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Johnson DA. Neighborhoods: place-based opportunities for advancing sleep health. Sleep 2024; 47:zsad322. [PMID: 38141244 PMCID: PMC10851841 DOI: 10.1093/sleep/zsad322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Indexed: 12/25/2023] Open
Affiliation(s)
- Dayna A Johnson
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
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Attarian H, Dunietz GL, Gavidia-Romero R, Jansen E, Johnson DA, Kelman A, Knutson K. Addressing sleep deserts: A proposed call for action. Sleep Health 2024; 10:S15-S18. [PMID: 37926658 DOI: 10.1016/j.sleh.2023.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Revised: 09/15/2023] [Accepted: 09/18/2023] [Indexed: 11/07/2023]
Abstract
Sleep deserts are a major cause of health inequity. They occur primarily in disadvantaged neighborhoods because of structural racism, social and environmental factors, and dearth of medical services. We describe several strategies that can serve as a feasible action plan to target structural racism, environmental pollution, and impact of climate change. We also suggest ways healthcare providers in these underserved areas can incorporate sleep medicine into their practice. Lastly, we highlight strategies to increase community awareness of sleep health in a culturally sensitive manner. There are several ways, from a policy level to healthcare that we can begin to eliminate sleep deserts, which is urgently needed.
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Affiliation(s)
- Hrayr Attarian
- Northwestern University, Feinberg School of Medicine, Department of Neurology, Chicago, Illinois, USA.
| | - Galit Levi Dunietz
- University of Michigan Medical School, Department of Neurology, Ann Arbor, Michigan, USA
| | - Ronald Gavidia-Romero
- University of Michigan Medical School, Department of Neurology, Ann Arbor, Michigan, USA
| | - Erica Jansen
- University of Michigan Medical School, Department of Neurology, Ann Arbor, Michigan, USA
| | - Dayna A Johnson
- Emory University, Rollins School of Public Health, Department of Epidemiology, Atlanta, Georgia, USA
| | - Alexa Kelman
- University of Michigan Medical School, Department of Neurology, Ann Arbor, Michigan, USA
| | - Kristen Knutson
- Northwestern University, Feinberg School of Medicine, Department of Neurology, Chicago, Illinois, USA
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Full KM, Johnson DA, Kaufmann CN, Malhotra A. An Update on Sleep Duration, Obesity, and Mortality Risk in Women. Sleep Med Clin 2023; 18:415-422. [PMID: 38501514 PMCID: PMC10969361 DOI: 10.1016/j.jsmc.2023.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/20/2024]
Abstract
Sleep health is an essential component to overall health. Because of numerous societal, economic, and biological factors, obtaining adequate sleep poses a unique challenge to aging women. Yet, women have been traditionally understudied in sleep research. An increasing body of research supports abnormal sleep duration as a risk factor for obesity, cardiovascular disease, and mortality. This review focuses specifically on 3 areas of the discussion of insufficient sleep in women: (1) the mysterious poor health of long sleepers, (2) the potential underlying mechanisms linking abnormal sleep duration and cardiometabolic health, and (3) the need to investigate multiple levels of social determinants driving sleep disparities.
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Affiliation(s)
- Kelsie M Full
- Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, 2525 West End Avenue, Suite 600, Nashville, TN 37203, USA.
| | - Dayna A Johnson
- Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Road, Atlanta, Georgia, 30322, USA
| | - Christopher N Kaufmann
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, 2004 Mowry Road, Gainesville, Florida, 32603, USA
| | - Atul Malhotra
- Division of Pulmonary, Critical Care and Sleep Medicine, School of Medicine, University of California San Diego, 9500 Gilman Drive, La Jolla, California, 92093, USA
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Adjaye-Gbewonyo D, Ng AE, Jackson CL, Johnson DA. The perceived neighborhood walking environment and self-reported sleep health in a nationally representative sample of the United States. Health Place 2023; 83:103066. [PMID: 37385129 DOI: 10.1016/j.healthplace.2023.103066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 06/08/2023] [Accepted: 06/09/2023] [Indexed: 07/01/2023]
Abstract
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.
