Racialized economic segregation and health outcomes: A systematic review of studies that use the Index of Concentration at the Extremes for race, income, and their interaction
Extensive research shows that residential segregation has severe health consequences for racial and ethnic minorities. Most research to date has operationalized segregation in terms of either poverty or race/ethnicity rather than a synergy of these factors. A novel version of the Index of Concentration at the Extremes (ICERace-Income) specifically assesses racialized economic segregation in terms of spatial concentrations of racial and economic privilege (e.g., wealthy white people) versus disadvantage (e.g., poor Black people) within a given area. This multidimensional measure advances a more comprehensive understanding of residential segregation and its consequences for racial and ethnic minorities. The aim of this paper is to critically review the evidence on the association between ICERace-Income and health outcomes. We implemented the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to conduct a rigorous search of academic databases for papers linking ICERace-Income with health. Twenty articles were included in the review. Studies focused on the association of ICERace-Income with adverse birth outcomes, cancer, premature and all-cause mortality, and communicable diseases. Most of the evidence indicates a strong association between ICERace-Income and each health outcome, underscoring income as a key mechanism by which segregation produces health inequality along racial and ethnic lines. Two of the reviewed studies examined racial disparities in comorbidities and health care access as potential explanatory factors underlying this relationship. We discuss our findings in the context of the extant literature on segregation and health and propose new directions for future research and applications of the ICERace-Income measure.
Re: "Academic Productivity Differences by Gender and Child Age in Science, Technology, Engineering, Mathematics, and Medicine Faculty During the COVID-19 Pandemic," by Krukowski et al [Comment]
Assessment of Racial and Ethnic Disparities in Access to COVID-19 Vaccination Sites in Brooklyn, New York
Socioeconomic Disparities in Positive Airway Pressure Adherence: An Integrative Review
Nonadherence with positive airway pressure (PAP) therapy impedes the effectiveness of treatment and increases risk of mortality. Disparities in PAP adherence as a function of socioeconomic status (SES) are not well understood. A literature search identified 16 original publications meeting inclusion criteria that described effects of SES factors on objective PAP adherence; 69% of these articles found evidence of lower adherence as a function of SES. This integrative review provides a structured summary of the findings, highlights factors that may contribute to disparities among adult PAP users, and identifies future directions to improve equity in the management of OSA.
What makes people want to make changes to their sleep? Assessment of perceived risks of insufficient sleep as a predictor of intent to improve sleep
OBJECTIVES/OBJECTIVE:The objective of the present study is to identify which underlying beliefs about the impact of sleep on health may motivate change in sleep behavior. DESIGN/METHODS:A cross-sectional study conducted between 2012 and 2014. SETTING/METHODS:Data were from the Sleep and Healthy Activity, Diet, Environment, and Socialization (SHADES) study conducted in Philadelphia, PA, and its surrounding regions. PARTICIPANTS/METHODS:Participants consisted of NÂ =Â 1007 community-dwelling adults age 22-60. MEASUREMENTS/METHODS:Respondents indicated behaviors they could improve on to facilitate sleep and their corresponding readiness to change. They were also asked items from the Sleep Practices and Attitudes Questionnaire (SPAQ) regarding the degree to which they agree with whether "not getting enough sleep" can impact a variety of health factors. RESULTS:In adjusted analyses, stage of change was associated with degree of agreement that insufficient sleep can cause sleepiness (odds ratio [OR] = 1.17, P = .035), weight gain (ORÂ =Â 1.20, P < .0005), heart disease (ORÂ =Â 1.21, PÂ =Â .001), cholesterol (ORÂ =Â 1.13, PÂ =Â .047), hypertension (ORÂ =Â 1.16, PÂ =Â .014), moodiness (ORÂ =Â 1.42, P < .0005), decreased energy (ORÂ =Â 1.30, PÂ =Â .002), absenteeism (ORÂ =Â 1.13, P = .007), decreased performance (ORÂ =Â 1.20, P = .003), concentration/memory problems (ORÂ =Â 1.23, PÂ =Â .004), diabetes (ORÂ =Â 1.14, P = .042), and feeling tired (ORÂ =Â 1.39, P < .0005). When sleep duration was added to the model, significant associations remained for all except cholesterol. When accounting for insomnia, significant associations were maintained for only weight, moodiness, performance, diabetes, and tiredness. CONCLUSIONS:Degree of belief that insufficient sleep can cause outcomes such as moodiness, occupational problems, and health problems may impact whether an individual is contemplating/attempting to change their sleep-related behaviors. Targeting these key messages about the associations between sleep health with moodiness and weight gain in informational material may enhance education/outreach efforts aimed at adults.
