges as an important issue for retention, equity, and inclusion.