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Demographic, Household, and Neighborhood Factors Associated with Sleep Health Among Adolescents

Sat, March 23, 2:30 to 4:00pm, Baltimore Convention Center, Floor: Level 3, Room 318

Integrative Statement

Introduction: This paper characterizes the social patterning of sleep health in the first national sample of actigraphy-assessed sleep health among adolescents. Adolescence is a crucial developmental period that sets the stage for adult wellbeing, and adolescent sleep is vulnerable due to a biological shift toward a later circadian timing. Prior research on the predictors of adolescent sleep health has either (1) used national studies which collected self- or parent-reported measures of nightly adolescent sleep times, sleep adequacy, or sleep quality or (2) collected high-quality sleep measures, such as actigraphy, in community samples. However, given increasingly low-cost non-invasive methods of collecting sleep measurements, it is now feasible to bring a population-based approach to studies of objective sleep data. Therefore, we extend this literature using newly-available actigraphy data from a diverse birth cohort study in the United States. The Fragile Families and Child Wellbeing Study (FFCWS) allows us to assess contextual components of adolescent sleep; prior literature has rarely examined the household and neighborhood correlates of sleep health among adolescents.

Hypotheses: Consistent with prior literature, we anticipate that males and ethnoracial minorities will have shorter sleep durations and lower sleep quality than females and non-Hispanic whites, respectively. In addition, we hypothesize that adolescents living in more chaotic households will have worse sleep health than adolescents living in less chaotic settings. Finally, we predict that adolescents living in more disadvantaged neighborhoods will have less and lower-quality sleep than adolescents living in more advantaged neighborhood settings.

Study population: FFCWS is a population-based birth cohort of children born between 1998-2000 in large American cities (population > 200,000). We analyze the 2014-2016 study wave, when participants (N=693) were approximately age 15.

Methods: Using cross-sectional OLS and logistic regression models, we assess how demographic, household, and neighborhood factors are associated with different facets of objective actigraphically-assessed sleep, including weekday sleep duration (24-hour, night, and nap), sleep quality (wake after sleep onset [WASO]), and sleep timing (clocktime and variability).

Results: Both demographic and contextual factors are associated with adolescent sleep health. Males obtain less weekday sleep and exhibit poorer sleep quality than females. Though non-Hispanic blacks sleep about 17 minutes less per night and have more WASO than non-Hispanic whites, this difference is recuperated by daytime napping. Non-Hispanic whites have the most variable sleep schedules of any ethnoracial group, despite having the longest sleep durations. Among household factors, lower socioeconomic status is associated with more naps and lower sleep quality, and sharing a bed or bedroom is associated with more variable sleep schedules. Additionally, chaotic households are associated with worse adolescent sleep health: adolescents whose interviews were frequently interrupted have shorter sleep durations and sleep at later hours than do adolescents living in less intrusive settings. Finally, neighborhood factors including poverty and safety are associated with differences in sleep duration and WASO.

Conclusion: Improving adolescent sleep health may require interventions at individual, household, and neighborhood levels, as sleep health disparities are present in a national sample of adolescents and multiple contextual factors are associated with sub-optimal sleep health.

Authors