Faculty Bibliography

AIM: The aim of this study was to synthesize the literature on the cultural aspects of sleep and their relevance to behavioral sleep research. METHODS: A narrative synthesis of the existing literature on sleep was conducted with a focus on its biological, sociological, political, and anthropological aspects. This synthesis was guided by the PEN-3 cultural model, developed by the primary author. RESULTS: The findings highlight the cross-cultural contexts within which people sleep and the role of varied sleeping arrangements in influencing sleep behavior and perspectives. Furthermore, the contexts in which sleep occurs, coupled with the influence of the family, and the positive aspects of sleep helped illustrate why cultural aspects of sleep are vital for a broader understanding of sleep. DISCUSSION: The authors conclude by highlighting the need to integrate studies on the biological, sociological, and political aspects of sleep. Our examination of the literature strongly suggests that careful assessment of epidemiological and clinical sleep data should consider the cultural aspects of sleep as well as the context in which sleep occurs, the role of the family, and positive aspects of sleep.

AIM: The aim of this study was to evaluate the National Institute of Health (NIH)-funded PRIDE Institute in Behavioral Medicine and Sleep Disorders Research at New York University (NYU) Langone Medical Center. The NYU PRIDE Institute provides intensive didactic and mentored research training to junior underrepresented minority (URM) faculty. METHOD: The Kirkpatrick model, a mixed-methods program evaluation tool, was used to gather data on participant's satisfaction and program outcomes. Quantitative evaluation data were obtained from all 29 mentees using the PRIDE REDcap-based evaluation tool. In addition, in-depth interviews and focus groups were conducted with 17 mentees to learn about their experiences at the institute and their professional development activities. Quantitative data were examined, and emerging themes from in-depth interviews and focus groups were studied for patterns of connection and grouped into broader categories based on grounded theory. RESULTS: Overall, mentees rated all programmatic and mentoring aspects of the NYU PRIDE Institute very highly (80-100%). They identified the following areas as critical to their development: research and professional skills, mentorship, structured support and accountability, peer support, and continuous career development beyond the summer institute. Indicators of academic self-efficacy showed substantial improvement over time. Areas for improvement included tailoring programmatic activities to individual needs, greater assistance with publications, and identifying local mentors when K awards are sought. CONCLUSIONS: In order to promote career development, numerous factors that uniquely influence URM investigators' ability to succeed should be addressed. The NYU PRIDE Institute, which provides exposure to a well-resourced academic environment, leadership, didactic skills building, and intensive individualized mentorship proved successful in enabling URM mentees to excel in the academic environment. Overall, the institute accomplished its goals: to build an infrastructure enabling junior URM faculty to network with one another as well as with senior investigators, serving as a role model, in a supportive academic environment.

OBJECTIVE: Obstructive sleep apnea (OSA) is a leading sleep disorder that is disproportionately more prevalent in minority populations and is a major risk factor for cardiovascular disease (CVD) morbidity and mortality. OSA is associated with many chronic conditions including hypertension, diabetes, and obesity, all of which are disproportionately more prevalent among blacks (ie, peoples of African American, Caribbean, or African descent). METHODS: This article reviews studies conducted in the United States (US) that investigated sleep screenings and adherence to treatment for OSA among blacks. In addition, guidelines are provided for implementing a practical framework to increase OSA screening and management among blacks. RESULTS: Several studies have documented racial/ethnic disparities in adherence to treatment for OSA. However, despite its public health significance, there is a paucity of studies addressing these disparities. Further, there is a lack of health programs and policies to increase screening and treatment of OSA among blacks and other minority populations. A practical framework to increase the number of blacks who are screened for OSA and treated appropriately is warranted. Such a framework is timely and major importance, as early identification of OSA in this high-risk population could potentially lead to early treatment and prevention of CVD, thereby reducing racial and ethnic disparities in sleep-related CVD morbidity and mortality.

