0374 Decline in Habitual Sleep Duration Over 10 Years and Worsening Sleep Disparities: Data From NHIS (2006-2015)

Abstract Introduction Despite claims in the media, evidence that habitual sleep has declined in recent years is scant. Few data sources exist that systematically document sleep duration in a nationally representative sample, in the same way, over several years. Methods Data from 10 years of the National Health Interview Survey were used (N=305,555). During all years, habitual sleep duration, age, sex, race/ethnicity, and height/weight were recorded in the same way. Weighted regression analyses examined sleep duration as the outcome, year as linear predictor, and sociodemographics as covariates. Then, interaction terms examined whether the linear change associated with years was differentially experienced by different sociodemographic groups. Results The linear trend of sleep duration over the past 10 years is a loss of 0.78 minutes per year (95%CI -0.91,-0.64; p<0.0001). After adjustment for age, sex, race/ethnicity and BMI, this remained relatively unchanged at 0.86 minutes (95%CI -0.99,-0.73; p<0.0001). A year-by-race/ethnicity interaction was observed (p<0.05). In stratified analyses, Non-Hispanic Whites showed a loss of 0.68 minutes per year (95%CI -0.84,-0.52, p<0.0001). This was 1.33 minutes/year in Blacks/African-Americans (95%CI -1.74,-0.92; p<0.0001), 1.57 minutes/year in Mexican-Americans (95%CI -1.98,-1.16; p<0.0001), 0.99 minutes/year in other Hispanics/Latinos (95%CI -1.51,-0.47; p<0.0001), 0.74 minutes/year in Asians (95%CI -1.24,-0.25; p=0.003), and 1.80 minutes/year in American Indians/Alaskan Natives (95%CI -3.57,-0.03, p=0.046). Conclusion On average, the US population has lost 47 seconds of nightly sleep per year over a 10-year period, equating to about 4.7 hours of sleep per year, but racial/ethnic groups were impacted differently. Compared to Non-Hispanic Whites, Blacks/African-Americans lost 96% more sleep, Mexicans lost 131% more sleep, other Hispanics/Latinos lost 46% more sleep, Asians lost 9% more sleep, and American Indians lost 165% more sleep. Thus, sleep disparities may be widening. Support Dr. Grandner is supported by R01MD011600

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Abstract P344: Sleep Duration and Obesity: Impact of Demographics, Socioeconomic Status, Health Behaviors, and Health Status

Circulation ◽

10.1161/circ.137.suppl_1.p344 ◽

2018 ◽

Vol 137 (suppl_1) ◽

Author(s):

Michael Grandner

Keyword(s):

Socioeconomic Status ◽

Health Status ◽

Health Behaviors ◽

Sleep Duration ◽

Heavy Drinking ◽

Add Health ◽

Short Sleep ◽

Interaction Terms ◽

Long Sleep ◽

Race Ethnicity

Introduction: Many studies have shown that sleep duration is associated with obesity. It is unclear, though, whether this relationship exists equally across groups and whether it depends on demographics, socioeconomics, or aspects of health. Methods: Nationally-representative data from the 2016 BRFSS was used. Obesity was calculated as BMI≥30. Sleep duration was categorized as very short (≤4), short (5-6), normal (7-8), and long (≥9). Covariates included demographics (age, sex, race/ethnicity, education, marital status), socioeconomics (education, income, employment, # children), health risk factors (smoking, heavy drinking, sedentary lifestyle, access to a doctor, foregoing medical care due to cost), and health status (physical health, mental health, health-related limitations). Weighted logistic regression examined 5 models (unadjusted, demographics, add socioeconomics, add health behaviors, add health status). Whether relationships depended on covariates were evaluated with interaction terms and followed up by stratified analyses. Results: See Table for associations between sleep duration and obesity across all 5 models. In all models, very short, short, and long sleep were all associated with obesity, with very short sleep carrying the greatest risk. Note that as the number of covariates increased, the analytic samples were smaller. Interaction terms for all variables were statistically significant (p<0.001). Very short and short sleep effects were strongest in the youngest adults. Relationships were stronger in women. Sedentary individuals, heavy drinkers, and smokers demonstrated a weaker relationship. Lack of care was associated with a stronger relationship. Conclusions: Both short and long sleep are associated with obesity, even after accounting for many covariates. However, this relationship depends on factors such as age, sex, race/ethnicity, socioeconomic status, and health. This will help towards understanding risk and targeting interventions.

