scholarly journals 0919 Health Disparities in the Persistence of Childhood Insomnia Symptoms in the Transition to Adolescence: The Penn State Child Cohort

SLEEP ◽  
2020 ◽  
Vol 43 (Supplement_1) ◽  
pp. A349-A349
Author(s):  
E Bourchtein ◽  
K Puzino ◽  
S L Calhoun ◽  
C Criley ◽  
F He ◽  
...  
Keyword(s):  
Socioeconomic Status ◽  
Ethnic Minorities ◽  
Remission Rate ◽  
Self Report ◽  
Full Remission ◽  
Penn State ◽  
State Child ◽  
Racial Ethnic ◽  
Insomnia Symptoms

Abstract Introduction A strong body of cross-sectional evidence indicates that social determinants of health (SDH), such as race, ethnicity, socioeconomic status, and sex/gender, are linked to sleep problems, including insomnia symptoms. Few studies have examined the longitudinal association between SDH and the persistence and remission of insomnia symptoms in the transition between childhood and adolescence, a critical period for sleep health. Methods The Penn State Child Cohort is a random, population-based sample of 700 children (5-12y at baseline), of whom 421 were followed up as adolescents (12-23y at follow-up). All subjects underwent polysomnography, clinical history, physical exam, and parent- and self-reported scales at baseline and follow-up. Childhood insomnia symptoms were defined as a parent- and/or self-report of difficulty falling and/or staying asleep. All subjects or their parents identified the subject’s sex, race, and ethnicity, and reported on socioeconomic status (SES) of the household. Results Females (32.7%) and racial/ethnic minorities (25.0%) were associated with a significantly lower remission rate as compared to males (53.3%) and non-Hispanic whites (48.3%), respectively. Non-Hispanic whites of low SES were associated with a significantly lower full remission rate (26.3%) as compared to non-Hispanic whites of higher SES (42.0%), while racial/ethnic minorities were associated with the lowest full remission rates regardless of whether they were of low (9.1%) or higher (11.1%) SES. Conclusion Our novel data indicate that gender-, racial/ethnic- and socioeconomic-related disparities in insomnia not only occur as early as childhood but are important determinants of insomnia’s chronic course throughout development. Support National Institutes of Health (R01HL136587, R01HL97165, R01HL63772, UL1TR000127)

scholarly journals Natural history of insomnia symptoms in the transition from childhood to adolescence: population rates, health disparities, and risk factors

SLEEP ◽  
2020 ◽  
Author(s):  
Julio Fernandez-Mendoza ◽  
Elizaveta Bourchtein ◽  
Susan Calhoun ◽  
Kristina Puzino ◽  
Cynthia K Snyder ◽  
...  
Keyword(s):  
Risk Factors ◽  
Low Socioeconomic Status ◽  
Clinical History ◽  
Population Based ◽  
Self Report ◽  
Full Remission ◽  
Penn State ◽  
Racial Ethnic ◽  
Insomnia Symptoms

Abstract Study Objectives To determine the sociodemographic, behavioral, and clinical risk factors associated with the persistence, remission, and incidence of insomnia symptoms in the transition from childhood to adolescence. Methods The Penn State Child Cohort is a random, population-based sample of 700 children (5–12 years at baseline), of whom 421 were followed-up as adolescents (12–23 years at follow-up). Subjects underwent polysomnography, clinical history, physical exam, and parent- and self-reported scales at baseline and follow-up. Insomnia symptoms were defined as a parent- or self-report of difficulty falling and/or staying asleep. Results The 421 subjects with baseline (Mage = 8.8 years) and follow-up (Mage = 17 years) data were 53.9% male and 21.9% racial/ethnic minorities. The persistence of childhood insomnia symptoms (CIS) was 56% (95% CI = 46.5–65.4), with only 30.3% (95% CI = 21.5–39.0) fully remitting. The incidence of adolescent insomnia symptoms was 31.1% (95% CI = 25.9–36.3). Female sex, racial/ethnic minority, and low socioeconomic status as well as psychiatric/behavioral or neurological disorders, obesity, smoking, and evening chronotype were associated with a higher persistence or incidence of insomnia symptoms. Conclusions CIS are highly persistent, with full remission occurring in only a third of children in the transition to adolescence. Sex-, racial/ethnic-, and socioeconomic-related disparities in insomnia occur as early as childhood, while different mental/physical health and lifestyle/circadian risk factors play a key role in the chronicity of CIS versus their incidence in adolescence. CIS should not be expected to developmentally remit and should become a focus of integrated pediatric/behavioral health strategies.