BACKGROUND: The global prevalence of skin depigmentation/skin bleaching among blacks, estimated at 35%, is on the rise and is associated with a host of negative health and medical consequences. Current etiological approaches do not fully capture the emotional and psychological underpinnings of skin bleaching. The current study investigated the potential mediating role of depression, or post-traumatic stress symptoms (avoidance and hyperarousal) on the relationship between childhood physical and sexual abuse (CPSA) and skin bleaching. METHODS: A total of 1226 university participants (ages 18-30 years and 63.4% female) from three Caribbean countries (Jamaica, Barbados, and Grenada) provided data for the current analysis. They all completed self-reported measures of general demographic information along with the short screening scale for posttraumatic stress disorder (DSM-IV), childhood trauma, and skin bleaching questions. RESULTS: The prevalence of skin bleaching in our study was 25.4%. Our findings showed that individuals who bleached their skin were more likely to have been abused as children (21.6% versus 13.5%, p<0.001), were more likely to have significant symptoms of trauma (34.1% versus 24.0%, p=0.005), and were more likely to have significant depression (43.7% versus 35.1%, p=0.032). We found that trauma-related hyperarousal symptoms positively mediated the relationship between childhood physical and sexual abuse and skin bleaching (Indirect Effect=0.03, p<0.05), while avoidance (Indirect Effect=0.000, p>0.05) and depressive (Indirect Effect=0.005, p>0.05) symptoms did not. CONCLUSION: The presence of trauma symptoms and childhood physical and sexual abuse (CPSA) may increase the likelihood of skin bleaching. Findings suggest that further exploration is needed to ascertain if the presence of skin bleaching warrants being also screened for trauma.

We examined the relationship between sleep duration and arterial stiffness among a multi-ethnic cohort, and whether the associations differed among ethnic minority groups in the Netherlands. Data were derived from 10 994 participants (aged 18-71 years) of the Healthy Life in an Urban Setting (HELIUS) study. Self-reported sleep duration was categorized into: short (<7 h/night), healthy (7-8 h/night) and long (>/=9 h/night). Arterial stiffness was assessed by duplicate pulse-wave velocity (PWV in m/s) measurements using the Arteriograph system. The association of sleep duration with PWV was analysed using linear regression (beta) with 95% confidence interval (CI). Results showed that neither short nor long sleep was related to PWV in all ethnic groups, except for long sleep in Dutch men which was associated with higher PWV (indicating stiffer arteries) after adjustment for potential confounders (beta = 0.67, 95%CI, 0.23-1.11). Our study showed no convincing evidence that sleep duration was related to arterial stiffness among various ethnic groups. The link between sleep duration and cardiovascular outcomes does not seem to operate through arterial stiffness. Further research is needed to consolidate these findings.

BACKGROUND: Metabolic syndrome poses an increased global burden of disease and causes immense financial burden, warranting heightened public health attention. The present study assessed the prevalence and severity of cardiometabolic risk among foreign-born versus US-born blacks, while exploring potential gender-based effects. METHODS: A total of 1035 patients from the Metabolic Syndrome Outcome Study (Trial registration: NCT01946659) provided sociodemographic, medical history, and clinical data. General Linear Model (GLM) was used to assess the effects of birthplace and gender on cardiometabolic parameters, adjusting for age differences in the sample. RESULTS: Of the sample, 61.6 % were foreign-born blacks (FBB) and 38.4 % were US-born blacks (USB). FBB had significantly lower BMI compared with USB (32.76 +/- 0.35 vs. 35.41 +/- 0.44, F = 22.57), but had significantly higher systolic blood pressure (136.70 +/- 0.77 vs. 132.83 +/- 0.98; F = 9.60) and fasting glucose levels than did USB (146.46 +/- 3.37 vs. 135.02 +/- 4.27; F = 4.40). Men had higher diastolic BP (76.67 +/- 0.65 vs. 75.05 +/- 0.45; F = 4.20), glucose (146.53 +/- 4.48 vs. 134.95 +/- 3.07; F = 4.55) and triglyceride levels (148.10 +/- 4.51 vs. 130.60 +/- 3.09; F = 10.25) compared with women, but women had higher LDL-cholesterol (109.24 +/- 1.49 vs. 98.49 +/- 2.18; F = 16.60) and HDL-cholesterol levels (50.71 +/- 0.66 vs. 42.77 +/- 0.97; F = 46.01) than did men. CONCLUSIONS: Results showed that birthplace has a significant influence on cardiometabolic profiles of blacks with metabolic syndrome. Patients' gender also had an independent influence on cardiometabolic profile.