Translational Sleep Science in Behavioral Medicine: Introduction to this Special Issue
The consideration of sleep and circadian rhythms in the context of health is a relatively recent development in the history of the field of behavioral medicine. This special issue of the International Journal of Behavioral Medicine recognizes that sleep and circadian rhythms are fundamental to appreciating physiological, psychological, social, and environmental factors in the health and well-being of the population. The articles included in this issue draw attention to the breadth and saliency of sleep as a marker of health status and as a target of behavioral intervention to promote health. Such research highlights the diversity of participants, research methods, and clinical significance of translational sleep science allowing us to recognize the role of sleep in the context of health in new ways. These studies also illustrate progress in integrating theory, employing prospective and longitudinal designs and multimodal and integrative assessments. This introduction to the special issue concludes by discussing challenges and opportunities in the field of behavioral sleep medicine, including those posed by the coronavirus disease 2019 (COVID-19) pandemic and the need to more effectively provide sleep disorder treatment among underserved populations.
Self-reported obstructive sleep apnea, amyloid and tau burden, and Alzheimer's disease time-dependent progression
INTRODUCTION/BACKGROUND:Obstructive sleep apnea (OSA) is associated with Alzheimer's disease (AD) biomarkers in cognitively normal (CN) and mild cognitive impaired (MCI) participants. However, independent and combined effects of OSA, amyloid beta (AÃŽÂ²) and tau-accumulation on AD time-dependent progression risk is unclear. METHODS:Study participants grouped by biomarker profile, as described by the A/T/N scheme, where "A" refers to aggregated AÃŽÂ², "T" aggregated tau, and "N" to neurodegeneration, included 258 CN (OSA-positive [OSA+] [A+TN+ n = 10, A+/TN- n = 6, A-/TN+ n = 10, A-/TN- n = 6 and OSA-negative [OSA-] [A+TN+ n = 84, A+/TN- n = 11, A-/TN+ n = 96, A-/TN- n = 36]) and 785 MCI (OSA+ [A+TN+ n = 35, A+/TN- n = 15, A-/TN+ n = 25, A-/TN- n = 16] and OSA- [A+TN+ n = 388, A+/TN- n = 28, A-/TN+ n = 164, A-/TN- n = 114]) older-adults from the Alzheimer's Disease Neuroimaging Initiative cohort. Cox proportional hazards regression models estimated the relative hazard of progression from CN-to-MCI and MCI-to-AD, among baseline OSA CN and MCI patients, respectively. Multi-level logistic mixed-effects models with random intercept and slope investigated the synergistic associations of self-reported OSA, AÃŽÂ², and tau burden with prospective cognitive decline. RESULTS:Independent of TN-status (CN and MCI), OSA+/AÃŽÂ²+ participants were approximately two to four times more likely to progress to MCI/AD (P < .001) and progressed 6 to 18 months earlier (P < .001), compared to other participants combined (ie, OSA+/AÃŽÂ²-, OSA-/AÃŽÂ²+, and OSA-/AÃŽÂ²-). Notably, OSA+/AÃŽÂ²- versus OSA-/AÃŽÂ²- (CN and MCI) and OSA+/TN- versus OSA-/TN- (CN) participants showed no difference in the risk and time-to-MCI/AD progression. Mixed effects models demonstrated OSA synergism with AÃŽÂ² (CN and MCI [ÃŽÂ² = 1.13, 95% confidence interval (CI), 0.74 to 1.52, and ÃŽÂ² = 1.18, 95%CI, 0.82 to 1.54]) respectively, and with tau (MCI [ÃŽÂ² = 1.31, 95% CI, 0.87 to 1.47]), P < .001 for all. DISCUSSION/CONCLUSIONS:OSA acts in synergism with AÃŽÂ² and with tau, and all three acting together result in synergistic neurodegenerative mechanisms especially as AÃŽÂ² and tau accumulation becomes increasingly abnormal, thus leading to shorter progression time to MCI/AD in CN and MCI-OSA patients, respectively.