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Affiliation(s)
- Dzifa Adjaye-Gbewonyo
- National Center for Health Statistics, Centers for Disease Control and Prevention, 3311 Toledo Road, Hyattsville, MD, 20782, USA.
| | - Amanda E Ng
- National Center for Health Statistics, Centers for Disease Control and Prevention, 3311 Toledo Road, Hyattsville, MD, 20782, USA.
| | - Chandra L Jackson
- Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Services, 111 T.W. Alexander Drive, Research Triangle Park, NC, 27709, USA; Intramural Program, National Institute on Minority Health and Health Disparities, National Institutes of Health, Department of Health and Human Services, 6707 Democracy Blvd Ste 800, Bethesda, MD, 20892, USA.
| | - Dayna A Johnson
- Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Rd, NE, Atlanta, GA, 30322, USA.
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Claussen AH, Dimitrov LV, Bhupalam S, Wheaton AG, Danielson ML. Short Sleep Duration: Children's Mental, Behavioral, and Developmental Disorders and Demographic, Neighborhood, and Family Context in a Nationally Representative Sample, 2016-2019. Prev Chronic Dis 2023; 20:E58. [PMID: 37441755 PMCID: PMC10364829 DOI: 10.5888/pcd20.220408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/15/2023] Open
Abstract
INTRODUCTION Many children and adolescents experience insufficient sleep, which poses risks for their short- and long-term health and development. This study examined the concurrent associations of contextual factors, including child, demographic, neighborhood, and family factors, with short sleep duration. METHODS We combined data on children aged 3 to 17 years from the 2016-2019 National Survey of Children's Health (N = 112,925) to examine the association of parent-reported child short sleep duration (ages 3-5 y, <10 h; 6-12 y, <9 h; 13-17 y, <8 h) with mental, behavioral, and developmental disorders (MBDDs); selected physical health conditions; and demographic, neighborhood, and family factors. RESULTS Overall, 34.7% of children experienced short sleep duration. The prevalence was highest among children aged 6 to 12 years (37.5%); children from racial and ethnic minority groups, especially non-Hispanic Black children (50.0%); children from low-income households (44.9%); children with an MBDD (39.6%); children experiencing negative neighborhood factors (poor conditions and lack of safety, support, and amenities, 36.5%); and family factors such as inconsistent bedtime (57.3%), poor parental mental (47.5%) and physical health (46.0%), and adverse childhood experiences (44.1%). The associations between sleep and demographic, neighborhood, and family factors, and MBDD remained significant after controlling for all other factors. CONCLUSION This study identified several individual, family, and community factors that may contribute to children's short sleep duration and can be targeted to improve healthy development, particularly among children with an MBDD, from households with low socioeconomic status, or from racial and ethnic minority groups who are at increased risk for short sleep duration.
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Affiliation(s)
- Angelika H Claussen
- Centers for Disease Control and Prevention, National Center on Birth Defects and Disabilities, Division of Human Development and Disability, Atlanta, Georgia
- Centers for Disease Control and Prevention, 4770 Buford Hwy, S106-4, Atlanta, GA 30341-3717
| | - Lina V Dimitrov
- Centers for Disease Control and Prevention, National Center on Birth Defects and Disabilities, Division of Human Development and Disability, Atlanta, Georgia
- Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee
| | - Sivapriya Bhupalam
- Centers for Disease Control and Prevention, National Center on Birth Defects and Disabilities, Division of Human Development and Disability, Atlanta, Georgia
- Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee
| | - Anne G Wheaton
- Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Division of Population Health, Atlanta, Georgia
| | - Melissa L Danielson
- Centers for Disease Control and Prevention, National Center on Birth Defects and Disabilities, Division of Human Development and Disability, Atlanta, Georgia