Introduction: Poor adherence to evaluation and treatment of obstructive sleep apnea (OSA) is a public health challenge. Despite higher prevalence of OSA, blacks are less likely to adhere to physician-recommended OSA care than are whites. Methods: Among black patients with metabolic syndrome, we compared, in an RCT, effectiveness of a telephone-delivered culturally and linguistically tailored OSA health messages over 6 months (Intervention) versus standard patient education (Control) in improving adherence to recommended OSA care. We hypothesized that patients randomized to the intervention arm would exhibit greater adherence to OSA consultation, evaluation, and treatment than those in the control arm. We also evaluated the predictive role of baseline sociodemographics, health risks, comorbidity, and psychosocial factors on adherence status using multivariate-adjusted regression analyses. Results: 380 patients (mean age = 59yrs; 71%, women) were enrolled with 80% retention rate (intervention = 160 and control = 143). Of the sample, 69.4% of patients exposed to the intervention attended initial consultations, compared with 36.7% of patients in the control arm (p < .001); 74.7% versus 66.7% of patients in the intervention and control arms, respectively, completed diagnostic evaluations (p = 0.46), while 86.4% versus 88.9% in the intervention and control arm, respectively, adhered to OSA treatment. Based on adjusted logistic regression, patients in the intervention arm were 3.17 times (95% CI = 1.68-5.99, p < 0.001) more likely to have initial consultations, relative to controls. Treatment self-efficacy was the strongest predictor of OSA adherence (OR = 1.11, 95% CI = 1.03-1.20, p < 0.01). Adjusted models revealed no significant differences between the two arms regarding adherence to OSA evaluation and treatment. Conclusion: The culturally and linguistically tailored OSA health messages were successful in improving initial consultation for OSA diagnosis. However, once patients were in treatment, there was no difference in OSA adherence rates between the two groups

Introduction: Health intervention is successful when messages are culturally and linguistically tailored to a specific population. The current study utilized a comprehensive approach involving multiple stakeholders to develop tailored health messages to promote awareness of sleep apnea among Blacks. Methods: We engaged several stakeholders (community-based organizations, patients, and healthcare providers) to develop and implementan online sleep educational inter vention. First round of focus groups were conducted with patients (N = 35; 71% Female, 100% Black, average age 45.2 years). Next, community leaders from churches, barbershops, and other organizations (N = 8, 75% Female, 87% Black, average age 48.1 years). Finally, interviews were conducted with healthcare providers (N = 6, 16% Female, 83% White, average age 51.2 years). All data collection was focused on barriers to awareness, diagnosis and treatment of sleep apnea. This paper presents results of the qualitative analysis conducted to inform the design of this community-engaged, linguistically and culturally tailored online sleep education program. Results: Analysis illuminated key barriers preventing sleep apnea awareness, including 1) low knowledge about the connection between daytime somnolence and associated sleep difficulties, 2) embarrassment about snoring and sleep apnea, and 3) inadequate healthcare access for effective treatments. The educational tool was designed using evidence-based approaches to diagnosis and treatment of sleep apnea, while acknowledging the primary themes identified in the focus groups. The tool was then refined with feedback from stakeholders (community members, sleep medicine doctors, and health communication experts. The TASHE resource included four key components, 1) tailored, population-appropriate reading level, 2) evidence-based tips and suggestions for sleep health and sleep apnea, 3) partnership with community-based organizations, and 4) cultural context. Conclusion: A conceptual model for tailored interventions in sleep medicine has been developed and implemented based on the principles of community-engaged research to ensure acceptability of tailored health messages and sustainability of the online sleep apnea educational program. The model developed can be used to structure the design and implementation of community-based, tailored sleep education programs that aim to promote sleep health at the population level