Abstract P249: Incident Sleep-Disordered Breathing is Associated with Obesity: Penn State Child Cohort

Circulation ◽  
2013 ◽  
Vol 127 (suppl_12) ◽  
Author(s):  
Edward O Bixler ◽  
Alexandros N Vgontzas ◽  
Duanping Liao ◽  
Susan Calhoun ◽  
Julio Fernandez-Mendoza ◽  
...  
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Sleep Disordered Breathing ◽  
Population Sample ◽  
Population Based ◽  
Penn State ◽  
Potential Risk Factors ◽  
State Child ◽  
Disordered Breathing

Objectives: To study the epidemiology of sleep-disordered breathing (SDB) in adolescents, which has received little attention. Methods: The Penn State Child Cohort (PSCC) is a representative general population sample of 700 children aged 5-12 years. Our preliminary results are based on an average 8 year follow up of the initial 300 prospective subjects (~43%) from this ongoing cohort study. A logistic regression was used to assess the association between potential risk factors and incident SDB. Results: The mean age at the 8-year follow up examination was 17.2 ± 0.1 years, with an average BMI percentile of 66.6 ± 1.6 and 56.5% boys. At baseline 1.5% of this subsample had SDB, defined by Apnea Hypopnia Index (AHI > 5 /hour). Surprisingly, there was no persistence of SDB. Eight-year incident SDB was 10.5%. The average AHI in those with incident SDB was 12.7 with a maximum of 92.4. Incident SDB was similar for girls (7.8%) and boys (12.7%). Those with SDB were older than those without (18.7 vs 17.0 years, P<0.001) and girls with SDB were older than boys with SDB (20.0 vs 18.0 years, P=0.002). Those with incident SDB tended to have a greater change in BMI percentile (8.2 vs 1.8, P = 0.143) during the follow up and slightly higher minority representation (25.8% vs 21.9%, P=0.655). A logistic regression model identified three variables that were associated with incident SDB, controlling for baseline AHI: age (OR = 1.5 (1.3, 1.9) P<0.001), male (OR= 2.5 (1.11,10.00) P=0.021), and [[Unable to Display Character: &#8710;]]BMIPCT (OR=1.2(1.02, 1.5) P=0.032). Conclusion: In this population based sample of adolescents, the 8-year incidence of SDB was high (10.5%), whereas childhood SDB did not persist into adolescence. Further, the results indicate that risk factors for incident SDB in adolescents are age, male and the development of obesity.

scholarly journals Shared Disadvantage as a Determinant of the Relationship Between White Americans’ Socioeconomic Status and Racial/Ethnic Prejudice

2021 ◽  
Author(s):  
Bryon Hines ◽  
Kimberly Rios
Keyword(s):  
Socioeconomic Status ◽  
Ethnic Minorities ◽  
Mexican Americans ◽  
Behavioral Measure ◽  
Low Ses ◽  
White Americans ◽  
Ethnic Prejudice ◽  
Subjective Socioeconomic Status ◽  
Arab Immigrants ◽  
Racial Ethnic

The present studies examined the conditions under which low subjective socioeconomic status (SES) is associated with greater racial/ethnic prejudice among White Americans. Based on theories of intergroup threat and inclusive victim consciousness, we predicted that describing racial/ethnic minorities as disadvantaged (versus as competitive or in neutral terms) would increase empathy and reduce prejudice among White Americans who consider themselves low in SES. Study 1 provided correlational evidence that White Americans who perceived themselves as low-SES (but not high-SES) were less prejudiced against racial/ethnic minorities the more they perceived minorities as disadvantaged. In Study 2, portraying the target outgroup (Arab immigrants) as disadvantaged increased outgroup empathy, and in turn reduced prejudice, among participants induced to think of themselves as low-SES. Study 3 conceptually replicated these results using a different outgroup (Mexican Americans) and a behavioral measure of prejudice. Implications for reducing prejudice among White Americans of different socioeconomic backgrounds are discussed.

scholarly journals The Appalachia Mind Health Initiative (AMHI): A pragmatic clinical trial of adjunctive internet-based Cognitive Behavior Therapy for treating major depressive disorder among primary care patients