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Brooks Holliday S, Dong L, Haas A, Ghosh-Dastidar MB, Dubowitz T, Buysse DJ, Hale L, Troxel WM. Longitudinal associations between sleep and BMI in a low-income, predominantly Black American sample. Sleep Health 2023; 9:11-17. [PMID: 36456450 PMCID: PMC9992091 DOI: 10.1016/j.sleh.2022.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 10/04/2022] [Accepted: 10/27/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Black individuals and those experiencing socioeconomic disadvantage are at increased risk for sleep problems and obesity. This study adds to the limited extant literature examining longitudinal associations between objectively measured sleep and changes in body mass index (BMI) in Black Americans. DESIGN We focused on individuals with at least 1 observation of sleep and BMI at 1 of 3 study time points (2013, 2016, and 2018). We modeled longitudinal trends in BMI as a function of time, average of each sleep variable across assessments, and within-person deviations in each sleep variable over time. SETTING Data were collected via interviewer-administered at-home surveys and actigraphy in Pittsburgh, PA. PARTICIPANTS Our sample comprised 1115 low-income, primarily Black adults, including 862 women and 253 men. MEASUREMENTS Sleep measures included actigraphy-measured total sleep time, sleep efficiency, and wakefulness after sleep onset, as well as self-reported sleep quality. We also included objectively measured BMI. RESULTS In models adjusted for age, gender, and other sociodemographic covariates (eg, income, marital status), there were no significant longitudinal associations between total sleep time, sleep efficiency, wakefulness after sleep onset, or subjective sleep quality and changes in BMI. CONCLUSIONS This study provides further evidence that, among a sample of low-income Black adults, sleep problems are not longitudinally predictive of BMI. Although ample cross-sectional evidence demonstrates that sleep problems and obesity commonly co-occur, longitudinal evidence is mixed. Better understanding the overlap of sleep and obesity over time may contribute to prevention and intervention efforts.
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Affiliation(s)
| | - Lu Dong
- RAND Corporation, Santa Monica, California, USA
| | - Ann Haas
- RAND Corporation, Pittsburgh, Pennsylvania, USA
| | | | | | | | - Lauren Hale
- University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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McKenzie KNA, Comeau J, Reid GJ. Examining the interactive association of family- and neighborhood-level socio-economic characteristics on children's sleep beyond the associations of residency and neighborhood violence. Sleep Health 2022; 8:458-466. [PMID: 35927180 DOI: 10.1016/j.sleh.2022.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 05/30/2022] [Accepted: 06/06/2022] [Indexed: 10/16/2022]
Abstract
OBJECTIVE To examine the interactive association of neighborhood and family socio-economic characteristics (SEC) on children's sleep. DESIGN Secondary data analyses were completed on the 2014 Ontario Child Health Study, a cross-sectional sample of 10,802 children aged 4-17. PARTICIPANTS Children (aged 4-11, 50% male; N = 6264) with available sleep outcome data. METHODS Multilevel modeling was used to assess the interactive relationship between family- and neighborhood-level poverty in relation to child sleep outcomes (problems falling asleep, problems staying asleep, weekday and weekend time in bed), above the associations of variables known to be related to sleep at the child (ie, child age, sex, internalizing problems, externalizing problems, chronic illness), family (ie, negative parenting behaviors, family structure, parent mental health, years lived in neighborhood, parent education level), and neighborhood levels (ie, neighborhood size, antisocial behavior). RESULTS Neighborhood poverty (p < .01, ß = -0.001, 95% confidence interval [-0.007, -0.002]) was significantly related to shorter weekday time in bed and the interactive association of family and neighborhood poverty was significantly related to weekend time in bed (p < .05, ß = 0.012, 95% confidence interval [0.004, 0.021]). Children living in low poverty neighborhoods with families of higher SEC backgrounds, and children living in high poverty neighborhoods with families of lower SEC backgrounds had the shortest weekend time in bed (9.7 hours). CONCLUSIONS There is a compound relationship of family and neighborhood poverty on children's sleep above and beyond family- and child-level risk factors.