Acculturation Associated with Sleep Duration, Sleep Quality, and Sleep Disorders at the US-Mexico Border
Sleep disparities exist among Hispanics/Latinos, although little work has characterized individuals at the United States (US)-Mexico border, particularly as it relates to acculturation. This study examined the association of Anglo and Mexican acculturation to various facets of sleep health among those of Mexican descent at the US-Mexico border. Data were collected from N = 100 adults of Mexican descent in the city of Nogales, Arizona (AZ). Surveys were presented in English or Spanish. Acculturation was assessed with the Acculturation Scale for Mexican-Americans (ARSMA-II). Insomnia was assessed with the Insomnia Severity Index (ISI), sleepiness was assessed with the Epworth Sleepiness Scale (ESS), sleep apnea risk was assessed with the Multivariable Apnea Prediction (MAP) index, weekday and weekend sleep duration and efficiency were assessed with the Sleep Timing Questionnaire, sleep quality was assessed with the Pittsburgh Sleep Quality Index (PSQI), and sleep duration and sleep medication use were assessed with PSQI items. No associations were found between Mexican acculturation and any sleep outcomes in adjusted analyses. Anglo acculturation was associated with less weekend sleep duration and efficiency, worse insomnia severity and sleep quality, and more sleep apnea risk and sleep medication use. These results support the idea that sleep disparities may depend on the degree of acculturation, which should be considered in risk screening and interventions.
Suboptimal sleep and incident cardiovascular disease among African Americans in the Jackson Heart Study (JHS)
BACKGROUND:Suboptimal sleep, including insufficient/long sleep duration and poor sleep quality, is a risk factor for cardiovascular disease (CVD) common but there is little information among African Americans, a group with a disproportionate CVD burden. The current study examined the association between suboptimal sleep and incident CVD among African Americans. METHODS:This study included 4,522 African Americans without CVD at baseline (2000-2004) of the Jackson Heart Study (JHS). Self-reported sleep duration was defined as very short (<6Â h/night), short (6Â h/night), recommended (7-8Â h/night), and long (â‰¥9Â h/night). Participants' self-reported sleep quality was defined as "high" and "low" quality. Suboptimal sleep was defined by low quality sleep and/or insufficient/long sleep duration. Incident CVD was a composite of incident coronary heart disease and stroke. Associations between suboptimal sleep and incident CVD were examined using Cox proportional hazards models over 15 follow-up years with adjustment for predictors of CVD risk and obstructive sleep apnea. RESULTS:Sample mean age was 54 years (SDÂ =Â 13), 64% female and 66% reported suboptimal sleep. Suboptimal sleep was not associated with incident CVD after covariate adjustment [HR(95% CI)Â =Â 1.18(0.97-1.46)]. Long [HR(95%CI)Â =Â 1.32(1.02-1.70)] and very short [HR(95% CI)Â =Â 1.56(1.06-2.30)] sleep duration were associated with incident CVD relative to recommended sleep duration. Low quality sleep was not associated with incident CVD (pÂ =Â 0.413). CONCLUSIONS:Long and very short self-reported sleep duration but not self-reported sleep quality were associated with increased hazard of incident CVD.
Tailored Approach to Sleep Health Education (TASHE): a randomized controlled trial of a web-based application
STUDY OBJECTIVES/OBJECTIVE:In a randomized controlled trial, we compared the effect of the Tailored Approach to Sleep Health Education (TASHE) on obstructive sleep apnea (OSA) self-efficacy among community-dwelling blacks in New York City. METHODS:Study participants were 194 blacks at high risk for OSA based on the Apnea Risk Evaluation System. TASHE intervention was delivered via a Wi-Fi-enabled tablet, programmed to provide online access to culturally and linguistically tailored information designed to address unique barriers to OSA care among blacks. Blacks in the attention-controlled arm received standard sleep information via the National Sleep Foundation website. Blacks in both arms accessed online sleep information for 2 months. Outcomes (OSA health literacy, self-efficacy, knowledge and beliefs and sleep hygiene) were assessed at baseline, at 2 months, and at 6 months. RESULTS:We compared outcomes in both arms based on intention-to-treat analysis using adjusted Generalized Linear Mixed Modeling. TASHE exposure significantly increased OSA self-efficacy (OSA outcome expectation [ÃŸ = 0.5, 95% CI: 0.1-0.9] and OSA treatment efficacy [ÃŸ = 0.4, 95% CI: 0.0-0.8]) at 2 months, but not at 6 months. Additionally, TASHE exposure improved sleep hygiene at 6 months (ÃŸ = 6.7, 95% CI: 2.2-11.3), but not at 2 months. CONCLUSIONS:Community-dwelling blacks exposed to TASHE materials reported increased OSA self-efficacy compared to standard sleep health education. Stakeholder-engaged, theory-based approaches, as demonstrated in the TASHE intervention, can be used successfully to deliver effective sleep health messages. CLINICAL TRIAL REGISTRATION/BACKGROUND:ClinicalTrials.gov identifier NCT02507089.