2021 ◽  
Author(s):  
Robert M. Bossarte ◽  
Ronald C. Kessler ◽  
Andrew A. Nierenberg ◽  
Pim Cuijpers ◽  
Angel Enrique ◽  
...  
Keyword(s):  
Treatment Effects ◽  
Remission Rate ◽  
Self Report ◽  
Cognitive Behavior ◽  
Major Depressive ◽  
Treatment Providers ◽  
Health Initiative ◽  
Heterogeneity Of Treatment Effects ◽  
Comparative Treatment

Abstract Background: Major Depressive Disorder (MDD) is a leading cause of disease morbidity. Combined treatment with antidepressant medication (ADM) plus psychotherapy yields a much higher MDD remission rate than ADM-only. But 77% of US MDD patients are nonetheless treated with ADM-only despite strong patient preferences for psychotherapy. This mismatch is due at least in part to a combination of cost considerations and limited availability of psychotherapists, although stigma and reluctance of PCPs to refer patients for psychotherapy are also involved. Internet-based Cognitive Behavior Therapy (i-CBT) addresses all of these problems. Methods: Enrolled patients (n=3,360) will be those who are beginning ADM-only treatment of MDD in primary care facilities throughout West Virginia, one of the poorest and most rural states in the country. Participating treatment providers and study staff at West Virginia University School of Medicine (WVU) will recruit patients and, after obtaining informed consent, administer a baseline self-report questionnaire (SRQ) and then randomize patients to 1 of 3 treatment arms with equal allocation: ADM-only, ADM + self-guided i-CBT, and ADM + guided i-CBT. Follow-up SRQs will be administered 2, 4, 8, 13, 16, 26, 39, and 52 weeks after randomization. The trial has two primary objectives: to evaluate aggregate comparative treatment effects across the 3 arms; and to estimate heterogeneity of treatment effects (HTE). The primary outcome will be episode remission based on a modified version of the patient-centered Remission from Depression Questionnaire (RDQ). The sample was powered to detect predictors of HTE that would increase the proportional remission rate by 20% by optimally assigning individuals as opposed to randomly assigning them into three treatment groups of equal size. Aggregate comparative treatment effects will be estimated using intent-to-treat analysis methods. Cumulative inverse probability weights will be used to deal with loss to follow-up. A wide range of self-report predictors of MDD heterogeneity of treatment effects based on previous studies will be included in the baseline SRQ. A state-of-the-art ensemble machine learning method will be used to estimate HTE.Discussion: The study is innovative in using a rich baseline assessment and in having a sample large enough to carry out a well-powered analysis of heterogeneity of treatment effects. We anticipate finding that self-guided and guided i-CBT will both improve outcomes compared to ADM-only. We also anticipate finding that the comparative advantages of adding i-CBT to ADM will vary significantly across patients. We hope to develop a stable individualized treatment rule that will allow patients and treatment providers to improve aggregate treatment outcomes by deciding collaboratively when ADM treatment should be augmented with i-CBT. Trial registration: The Appalachian Mind Health Initiative (AMHI; registry name) was prospectively registered on 10/9/19 (ClinicalTrials.gov Identifier: NCT04120285).

scholarly journals 0758 Natural History of Insomnia Symptoms from Childhood through Adolescence into Young Adulthood: The Penn State Child Cohort

SLEEP ◽  
2019 ◽  
Vol 42 (Supplement_1) ◽  
pp. A304-A305
Author(s):  
Julio Fernandez-Mendoza ◽  
Susan L Calhoun ◽  
Kristina Puzino ◽  
Jacqueline M Danisi ◽  
Fan He ◽  
...  
Keyword(s):  
Natural History ◽  
Young Adulthood ◽  
Penn State ◽  
History Of ◽  
State Child ◽  
Insomnia Symptoms

scholarly journals Multiple sleep dimensions and type 2 diabetes risk among women in the Sister Study: differences by race/ethnicity

2019 ◽  
Vol 7 (1) ◽  
pp. e000652 ◽  
Author(s):  
Ketrell L McWhorter ◽  
Yong-Moon Park ◽  
Symielle A Gaston ◽  
Kacey B Fang ◽  
Dale P Sandler ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Ethnic Minorities ◽  
Sleep Latency ◽  
Diabetes Risk ◽  
Poor Sleep ◽  
Increased Risk ◽  
Race Ethnicity ◽  
Racial Ethnic