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0372 Disparities in Sleep Timing in the US: Data From the National Health and Nutrition Examination Survey 2015-2016

SLEEP ◽

10.1093/sleep/zsaa056.369 ◽

2020 ◽

Vol 43 (Supplement_1) ◽

pp. A142-A143

Author(s):

K Mota Villalobos ◽

A A Seixas ◽

N J Williams ◽

G Jean-Louis ◽

W D Killgore ◽

...

Keyword(s):

African Americans ◽

Sleep Duration ◽

National Health ◽

Depressed Mood ◽

Mexican Americans ◽

Population Level ◽

Income Poverty ◽

Nutrition Examination Survey ◽

Sleep Timing ◽

Health And Nutrition

Abstract Introduction Several studies have demonstrated population-level disparities in sleep duration and sleep quality. Population-level estimates of bedtime and waketime have been unavailable. Considering the important role of circadian rhythms in health, population-level disparities in timing have important public health implications. Methods Data from the 2015-2016 National Health and Nutrition Examination Survey (NHANES) from the CDC were used (N=4,491). Typical time in and out of bed were assessed and were converted to minutes. Race/ethnicity was self-reported and coded as non-Hispanic White, Black/African-American, Mexican-American, Other Hispanic/Latino, Asian, and Multiracial/Other. Covariates included age, sex, education level, income/poverty ratio, body mass index, and overall health. Additional models controlled for habitual sleep duration, frequency of sleep disturbance, depressed mood, and daytime tiredness/fatigue. Multiple linear regression analyses with time as an outcome were weighted using CDC-provided NHANES sample weights. Results In adjusted analyses, compared to non-Hispanic Whites, Blacks/African-Americans went to bed 29.4 mins later (p<0.0005), Asians went to bed 37.0 mins later (p<0.0005) and woke 27.7 mins later (p<0.0005), and Mexican-Americans woke 16.3 mins earlier (p=0.018). After further adjustment for sleep duration and sleep disturbances, Blacks/African-Americans went to bed 22.1 mins later (p<0.0005) and woke 22.2 mins later (p<0.0005), and Asians went to bed 36.1 mins later (p<0.0005) and woke 40.6 mins later (p<0.0005). These relationships remained generally unchanged when depressed mood and daytime tiredness/fatigue were adjusted in the model. Conclusion This is the first nationally-representative study to demonstrate population-level disparities in sleep timing. Specifically, Blacks/African-Americans and Asians present with delayed sleep, even after adjusting for other aspects of sleep. Support Dr. Grandner is supported by R01MD011600

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0226 Sleep Duration and Symptoms Associated with Race/Ethnicity in Elite Collegiate Athletes

SLEEP ◽

10.1093/sleep/zsaa056.224 ◽

2020 ◽

Vol 43 (Supplement_1) ◽

pp. A87-A88

Author(s):

T Ramsey ◽

A Athey ◽

A Auerbach ◽

R Turner ◽

N Williams ◽

...

Keyword(s):

General Population ◽

Sleep Duration ◽

American Indians ◽

Collegiate Athletes ◽

Early Morning ◽

Depression Score ◽

Sleep Paralysis ◽

Falling Asleep ◽

Wide Range ◽

Race Ethnicity

Abstract Introduction Previous studies have documented sleep disparities in the general population. Given the increased interest in sleep among athletes, and the degree to which demographics and schedules among athletes differ from the general population, this analysis aims to examine the relationship between race/ethnicity and sleep duration and symptoms among elite college athletes. Methods Data were obtained from N=189 Division-1 collegiate athletes across a wide range of sports played. Race/ethnicity was self-reported and categorized as Non-Hispanic White, Black/African-American, Hispanic/Latino, Asian, and American Indian/Alaskan Native. Outcomes of interest included self-reported typical sleep duration (in hours), CESD depression score, and frequency of sleep symptoms, assessed using items from the Sleep Disorders Symptom Check List (difficulty falling asleep, difficulty staying asleep, early morning awakenings, tiredness, sleepiness, loud snoring, choking/gasping, fragmentation, hypnogogic/pompic hallucinations, sleep paralysis, and nightmares). Sleep duration and depression were evaluated with linear regression, and symptoms were evaluated as ordinal. Covariates included age and sex. Results Compared to Non-Hispanic Whites, Blacks/African-Americans reported less sleep (B=-0.80, p<0.0005), more depression (B=2.85, p=0.046), more difficulty maintaining sleep (oOR=2.12, p=0.034), early morning awakenings (oOR=3.15, p=0.001), and sleepiness (oOR=2.11, p=0.048); Hispanic/Latinos reported more hypnogogic/pompic hallucinations (oOR=2.90, p=0.007), sleep paralysis (oOR=2.72, p=0.026), and nightmares (oOR=2.22, p=0.035); Asians reported more depression (B=4.46, p=0.028), sleepiness (oOR=5.06, p=0.003), loud snoring (oOR=4.71, p=0.018), and sleep paralysis (oOR=3.57, p=0.031); and American Indians/Alaskan Natives reported less sleep (B=-1.00, p=0.018). Conclusion Racial/ethnic differences in sleep duration and sleep symptoms were seen among athletes. Future studies will be needed to replicate and further explain these findings. Support The REST study was funded by an NCAA Innovations grant. Dr. Grandner is supported by R01MD011600