Introduction: Although sleep apps are among the most popular commercially available health apps, little is known about how well these apps follow evidenced-based guidelines or are grounded in behavioral theory. We present an analysis of the incorporation of theoretical constructs of behavior change in popular sleep apps created for smartphones using Android and iOS platforms. Methods: Three-hundred and sixty-nine apps were initially identified (n = 272 from the Google play store; n = 97 from iTunes) using the term "sleep" in September 2015. The final sample consisted of 35 apps that met the following inclusion criteria: 1) Stand-alone functionality; 2) Sleep tracker or monitor apps ranked by 100+ users; and 3) Sleep Alarm apps ranked by 1000+ users. Only 5 (14%) of the apps included were paid apps. A coding instrument was developed to assess the presence of 19 theoretical constructs in the following four categories: 1) knowledge; 2) cognitive strategies, 3) behavior strategies, 4) emotionfocused strategies, and 5) therapeutic interventions. Two graduate students downloaded and coded 17 apps to evaluate content and reach consensus with coding procedures (IRR = .993). A "1" was assigned if a construct was present in the app and "0" if it was not. Mean scores were calculated across all apps, and comparisons were made between total scores and app ratings using R. Results: The mean behavior construct scores (BCS) across all apps was 34% (range, 5% to 84%). Behavioral constructs for realistic goal setting (85.7%), time management (77.1%), and self-monitoring (65.7%) were most common. iOS apps (33%) had higher BCS compared to android apps (28%), and a positive association was observed between BCS and user ratings, but neither was found to be statistically significant (p > 0.05). Conclusion: While the overall behavior construct scores were low, an opportunity exists to develop or modify existing apps to support sustainable sleep hygiene practices

Introduction: There is growing evidence suggesting relationships between depression and insomnia symptoms, yet scant evidence indicating directionality of those relationships or potential mediators. Evidence also suggests that social connectedness is a vital, protective factor for depression. Social connectedness may hold promise for helping sleep scientists better understand relationships between disrupted sleep and depression symptomology. Methods: The current study drew on social network analysis, an underexplored approach in sleep medicine, and survey methods to examine social connections, insomnia severity, and depression symptoms. Participants (n = 38) were 44.7% female, with an average age of 56.7 years; 86.8% of the participants self-identified as black. Bivariate correlations and logistic regression were performed to examine relationships between social connectedness, insomnia severity, and depression symptoms. Results: Of the sample, 71.1% reported insomnia and 23.7% reported depression. Participants provided responses to social network items across kin (m = 2.8 people), non-kin (m = 2.4 people), and formal networks (m = 1.6 people). Case by case agreement was strong between kin network size and depression symptomology (chi square < .05), but not between kin network and insomnia (chi square = .658). The logistic regression in the current study showed individuals with depressive symptoms were 6.75 (95% CI 1.45-31.47, p < 0.) times more likely to have severe insomnia versus individuals without clinically significant depression symptoms. There was no significant relationship in the regression between network variables and insomnia or depression symptoms. Conclusion: Our findings are consistent with previous findings and evidence on a strong, positive relationship between depression symptomology and insomnia severity. However, they are not in line with literature suggesting a positive relationship between kin networks and depression symptomology. It is of interest to explore the causal relationship between social connectedness and sleep, and how social networks might serve as a protective (or risk) factor for insomnia, and maybe depression