Background:
Short sleep duration (e.g., <9 hours (hrs) for 6-12 years and <8 hrs for 13-18 years) is highly prevalent and associated with cardiometabolic risk among adolescents. Significant racial disparities in sleep duration among adolescents have been found. Investigating mechanisms driving sleep disparities is important for informing interventions to reduce disparities. Neighborhood and household stressors may contribute to racial disparities in sleep among adolescents as prior literature have found them to be patterned by race/ethnicity and associated with sleep duration. This study examined neighborhood and household context as mediators in the association between race/ethnicity (a proxy for sociocultural factors such as racism) and sleep duration among adolescents.
Methods:
Participants (n=13,019) were from Waves I and II of the National Longitudinal Study of Adolescent to Adult Health, a nationally representative multi-ethnic sample of adolescents and their health in adulthood. Sleep duration was self-reported in whole hours per day and categorized based on age-specific cut-offs for short sleep (6-12 years: <9 hrs, 13-18 years: <8 hrs, 19-25 years: <7 hrs) vs. recommended (6-13 years: 9-11 hrs, 14-17 years: 8-10 hrs, 18-25 years: 7-9 hrs). Neighborhood factors included neighborhood socioeconomic status (SES) (e.g. census tract measures: proportions of female-headed households, individuals below the poverty threshold, individuals receiving public assistance, adults with < high school education, and adults unemployed), perceived safety and social cohesion. Household factors included living in a single parent household and household SES (e.g. highest parental education, income, and occupation). Structural equation modeling (SEM) was used to simultaneously assess mediation of neighborhood and household context in the association between race/ethnicity and short sleep duration adjusting for age and sex.
Results:
The sample was 4% Asian, 15% African American (AA), 2% American Indian (AI), 12% Hispanic, and 66% non-Hispanic White (NHW) and mean age 15 years (SD=.1). In SEM, AAs (β=.055, p<.001) and Asians (β=.047, p=.047) were more likely to have short sleep duration than NHW. Higher household SES was associated with a greater probability for short sleep duration (β=.061, p=.004) in the total sample. Only household SES was a significant mediator, explaining 11.6%, 9.9%, and 42.4% of AA-NHW, AI-NHW, and Hispanic-NHW differences, respectively.
Conclusion:
Although household SES partially explained racial disparities, improving household SES conditions for racial/ethnic minority adolescents may not reduce disparities, given that higher household SES was positively associated with short sleep duration. Future studies should explore buffers for racial/ethnic minority adolescents in the context of SES to inform interventions and reduce disparities in sleep.
Discrimination and Substance Use: Examining the Moderating Role of Impulsivity among Racial-Ethnic Minority Adolescents