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Prevalence Trend and Disparities in Rheumatoid Arthritis among US Adults, 2005–2018

Journal of Clinical Medicine ◽

10.3390/jcm10153289 ◽

2021 ◽

Vol 10 (15) ◽

pp. 3289

Author(s):

Yingke Xu ◽

Qing Wu

Keyword(s):

Rheumatoid Arthritis ◽

African Americans ◽

Linear Trend ◽

P Value ◽

Significant Linear Trend ◽

Men And Women ◽

Health And Nutrition ◽

Income Ratio ◽

Race Ethnicity ◽

Multivariable Adjustment

Rheumatoid arthritis (RA) trends among US adults and disparities in RA patients in recent years have not been well described. We aimed to examine the trend of RA prevalence and disparities among US adults. Data from the National Health and Nutrition Examination Survey (NHANES) of the years 2005–2018 were analyzed to examine the self-reported RA prevalence trend. Age-adjusted RA prevalence stratified by race/ethnicity and socioeconomic status (SES), as well as associated linear trends, were calculated for both genders. The multivariable adjustment was used to evaluate the association between race, SES, and RA. During 2005–2018, there was no significant linear trend in the age-adjusted self-reported RA prevalence among men and women, but significant differences among people from different races, educational levels, and family poverty income ratio (PIR) groups were observed. The RA rate difference was significant for both genders and between Non-Hispanic Caucasians and Non-Hispanic African Americans (both p-value ≤ 0.001). Both men and women with a higher educational level and a higher PIR had a lower age-adjusted RA rate. Age-adjusted RA prevalence fluctuated for both men and women during 2005–2018. Non-Hispanic African Americans and people with low SES had significantly higher age-adjusted RA prevalence and RA risk.

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172 Sleep Disparities in Preschool-Aged Children

SLEEP ◽

10.1093/sleep/zsab072.171 ◽

2021 ◽

Vol 44 (Supplement_2) ◽

pp. A70-A70

Author(s):

Jennifer Holmes ◽

Olivia Hanron ◽

Rebecca Spencer

Keyword(s):

Sleep Duration ◽

Ethnic Disparities ◽

Data Race ◽

Older Children ◽

Hispanic Children ◽

Sleep Habits ◽

Chi Square ◽

White Children ◽

Race Ethnicity ◽

And Gender

Abstract Introduction Sleep is known to be associated with socioeconomic status (SES) in older children and adults with those from lower SES households often experiencing poorer sleep quality. Whether this disparity exists in early childhood is relatively unknown, despite being an important age marked by sleep transitions and the establishment of lifelong sleep habits. Furthermore, it is a critical period for cognitive development and learning, which are supported by sleep. Here, we explore associations between sleep and SES in a preschool population. We hypothesized that children from lower SES households would exhibit shorter overnight sleep, longer and more frequent naps, and shorter 24-hr sleep. Additionally, we considered racial and ethnic disparities in sleep which can be confounded with SES in some samples. Methods Child (n=441; M age=51.9mo; 45.4% female) sleep was measured objectively using actigraph watches, worn for 3-16 days (M=9.5 days). Caregivers reported child demographics and household data. Race/ethnicity of our sample was 72% White, 10.2% Black, 17.8% other or more than one race, and 28.4% identified as Hispanic. 20.1% of our sample was categorized as low SES. Effects of SES and race/ethnicity on continuous sleep measures were assessed using multiple regression models, with age and gender as covariates. Nap habituality was assessed using chi-square tests. Results Lower SES was associated with shorter nighttime sleep duration, longer nap duration, and shorter 24-hr sleep duration (p’s<.001). Children from lower SES households were also more likely to nap habitually (p=.04) as were Hispanic children (p<.001). Hispanic children also tended to have longer nap bouts (p=.002). Hispanic and Black children on average had shorter overnight sleep durations than White children (p’s<.04), but their 24-hr sleep did not differ. Conclusion SES-related sleep disparities were present in this preschool population, with lower SES children exhibiting poorer sleep. When controlling for SES, Hispanic children tended to sleep less overnight which was compensated for by longer, more frequent naps. This underscores the necessity of naps for some children to achieve adequate sleep. Future directions will explore the relationship between parenting factors and sleep, such as bedtime routines and parent knowledge surrounding child sleep needs. Support (if any) NIH R01 HL111695