ObjectivePoor sleep has been associated with type 2 diabetes. Since racial/ethnic minorities experience a disproportionately high prevalence of poor sleep and type 2 diabetes, we sought to determine the relationships between multiple sleep dimensions and incident type 2 diabetes and to investigate if these relationships vary by race/ethnicity.Research design and methodsProspective data were analyzed from the Sister Study, which enrolled 50 884 women from 2003 to 2009. Participants self-reported sleep duration, sleep latency, night awakenings, and napping at baseline, and a physician’s diagnosis of type 2 diabetes at follow-up. Multivariable-adjusted HRs and 95% CIs were estimated using Cox proportional hazards models.ResultsAmong the 39 071 eligible participants, 87% self-identified as white, 8% black and 5% Hispanic/Latina. The mean follow-up period was 8.5±2.1 years and 1785 type 2 diabetes cases were reported. The incidence rate per 1000 person-years was 5.4 for whites, 13.3 for blacks and 11.6 for Hispanics/Latinas. There was a positive but non-significant increased risk of type 2 diabetes among women who reported short sleep, latency >30 min and frequent night awakenings. In fully-adjusted models, frequent napping was associated with a 19% (HR 1.19, 95% CI 1.04 to 1.37) higher type 2 diabetes risk in the overall sample. Poor sleep among racial/ethnic minorities ranged from a 1.4-fold to a 3.2-fold higher type 2 diabetes risk than whites with recommended sleep.ConclusionsFrequent napping was associated with higher type 2 diabetes risk. Racial/ethnic minorities with poor sleep had a higher type 2 diabetes risk than whites with recommended sleep.

Abstract MP84: Incident Sleep-Disordered Breathing is Associated with Higher Blood Pressure and its Reactivity: Penn State Child Cohort

Circulation ◽  
2013 ◽  
Vol 127 (suppl_12) ◽  
Author(s):  
Edward O Bixler ◽  
Duanping Liao ◽  
Alexandros N Vgontzas ◽  
Fan He ◽  
Sol M Rodriguez-Colon ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Sleep Disordered Breathing ◽  
Vascular Reactivity ◽  
Population Based ◽  
Increased Risk ◽  
Penn State ◽  
State Child ◽  
The Difference ◽  
Disordered Breathing

Objectives: To examine the association between incident sleep-disordered breathing (SDB) and blood pressure and blood pressure reactivity in a population based sample of adolescents. Methods: The Penn State Child Cohort is a general population based sample of 700 children aged 5-12 years at the baseline examination (2000-2005). Currently, 300 participants have completed their 8-year follow up examination. Blood pressure was assessed at follow up in the evening using an automated device prior to the sleep recording in three positions. Three assessments in the seated position were completed after 5 minutes of rest. This was followed by 3 assessments in the supine position after 5 minutes of rest. The averages of the 2 nd and 3 rd readings for both positions are reported. Finally the subject was asked to stand as fast as possible and 2 additional readings were completed immediately upon their foot hitting the floor. These two standing readings were averaged. The difference between standing and supine BP was used as measures of vascular reactivity. The age, gender and height adjusted mean level of BP measures comparing individuals with and without incident SDB (defined as Apnea Hypopnia Index, AHI>5/hr) after excluding individuals with baseline SDB were calculated. Results: We observed no significant differences in diastolic blood pressure across the three positions. However, systolic blood pressure across all three positions and vascular reactivity were significantly elevated in those with incident SDB, as summarized in Table 1. Conclusion: In an 8-year followup of this population based sample of children, there was no persistence of SDB from baseline. Incident SDB (about 11%) was significantly associated with elevated systolic BP across all three positions. Further, SDB was associated with increased systolic BP reactivity, which has been associated with increased risk of CVD and the development of hypertension in adults.

scholarly journals 0366 Sleep Health Dimensions, Disturbances, and Disruptors Among White, Black, Hispanic/ Latina, and Asian Women

SLEEP ◽  
2020 ◽  
Vol 43 (Supplement_1) ◽  
pp. A140-A140
Author(s):  
C L Jackson ◽  
S A Gaston ◽  
J McGrath ◽  
D P Sandler
Keyword(s):  
Ethnic Groups ◽  
Ethnic Minorities ◽  
White Women ◽  
Light Exposure ◽  
Poor Sleep ◽  
Sleep Health ◽  
Short Sleep ◽  
Sleep Debt ◽  
Racial Ethnic ◽  
Insomnia Symptoms