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Affiliation(s)
| | - Jinette Comeau
- Department of Sociology, King's University College at Western University, London, ON, Canada; Division of Children's Health and Therapeutics, Children's Health Research Institute, Lawson Health Research Institute, Western University, London, ON, Canada
| | - Graham J Reid
- Department of Psychology, The University of Western Ontario, London, ON, Canada; Division of Children's Health and Therapeutics, Children's Health Research Institute, Lawson Health Research Institute, Western University, London, ON, Canada; Department of Family Medicine, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, ON, Canada; Department of Pediatrics, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, ON, Canada
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Baugh A, Buhr RG, Quibrera P, Barjaktarevic I, Barr RG, Bowler R, Han MK, Kaufman JD, Koch AL, Krishnan J, Labaki W, Martinez FJ, Mkorombindo T, Namen A, Ortega V, Paine R, Peters SP, Schotland H, Sundar K, Zeidler MR, Hansel NN, Woodruff PG, Thakur N. Risk of COPD exacerbation is increased by poor sleep quality and modified by social adversity. Sleep 2022; 45:6602021. [PMID: 35665826 PMCID: PMC9366643 DOI: 10.1093/sleep/zsac107] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 04/19/2022] [Indexed: 02/03/2023] Open
Abstract
STUDY OBJECTIVES Sleep is an important dimension in the care of chronic obstructive pulmonary disease (COPD), but its relevance to exacerbations is unclear. We wanted to assess whether sleep quality as measured by the Pittsburgh Sleep Quality Index (PSQI) is associated with an increased risk of COPD exacerbations and does this differ by socio-environmental exposures. METHODS We included 1647 current and former smokers with spirometrically confirmed COPD from the SPIROMICS cohort. We assessed incidence rate ratios for exacerbation using zero-inflated negative binomial regression adjusting for demographics, medical comorbidities, and multiple metrics of disease severity, including respiratory medications, airflow obstruction, and symptom burden. Our final model adjusted for socio-environmental exposures using the Area Deprivation Index, a composite measure of contemporary neighborhood quality, and Adversity-Opportunity Index, a composite measure of individual-level historic and current socioeconomic indicators. We used a pre-determined threshold of 20% missingness to undertake multiple imputation by chained equations. As sensitivity analyses, we repeated models in those with complete data and after controlling for prior exacerbations. As an exploratory analysis, we considered an interaction between socio-environmental condition and sleep quality. RESULTS After adjustment for all co-variates, increasing PSQI scores (range 0-21) were associated with a 5% increased risk for exacerbation per point (p = .001) in the imputed dataset. Sensitivity analyses using complete cases and after controlling for prior exacerbation history were similar. Exploratory analysis suggested less effect among those who lived in poor-quality neighborhoods (p-for-interaction = .035). CONCLUSIONS Poor sleep quality may contribute to future exacerbations among patients with COPD. This represents one target for improving disease control. CLINICAL TRIAL REGISTRATION Subpopulations and Intermediate Outcome Measures in COPD Study (SPIROMICS). ClinicalTrials.gov Identifier# NCT01969344. Registry URL: https://clinicaltrials.gov/ct2/show/.
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Affiliation(s)
- Aaron Baugh
- Corresponding author. Aaron Baugh, University of California, San Francisco, Box 0111, 505 Parnassus Ave, San Francisco, CA 94143, USA. E-mail:
| | - Russell G Buhr
- Department of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Pedro Quibrera
- Collaborative Studies Coordination Center, University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - Igor Barjaktarevic
- Department of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - R Graham Barr
- Department of Medicine, Columbia University, New York, NY, USA
| | - Russell Bowler
- Department of Medicine, National Jewish Health, Denver, CO, USA
| | - Meilan King Han
- Department of Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Joel D Kaufman
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - Abigail L Koch
- Department of Medicine, Veterans Administration Miami Healthcare, Miami, FL, USA
| | - Jerry Krishnan
- Department of Medicine, University of Illinois at Chicago, Chicago, IL, USA
| | - Wassim Labaki
- Department of Medicine, University of Michigan, Ann Arbor, MI, USA
| | | | | | - Andrew Namen
- Department of Medicine, Wake Forest Baptist Health, Winston-Salem, NC, USA
| | - Victor Ortega
- Department of Medicine, Mayo Clinic, Phoenix, AZ, USA
| | - Robert Paine
- Department of Medicine, University of Utah, Salt Lake City, UA, USA
| | - Stephen P Peters
- Department of Medicine, Wake Forest Baptist Health, Winston-Salem, NC, USA
| | - Helena Schotland
- Department of Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Krishna Sundar
- Department of Medicine, University of Utah, Salt Lake City, UA, USA
| | - Michelle R Zeidler
- Department of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Nadia N Hansel
- Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Prescott G Woodruff
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Neeta Thakur
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