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Tobacco Use Status and Temptation to Try E-Cigarettes among a Sample of Appalachian Youth

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18136755 ◽

2021 ◽

Vol 18 (13) ◽

pp. 6755

Author(s):

Delvon T. Mattingly ◽

Jayesh Rai ◽

Osayande Agbonlahor ◽

Kandi L. Walker ◽

Joy L. Hart

Keyword(s):

Tobacco Use ◽

Tobacco Prevention ◽

Cigarette Use ◽

Factorial Anova ◽

Interaction Terms ◽

Middle Schoolers ◽

Prevention Interventions ◽

Race Ethnicity ◽

And Gender ◽

Adjusted Association

E-cigarettes are commonly used tobacco products among youth populations, including Appalachian youth. However, knowledge of the extent to which tobacco use status relates to temptation to try e-cigarettes is limited. Data from the Youth Appalachian Tobacco Study (n = 1047) were used. Temptation to try e-cigarettes was derived from a 12-item situational inventory. Tobacco use status was defined as never, ever non-e-cigarette, and ever e-cigarette use. A factorial ANOVA was used to estimate the adjusted association between tobacco use status and the e-cigarette use temptation scale. Two-way interaction terms between tobacco use status and gender, and tobacco use status and race/ethnicity, were plotted to depict effect modification. Approximately 10% of youth were ever non-e-cigarette users and 24% were ever e-cigarette users. Never and ever non-e-cigarette user middle schoolers had higher temptation to try e-cigarettes than their high school counterparts. The same relationship was found among never and ever e-cigarette users living in households with tobacco users. The ANOVA results suggest a positive, monotonic relationship between tobacco use status and temptation to try e-cigarettes, and that the adjusted group means differ by gender and race/ethnicity. The findings can inform tobacco prevention interventions for youth at higher risk for e-cigarette use, especially youth who have not yet tried e-cigarettes.

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575 Sleep Duration in American Children with Autism Spectrum Disorder and the Role of Physical Activity

SLEEP ◽

10.1093/sleep/zsab072.573 ◽

2021 ◽

Vol 44 (Supplement_2) ◽

pp. A227-A227

Author(s):

Stacey Elkhatib Smidt ◽

Nalaka Gooneratne ◽

Edward Brodkin ◽

Maja Bucan ◽

Jonathan Mitchell

Keyword(s):

Physical Activity ◽

Autism Spectrum Disorder ◽

Sleep Duration ◽

Autism Spectrum ◽

Spectrum Disorder ◽

Physically Active ◽

Caregiver Education ◽

The Past ◽

Interaction Terms ◽

American Children

Abstract Introduction Sleep dysfunction is prevalent in autism spectrum disorder (ASD) and can have major daytime behavioral consequences. Emerging evidence suggests that physical activity may be associated with improved sleep in children, including those with ASD. We aimed to determine if there was an association between physical activity and sleep duration in American youth and if the association was consistent in children with and without ASD. Methods We analyzed data from children ages 6–17 years whose caregivers completed the 2018 National Survey of Children’s Health (N=20,980). ASD was self-reported (N=687), and we determined if reported ASD was mild, moderate, or severe, and if reported ASD occurred with intellectual disability (ID). Participants self-reported their weekday sleep duration and days of physical activity in the past week. We classified children as sleep sufficient or insufficient based on age-specific recommendations. Logistic regression was used to determine if physical activity and ASD were associated with sleep sufficiency. Physical activity-by-ASD interaction terms were used to determine if any physical activity association was modified by ASD status. Covariates included: age, sex, race, Hispanic ethnicity, highest caregiver education level, and overweight status. Results Compared to children without ASD, children with ASD were 29% less likely to have sufficient sleep (OR=0.71; 95% CI: 0.52–0.99), but this association attenuated to the null after adjusting for physical activity (OR=0.77; 95% CI: 0.55–1.07). Compared to zero days, being physically active for 1–3, 4–6 or 7 days in the past week was associated with increased odds of sufficient sleep, even with adjustment for ASD status (e.g., 4–6 days: OR=1.85; 95% CI: 1.48–2.32). We did not observe a statistically significant interaction between physical activity and ASD status with respect to sleep sufficiency (P-interaction=0.571), which remained consistent when using ASD severity and ASD with ID exposure variables. Conclusion Physical activity was associated with increased odds of meeting age-specific sleep duration recommendations in children with and without ASD. Our observations support pursuing physical activity in future studies as a potential intervention target to improve sleep duration in children, including those with ASD. Support (if any) NIH T32HL07713 and University of Pennsylvania’s Institute for Translational Medicine and Therapeutics