Abstract Introduction Despite the importance of sleep for health promotion and disease prevention, data are limited regarding the distribution of multiple sleep health dimensions, disturbances, and disruptors among women, especially racial/ethnic minorities who disproportionately experience poor sleep. Methods To determine the prevalence of sleep health, disturbances, and disruptors (e.g., short sleep duration, sleep debt, insomnia symptoms, light exposure at night) overall and among Black, Hispanic/Latina, and Asian compared to White women, we used cross-sectional data collected by the Sister Study at enrollment (2003-2009) and two follow-ups (2012-2014, 2014-2016). Adjusting for sociodemographics, health behaviors, and health conditions including depression, we used Poisson regression with robust variance to estimate prevalence ratios (PRs) for unfavorable sleep among racial/ethnic minority compared to White women. Results Of the 49,874 eligible women (mean age ± standard deviation: 55.7 ± 9.0 years, 84.8% ≥high school education, 74.7% married) 85.3% were White, 9.0% Black, 5.1% Hispanic/Latina, and 0.7% Asian. Overall, 70% reported the recommended amount of sleep, 15.7% inconsistent weekly sleep patterns, 26% sleep debt, and 14% insomnia symptoms plus short sleep. Racial/ethnic minorities were much more likely than whites to report very short (≤5 hours) sleep (PRBlack)=5.98[95% Confidence Interval: 4.67-7.66]; PRLatina=2.83[1.98-4.04]; PRAsian=5.41[2.41-12.13] and to report needing &lt;7 hours to feel their best (PRBlack=2.95[2.75-3.17]; PRLatina=1.85[1.65-2.07]; PRAsian=2.66[2.10-3.37]). Black and Hispanic/Latina women had a higher prevalence than whites of insomnia, short sleep plus insomnia, inconsistent sleep, sleep debt, and frequent napping; however, all racial/ethnic minorities were less likely to report daytime sleepiness (PRBlack=0.82[0.78-0.85]; PRLatina=0.94[0.89-0.98]; PRAsian=0.79[0.69-0.92]) and restless leg syndrome. Witnessed sleep apnea was higher among Black women, and REM sleep disorder did not differ across racial/ethnic groups. Sleeping with room lights or a television on was more prevalent among racial/ethnic minorities (PRBlack=1.78[1.71-1.86]; PRLatina=1.27[1.17-1.37]; PRAsian=1.62[1.32-1.99]). Conclusion Poor sleep health, disturbances, and disruptors were prevalent among women and varied across racial/ethnic groups in ways that may contribute to health disparities. Support This work was funded by the Intramural Program at the National Institutes of Health, National Institute of Environmental Health Sciences (Z1A ES103325-01 to (CLJ) and Z01 ES044005 to (DPS)).

scholarly journals Temperament-Based Treatment for Young Adults with Eating Disorders: Acceptability and Initial Efficacy of an Intensive, Multi-Family, Parent-Involved Treatment.

2021 ◽  
Author(s):  
Stephanie Knatz Peck ◽  
Terra Towne ◽  
Christina Wierenga ◽  
Laura Hill ◽  
Ivan Eisler ◽  
...  
Keyword(s):  
Eating Disorders ◽  
Young Adults ◽  
Eating Disorder ◽  
Self Report ◽  
Program Satisfaction ◽  
Full Remission ◽  
Eating Disorder Psychopathology ◽  
Clinical Impairment ◽  
Spectrum Disorders

Abstract Background: Adult eating disorder treatments are hampered by lack of access and limited efficacy. This open-trial study evaluated the acceptability and preliminary efficacy of a novel intervention for adults with eating disorders delivered to young adults and parent-supports in an intensive, multi-family format (Young Adult Temperament-Based Treatment with Supports; YA-TBT-S). Methods: 38 YA-TBT-S participants (m age = 19.58; SD 2.13) with anorexia nervosa (AN)-spectrum disorders, bulimia nervosa (BN)-spectrum disorders, and avoidant/restrictive food intake disorder (ARFID) completed self-report assessments at admission, discharge, and 12-month follow-up. Assessments measured program satisfaction, eating disorder psychopathology and impairment, body mass index (BMI), and trait anxiety. Outcomes were analyzed using linear mixed effects models to examine changes in outcome variables across diagnoses over time. Results: Treatment was rated as highly satisfactory. 53.33% were in partial or full remission at 12-month follow-up. Participants reported reductions in ED symptomatology (AN and BN), increases in BMI (AN and ARFID), and reductions in clinical impairment (AN and ARFID) at 12-month follow-up. Conclusions: YA-TBT-S is a feasible and acceptable treatment that may improve ED outcomes in young adults with a broad range of diagnoses. Further evaluation of efficacy is needed in larger samples, and to compare YA-TBT-S to other ED treatment approaches.

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