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Li M, Lo VSY, Liu P, Smith E. The impact of Timothy's Law on hospitalization among patients with mental health conditions in New York State. Int J Ment Health Syst 2022; 16:25. [PMID: 35597963 PMCID: PMC9124051 DOI: 10.1186/s13033-022-00535-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 05/03/2022] [Indexed: 11/24/2022] Open
Abstract
Background Timothy's law to reduce mental health care disparities was enacted in January 2007 in New York state (NY). According to Timothy's law, "if a patient is suffering from a Biologically Based Mental Illness, or is a Child with Serious Emotional Disturbances, the Inpatient mental health benefit will be the same as for any other illness". An assessment of its impact on inpatient mental health care is lacking. We provide a rigorous study of this policy intervention’s effect over the first year of its implementation. Methods We used a quasi-experimental design to combine the difference-in-difference method and propensity score weighting. Data are from inpatient records in NY and California (CA) (as a control) between January 2006 to December 2006 (the pre-enactment year in NY) and January to December 2007 (the enactment year) for non-Medicare/Medicaid patients hospitalized in both years with specific illnesses covered by Timothy's Law. Change in length of stay from 2006 to 2007 was measured for each patient, and the differences observed in NY and California were compared to each other (Difference-in-Difference), with differences in the characteristics of patients in NY and California addressed through Propensity Score Weighting (PSW). Results Before Timothy's Law was enacted (2006), length of stay (LOS) in NY was 16.3 days on average, and length of stay per hospitalization (LOSPH) was 11.72 days on average for the 1237 patients under study in 2006. In 2007, LOS increased by 4.91 days in NY (95% CI (2.89, 7.01)) compared with similar patients in California, and LOSPH by 3.25 days (95% CI (1.96, 4.57)). Among patients with serious mental illness diagnoses, LOS in NY increased by 7.07 days (95% CI (4.15, 10.17)), and LOSPH by 4.04 days (95% CI (1.93, 6.03)) compared to California. Conclusions Our study strongly suggests that, within the time frame of just a single year, Timothy's Law significantly increased inpatient mental healthcare utilization in NY. Our study raises the possibility that similar laws in other locations could have similar effects. Supplementary Information The online version contains supplementary material available at 10.1186/s13033-022-00535-w.
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Affiliation(s)
- Mingfei Li
- Department of Mathematical Sciences, Bentley University, Waltham, MA, USA. .,Center for Healthcare Organization and Implementation Research (CHOIR), Bedford VA Healthcare System, Bedford, MA, USA.
| | - Victor S Y Lo
- Workplace Investing, Fidelity Investments, Boston, MA, USA
| | - Piaomu Liu
- Department of Mathematical Sciences, Bentley University, Waltham, MA, USA
| | - Eric Smith
- Center for Healthcare Organization and Implementation Research (CHOIR), Bedford VA Healthcare System, Bedford, MA, USA.,Departments of Psychiatry and Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
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Kim B, Branas CC, Rudolph KE, Morrison CN, Chaix B, Troxel WM, Duncan DT. Neighborhoods and sleep health among adults: A systematic review. Sleep Health 2022; 8:322-333. [DOI: 10.1016/j.sleh.2022.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 03/21/2022] [Accepted: 03/23/2022] [Indexed: 11/26/2022]
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Baird MD, Dubowitz T, Cantor J, Troxel WM. Examining the impact of employment status on sleep quality during the COVID-19 pandemic in two low-income neighborhoods in Pittsburgh, PA. Sleep 2022; 45:6501247. [PMID: 35018476 PMCID: PMC8755386 DOI: 10.1093/sleep/zsab303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 12/16/2021] [Indexed: 11/17/2022] Open
Abstract
Study Objectives African Americans have faced disproportionate socioeconomic and health consequences associated with the COVID-19 pandemic. The current study examines employment and its association with sleep quality during the initial months of the pandemic in a low-income, predominantly African American adult sample. Methods In the early months of COVID-19 (March to May 2020), we administered a survey to an ongoing, longitudinal cohort of older adults to assess the impact of COVID-related changes in employment on self-reported sleep quality (N = 460; 93.9% African American). Participants had prior sleep quality assessed in 2018 and a subset also had sleep quality assessed in 2013 and 2016. Primary analyses focused on the prevalence of poor sleep quality and changes in sleep quality between 2018 and 2020, according to employment status. Financial strain and prior income were assessed as moderators of the association between employment status and sleep quality. We plotted trend lines showing sleep quality from 2013 to 2020 in a subset (n = 339) with all four waves of sleep data available. Results All participants experienced increases in poor sleep quality between 2018 and 2020, with no statistical differences between the employment groups. However, we found some evidence of moderation by financial strain and income. The trend analysis demonstrated increases in poor sleep quality primarily between 2018 and 2020. Conclusions Sleep quality worsened during the pandemic among low-income African American adults. Policies to support the financially vulnerable and marginalized populations could benefit sleep quality.