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Medical and Social Determinants of Brain Health and Dementia in a Multicultural Community Cohort of Older Adults

Journal of Alzheimer s Disease ◽

10.3233/jad-215020 ◽

2021 ◽

pp. 1-14

Author(s):

James E. Galvin ◽

Stephanie Chrisphonte ◽

Lun-Ching Chang

Keyword(s):

Older Adults ◽

Health Disparities ◽

African Americans ◽

Health Outcomes ◽

Sex Education ◽

Screening Program ◽

Healthcare Services ◽

Social Dimension ◽

Medical Comorbidities ◽

Race Ethnicity

Background: Socioeconomic status (SES), race, ethnicity, and medical comorbidities may contribute to Alzheimer’s disease and related disorders (ADRD) health disparities. Objective: Analyze effects of social and medical determinants on cognition in 374 multicultural older adults participating in a community-based dementia screening program. Methods: We used the Montreal Cognitive Assessment (MoCA) and AD8 as measures of cognition, and a 3-way race/ethnicity variable (White, African American, Hispanic) and SES (Hollingshead index) as predictors. Potential contributors to health disparities included: age, sex, education, total medical comorbidities, health self-ratings, and depression. We applied K-means cluster analyses to study medical and social dimension effects on cognitive outcomes. Results: African Americans and Hispanics had lower SES status and cognitive performance compared with similarly aged Whites. We defined three clusters based on age and SES. Cluster #1 and #3 differed by SES but not age, while cluster #2 was younger with midlevel. Cluster #1 experienced the worse health outcomes while cluster #3 had the best health outcomes. Within each cluster, White participants had higher SES and better health outcomes, African Americans had the worst physical performance, and Hispanics had the most depressive symptoms. In cross-cluster comparisons, higher SES led to better health outcomes for all participants. Conclusion: SES may contribute to disparities in access to healthcare services, while race and ethnicity may contribute to disparities in the quality and extent of services received. Our study highlights the need to critically address potential interactions between race, ethnicity, and SES which may better explain disparities in ADRD health outcomes.

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Marie Baldwin, Racism, and the Society of American Indians

American Indian Culture and Research Journal ◽

10.17953/aicrj.44.1.lewandowski ◽

2020 ◽

Vol 44 (1) ◽

pp. 35-52

Author(s):

Tadeusz Lewandowski

Keyword(s):

African Americans ◽

Conference Proceedings ◽

American Indians ◽

Full Account ◽

Women's Equality ◽

Indian Affairs ◽

Indian Rights ◽

Point Of Departure

The French/Ojibwa lawyer, activist, and Office of Indian Affairs employee, Marie Louise Bottineau Baldwin (1863–1952), often receives mention in scholarly works on the Society of American Indians (SAI). Very few, however, have examined her contributions in detail. Only one article focusing exclusively on Baldwin has ever been published. Cathleen D. Cahill’s flattering portrait depicts Baldwin as a devoted suffragette and leading SAI figure who, in her roles as cofounder and treasurer, promoted the cause of Indian rights and her own Ojibwa values concerning women’s equality. Cahill explains Baldwin’s sudden exit from the SAI as a result of attacks by male, anti-Indian Office “radicals” who condemned her as disloyal for holding a government post, such as Carlos Montezuma (Yavapai) and Philip Gordon (Ojibwa). Closer inspection of the SAI’s conference proceedings and epistolary record reveals a very different story. In providing the first full account of Baldwin’s involvement in intertribal activism, this essay counters Cahill’s inaccurate interpretation of Baldwin’s withdrawal from the society, and, more importantly, examines Baldwin’s underreported, yet openly racist campaign among key SAI members to ban African Americans from the Indian Service. Baldwin’s incendiary statements on race offers a point of departure for further study of how the Society of American Indians viewed African Americans during the Progressive era’s intense segregation and prevailing social Darwinist theories of race.

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