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Affiliation(s)
- Matthew D Baird
- Department of Economics, Sociology, and Statistics, RAND Corporation , Pittsburgh, PA , USA
| | - Tamara Dubowitz
- Department of Behavioral and Policy Sciences, RAND Corporation , Pittsburgh, PA , USA
| | - Jonathan Cantor
- Department of Economics, Sociology, and Statistics, RAND Corporation , Santa Monica, CA , USA
| | - Wendy M Troxel
- Department of Behavioral and Policy Sciences, RAND Corporation , Pittsburgh, PA , USA
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Troxel WM, Haas A, Dubowitz T, Ghosh-Dastidar B, Butters M, Gary-Webb TL, Weinstein A, Rosso AL. Sleep Disturbances, Changes in Sleep, and Cognitive Function in Low-Income African Americans. J Alzheimers Dis 2022; 87:1591-1601. [PMID: 35527545 PMCID: PMC10646789 DOI: 10.3233/jad-215530] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Sleep problems may contribute to the disproportionate burden of Alzheimer's disease and related dementias (ADRD) among African Americans (AAs). OBJECTIVE To examine the role of sleep problems in contributing to cognitive function and clinically adjudicated cognitive impairment in a predominantly AA sample. METHODS This study (n = 216, 78.8% female; mean age = 67.7 years) examined associations between 1) the level (i.e., measured in 2018) and 2) change over time (from 2013 to 2018; n = 168) in actigraphy-assessed sleep with domain-specific cognitive function and clinically adjudicated cognitive impairment (2018) in a community-dwelling, predominantly AA (96.9%) sample. A comprehensive cognitive battery assessed global cognitive function (3MS) and domain-specific cognitive function (attention, visuo-spatial ability, language, delayed recall, immediate recall, and executive function) in 2018. Sleep was measured in 2013 and 2018 via actigraphy. RESULTS Higher sleep efficiency and less wakefulness after sleep onset (WASO; measured in 2018) were associated with greater attention, executive function, and visuospatial ability. Increases in sleep efficiency between 2013 and 2018 were associated with better executive function, language, immediate recall, and visuospatial ability, whereas increases in WASO (2013-2018) were associated with poorer attention, executive function, and visuospatial ability. Level or change in sleep duration were not associated with domain-specific cognitive function, nor were any sleep measures associated with clinically adjudicated cognitive impairment. CONCLUSION In a predominantly AA sample of older adults, both the level and change (i.e., worsening) of sleep efficiency and WASO were associated with poorer cognitive function. Improving sleep health may support ADRD prevention and reduce health disparities.
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Affiliation(s)
- Wendy M. Troxel
- Division of social and economic well-being, RAND Corporation, Pittsburgh, PA 15213
| | - Ann Haas
- Division of social and economic well-being, RAND Corporation, Pittsburgh, PA 15213
| | - Tamara Dubowitz
- Division of social and economic well-being, RAND Corporation, Pittsburgh, PA 15213
| | | | - Meryl Butters
- Department of psychiatry, University of Pittsburgh, Pittsburgh PA 15213
| | - Tiffany L. Gary-Webb
- Department of epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA 15216
| | - Andrea Weinstein
- Department of psychiatry, University of Pittsburgh, Pittsburgh PA 15213
| | - Andrea L. Rosso
- Department of epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA 15216
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